New Years Resolution: I Want to Run
So you have the New Years Resolution to start running this year? Awesome! Start here!
In my career, I’ve worked with hundreds of runners at all levels—recreational joggers, elite Olympians, sprinters, hurdlers, mid-distance competitors, long-distance athletes, “Turkey Trotters,” and Ironman participants. An experienced clinician is skilled at identifying common patterns and developing training programs tailored to the unique needs of each client.
One thing I’ve observed over the years is that runners are often compartmentalized. For example, a blog might say, “Having Achilles pain? Buy X product or do Y exercise.” However, these “fix-all” solutions rarely address the root problem and often fail to prescribe the correct dosage to achieve muscle or tendon adaptation. Similarly, how many times have you heard, “You’re a pronator, so you need these shoes!” Here’s the secret: everyone pronates.
With the New Year fast approaching, resolutions will inspire many runners to set new goals, chase personal bests, or try something they’ve never done before. This blog is dedicated to helping runners—novice or experienced—by addressing basic anatomy, common injuries, and mistakes I often see, especially in beginners.
The Complex Foot and Its Impact
The foot and ankle are incredibly intricate structures. The foot consists of three main areas—hindfoot, midfoot, and forefoot—that can move independently. Its static (still) posture influences the alignment of the rest of the body.
For instance, flat feet (pes planus)—whether congenital (present at birth) or acquired—place the midfoot and forefoot in a pronated position. This alters the positioning of the talus (a hindfoot bone beneath the tibia and fibula), causing the tibia and fibula to externally rotate. This, in turn, leads the femur (thigh bone) to internally rotate, potentially resulting in a “knock-knee” posture. This impaired alignment affects how ground reaction forces (GRF) are distributed through the body, contributing to injury risk.
Assessing Runners
Because most running injuries result from overuse, I ask specific questions to better understand a runner’s background:
For all runners:
• How long have you been running?
• How far do you run per session?
• How many miles per week do you run?
• What is your strength training history?
• What are your eating habits?
For experienced runners:
• What is your strike pattern?
• What is your comfortable pace?
• Do you have a history of plyometric training?
For women (if warranted):
• Do you have a history of eating disorders?
• Have you experienced irregular menstrual cycles?
• Are you breastfeeding? If not, when did you stop?
These additional questions for women are crucial for understanding metabolic factors that may affect training capacity and nutrient absorption. Irregular menstrual cycles or a history of disordered eating can influence performance and recovery. Breastfeeding introduces the hormone relaxin, which increases ligament laxity, especially around the lower back, pelvis, and hips.
Common Injuries and Their Causes
Hamstring Tendinopathy (Proximal)
This injury is common in novice runners, especially those who are “heel strikers” (landing on the heel first), which lengthens their stride and increases hip flexion. The repeated pulling on the tendon causes inflammation, often presenting as lower back pain or being mistaken for sciatica. Sprinting can also exacerbate this injury due to longer strides.
Knee Injuries
1. Patellar Tendinopathy
This injury, presenting as pain just below the kneecap, is often caused by a sudden increase in running volume, distance, or frequency. Even if a runner has strong muscles, distance running places unique stress on the body. For example, CrossFit athletes transitioning to long-distance running often experience this issue because of inadequate progressive exposure to the demands of both activities.
2. Patellofemoral Pain Syndrome (PFPS)
PFPS differs from patellar tendinopathy, as pain is usually reported as being “behind the kneecap” or in non-specific areas. Prolonged sitting or standing often aggravates it. Like other overuse injuries, rapid increases in volume or intensity are the primary cause.
3. Iliotibial Band (ITB) Syndrome
This injury can persist if mismanaged (and usually is due to either self management, coach, or even therapist), often being confused with meniscus injuries or other knee conditions due to the ITB’s anatomical connections. The ITB cannot be effectively stretched because it is a non-contractile tissue. Foam rolling may provide temporary relief due to its effect on the nervous system, but it does not address the root problem. The primary cause is often hip or pelvic weakness, which results in the foot crossing the midline during foot strike and adding stress to the ITB.
Anatomy Graphic of Knee injuries
Below the Knee
1. Medial Tibial Stress Syndrome (“Shin Splints”)
More common in women than men, this injury is often linked to past injuries, foot pronation patterns, and increased hip range of motion. It can sometimes be confused with stress fractures, especially in women, which is why I ask specific questions during consultations (see above). The rate of pronation, not just its presence, is the key factor and can be improved through strength training and increasing load capacity.
2. Achilles Tendinopathy and Plantar Fasciopathy
Achilles tendinopathy can occur in two areas: the mid-substance (most common) and the insertional point (near the heel), which is more common in people over 35. Insertional tendinopathy takes longer to heal due to poor circulation in the tissue. Recovery can take 12–24 weeks but yields excellent outcomes with consistent management.
Plantar fasciopathy, affecting the bottom of the foot or heel, is most common between ages 45–65. Contributing factors can include health issues beyond external factors. Like Achilles tendinopathy, recovery is slow but manageable with consistent care.
Key Takeaways
As shown, the majority of running injuries are caused by overuse. Progressing slowly and listening to your body are critical for prevention. Surrounding yourself with a supportive team can make all the difference in achieving your running goals.
If you want to learn more or need help with your training, contact me for a complimentary introductory call!
joshua@joshuafede.com
954-228-0754
