Running injuries to the lower extremity are common and are very often caused by cumulative trauma. Even an acute injury such as a hamstring strain can occur as a result of chronic muscle imbalances in the body. Uncovering weak links in the musculoskeletal system is one of the key prerequisites prior to building a strengthening plan and a key component for a successful rehabilitation program.Three common injuries addressed here: hamstring strain, patellofemoral pain and plantar fasciitis were chosen due to their frequency of occurrence as well as due to some common factors likely causing those injuries to occur. Overactive hip flexor complex and outer calve musculature in conjunction with a weak core seems to be the recipe for getting hurt.

A muscle imbalance that develops in the body often begins with poor static posture such as prolonged sitting at the desk, which causes certain muscles such as pectoralis major and minor as well as the upper trapezius and hip flexors to shorten and become overactive while their antagonist lengthen and become weak, lower trapezius and gluteus maximus for example. Poor static posture that leads to changes in the muscle and muscle-tendon junction leads to biomechanical changes in the joint biomechanics and alter typical movement patterns.

Hamstring strain

Hamstring strain usually occurs while the hamstring is lengthening under the load. During the gait the leg goes from push off to pull through to landing (simplified). While preparing for landing, the limb starts extending at the knee. Hamstrings regulate the rate of this extension and prevent it from occurring too rapidly. If hamstrings are weak, fibrous or compromised in any other way, a tear can happen in the muscle fibers: any where from minor grade one tears, to severe avulsions when the muscle tears at the attachment on the "sit bone" and a piece of bone is chipped along with the muscle.

The best treatment is rest and ice in the acute stages followed by cross friction massage and eccentric training to aid in scar tissue management followed by a functional screen to determine why the injury occurred in the first place.

Likely overactive muscles in the case of a hamstring strain are the hip flexor complex, abdominal complex and lateral gastrocnemius. Underactive muscles are usually gluteus maximus and core muscles such as transverse abdominis, multifidus, transversospinalis and internal obliques as well as the pelvic floor.

Best injury prevention is myofascial treatment of abdominal muscles as well as the hip flexor complex followed by a lengthening program of those muscles. Muscles that need strengthening are the core and gluteus maximus. Note that the core and the gluteus maximus might be strong statically but need to ‚Äúre-learn‚Äù how to engage in a dynamic situation.  Recommended exercises are alternating hyperexetension on a physioball and walk around the clock on the physioball.

Patellofemoral pain

Patellofemoral pain is pain in the knee area. It is often caused by softening of the cartilage behind the kneecap due to improper patellar tracking. Instead of staying in the groove during straightening and bending the knee, patella tracks laterally and grinds over a small bony prominence, which functions as a side barrier preventing the knee cap from dislocating in a healthy knee.

Likely overactive muscle in this case would be adductor muscles (which can be overactive due to a weak core musculature therefore they work overtime to stabilize the pelvis), lateral side of quadriceps, gastrocnemius and the hamstrings. Likely weak muscles would be gluteus medius and minimus (stabilizers of the hip), medial portion of the quadriceps and anterior tibialis .

The advised strategy to take care of the patellofemoral pain is myofascial release of the overactive muscles and lengthening of adductors, outer hamstrings and quads as well as the calves. Strengthening exercises recommended in this case are a lunge in transverse plane and single leg deadlift.

Plantar Fasciitis

Connective tissue at the bottom of the foot is called plantar fascia. Plantar fasciitis is an inflammation of this fascia and the common symptoms include sharp pain when first stepping on the foot in the morning, temporarily eased with activity. There is a tender spot at the attachment of plantar fascia on the inner side of the heel. People with flat feet or high arches are predisposed to this injury.

Musculature on the outer side of the leg above and below the knee that is shortened and overactive can affect foot mechanics and irritate the plantar fascia. Muscle release techniques in combination with lengthening techniques can re-set those muscles to their proper length. Disengaged or weak muscles in the case of plantar fasciitis are anterior and posterior tibialis, inner part of the calves and gluteus medius. Good exercises in this case would be side lunge on the BOSU, single leg stance on the BOSU and bare foot walking whenever possible.

Injury and pain during running is wrongly perceived a necessary evil. Proper assessment of athlete's baseline state particularly from a musculoskeletal perspective can produce invaluable information on how to properly design a training plan, which should include corrective exercises. "Off-season" is an ideal opportunity to identify the weak links, strengthen them and prepare for the healthiest season yet.

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