Returning to Running Post Injury: Part 2 – High Speed running

Tendon problems can be characterised mainly into tendinopathies and tenosynovitis. Tendinopathies are usually more common, and can be seen in the period after quick spikes in training load, or changes in surface, terrain or even footwear. The most common tendinopathy areas in the foot are the Achilles, the tibialis posterior, and the flexor hallucis brevis. The best part about most tendinopathies is you can usually train through them to a degree, it’s just a question of how much. This is dependent on a case-by-case basis, and should be discussed with your allied health practitioner. Tendinopathies usually present as pain first thing in the morning, or after a run; pain which warms up throughout a run; and thickening and tenderness over the site of the tendon.Tendon problems can be characterised mainly into tendinopathies and tenosynovitis. Tendinopathies are usually more common, and can be seen in the period after quick spikes in training load, or changes in surface, terrain or even footwear. The most common tendinopathy areas in the foot are the Achilles, the tibialis posterior, and the flexor hallucis brevis. The best part about most tendinopathies is you can usually train through them to a degree, it’s just a question of how much. This is dependent on a case-by-case basis, and should be discussed with your allied health practitioner. Tendinopathies usually present as pain first thing in the morning, or after a run; pain which warms up throughout a run; and thickening and tenderness over the site of the tendon.There are many ligaments throughout the foot, but often these don’t actually cause us issues during long-distance running, and also often aren’t injured with distance running, although present more frequently in trail running communities. Ligaments don’t like sudden changes in force or sudden changes of direction. Take your ankle ligaments, for example. These are often injured by rolling your ankle, which can occur when running on uneven ground e.g. over tree roots, rocks and undulating surfaces associated with trail running. During rehabilitation, we often promote straight line activity for ligament injuries as early as possible, as this doesn’t tend to flare these injuries too much if done in moderation.A distance runner’s worst nightmare. Bony injuries are usually responsible for the most time missed by endurance athletes due to the difficulty associated with healing. The bones of the foot can be even more complex with healing times, due to the variability in blood supply. Stress injuries to the 5th metatarsal and navicular for example, take much longer to heal and should be treated with much more care due to their lack of blood supply. In contrast, calcaneal stress fractures have much lower associated risk, because of the improved blood supply. Bony stress injuries are usually characterised by ongoing pain which worsens with running or weightbearing, localised pain area and a dull, aching nature at rest, which sharpens with activity. If you suspect that you may have a bony stress injury, consult your allied health professional immediately, who may also involve a sports physician or orthopaedic surgeon if more severe. The rehabilitation process for a bony stress injury is multi-faceted, often involving a number of different professionals, including Dietitians, S&C coaches, Sports Physicians and your own coach.