Dr. Ross Henshaw, a fellowship-trained knee, hip and shoulder orthopedic surgeon, specializes in Sports Medicine at Danbury Orthopedics. He is also Medical Director of Danbury Hospital's Sports Medicine program. Dr. Henshaw treats athletes of all ages and levels – from the recreational to the professional.
Running can be a wonderfully efficient way to improve your health. This simple sport is one of the most rewarding and convenient exercise activities. It can be enjoyed at any age and any level of experience. It’s not just a sport for competitive athletes. Exposing children to running and signing them up for a local road race is a great way to bond and promote healthy living. Running is something the whole family can do together. But it is important to get started off on the right foot. The best way to safely enjoy a running program is to start smart, with a progressive training schedule that gradually builds the intensity and duration of your workouts.
What the Pros Say
While there are obvious skeletal and metabolic differences between children and adults, training techniques and conditioning are very similar. Even though children’s bones are growing, running whether for distance or sprinting does not negatively affect growth. However, instead of getting inflamed tendons as adults do, growing children; sometimes develop inflammation around their growth plates. Follow a training schedule developed by a coach or experienced runner can help avoid these problems.
Typically, a running coach or trainer will recommend increasing distances no more than 10% a week. If you have never been a runner, seek advice from friends, trainers or your local running store. There are also great resources online and in print. But if you have an underlying health condition or are new to exercise, make your first step a consultation with your physician to be sure it’s OK to start running. Orthopedically, running is a safe exercise for most people but there are exceptions, even among athletes. So, if you have a history of orthopedic injury or joint pains, particularly those involving the legs or spine, seek the advice of an orthopedic surgeon.
While any form of exercise can cause or aggravate a preexisting injury, endurance sports generate typical injury patterns. Endurance sports by definition involve prolonged repetitive motion. While a soccer player may run 3-7 miles in a game, depending on position, he or she is rarely only running straight ahead at the same speed. But runners go straight ahead at a maintained speed, which means your hip, knee, ankle and arm motions are roughly the same for the duration of the exercise. Hills change the degree of motion and add more jarring forces.
The longer the duration and hillier the terrain, the more our joints are cycling and the more our tendons and ligaments are pulling and rubbing around our joints. When we start an endurance sport like running and build up too quickly, the abrupt increase in joint motion can lead to ‘overuse’ injuries.
The Top 5 Complaints
In my practice, the most common running injuries are hip bursitis, knee cap pain, shin splints, Achilles tendinitis and plantar fasciitis. Here’s a quick anatomy lesson:
‘Trochanteric Bursitis’ is an overuse injury caused by friction between the illiotibial tendon band and the hip bone. This large tendon travels over the bony prominence on the outside of the hip, goes all the way down to the leg and attaches just below the outer side of the knee. When we run, this band rubs back and forth over the outer hip bone; over time the friction creates inflammation. Our bodies have natural ‘cushions’ called ‘bursa’ that are designed to reduce this friction, but if they have not had time to adapt they can swell and hurt. (A related injury is ITB syndrome.) While ITB syndrome is more common in adults it can happen in children and adolescents as well, but these growing athletes are also susceptible to grow plate inflammations where the thigh muscles such and the quadriceps and hamstring muscles attach to the pelvis.
Kneecap pain and Patella Tendinitis
Often grouped as ‘anterior knee pain’, this refers to pain in the front of the knee and is common among runners young and old. The quadriceps muscle in the front of the thigh powers our ability to straighten the knee. It works by using the kneecap or ‘patella’ for leverage across the knee. This generates pressure and can cause the kneecap to become sore. It’s especially evident when people walk down stairs or inclines and is precipitated by excessive downhill running. The quadriceps muscle tapers to become a tendon that attaches to the kneecap and then to the shin bone (tibia) via the patella tendon. When strained, the quadriceps and patella tendons can also develop micro tears and become inflamed. Treatment includes rest, anti-inflammatories, strengthening exercises, cross training and progressing back to running while avoiding hills. In growing children, this same mechanism can lead to inflammation of the growth plate at the knee and just as with adults, rest is recommended.
Shin splints, or ‘posteromedial tibial stress syndrome’, can occur on one or both shins, but most commonly on the dominant leg depending on your stride. Pain originates at the lower third of the inner part of the shin just behind the bone. The pain is usually discrete and easily reproduced by pressing on the trigger point. This condition is caused by inflammation where the Soleus muscle in the calf attaches to the tibia. As the muscle helps runners with ‘pushing off’ it pulls on the attachment site, which may become inflamed and swollen. This pain usually hurts only when running, early or later in a run. Some people try to run through the pain, which worsens it so that even walking becomes painful. Treatment for this overuse is rest and cross training. Some people may be predisposed to shin splints because of running style or leg, ankle or foot alignment.
The strong Achilles tendon is prone to inflammation when starting a running program, particularly on hilly terrain. Our calf muscle tapers off to become the Achilles tendon that inserts into the heel and powers the push-off of the running stride. Running uphill demands more stretch from the calf, forcing it to work harder. This can lead to micro tears of the small Achilles fibers. Micro tears do not become full tendon ruptures, but cause inflammation and swelling as the body tries to repair and regenerate the area. The usual treatment for this pain is rest, stretching, strengthening, cross-training and as the pain dissipates, a gradual return to running with limited hills.
Dreaded heel pain! Its most common early symptom comes not with running, but with the morning’s first step. The plantar fascia is a tight band of tissue that supports the foot arch. It attaches to the heel and traverses across the sole, attaching broadly across the end of the foot. When we run the plantar fascia can become overstressed at the smaller attachment on the heel, especially in individuals with tight calf muscles. Initially, inflammation starts after the run and hurts upon standing after a period of inactivity. When the foot and ankle bend to stand flat, the fascia stretches and hurts. Best treatment is to recognize it early and rest, cross train and take an anti-inflammatory. More severe cases may require calf stretching, night splints that keep the plantar fascia stretched, and heel pads. In children, the heel growth plate can become inflamed and is treated the same as with plantar fasciitis.
Pain is a warning!
While it sounds like a lot can go wrong, most of us can enjoy running without ever suffering from these common maladies. As a sports medicine specialist, my best advice is to recognize symptoms early and not ignore the pain. Early recognition and treatment generally lead to a quicker recovery. I also recommend cross training. Even if you prefer running as your primary aerobic exercise, you’ll benefit by incorporating other forms of conditioning such as biking, elliptical, stair master or swimming. If you pay attention to symptoms and mix it up, you can help avoid painful injuries due to repetitive overuse of the joints … and stay active.
About OrthoConnecticut/Danbury Orthopedics
OrthoConnecticut is a multispecialty practice staffed by leaders in orthopedic care, and is the parent practice of Danbury Orthopedics, New Milford Orthopedics, and Coastal Orthopedics. The practice’s Centers of Excellence provide integrated treatment, offering individualized and compassionate care by a team of board-certified, fellowship-trained specialists. The goal of the practice is to help patients regain mobility, lead active lives, and attain optimal well-being. To make an appointment with any of the practice’s specialists, please visit