Cross Country Running Injuries: Types, Diagnosis, & Treatment

Cross Country running injuries are common and there are a few types of injuries that are more common than others. Running is a repetitive motion and impact related sport which makes Cross Country running injuries difficult for many understand, diagnose and treat properly.

Diagnosing Cross Country Running Injuries

At the San Diego Running Institute I have treated and fixed Cross Country runners and running injuries for over 10 years. I understand the complexity of Cross Country runners and how to accurately diagnose and fix their running injury in the shortest amount of time in order to help them get back into racing and achieve their goals. Generally speaking, the Altered Gravity Treadmill is the best way to rehabilitate cross country running injuries.

Two Types of Cross Country Running Injuries

There are two types of Cross Country running injuries:

Impact or bone related injuries
Repetitive motion or overuse injuries such as tendonitis.

While both types of injuries may be painful and cause the runner to stop running Cross Country they are much different in how they affect the athlete and how they can be treated.

Cross Country Running – Bone Injuries

Bone injuries are common in Cross Country running. Common bone injuries that affect Cross Country runners are stress fractures, bone marrow edema, and bone swelling. These painful conditions will usually affect the same area even in different runners. The feet, ankle, knee, hip and pubic region seem to be the most common areas affected by Cross Country running injuries that affect bone.

Stress Fractures

Stress fractures are confusing to many Cross Country runners and doctors because the athlete will often say it does not hurt when they run. If pressed they will admit it hurts worse at the end of a long run of AFTER running. An ominous sign is a Cross Country runner that limps after running, later that day or is unable to run the following day because of the pain. Stress fractures can usually not be seen on x-ray. It is common for Cross Country runners and their parents to be given a false sense of security when the x-ray shows “nothing”.

The gold standard for imaging a stress fracture in a Cross Country Runner is an MRI. At the San Diego Running Institute we have a thorough examination that will usually reveal whether or not a stress fracture is present without the aid of MRI evidence. If we feel an MRI is warranted we will provide you with a prescription. In the past Cross Country runners with stress fractures would have to stop running and other weight bearing activities for 4-6 weeks. This resulted in extreme emotional stress as well as physical deconditioning and loss of running performance. At San Diego Running Institute we employ the most modern technology in order to get the Cross Country runner back to running more quickly than ever before possible.

Bone Marrow Edema

Bone marrow edema is swelling inside the cavity of the bone that creates pressure and pain within the bone. Cross Country runners will usually describe pain associated with bone marrow edema in a similar fashion as they describe the pain associated with a stress fracture. Typical complaints are pain that gets progressively worse with running or jumping, pain at the end of longer runs and pain that may result in limping after running. Bone marrow edema will not show on x-ray but may show on MRI.

At the San Diego Running Institute we have a thorough examination that will usually reveal whether or not a bone marrow edema is present without the aid of MRI evidence. If we feel an MRI is warranted we will provide you with a prescription. At San Diego Running Institute we employ the most modern technology in order to get the Cross Country runner back to running more quickly than ever before possible.

The Altered Gravity Treadmill (AlterG) allows for us to lessen the Cross Country runners body weight which results in less impact on the injured bone. By reducing the impact beneath the threshold for pain and injury the AlterG allows the runner to continue running while the bone marrow edema improves. The AlterG also takes advantage of Wolfe’s Law which states that bone and other connective tissue such as ligament, tendon and muscle will be stimulated to grow and repair in response to appropriate stress. In this way the AlterG allows for the Cross Country runners body to accelerate the healing process and return to full function in less time. As the Cross Country runners body repairs and heals we can increase the runner’s weight on the AlterG so that as they near 100% resolution they are running near 100% of their true body weight. This allows the athlete to return to full form and function almost immediately upon healing!

Fractures

Sometimes a Cross Country runner suffers a hairline fracture or some other form of fracture while participating in another sport. Fractures always resulted in 6-8 weeks of no running which could easily end a season for the Cross Country runner while the bone heals. When you consider 6 weeks of no running then another 3-4 weeks of progressive training just to get back to where the athlete left off it is hard to imagine them competing competitively following a fracture. At San Diego Running Institute we employ the most modern technology in order to get the Cross Country runner back to running more quickly than ever before possible.

The Altered Gravity Treadmill (AlterG) allows for us to lessen the Cross Country runners body weight which results in less impact on the fractured bone. By reducing the impact beneath the threshold for pain and injury the AlterG allows the runner to continue running while the fracture heals. The AlterG also takes advantage of Wolfe’s Law which states that bone and other connective tissue such as ligament, tendon and muscle will be stimulated to grow and repair in response to appropriate stress. In this way the AlterG allows for the body to accelerate the healing process and return the Cross Country runner to full function in less time. As the Cross Country runners bone repairs and heals we can increase the runner’s weight on the AlterG so that as they near 100% resolution they are running near 100% of their true body weight. This allows the athlete to return to full form and function as soon as the bone is healed!

Cross Country Running – Repetitive Motion Injuries

Repetitive motion or overuse injuries are also common in Cross Country running. Common overuse injuries that affect Cross Country runners are plantar fasciitis, Achilles tendonitis, Posterior Tibialis tendonitis (shine splints), Patella tendonitis, Patella tracking errors, Hip flexor tendonitis, Hip Bursitis, Adductor Strains and Piriformis syndrome.

Overuse Injuries are also referred to as Repetitive Strain Injuries (RSI’s) or Repetitive Motion Injuries. The idea is that the cross country runner overused their body by running to far or too often without enough recovery time in between training. On the surface this may seem like a plausible reason to explain the injury but if we use simple logic to analyze this diagnosis we can find a major flaw in it. Since the cross country runner ran on both legs then a true overuse injury would affect both sides. However, most Repetitive Strain Injuries occur on one side which brings into question how it can be from overuse.

It is my belief that there is something unique about the cross country runner’s side that was injured making it different from the non-injured side. This could be a foot larger than the other, one leg longer than another, one knee more “knock-kneed” than another, one leg or foot that turns outward more than another or one hip higher than the other. Any of these variants could cause the cross country runner to distribute forces unevenly and compensate while running. This might cause asymmetrical and excessive stress on the injured side of their body and predispose them to injury.

Our biomechanical and orthopedic exam and computerized gait analysis will reveal the asymmetry allowing us to restore balance to the athlete as well as fix the injury. Below are common examples of overuse injuries that commonly occur in cross country runners.

Plantar Fasciitis

Plantar fasciitis is a painful condition that affects the arch usually near the heel that hurts worse after running and may hurt worse when getting out of bed or after sitting for awhile. Typical treatments are largely ineffective especially the use of ice and NSAID drugs. At San Diego Running Institute we physically treat the injured site using manual techniques. We then support the injured area using Kinesiotaping methods (or KT Tape or Rocktape) and teach the athlete how to do home treatment techniques that accelerate the healing process. For difficult cases we also recommend either an over the counter orthotic specific for running or we make the cross country runner a custom orthotic.

Achilles Tendonitis

Achilles tendonitis affects the tendon in the back of the ankle that attaches on the cross country runners heel. It is characterized by pain during running that may get worse with speed, hills and distance. It is often painful for the athlete to do toe raises. This condition must be managed correctly or it may turn into a chronic condition called Achilles Tendonosis. At the San Diego Running Institute we have excellent results utilizing our manual protocols and therapeutic ultrasound directly on and into the Achilles tendon. We also teach the runner how to manage this condition in between treatments to accelerate the healing process.

Calf Strain

There are many muscles that make up the calf. There are a medial and lateral Gastrocnemius muscle and the Soleus muscle. A Strain is a nice way of describing a small tear in the muscle that results in pain and a feeling of tightness in it. It is important to identify which area of the muscle is injured and provide the correct form of therapy to the area. Muscle strains will usually respond well to heat modalities and poorly to cold interventions. Stretching must also be done both correctly and frequently. There are additional strategies such as compression that many cross country runners find very helpful.

Shin Splints

I do not like this diagnosis but must address it anyway. The word Shin “Splints” is attempting to describe the muscle “splinting” in response to injury. Muscles can “splint” in response to injury directly to the muscle or tendon but also to the underlying bone. The diagnosis of shin splints somehow minimizes the injury and often the cross country runner continues to run on it making it worse. The injury is characterized by main along the medial or inside of the shine that either gets worse while running or may warm up while running but hurt later. Usually if the pain is getting worse while running it is tendonitis. When the pain is worse after running and the athlete is limping it is a sign of possible bone injury.

Medial Tibial Stress Syndrome

Medial tibial stress syndrome is just another term for shin splints. It describes pain along the medial leg or Tibial region. The pain can be the result of the muscle or tendon or the underlying bone. Limping after running is never a good sign and should be taken seriously.

Posterior Tibialis Tendonitis

This is the tendon associated with tendonitis that runs along your medial shin. This condition is treated successfully in its early stages using ultrasound, manual muscle techniques, compression and taping. Often over the counter orthotics specific to running or custom orthotics can be made for the cross country runner to alleviate the excess stress on the posterior Tibialis tendon.

Runner’s Knee

This condition is often described as a general achiness around the front of the knee that the runner has difficulty locating and describing. It can hurt while running and after running especially if sitting with a bent knee position like you would in class. Runner’s knee can be caused by muscle imbalances, excessive downhill running or a patella (kneecap) misalignment problem resulting from excessive knock-kneed, bowleg or overpronation position. At San Diego Running Institute we employ specific strengthening exercises to restore alignment and custom orthotics to reduce excess stress on the knees.

Chondromalacia

Is another name used for runner’s knee. It describes the undersurface of the kneecap as being damaged by the misalignment. If the kneecap does not glide properly during running one side of it receives excessive wear and tear and essentially is bruised which then causes the achiness the cross country runner feels.

Quadriceps Strain

The Quadriceps muscle group consist of 4 different muscles. It is important to identify which of the 4 is strained so that we can provide direct treatment to the injured area. A muscle strain describes a small tear in the muscle that will normally respond well to heating intervention such as ultrasound and compression. The use of ice and NSAID’s may actually prolong the injury and prevent it from fully recovering.

Iliotibial Band Syndrome

This common knee running injury affects the lateral or outside of the cross country runners knee. The pain can progress to the point that it forces the athlete to stop running. If not treated properly and allowed to worsen the injury can sideline the runner for months. If treated early ITBS (Iliotibial Band Syndrome) can be corrected quickly and effectively. The techniques we use accelerate the healing response allowing the runner to continue running while their knee repairs.

Patella Tendonitis

The pain is felt below the kneecap where the Quadriceps tendon attaches to the Tibial Tuberosity. This condition can also be confused with Osgood Schlatters Syndrome which is inflammation of the actual bone rather than the Patella tendon. It is important to reduce the inflammation and take excess stress away from the injured tendon. Our comprehensive approach includes reducing the inflammation as well as addressing the faulty mechanics that led to the injury.

Hamstring Strain

There are four hamstrings that can strain or tear in response to overload on the muscle and is worsened by running faster or uphill. Hamstring strains are often confused with Ischial Bursitis, Piriformis Syndrome and Sciatica. It is crucial to have an accurate diagnosis and then direct treatment at the hamstring muscle or tendon that is strained. Our protocols for hamstring strains work quickly and effectively to return the cross country runner back to training and racing.

High Hamstring Tendonitis

Tendonitis in the high hamstring tendon results in pain near the ‘SITS” bone or Ischial Tuberosity. This injury is often confused with Ischial Bursitis. High Hamstring strains can be slow to heal as the tendon has a relative lack of blood flow and so is slow in healing. Our healing protocols involve increasing blood flow into the tendon and reducing strain on it. This technique has worked very well and allowed us to return runners back to normal training and racing quickly.

Ischial Bursitis

Ischial bursitis results in local pain around the “Sits” bone that gets worse with running and often even sitting. The Ischial Bursa is a fluid sac that lies between the tendon and bone who’s responsibility is to reduce friction and impact between the hamstring attachment to the Ischial Tuberosity. Once inflamed Bursa can be difficult to heal and become chronic.

Trochanteric Bursitis

This bursitis affect the lateral hip and results in pinpoint pain that the cross country runner can point directly to. It is often confused with stress fractures. An accurate diagnosis is necessary to ensure the athlete does not run on a stress fractured femur. Trochanteric Bursitis is easily treated and fixed once identified.

Gluteus Medius Syndrome

The Gluteus Medius Muscle is an important muscle while running because it stabilizes your hip and lower back while in the stance phase of the running gait cycle. If any imbalances exist this is one of the most common muscles to undergo mechanical strain. This injury is often confused with Piriformis Syndrome, Sciatica and bursitis. Once accurately diagnosed this condition is easily treated and fixed. Our protocols are designed to fix the Gluteus Medius and also identify the imbalance that created it.

Piriformis Syndrome

Is a painful condition that results in pain in the gluteal region that may radiate down the cross country runner’s thigh to the back of their knee. It is often misdiagnosed as sciatica. We treat and correct Piriformis Syndrome on a regular basis by directing therapy at the muscle itself and identifying structural imbalances and correcting the underlying cause of the condition.

To schedule an appointment with Dr. Allen D.C. call 858-268-8525