Tendonitis and Tendinosis from Running

Runners commonly experience muscle and tendon injuries following several weeks or months of running. Think of how many steps you have taken this year. With each step there is the impact of your body weight against the road. Gravity is pulling you down and that pounding is absorbed by muscles, tendons, and joints. Sometimes your running is smooth, so there is less impact against the road. However, we have all felt the times where our legs are wobbly and every step is a slow pound against the concrete. Over time, this stress from running can injure muscles, ligaments or tendons; causing inflammation, swelling, and pain.

Think of a tendon like a rope tied to a tree. Each tug on the rope places tension and stress on the rope, especially where the rope is tied to the tree. With time and repletion this creates an area where the rope becomes damaged and frayed. With enough pulling and fraying the rope can become severely damaged. The rope will show early signs of fraying, but most people wait until the rope is severely frayed to seek help.

Repeated stress "frays" tendons and ligaments, leading to injuries. This situation is a mechanical problem which requires treatment to decrease stress and promote healing. Multiple therapies are available to speed the healing and recovery process. The most important part of therapy is removing the problems that lead to the injury. For example, IT band tendonitis is often caused by a combination of gluteus medius weakness, lateral quadriceps spasms, and scar tissue limiting elasticity of the IT band fascia. All of these factors contribute to the IT band tendon rubbing and fraying against the outside of the knee.

After stopping the pain, decreasing the inflammation, and getting the tendon to heal, the risk of future IT band tendinosis remains high. The quadriceps muscle needs to be properly stretched and the gluteus medius muscle needs to be strengthened. Failure to fix the underlying problems will most likely lead to future running IT band injuries.

Every runner has a friend who has a chronic running injury. They will have stories about trying numerous therapies, tricks, stretches, and periods of rest. The problem keeps coming back because the system is not fixed. They use foam rollers religiously and buy club store-size packages of Kinesio/Rock Tape. They keep trying to work on the sore spot, not what is contributing to the sore spot.

Running is a gait cycle starting with your right foot hitting the ground, absorbing the forces applied, and then propelling you forward. At that point the foot is behind you and needs to swing in front to land again to complete the cycle. Meanwhile the left foot is going through its own cycle.

Both legs have to work together. What the left foot does affects the ability of the right foot to land, absorb, push, and swing back around. Weakness or problems on the left will alter the right leg's gait cycle.

For some reason, we like to pretend that injuries are independent of the system. Injuries are commonly a consequence of a weakness or limitation elsewhere in the body. So next time your running partner complains of IT band pain, look at their gait. Watch how the feet strike, toe off, and land. Watch to see if the knee dips inward. Are their feet straight or does a toe flare to the side? How smooth do they land and absorb the impact forces? Does their waist rotate or swing during the running gait cycle?

Running injuries, especially IT band syndrome, are a consequence of weakness and a failure of the running gait cycle. This places excessive stress on the tendons leading to fraying, pain, and skipping runs.

Good treatment and dedication can and will resolve most injuries. Sometimes combinations of treatments are necessary to address all of the weakness, tightness, spasms, and deficiencies. Tell your running partner to fix the problem and quit using all that darn tape.

More information can be found about ITB Injuries here.