Endurance Athletes, Overuse Injuries, & Exercises to Prevent/Rehabilitate Them

Overuse injuries such as plantar fasciitis, iliotibial band friction syndrome, patellar tendoninits/tendonopathy, Achilles tendonitis/tendonopathy, patello-femoral syndrome, “shin splints” etc. are very common in endurance athletes.

The most common causes of these injuries are typically too much activity and not enough rest, increasing activity (aka mileage) too quickly, or poor form caused by muscle imbalances and biomechanical abnormalities. All of these aspects should be considered when dealing with an overuse injury, as well as whether there has been a recent change in footwear/equipment. A training ratio with too much activity to too little rest can lead to tissue breakdown, since the necessary cellular reparative mechanisms cannot take place.1 Histologically, studies have shown that in most overuse injuries there is an absence of inflammatory cells, and instead cellular degeneration is present.2 Therefore, rehabilitation may be more successful if focused on correcting muscle imbalances and biomechanical abnormalities rather than anti-inflammatory treatments like ice, NSAID’s (i.e. Advil) or cortisone injections.

There is no one-fix-all program to prevent or treat the overuse injuries listed above. In order to address all of the contributing factors, a thorough examination by your Physical Therapist is recommended. However, here are 5 suggestions for exercises that target common impairments in endurance athletes.

1. Band Walks – strengthens gluteus medius and hip external rotators

   1. Place resistance band around ankles

   2. Get into mini squat position with feet hip width apart

   3. Slowly walk sideways maintaining tension on the band

   4. Be sure that as you step you lead with your heel and not your toe and that neither knee caves inward

   5. Walk laterally to R for approximately 10 yards and then to L for 10 yards

2. Wall Leans – strengthens intrinsic foot muscles to help support arch

   1. Stand barefooted 2 feet in front of wall

   2. Curl toes under so as to lift arch of foot off of floor

   3. With body straight, lean towards wall as far as you can without falling and without allowing foot to flatten

   4. Hold for 10 seconds and repeat 10 times

3. Foam Roll ITB – breaks up myofascial adhesions in the iliotibial band

   1. Lay on side with outside of leg on foam roller

   2. Slowly roll foam roller up and down outside of leg to just below knee, spending extra time on sore spots

   3. Perform for 1-2 minutes on each side

4. Eccentric calf raises – strengthens Achilles tendon and calves without aggravating tendonitis/tendonopathy

   1. Find a stair with railings

   2. Use both legs and your hand on the railing to push into a calf raise, then take 1 foot off of step and slowly lower heel until you feel a stretch in your calf

   3. Use other foot and railing to push back into raised position

   4. Repeat 10 times and then switch feet

5. Squat with abductor/external rotator activation – strengthens gluteus maximus and medius and hip external rotators

   1. Place resistance band just above your knees

   2. Place feet hip width apart and keep knees over 2nd toe and slowly lower into a squat position

   3. Be sure that knee tracks over 2nd toe and that knees do not come in front of toes

   4. Maintain all weight in your heels as you lower and raise back to starting position.

   5. Perform two sets of 10

References:

1. Cosca DD, Navazio F. Common problems in endurance athletes. American Family Physician. 2007; 76(2):237-244.

2. Kahn KM, Cook JL, Bonar F, Harcourt P, Astrom M. Histopathology of common tendinopathies: Update and implications for clinical management. Sports Medicine. 1999; 27:393-408.