Today, we’re going to go through how to figure out what hurts by asking the right questions. Runners can sustain lots of different injuries, but they tend to get three different things, muscle strains, tendon injuries, and bone stress injuries. It’s essential to figure out what one of these you might be dealing with because it guides how we get you back to running. And there’s four important questions we have to answer to figure out what we’re dealing with. When did it happen? Where is the pain located? What makes it better? And what makes it worse?
A muscle strain is often called a pulled muscle, but what it really means is a muscle tear. When you strain a muscle, you tear a muscle. These injuries are much more common in high-velocity sports. And these normally occur in biarticulate muscles, muscles that cross two joints. These aren’t super common in distance runners because we’re not operating at that top end speed. Now, that’s not to say that they don’t get misdiagnosed with muscle strains often. To sustain a muscle strain, you’re going to tell me that there is a specific moment when it occurred. Bam, you felt that muscle tear. Muscle strains get worse when we have that muscle contract or when we stretch that muscle.
So if I have a strain in my hamstring, if I do a deadlift or a bridge, something that requires that hamstring to contract, I might report some pain. Your pain is going to be located specifically over a muscle. If we think about the hamstring, you’re likely going to report pain right in the middle of that hamstring muscle. You also might report some bruising or swelling that you can visibly see. If you have a muscle strain, you’re going to point to a specific muscle. It’s going to be painful if you can track that muscle or potentially stretch that muscle, and there’s going to be a specific mechanism of injury. And remember, these aren’t super common in distance runners.
Do I have a tendinopathy? Tendonopathy is a broad term that we use for pain located within a tendon. You’ll sometimes see this referred to as tendonitis or tendonosis. Tendonosis means that there’s been some degeneration in the tendon. Tendonitis means there’s some inflammation in the tendon. Now, this isn’t a situation where we’re worried about this tendon snapping or tearing. That’s a common worry for a lot of runners. If you’re a distance runner, the likelihood of use sustaining a tear in at tendon where it completely tears, it’s not that likely.
Because of the specific demands of running, we’re going to see these complaints in the patellar tendon, in the IT band, in the proximal hamstring, the Achilles tendon, and the planter fascia. This is the front of your knee. Your quadricep turns into your quadricep tendon, it blends into your knee cap, and then it attaches into your patellar tendon, finally, down to your tibia. This serves as one unit, and your quadricep in this whole complex allows us to our knee under weight. It’s under a lot of stress when we run.
If you’re reporting tendon pain, you are going to point to a specific tendon where the pain is located. Now, tendon pain is gradual over time. There’s normally not a specific mechanism of injury. It’s this gradual increase in symptoms as we run more, run faster, or have some other changes happen in our training. It generally gets worse if we have that muscle-tendon unit have to work a lot. So if we go back to our quadriceps example, if we’re doing a lot of squats, a lot of lunges, a lot of downhill running, things that are going to bias this area a little bit more, that tends to make it worse.
Tendons often report a warmup phenomenon. Means, if they’re more active, they tend to feel a little bit better as long as they’re not going overboard with their activity. That’s an important way for us to differentiate muscle-tendon pain versus bone pain because sometimes this will actually warm up and feel better if we’re more active. With tendinopathy, you’re going to report pain over a tendon, a gradual onset of symptoms, potentially have those symptoms warm up if we’re active, and it’s going to be worse if we do things that make that tendon and muscle work.
Do I have a bone stress injury? Our bones help us absorb the shock of running. They also have to deal with our muscles and tendons tugging on them thousands and thousands of times during a training run. They’re under a lot of stress. That’s part of the reason why we see such a high percentage of distance runners getting bone stress injuries. A bone stress injury just means a stress fracture or a stress reaction. It’s important for us to differentiate this from a muscle or tendon injury because these often require complete rest and cessation of running. Now, with bone stress injuries, we’re going to see a gradual onset of symptoms in pain that’s not located over a tendon, and it’s potentially going to get worse with weight-bearing activities, walking, standing, jumping, and running. And this is generally going to feel better with rest.
So if we’re dealing with pain that’s not local over a tendon, there’s a gradual onset of symptoms, and it gets worse with weight-bearing activities, we start to think of this as a bone stress injury. The management of these are very different. Normally, it’s going to require time on crutches or in a cam boot, potentially, non-weight bearing altogether, and definitely holding off on running. This injury is a little bit more serious than muscles and tendons. So remember to ask these four questions. When did the injury occur? Where is the pain located? Makes it worse? What makes it better? And that helps us get you back to running quicker. Thanks for taking the time to watch. Hope you found this video helpful. If you’ve got questions, leave a comment below.