Overload damage during running/jogging

Far more often than accidents, damage to the musculoskeletal system is caused by overloading or incorrect loading. Knee joint The knee joint is subject to heavy strain when walking. If the knee joint is damaged, as in the case of knee joint arthrosis (gonarthrosis), it is less resilient and tends to become irritated, which can result in pain, overheating and effusion of the knee joint.

Wear-related meniscal damage (degenerative meniscal ruptures, meniscal damage) can also lead to knee joint complaints. They usually manifest themselves as pain on the inside or outside of the knee joint gap. Occasionally, however, pain in the hollow of the knee is also the main symptom.

The initially only “annoying” complaints can ultimately make walking impossible and also cause pain and swelling of the knee joint at rest. A typical accident event is usually not memorable A very common pain symptomatology affects the kneecap (patella), which is why the runner’s kneecap pain is also known as “runner’s knee” or runner’s knee (tractus syndrome) The pain is caused by damage to the cartilage of the patella and/or its sliding bearing on the thigh (chondropathia patellae) and local inflammation of the mucous membranes.The causes of this clinical picture are manifold: Other forms of knee joint pain include overloading with inflammation of Hoffa’s fat body and irritation of the muscle/tendon attachments. When the Hoffa’s fat body is inflamed, the pain is felt inside the knee joint, behind the patellar tendon.

Typical is a slow, increasing pain and pain during knee extension. Characteristic tendon insertion complaints (enthesiopathy) affect the Pes anserinus (“goosefoot”, common insertion of the sartorius muscle, M. gracilis, M. semitendinosus) in the area of the inner (medial) tibial head of the tibia. According to their function, pain occurs mainly during internal rotation of the flexed knee joint.

Pain in the area of the lateral knee joint can be caused by rubbing the iliotibial tractus. The tractus iliotibialis is an extensive reinforcement of the muscle sheath of the thigh (fascia lata). It is tensioned by muscle fibers of the muscle tensor fascie latae and the gluteus maximus muscle.

The tractus iliotibialis runs as a path along the lateral thigh to the lateral tibial head. Rubbing this tractus in the area of the lateral knee joint can cause discomfort during walking and the formation of inflammatory bursae. A bowleg malposition favors the occurrence of this clinical picture.

Ankle joint The foot has the most direct contact with the ground when running. The steps are only cushioned by the footwear. The structures of the foot are therefore exposed to great stress.

Malpositions of the foot or ankle joint with unnatural foot/ ankle joint stress therefore quickly lead to overstrain symptoms. The splayfoot describes a pathological lowering of the transversal arch of the foot and, by overloading the metatarsal heads II-IV, leads to forefoot pain, which can be easily treated with an appropriate insole. It is also responsible for the development of hammer and claw toes, which lead to painful corns (clavus).

The flattened foot leads to a flattening of the inner arch of the foot with overloading and pain of the small foot muscles in this area. Chronic tensile stress on the plantar aponeurosis can lead to the development of a painful heel spur. The therapy of choice for a heel spur is also the insole.

A hallux valgus is a malpositioning of the big toe and usually associated with a splayfoot. In hallux valgus, the big toe increasingly points outwards. The malpositioning and a wide forefoot lead to the development of a painful bursitis in the area of the metatarsophalangeal joint of the big toe.

Increased walking, especially with a forefoot runner (see below), can accelerate or become symptomatic of arthritis of the metatarsophalangeal joint of the big toe (hallux rigidus). In a hallux rigidus, the rolling motion of the forefoot is disturbed because the big toe is impaired in its erection due to wear. Fatigue fractures (stress fractures) occur particularly frequently in the area of the metatarsals.

However, they can also affect the fibula, the tibia, the neck of the femur or the pelvis (mostly pubic bone branch). The cause is always an imbalance between the load (hard training) and the resilience of the bone. Very slim women with poor bone metabolism (osteoporosis) and extreme running stress (e.g. marathon) are more frequently affected.

Fatigue fractures are rare in leisure sports. Overloading of the ankle joint leads to inflammation of the mucous membranes, ankle pain and effusion formation of the joint, especially when there is ankle instability. Non-accident-related complaints and swellings in the area of the outer ankle can be caused by a dislocation of the peroneal tendon (peroneal tendon dislocation) or partial dislocation (lateral calf muscles) caused by the condition.

This is a rare clinical picture. It is caused by a flat tendon sliding bed and weak ligament guidance of the peroneal tendons on their way from the outer ankle to the foot. Achilles tendon Overuse pain of the Achilles tendon is very common.

An axial malposition of the foot/ ankle joint (buckling, flat foot), overpronation when running (see below), incorrect footwear, uneven ground (especially running in sand), shortened calf muscles, differences in leg length, etc. can be causes for the complaints. As a collective term for pain in the Achilles tendon area, the term Achillodynia is commonly used.A distinction must be made between “real” inflammation of the Achilles tendon (tendinopathy) and inflammation of the tendon sliding tissue (peritendinitis achillae).

Strictly speaking, however, it is not an inflammation but rather a wear-related aging of the Achilles tendon (degeneration). Partial tears of the Achilles tendon occur and can ultimately lead to a complete rupture. The localization of the complaint is usually 5 cm above the Achilles tendon insertion at the heel bone.

The Achilles tendon can be swollen there, which is best seen on an ultrasound. An accumulation of fluid around the Achilles tendon is characteristic of an inflammation of the tendon’s gliding tissue. Characteristic are morning tarnishing pain or pain at the beginning of running.

After warming up, the symptoms improve, only to increase in intensity again after prolonged exertion. Further possibilities for pain in the Achilles tendon area are bursitis at the Achilles tendon attachment. The superficial bursitis between the skin and the Achilles tendon is usually caused by poorly fitting shoes that rub or chafe.

Deep bursitis affects the bursa between the Achilles tendon and the calcaneus and is usually caused by an anatomical variant of the heel bone (Haglund’s exostosis). Hip In contrast to the above-mentioned areas of discomfort, pain due to overstrain or misuse of the hip is relatively rare. In a broader sense, all tendon insertion complaints of the pelvis can be counted towards this.

Well-known are tendon insertion complaints of the adductor muscles, i.e. the muscle group responsible for spreading the legs. They start at the pubic bone and ischium and develop their complaints there as well (deep groin, ischium bone). Similarly, there are tendon attachment problems in the abductor muscles, i.e. the muscle group responsible for spreading the legs (especially gluteal muscles).

Load-dependent pain and pressure pain can be triggered in the area of the “hip bone” (greater trochanter). The “hip bone” can be palpated in depth on the lateral upper thigh. The clinical picture of bursitis trochanterica must be distinguished from this.

This is an inflammation of the bursa above the hip bone. When the leg is moved, the runner feels a painful rubbing sensation. There is considerable pain under pressure over the hip bone.

The coxa saltans is also a clinical picture which takes place in the area of the greater trochanter. The disease is characterized by a jerky, painful snapping of the iliotibial tractus over the greater trochanter. This is therefore also referred to as a “snapping hip“.

The cause of this problem is to be found in a congenital prominent greater trochanter, a difference in leg length or a general weakness of the connective tissue. As with knee joint arthrosis, hip joint arthrosis (coxarthrosis) can also lead to overuse pain in older runners. The clinical picture of bursitis trochanterica must be distinguished from this.

This is an inflammation of the bursa above the hip bone. When the leg is moved, the runner feels a painful rubbing sensation. There is considerable pain under pressure over the hip bone.

X-Legs
Reduced development of the patella (patellar dysplasia)
Reduced bearing capacity of the plain bearing
Tight strap guidance
Walking technique (overpronation)
Internal hip rotation
Muscle imbalance of the patella centering muscles
Muscle shortening with increased patellar pressure

Back pain when running occurs occasionally.

The lumbosacral transition (transition from the lumbar spine to the sacrum) is subject to particular stress. Due to weak back and abdominal muscles and shortened hip flexor muscles, the pelvis tilts forward.This is balanced by an increased lordosis of the lumbar spine (formation of a hollow back) with overloading of the intervertebral discs and the small vertebral joints. In the same way, well-trained runners experience muscular fatigue. The consequences can be facet arthrosis and herniated discs, especially in the lumbar spine.