8 Common Trail Running Injuries Explained

In the Lion City you’d assume most runners are pounding pavements, but trail running is becoming ever more popular and opportunities to race (like the Columbia Jungle Run) have also increased.

According to the International Trail Running Association, trail running is done on a combination of dirt, jungle, mountain and/or sand, with less than 20% being on concrete (ITRA. 2018). These varying terrains, inclines, and surfaces affect the way we run, and can make us vulnerable to injury.

Here are 8 common trail running injuries that City Osteopaths and Physiotherapists treat on a daily basis. They’ll be down at the Race on 7 October to provide first aid and advice, and can be contacted before Jungle Run to get you in tip-top racing condition.

1. Lower back pain

Believe it or not lower back pain is a common injury in trail runners, and is especially true for ultra-distance runners.

The lower back helps us to bend forwards and backwards; injury can happen if a twist interrupts this motion. When you run, you actually lean slightly forward to propel yourself forwards, activating your lower back. Bring an uneven trail into this with inclines, and your body will be twisting to stabilise… and here you see the risk of injury.

Commonly, this pain is from joint irritation, causing muscles and ligaments to go into spasm as they work harder to compensate for the lack of movement/pain. Symptoms include pain in the lower back or buttock, either on one side or both, with or without radiations that go down one or both legs. The nature of the pain can range from dull to sharp with movements often increasing the intensity.

2. Plantar fasciitis

Plantar Fasciitis is inflammation of the plantar fascia ligament, which runs from the heel along the arch in the sole of the foot to your toes. Recurrent and repetitive nature of running can cause tears in the ligament fibres, which causes irritation and pain. It can be felt as a sharp pain along the bottom of the foot and is usually worse in the morning.

Risk factors include running, poorly cushioned footwear, and flat feet. Treatment programmes focus on rehabilitation, stretching and taping.

3. Sprained ankles

With uneven terrain, roots and rocks, it’s not surprising that ankle sprains make this list of common trail injuries.

83% of all ankle sprains occur to the outside of the ankle, normally when the person lands on one leg on an uneven surface which obviously happens a lot in trial running (Fong et al 2007). If you’ve “rolled” your ankle before, it’s highly likely you’ll do it again – this injury’s reoccurrence rate is 73% (!) which is why rehab and initial care is super important (Yeung et al 1994).

Approach a trail with caution if the ground is particularly uneven or has a lot of leaves, mud, and high grass that might disguise what you’re stepping on. The best way to prevent sprains is to strengthen your ankle with exercises, and work on your balance.

4. Achilles Tendonitis

Achilles Tendonitis represents 5-12% of all trail running injuries (Malliaropoulos et al 2015), and is inflammation of the tendon at the heel and back of the ankle.

Overuse, hills, stairs, low heel drop shoes and flat feet are all risk factors for developing tendonitis. Treatment of Achilles problems often involves manual therapy to help reduce the tightness in the calf and you will often be prescribed exercises to stretch and strengthen the calf muscles, including heel drops or eccentric loading exercises.

Illustration by Todd Buck

5. Runners Knee (Patello-femoral pain)

Patellofemoral pain or “runner’s knee” is pain under or around the knee cap. It is the most common general running injury. Weight-bearing exercise (walking, stairs, squats and running) aggravates the pain.

A typical cause of Runner’s Knee is an imbalance in quadriceps muscles – if the outer quad is stronger than the inner, the knee cap will be pulled and pressured unevenly. It’s important to get enough rest and recovery during training. It’s recommended that you do not increase your training by more than 10% at a time (for both intensity and distance).

Working with an osteopath or physiotherapist can help to strengthen the different muscles, reduce tension, and increase the movement of the knee.

6. Iliotibial Band (ITB) and Hip Pain

ITB (Iliotibial Band) friction syndrome is a common overuse injury in runners. It is characterised by pain over the outside of the hip and down the thigh, caused by excessive friction between the ITB and bone.

When running, the ITB is used in the swing, stance and push off phase to help maintain hip flexion, extension and stability. In trail running this condition is typically aggravated by hills, different terrains and conditions.

Similar to all overuse injuries, increasing your mileage too quickly will predispose you to this problem. You running pattern or gait could also predispose you to this type of injury. If you’re new to trail running, try to increase the amount of time you spend on the trails gradually, start with a combination of road and trail till you get more used to it.

7. Cramping

Exercise associated muscle cramps are painful involuntary muscle contractions during or just after exercise (Schwellnus et al 2004). The cramping normally occurs in muscles that cross over more than one joint, which is why calves, hamstrings and quadriceps are very susceptible.

Fatigue is the main cause and risk factor for cramp (not electrolyte imbalances, as previously thought). Overuse causes imbalances and increase in the electrical impulses that cause the muscles to contract and when they stay contracted rather than relaxing, that’s the cramp.

The best way to avoid cramping is to adjust your training and fully preparing for races. Most important is to meet the start line feeling refreshed and relaxed! When you get a cramp, the best thing to do is to try and stretch it out.

8. Stress Fractures

Stress fractures are common overuse injuries in runners and account for about 16% of all running injuries. Due to softer surfaces of trails (i.e. not concrete), risk of stress fractures is actually slightly less in trail runners.

They occur when excess load or stress causes a mechanical micro-crack in the bone. Joints on the lower half of your body are particularly at risk of these, and micro fractures can develop into full fractures if not seen to.

Similar to many of the other injuries on this list, make sure you don’t do too much too fast and build up your mileage and intensity slowly.

As with all injuries, it’s best to get them checked out by a professional early. To get in tip-top shape ahead of the Columbia Jungle Run, we recommend getting any niggles seen to by City Osteopathy & Physiotherapy, who have clinics around Singapore and will be there to assist runners on Race Day.