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Painful Running - Is It Peroneal Tendinopathy?

physicaltherapy running Mar 03, 2021

Pain with Running?  Is It Peroneal Tendinopathy?  Learn What It Is and 5 Prevention Strategies in this blog. 

Most runners don't know how to increase miles and improve running performance without experiencing annoying overuse injuries. Have you been experiencing a nagging ache along the outside of your ankle that seems to get worse with activity and goes away with rest? Many long distance runners and dancers can experience these symptoms. Individuals with a history of ankle sprains can also develop these symptoms. 

What is Peroneal Tendinopathy?

Peroneal tendinopathy is a tendon injury that can cause pain along the outside of the ankle. When we think about a tendon injury let’s start with the basics. First off, tendons are connective tissue that attaches muscle to bone. Specifically the tendon muscles involved with peroneal tendinopathy are the peroneus longus and peroneus brevis located on the outside of the lower leg. Their main role is to move the foot outward and assist with the movement of pointing the ankle and foot down (plantar flexion). These muscles and tendons work together to balance the foot and ankle and provide stability. 

The peroneal tendinopathy tends to occur as an overuse injury rather than a sudden injury. The muscle and tendons mentioned above can be overworked usually due to incomplete mechanics. The first “I” in the I3 model. When we are talking about mechanics, we’re referring to the mechanics specifically of how the foot makes contact with the ground while walking and running. The next “I” is incidence, if you’re a runner and are logging lots of miles with incomplete mechanics such as your foot hitting the ground more on the outside, this can lead to placing more work on the muscle-tendon complex to maintain stability at the foot and ankle. This occurring time and time again can bring your symptoms from mild soreness after a few runs into the third “I” of the I3 model, injury. This occurs when your symptoms go from a minor nag or annoyance to a limiting factor to your training and daily activities. When symptoms occur as an overuse injury the tendons can respond by becoming enlarged, thickened and in some cases swollen. 

Helpful tip: Hey Runners, consider the surface you’ve been running on. Is it sloped? Uneven?  These variations can turn the foot inward and the ankle outward which may be exacerbating your symptoms. If your symptoms increase while running on an embankment or sloped beach - we recommend running on flat ground for the time being, or remember to run the other way to even things out! 

What to do about it?

Peroneal tendinopathy, like other muscle-tendon overuse injuries are important to get proper treatment as soon as it occurs, the sooner the better for outcomes and to minimize the nagging return in the future. We recommend seeing a trusted physical therapist to get you on the right track from the start. Physical therapists are movement experts and provide treatment plans that will help improve your active lifestyle for the long term. Your physical therapist’s evaluation will guide your targeted treatment plant. Most treatments include exercise, hands-on care and education to gain a better understanding of your body, symptoms and injury prevention and symptoms management strategies specific to you, your activity level and your goals. 

5 Injury Prevention Strategies: 

  • Maintain appropriate strength and flexibility throughout your leg from hips down to ankles as well as core strength. Reach out to work with one of our performance PT’s to create a customized strength program for you!
  • Choose proper footwear for your walking and running activities.
  • Build up your mileage and speed training over time, there’s no need to rush.
  • Gradually add in hills or uneven terrain training 
  • Check out your footwear, Is it supporting your ankles and your feet? Is it too soft and cushion? 

Below are exercises that we recommend trying out as a basic starting point.

Foot Intrinsic Strengthening Exercises

Single Leg Balance with Ankle Banded Pull for Pronation 

3 Way Balance Taps

Runner Warm Up  

Now’s the time to take action, choose your health, choose to live the life you were meant to live running and being active with family and friends. 

Head to the link below to download our free PDF: The 5 Best Strength Exercises for runners - A free, ebook download to help you improve your running performance long-term by allowing you to get stronger, run faster, and avoid nagging injuries and setbacks.

Follow the Bulletproof Body Exercise Program - A total fitness program that can be performed anywhere, designed by doctors, to help improve mobility, joint health, and strengthen key postural muscles to help you stay active with less pain or injury

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