“My right side is my bad side. If you could only replace my right side I wouldn’t be injured so often.”
The above statement is used interchangeably between right and left sides, but is heard far more often in the clinical setting that one would expect. Many runners talk about their “bad side” as a hot mess of recurring problems that have plagued both racing and training. For some, the injury is recurring and consistent: “Every time I ramp my mileage past XX/week, my Achilles flares up.” Substitute the Achilles for shin, knee, hip, plantar fascia, etc… you name it. In fact, the exact injury might not be interchangeable, but the side of your body is: “I’ve stress fractured my right shin, have suffered from right knee issues and my right hip gives me trouble during speed work.”
Recurring injury is often a biproduct of biomechanical error. Biomechanical injuries often respond to rest in the short term, but often boomerang themselves back into your life. You can always rest an injury (it’s probably the go-to move for most runners). With rest comes decreased inflammation and often symptom relief. You’re flying high; after all, you rested—your injury is now behind you. It’s not long before your hopes to return to training transform into frustration. Your rest, whether it be self-prescribed or dictated by that “just stop running” doctor, did nothing for your injury. Truth is, rest doesn’t restore strength or motion deficits. Injuries that result from poor biomechanics (strength, flexibility, etc.) are rarely, if ever, fixed through strict rest. An Achilles Tendon injury that results from poor glute strength will continue to suffer once your rest cycle is over. Without addressing the biomechanical issue (poor glute strength) the Achilles will continue to degrade and re-injure from increased load. The scenarios are endless, but they all end with you frustrated and angry.
Some runners are lucky enough to be one and done with an injuries. Training errors are often the case in this scenario. Injuries that result from training errors often respond well to rest, as the load of training has been removed and the tissue had time to heal; unfortunately, most training injuries are laced with biomechanical errors. What often appears to be a “one and done” injury can result in a single sided injury plague that may last weeks, months, or years.
Hang with a group of runners long enough and you’ll invariably hear, “such and such always gives me problems” or “all my injuries are on my right/left side.” Runners present me with laundry lists of single sided injuries. Stress fractures, on top of tendon injuries, blanketed with joint pain can be and often are single sided. Stop blaming age for a bad knee (note the singular: knee). Both knees are the same age. You’re the one with biomechanical errors causing one to wear down. Without having an hour of anatomical study or clinical experience it should be blatantly obvious to everyone that something anatomically is at fault. Runners joke about cutting off their right or left side because “it’s always a problem” or “doesn’t work right.” Whether it’s denial or failing to connect the dots, there’s no more excuses. Figure out your errors and address them.
The Single Sided Plague
Although there are varying reasons for recurring single-sided injuries, the best place to start is leg length. Leg length issues are more common than one might suspect. In fact, I’ve had three runners this week with significant differences between their right and left leg lengths. The reasons for a long limb are above the reach of this article; however, identifying (and fixing) a leg length discrepancy can be the answer to persistent single sided injuries. Depending on the length of “unevenness,” these patients typically respond rather quickly to treatment.
Leg length discrepancies occur for multiple reasons. Our pelvis is mobile—some more than others. The pelvis can shift up and down, slide forward and back, and rotate forwards and backwards. These shifts, slides, and rotations can occur from an external force (stepping into a hole) or internal force (muscular imbalance or pelvic instability). For some, the answer is purely anatomic as one leg simply grew longer than the other. None the less, such a simple find can pay huge dividends in long term running health.
Leg length discrepancies are the ninjas of the injury world. Due to our neuromuscular systems inept ability to subconsciously compensate, runners with a leg length discrepancy are typically oblivious to the difference; however, the unevenness is real. A short or long limb makes for an uneven gait, while drastically altering a finely calibrated muscular system that prefers a specific length-tension relationship. You may be thinking, “well both feed on the ground, so my leg length must be ok.” Sometimes the simple answer is the wrong answer. The best way to feel an uneven pelvis is to stand with one shoe on. Both feet can continue to touch the ground through compensation. With enough time you would acclimate to the acquired leg length difference and feel “symmetrical.” Crazy, huh?
Here’s an example of a runner with a significant leg length discrepancy due to muscular imbalance and pelvic instability: