Running injuries are extremely common; in fact, a mind-boggling 50% of runners get injured each year, according to Yale Medicine.1Running Injuries. (n.d.). Yale Medicine. https://www.yalemedicine.org/conditions/running-injury Getting injured as a runner can be incredibly demoralizing. It can stop our training in its tracks and grind to a halt any momentum we had.
The good news is most injuries are preventable.
When certain protocols are followed, you can dramatically decrease your risk of getting injured and stop them from re-occurring.
Knowing what causes these common injuries, how to treat them, and how to prevent them will keep you running, happy, and healthy for as long as possible!
Our articles are not designed to replace medical advice. The best way to get advice that is right for you is to go see a sports medicine professional or physical therapist.
In this article, we will look at the seven most common running injuries and how to treat them.
The 7 Most Common Running Injuries + How To Treat Them
#1: Runner’s Knee – Patellofemoral Pain Syndrome (PFPS)
Runner’s knee, also known as patellofemoral pain syndrome (PFPS), is a prevalent overuse injury in distance runners characterized by pain in the front of the knee or around the kneecap.
Symptoms
One common diagnostic indicator of PFPS is pain experienced during resisted knee muscle contraction.
Additional symptoms may include:
- Dull ache or pain located at or beneath the front or side of the kneecap
- Discomfort when bending the weight-bearing knee
- Increased pain while walking up and down stairs or downhill
- Swelling around the knee
- Tenderness when applying pressure around the knee
- Anterior knee pain during squatting is present in approximately 80% of individuals with PFPS2Cook, C., Hegedus, E., Hawkins, R., Scovell, F., & Wyland, D. (2010). Diagnostic Accuracy and Association to Disability of Clinical Test Findings Associated with Patellofemoral Pain Syndrome. Physiotherapy Canada, 62(1), 17–24. https://doi.org/10.3138/physio.62.1.17
Causes
Runner’s knee does not have a single underlying cause; rather, it can be attributed to factors such as muscle weakness, biomechanics (running form) issues, and training methods.
The following are the most common causes:
- Overuse: Overuse is the primary cause of this injury and is a common factor in most running-related injuries. The extent of overuse varies for each individual, depending on the stress endured by the body and subsequent recovery.
- Muscle Weakness: Weak muscles surrounding the knee can compromise the stability and alignment of the patella within the patellofemoral joint, potentially increasing the compressive and shearing forces on the joint and leading to patellofemoral pain.
Treatment Strategies
Early detection, management, and treatment of PFPS are vital. Long-term strengthening exercises are essential to prevent re-injury. Addressing these muscular weaknesses is crucial for recovery and preventing future knee problems.
A progressive overload program should concentrate on strengthening the quadriceps, hip rotation, and abduction.
In the initial stages, mobility work and isometric exercises can be particularly beneficial.
The level of exercise difficulty should be based on the severity of the injury.
As exercises become easier, gradual progression is recommended. If any exercise causes pain, it should be discontinued, modified to reduce difficulty, and attempted again later.
For an in-depth look at Runner’s Knee, check out the following sports injury guide:
#2: Achilles Tendonitis
The Achilles tendon is a commonly injured area among runners, and Achilles tendonitis is known as the second most prevalent musculoskeletal injury related to running.
Symptoms
Typically, signs of Achilles tendonitis include muscle loss (atrophy), swelling, asymmetry, and redness of the skin (erythema).
Palpating the tendon may cause localized tenderness.
You may also experience a limited range of motion, especially during ankle dorsiflexion (toes up) and heel raises.
Causes
Achilles tendonitis often results from overuse, where repeated energy storage and release lead to excessive compression and stress on the tendon.
Various factors, such as weak calf muscles, excessive pronation, and limited ankle range of motion, have been associated with the development of Achilles problems.
Treatment Strategies
The specific rehabilitation program for Achilles tendinopathy should be determined based on several factors, so seeking guidance from a medical professional is advisable.
Rehabilitation should be comfortable without subjecting the body to excessive stress.
Gradually increasing exercise helps improve the body’s capacity to handle load and stress.
Isometric tendon loading has been found to alleviate pain in tendons while maintaining baseline strength.
#3: IT Band Syndrome (Iliotibial Band Syndrome)
Iliotibial band syndrome (ITBS) can significantly impact your training and, if ignored, can ultimately force you to halt your activities.
Symptoms
If you’re experiencing pain on the outer side of your knee, ITBS may be the cause. Specifically, ITBS often presents with pain or tenderness when palpating the outer area of the knee.
Other symptoms include:
- Sharp pain on the outer side of the affected knee
- Pain radiating to the outer side of the thigh or calf muscle
- Increased pain when descending stairs or running downhill
- Swelling around the outer portion of the knee
Causes
ITBS is commonly regarded as a non-traumatic overuse injury. It is now believed to be caused by compression of localized innervated adipose tissue.
Studies suggest an “impingement zone” occurs when the knee is approximately 30 degrees of flexion during footstrike and the early stance phase of running.
During this phase, eccentric contraction of the gluteus maximus and hip causes leg deceleration, resulting in ITB compression.
The most common risk factor in runners is often attributed to a sudden increase in training volume.
Treatment Strategies
Modifying activities to avoid further aggravation is essential. Ignoring the pain will only lead to its worsening.
An initial period of active rest is crucial for effective treatment.
During active rest, it is important to keep moving but modify the types of activities undertaken. Cross-training is recommended to maintain conditioning while avoiding activities that exacerbate symptoms.
A deep friction massage by a sports massage therapist or using a foam roller on tight muscles can be beneficial. For more information, refer to our guide on foam rolling the ITB.
If clinically indicated, addressing muscle weakness with strength training may be necessary.
For an in-depth guide to treating an incidence of ITBS, read:
#4: Plantar Fasciitis
Plantar fasciitis is a commonly occurring foot injury among runners, resulting from the irritation or degradation of the fascia, a thick tissue layer on the sole of the foot.
Symptoms
Typically, pressure on the foot will cause heel pain, which can manifest as a dull, burning, or stabbing sensation.
The pain is most commonly felt around the heel bone (calcaneus), but it may also radiate from the heel toward the toes.
The pain tends to be most intense when getting out of bed in the morning, gradually subsiding as the foot muscles warm up.
Causes
Although the exact cause of plantar fasciitis remains unknown, it often affects runners who rapidly increase their mileage or are new to running.
Determining cause and effect in such cases can be challenging.
Plantar fasciitis is often characterized by the thickening or degeneration of collagen fibers in the plantar fascia.
Excessive tensile loading at the calcaneal enthesis has been historically associated with plantar fasciitis.
Treatment Strategies
It is crucial to assess the acuteness of your plantar fasciitis. During the acute stage, there may be inflammation within the fascia, and immediately engaging in stretching exercises could worsen the pain.
Emerging evidence suggests that implementing a stretching program focused on the calf complex, specifically targeting the plantar fascia, can aid in recovery.
Additionally, incorporating high-load strength training may expedite pain reduction and enhance overall function.
Some have felt relief with specific running shoes, inserts, or orthotics; however, getting to the root and treating the issue with physical therapy will be your best bet.
#5: Shin Splints
Shin splints, also known as medial tibial stress syndrome (MTSS), are believed to result from accumulated unrepaired microdamage and a “stress response” along the outer edge of the tibia.
Symptoms
You may experience a dull ache along the inner part of your tibia or shinbone (front side of your lower leg), primarily in the lower two-thirds, which becomes noticeable during or after a run.
Causes
MTSS commonly occurs in runners and athletes engaged in weight-bearing activities like long-distance running or jumping.
The primary cause of MTSS is training error.
Training error encompasses various factors, such as excessive mileage, sudden intensity changes, or running on different surfaces. Muscles and bones require time to adapt to new loads placed upon them.
Treatment Strategies
During the acute phase (first 2-6 weeks), it is crucial to prioritize rest and activity modification. Pain reduction can be achieved with the use of NSAIDs, ice, and soft tissue therapy.
Activity modification aims to reduce the load on the affected area of the bone while maintaining cardiovascular fitness and strength.
For MTSS, activity modification may involve alternative exercises like swimming, cycling, and strength training. These cross-training activities should be pain-free.
Taking care of your shin splints right away is imperative, as they may lead to stress fractures if left untreated.
For an in-depth guide on how to treat shin splints, check out:
#6: Hamstring Strain
The severity of a hamstring strain can vary, ranging from a mild strain with minimal discomfort to a complete muscle tear, resulting in significant pain and loss of function.
Ignoring a hamstring strain can lead to complete sidelining and increase the risk of recurrence if not properly treated.
Symptoms
Common symptoms of a hamstring strain include:
- Pain or tenderness in the back of the thigh
- Swelling or bruising in the affected area
- Stiffness or limited range of motion in the hip or knee
- Difficulty walking or running, especially when trying to extend the leg
Causes
A hamstring strain can occur due to direct trauma to the area or, like many running injuries, when the demands of your training exceed your body’s capacity to handle it.
Research has shown that a staggering 80% of running injuries are related to overuse.3Taunton, J. E. (2002). A retrospective case-control analysis of 2002 running injuries. British Journal of Sports Medicine, 36(2), 95–101. https://doi.org/10.1136/bjsm.36.2.95 Overuse occurs when the body is subjected to excessive force without sufficient time for repair or adaptation to the increased workload.
For hamstring strains, high-speed running poses a significant risk,4Jh, B., Cw, F., Sp, K., & Db, R. (2006, August 1). Incidence, Risk, and Prevention of Hamstring Muscle Injuries in Professional Rugby Union. The American Journal of Sports Medicine. https://pubmed.ncbi.nlm.nih.gov/16493170/ so it is important to gradually introduce or increase sprint training.
Treatment Strategies
Hamstring strains are highly likely to recur. Taking your recovery seriously will benefit you in the long run for future injury prevention.
Active participation in recovery can help prevent the injury from worsening and improve recovery time.
Rehabilitation is typically carried out in phases, progressing as the injury heals. Instead of running with a hamstring strain, focus on gradually strengthening the injured area.
Emphasize the eccentric phase (when the muscle lengthens) of the exercises.
For an in-depth look at how to recover from a hamstring strain, check out:
#7: Ankle Strain/Tendinopathy
An ankle sprain is the tearing or overstretching of a ligament (the tissue that connects bone to bone).
An ankle strain, also sometimes called a pulled muscle, is the tearing or overstretching of a muscle or tendon (the tissue that connects muscle to bone).
Symptoms
Common symptoms of an ankle strain:
- Pain (especially when stretching the ankle)
- Swelling
- Bruising (localized to a particular area)
- Inability to move the ankle
Causes
Sprains and strains are usually caused by a single movement, such as rolling the ankle, which makes them easy to identify.
Whilst the symptoms of a strain or sprain are very similar, the key difference is that tendinopathy is generally caused by repeated movement, as opposed to a single traumatic injury.
Tendonitis refers to the inflammation of a tendon. However, inflammation is usually only present during the first stage of tendonitis; past that point, it is more accurately described as tendinopathy.
There are many reasons why your ankles may hurt when you run. However, one outlier trumps the rest: overuse.
Treatment Strategies
Depending on the severity of the injury, gentle exercise and movement can help with the healing process by improving blood flow.
Most importantly – listen to your body. If an exercise aggravates the symptoms, then stop doing it.
Exercises that strengthen the calf muscles can reduce the risk of re-injury by increasing the resilience of the muscles and tendons surrounding the ankle.
A growing body of evidence suggests that incorporating a stretching program focusing on the calf complex can help recovery.
Additionally, high-load strength training may aid in a quicker reduction in pain and improve function.
For an in-depth look at why your ankle may be hurting, check out:
There you have it: the seven most common running injuries and their treatments. Follow your treatment plan carefully to recover quickly and get back running as soon as possible!
