Running is one of the simplest and most accessible ways to stay active. Whether you are training for your first 5 km, preparing for a marathon, or simply enjoying a few runs each week, running places repetitive loads through the muscles, tendons, joints and bones of the lower limb.
Most runners will experience some form of niggle or pain at some point. Running-related injuries are often associated with a mismatch between the load being placed on the body and the body’s ability to adapt to that load. This can happen after suddenly increasing running distance, adding speed work or hills, changing training surfaces, or returning to running after a period away.
The good news is that many common running injuries respond well to appropriate load management, strengthening and a gradual return to running.
Here are four common running injuries we see in clinic and some of the signs and symptoms to look out for.
1. Patellofemoral Pain – “Runner’s Knee”
Patellofemoral pain (PFP) is one of the most common causes of knee pain in runners. It is typically felt around or behind the kneecap and can develop gradually rather than following one specific injury.
Common signs and symptoms
Runners with patellofemoral pain may experience:
- Aching or discomfort around or behind the kneecap
- Pain that increases during or after running
- Pain with squatting, lunging or going up and down stairs
- Discomfort after sitting for prolonged periods with the knee bent
- Pain that increases as running distance or intensity increases
Patellofemoral pain is generally related to how the knee is responding to load rather than there being one single “problem” with the kneecap. Factors such as training load, hip and knee strength, running mechanics and overall capacity can all contribute.
What can you do?
The first step is usually to modify the activities that aggravate your symptoms rather than stopping all exercise.
For example, temporarily reducing running distance, avoiding particularly painful hills or reducing speed work may allow symptoms to settle while you continue to maintain fitness through other activities.
Clinical practice guidelines recommend combining hip- and knee-targeted strengthening for people with patellofemoral pain. A physiotherapist can also assess your running technique, strength, mobility and training program to identify factors that may be contributing to your symptoms.
2. Achilles Tendinopathy
The Achilles tendon connects the calf muscles to the heel bone and plays an important role in absorbing and producing force during running.
Achilles tendinopathy occurs when the tendon is unable to adequately adapt to the loads being placed on it. It is particularly common when runners suddenly increase their running volume, speed or hill training.
Common signs and symptoms
Typical symptoms include:
- Pain or stiffness at the back of the ankle
- Pain that is worse when starting a run
- Pain during calf raises or jumping
- Symptoms that increase with running, sprinting or hill running
The pain can sometimes improve as you warm up, only to become more noticeable later that day or the following morning.
What can you do?
Complete rest is not always the best solution for Achilles tendinopathy. Tendons need an appropriate amount of loading to become stronger and better able to tolerate running.
Calf strengthening is a key component of rehabilitation. This may initially involve controlled calf raises before progressing towards heavier resistance, single-leg exercises, hopping and eventually running-specific activities.
Your running load may also need to be modified. Rather than completely stopping, your physiotherapist may help you determine what amount of running your tendon can currently tolerate and gradually build from there.
3. Medial Tibial Stress Syndrome – “Shin Splints”
Medial tibial stress syndrome (MTSS), commonly referred to as “shin splints”, is a common running-related injury that causes pain along the inner border of the shin.
It is often seen when runners increase their training load faster than their body can adapt. This may occur when starting a new running program, increasing weekly kilometres, adding hills or returning to running after a break.
Common signs and symptoms
Runners may notice:
- Aching or tenderness along the inner part of the shin
- Pain that develops during or after running
- Symptoms that are worse with increased running volume
- Tenderness spread along a relatively broad area of the shin
- Symptoms that may initially settle with rest but return when running resumes
What can you do?
The most important first step is usually to review your running load.
Temporarily reducing running volume, speed or hills can help decrease the stress placed on the shin while maintaining fitness through lower-impact activities such as cycling or swimming, if these are comfortable.
Strengthening the calf and lower-limb muscles is also important. Your physiotherapist may prescribe exercises such as calf raises, soleus strengthening, tibialis anterior strengthening and progressive single-leg exercises.
As symptoms improve, running should be gradually reintroduced rather than going straight back to your previous training volume.
It is important to distinguish MTSS from a bone stress injury. Pain that becomes increasingly localised to one small area, pain at rest or at night, significant pain with walking, or persistent symptoms despite reducing running should be assessed by a healthcare professional.
4. Plantar Fasciitis
Plantar fasciitis is a common cause of pain underneath the heel and can affect runners as well as people who spend a lot of time standing or walking.
The plantar fascia is a strong band of connective tissue that runs along the bottom of the foot and helps support the foot during weight-bearing activities.
Common signs and symptoms
Typical symptoms include:
- Pain underneath or towards the inside of the heel
- Heel pain with the first few steps in the morning
- Pain when standing after a period of sitting or resting
- Pain that may improve after moving around but return with prolonged activity
What can you do?
As with many running injuries, managing the amount of load placed through the foot is an important first step.
Temporarily reducing running volume or avoiding activities that significantly increase symptoms can help. However, complete rest is not usually necessary.
Calf and foot strengthening can help improve the capacity of the tissues to tolerate running. Stretching the calf muscles and plantar fascia may also help reduce pain and improve function.
Your physiotherapist can also assess your foot and ankle strength, mobility, running load and footwear to determine what factors may be contributing to your symptoms.
What should you do if running starts to hurt?
One of the biggest mistakes runners make is either ignoring pain completely or stopping all activity for several weeks.
Instead, think about modifying your training load.
Ask yourself:
- Have I recently increased my running distance?
- Have I added speed sessions or hills?
- Have I suddenly increased the number of days I run?
- Have I returned to running after a break?
- Have I changed my running surface or training environment?
- Am I recovering adequately between sessions?
A temporary reduction in running volume or intensity may allow symptoms to settle while you continue to maintain your fitness through appropriate cross-training and strength work.
When returning to running after an injury, it is generally best to start with a manageable amount of running and progressively increase volume and intensity as your symptoms and physical capacity improve.
When should you see a physiotherapist?
Not every running niggle requires a physiotherapy appointment. However, if your pain is persistent, worsening, affecting your running technique, or repeatedly returning whenever you increase your training, it is worth getting assessed.
A physiotherapist can help determine what is causing your symptoms, identify factors that may have contributed to the injury and develop an individualised rehabilitation and return-to-running plan.
At SportsPlus Physiotherapy, our physiotherapists consider the demands of your sport and the loads placed on your body when assessing and rehabilitating running injuries. This can include assessing strength, mobility, running mechanics, training load and your specific running goals.
Remember, the goal of rehabilitation is not simply to get you out of pain. It is to build your capacity so that your body can tolerate the demands of running and help you get back to doing what you enjoy.
Don’t Put Off Getting Your Running Injuries Checked
If you’re experiencing pain while running, don’t let a small niggle turn into a bigger injury. Book an assessment with the SportsPlus Physiotherapy team to find out what may be contributing to your symptoms and how you can safely get back to running.
References
- Willy, R. W., Hoglund, L. T., Barton, C. J., et al. (2019). Patellofemoral Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health. Journal of Orthopaedic & Sports Physical Therapy, 49(9), CPG1–CPG95. doi:10.2519/jospt.2019.0302.
- Chimenti, R. L., Neville, C., Houck, J., Cuddeford, T., Carreira, D., & Martin, R. (2024). Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision – 2024. Journal of Orthopaedic & Sports Physical Therapy, 54(12), CPG1–CPG32. doi:10.2519/jospt.2024.0302.
- Lopes, A. D., Hespanhol Júnior, L. C., Yeung, S. S., & Costa, L. O. P. (2012). What are the Main Running-Related Musculoskeletal Injuries? A Systematic Review. Sports Medicine, 42, 891–905.
- Koc, T. A. Jr., Bise, C. G., Neville, C., Carreira, D., Martin, R. L., & McDonough, C. M. (2023). Heel Pain – Plantar Fasciitis: Revision 2023. Journal of Orthopaedic & Sports Physical Therapy, 53(12), CPG1–CPG39. doi:10.2519/jospt.2023.0303.
