Are runs leaving you in pain? If you’re a routine runner, you’re likely to encounter an injury during your career.
Over sixty-five percent of regular runners get hurt or have long-term pain every year, most of these being male (16). When done right, running can improve overall strength, heart health, and reduce stress – not to mention,“runner’s high.” Runners are less likely to develop diabetes and high blood pressure which contributes to their longer life expectancy (25, 14).
But the repetitive movement of running leads to more injuries. The nature of running paired with increasing mileage or intensity too fast can be troublesome. Overuse injuries are due to repetitive stress on muscles, joints and the musculoskeletal system, adding up overtime that eventually leads to more serious injuries (4). Knee and foot/ankle injuries are the most common in runners, followed by other parts of the leg, hips, and back. Long-term running injuries share common risk factors (15). In runners, overuse can show up as runner’s knee, shin splints , IT-band syndrome , achilles tendinitis, and plantar fasciitis.
Gnarly athlete Joslynn Peterson is a personal trainer and works with athletes to relieve and prevent overuse injuries. As a runner, she understands the impact running has on the body and how it impacts her clients. “I tend to see a lot of shin splints, knee pain, back pain or ankle instability. These are so common, and most people are not informed about the regular strength routines to keep those injuries away,” Joslynn said.
These types of injuries are most commonly due to a sudden, large increase in running volume (mileage or intensity). Pushing yourself too hard too fast can cause more harm than good. If you’re lucky enough to have had no injuries as a runner, it is important to watch your training to prevent overuse injuries from creeping up. Understanding what causes and how to prevent these injuries is important if you want to keep running.
common injuries
Runner’s knee (patellofemoral pain syndrome or PFPS) is a common injury in runners and jumpers alike. Runner’s knee is ultimately pain near the front or beneath the kneecap, likely due to irritation. Because the cause is uncertain, the definition isn’t straight forward. This causes trouble diagnosing these injuries (10). Some people notice the pain is worse with activities like squatting, cycling, or sitting for long periods of time (9). Having weak hips is thought to lead to this type of injury. Strengthening the muscles of the thigh and hip can ease pain and prevent this injury from coming back (6).
Shin splints (medial tibial stress syndrome or MTSS) is pain in the front of the lower leg. Similar to runner’s knee, shin splints don’t have a clear definition. This pain is likely due to pulling of the tibia, or shin bone, with muscle contractions during running. This injury is common early in the season or anytime when the volume of training suddenly increases (19). Although the specific cause is hard to determine, several things increase your risk for developing them. Runners with a higher BMI, weak foot arches, and transitioning from a high cushion to a lower support shoe have a higher risk. Women develop shin splints more than men and less experience as a runner can increase your risk too (17). Treatment for shin splints depends on the person. Many heal well with rest. It is important to return to running gradually if you’re experiencing this pain and consider strengthening your ankles to reduce your risk in the future (7).
Achilles tendinitis (Achilles tendinopathy) is due to repetitive flexion of the foot. Doing this movement again and again can cause the tendon to break down. When pressing your foot off the ground during a running stride, the Achilles points the foot downward. If this is done enough, it can cause pain near the heel. Foot massage and stretching can help lower the pain. Males and older runners are more likely to experience this injury (20).
Along the outside of the thigh, the IT band (iliotibial band) connects the outer hip to the knee. The IT Band’s purpose is to keep the knee inline. IT Band syndrome is pain on the outside of the upper leg, hip, and or knee. Pain may be worse when the knee is bent. Many believe this injury is caused by the IT band rubbing against the thigh bone, but like other overuse injuries the cause isn’t certain (5, 11). In distance runners, having weak glute muscles may cause the knee to be less stable. Runners who have more equal strength in the front and back of the upper leg have a better chance to stay clear of IT Band Syndrome.
Plantar fasciitis is the most common foot injury. There is a band of tissue that runs across the bottom of the foot. When this breaks down with overuse and becomes irritated. This can lead to pain or burning on the sole of the foot near the heel. It is common to have pain in the morning or during the first few steps after sitting (23). The purpose of this tissue helps support the arch of the foot and acts as a spring. Tight calves and achilles tendons may increase your odds of having this pain (8).
As a runner, Joslynn has personal experience with this injury: “I personally struggle with
Training, Prevention, and Treatment
So you recognize you may be dealing with an overuse injury…what’s next? First, consider the training you’ve been doing. If you’ve been pushing extra hard, this may be a sign that your body needs you to take it slower. Novice runners have a higher risk for overtraining-related injuries. If you’re new to running, consider getting help when building your program. A good rule of thumb for running is the 10% rule. This means you should not increase your running volume more than 10 percent each week. Using the 10% rule when increasing your training volume can greatly reduce your injury risk (22).
Warming up and cooling down will also make you less likely to encounter overuse injuries. If you’ve taken a break from running due to a hot-spot, there’s a few things to consider when you start again. After you’re feeling better, take a look at how you run. You can record yourself or have a friend (or professional) watch your movement patterns. Poor running technique has been shown to increase injury risks. Runners who tend to heel-strike place more stress on the lower body and are less energy efficient. Heel-striking is when the heel lands first with each leg stride. Over time, if you can retrain yourself to land on your mid- to forefoot you’ll reduce your risk for pain and likely become a better runner (18).
Maintaining good mobility in the ankles, knees, hips, and back (specifically mid-back, aka thoracic spine) keeps the body moving the way it was designed, pointing toward lowering your risk as well. Moving throughout the day, outside of your training sessions keeps nutrient-filled blood moving to recovering muscles and tissues.
Maintaining strength as a runner is important too. Joslynn agrees that strength training is an important part of injury prevention. Joslynn suggests, “If you were going to perform a few exercises as a base, I would suggest squats, nordic curls, lateral training and quadricep, hamstring and calf stretches. This will keep a well-rounded routine that is time efficient.”
Adequate protein consumption is essential for gaining muscle. “I love Gnarly Chocolate protein for muscle development and recovery! I like to mix it in hot chocolate as a dessert or you can add it to ice coffee in the morning,” Joslynn recommends.
Active (pain-free) recovery, even when you’re dealing with a hot-spot, can help you heal. Most importantly, do not run through pain. A “no pain, no gain” mindset shouldn’t be used when running. Pain is a signal from the body to tell you something is wrong. If it feels sketchy, it likely is. If you’ve been dealing with prolonged or worsening pain, speak to your doctor.
works cited
- Arnold, M. J., & Moody, A. L. (2018). Common running injuries: evaluation and management. American family physician, 97(8), 510-516.
- Ballas MT, et al. Common overuse running injuries: diagnosis and management. Am Fam Physician;55(7):2473-80.
- Basic Injury Prevention Concepts. ACSM Fit Society Page. American College of Sports Medicine, Spring 2010.
- DiFiori, J. P., Benjamin, H. J., Brenner, J. S., Gregory, A., Jayanthi, N., Landry, G. L., & Luke, A. (2014). Overuse injuries and burnout in youth sports: a position statement from the American Medical Society for Sports Medicine. British Journal of Sports Medicine, 48(4), 287-288.
- Fairclough, J., Hayashi, K., Toumi, H., Lyons, K., Bydder, G., Phillips, N., Best, T.M. & Benjamin, M. (2007). Is iliotibial band syndrome really a friction syndrome? Journal of Science and Medicine in Sport, 10(2), 74-76.
- Faller, B., Bonneau, D., Wooten, L., & Jayaseelan, D. J. (2021). Eccentric exercise in the prevention of patellofemoral pain in high-volume runners: A rationale for integration. Sports Medicine and Health Science.
- Galbraith, R. M., & Lavallee, M. E. (2009). Medial tibial stress syndrome: conservative treatment options. Current Reviews in Musculoskeletal Medicine, 2(3), 127-133.
- Goff , J. D., & Crawford, R. (2011). Diagnosis and treatment of plantar fasciitis. American Family Physician, 84(6), 676-682.
- Heintjes, E., Berger, M. Y., Bierma-Zeinstra, S. M., Bernsen, R. M., Verhaar, J. A., & Koes, B. W. (2004). Pharmacotherapy for patellofemoral pain syndrome. Th e Cochrane Database of Systematic Reviews (3), CD003470.
- Holmes, S. W., Jr., & Clancy, W. G., Jr. (1998). Clinical classifi cation of patellofemoral pain and dysfunction. Journal of Orthopaedic and Sports Physical Th erapy, 28(5), 299-306.
- Jiménez Díaz, F., Gitto, S., Sconfienza, L. M., & Draghi, F. (2020). Ultrasound of iliotibial band syndrome. Journal of Ultrasound, 23, 379-385.
- Kozinc, Ž., & Sarabon, N. (2017). Common running overuse injuries and prevention. Montenegrin Journal of Sports Science and Medicine, 6(2), 67.
- Lavine, R. (2010). Iliotibial band friction syndrome. Current Reviews in Musculoskeletal Medicine, 3(1-4), 18-22.
- Lee, D. C., Brellenthin, A. G., Thompson, P. D., Sui, X., Lee, I. M., & Lavie, C. J. (2017). Running as a key lifestyle medicine for longevity. Progress in cardiovascular diseases, 60(1), 45-55.
- Lopes AD, Hespanhol Júnior LC, Yeung SS, Costa LO. What are the main running-related musculoskeletal injuries? A systematic review. Sports Med. 2012;42(10):891–905.
- Messier, S. P. (2013). The Runners and Injury Longitudinal Study. Wake Forest University Winston-Salem United States.
- Newman, P., Witchalls, J., Waddington, G., & Adams, R. (2013). Risk factors associated with medial tibial stress syndrome in runners: a systematic review and meta-analysis. Open Access Journal of Sports Medicine, 4, 229-241.
- Novacheck, T. F. (1998). The biomechanics of running. Gait & Posture, 7(1), 77-95.
- Putukian, M., McCarty, E. C. , & Sebastianelli, W. (2010). Football. In M. C. Madden, M. Putukian, C. C. Young & E. C. McCarty (Eds.), Netter’s Sports Medicine. Philadelphia, US: Saunders/Elsevier
- Rees, J. D., Maff ulli, N., & Cook, J. (2009). Management of tendinopathy. The American Journal of Sports Medicine, 37(9), 1855-1867.
- Tschopp, M., & Brunner, F. (2017). Diseases and overuse injuries of the lower extremities in long distance runners. Zeitschrift fur Rheumatologie, 76(5), 443.
- Videbaek, S., Bueno, A. M., Nielsen, R. O., & Rasmussen, S. (2015). Incidence of Running-Related Injuries Per 1000 h of running in Diff erent Types of Runners: A Systematic Review and Meta-Analysis. Sports Medicine, 45(7), 1017-1026.
- Waclawski, E. R., Beach, J., Milne, A., Yacyshyn, E., & Dryden, D. M. (2015). Systematic review: plantar fasciitis and prolonged weight bearing. Occupational Medicine, 65(2), 97-106.
- Wen, D. Y. (2007). Risk factors for overuse injuries in runners. Current sports medicine reports, 6(5), 307-313.
- Williams, P. T., & Thompson, P. D. (2013). Walking versus running for hypertension, cholesterol, and diabetes mellitus risk reduction. Arteriosclerosis, Thrombosis, and Vascular Biology, 33(5), 1085-1091.
