The 6 Most Common Running Injuries (Plus How to Treat Them)

Running can be hard on the body. And although you’re bound to have minor aches and pains from time to time, getting sidelined from a running injury is the last thing any runner wants. Even so, when something does bother you, like a whiny hamstring or tender knee, it can be hard to decipher what’s actually going on and what’s causing it.

Here orthopaedic surgeon Michael Scarcella, MD, discusses six common injuries related to running that tend to plague runners the most.

Common running injuries

Small aches and some lingering soreness can be normal, but the most common running injuries include:

• Plantar fasciitis.
• Runners’ knee.
• Iliotibial band (ITB) syndrome.
• Achilles tendonitis.
• Shin splints.
• Stress fractures.

What are running injuries and can you prevent them?

Up to 60% of runners have or will experience an injury severe enough for them to put away their running shoes for several weeks or months. But ironically, shoes play the biggest role in injury prevention when it comes to running.

“Running shoes are the only protective equipment runners have to safeguard themselves from injury,” says Dr. Scarcella. “So choosing the correct running shoe is important.”

And as much as running shoes are important, there are several other variables at play when it comes to injuries during running. Training schedule and volume, flexibility, recovery, strength and form also need to be considered when talking about preventing or even treating running injuries.

Running injuries can either be acute or chronic, but both need to be managed within an appropriate timeframe to assure optimal healing.

Acute pain

Acute injuries are sudden, sometimes violent injuries. These include broken bones, sprains and lacerations. Proper first aid for acute injuries include:

• Stopping the bleeding.
• Applying ice to the injured area.
• Immobilizing the injured extremity.

Be on the lookout for immediate swelling or if there is persistent, severe pain. If you’re unable to use the injured part or if you hear or feel a tear, crack or pop, seek medical care as soon as possible.

Overuse (or chronic) pain

Overuse injuries are due to a low-grade, abnormal force being applied repeatedly over a prolonged period of time. (Hello running!) These are the most common injuries for a runner to have.

Many things can contribute to overuse injuries, including:

• Terrain.
• The condition of your running shoes.
• Individual foot anatomy (such as flat feet).
• Decreased strength and flexibility.
• Overtraining.
• Poor running form.
• Increasing weekly mileage too quickly.
• Transitioning too quickly from treadmill to outdoor running.

Overtraining is the leading cause of overuse injuries, says Dr. Scarcella.

So how do you know if you’re overtraining? Look out for these symptoms and warning signs:

• Weight loss.
• Persistent feeling of fatigue or soreness.
• Sleep disturbances.
• Morning pulse increased by 10 beats per minute.
• Recurrent sore throat or cold symptoms.
• Persistent aches and pains.
• Headaches.
• Increased incidence of injury.
• Not wanting to exercise or even run anymore.

Treating an overuse (or chronic) running injury

Think of a running injury like a traffic light. Green means you’re feeling great, yellow is a warning sign when the pain creeps in and red means severe pain. Most runners often fall in-between colors. Meaning some days they feel great and are in the green, and other days a mild ache or pain will annoy them on a run and they move into yellow. Other times, a runner will bounce between yellow and red when it’s a nagging injury that has been bothering them a while.

Whether you’re in the full-blown red zone or lingering in yellow, the simplest way to stop overuse pain is to reduce your training, using pain as a guide. Sometimes this means taking time off completely (sorry, your marathon might have to wait until next year) or dialing back on how often and how far you’re running each week.

Other ways to treat overuse injuries include:

• Apply ice to injured area 15 to 20 minutes, three to four times per day.
• Use compression to decrease swelling.
• Elevate injured area if possible.
• Take aspirin or ibuprofen.
• Determine cause of injury (like a weak hip muscle) and fix it.
• Work with a physical therapy or sports rehab program to treat and prevent running injuries.

You should contact your doctor or a physical therapist if your pain continues despite decreased training, if your pain persists beyond 10 to 14 days or if the pain resolves with rest, but recurs once you resume training.

The most common running injuries and how to treat them

Plantar fasciitis

The primary symptom of plantar fasciitis is pain in the bottom of the foot, from the heel into the arch. It’s especially painful when you get up in the morning and after you’ve been sitting for a long time. The discomfort may be present at the start of a run or subside during the run and then recur later.

Causes of plantar fasciitis:

• Feet with a high arch (supinator, or a person who rolls his or her feet too far outward while running).
• Flat feet (overpronator, or a person who rolls his or her feet too far inward while running)
• Running shoes with excessive wear.
• Incorrect shoe type (cushion versus motion control).
• Tight calf muscles.
• Training errors (increasing mileage or intensity too quickly).
• Poor running form.
• Transitioning too quickly from treadmill to outdoor running.

Treatment for plantar fasciitis:

• Decrease running (cross train with biking and/or swimming instead).
• Apply ice for 20 minutes two to three times per day.
• Stretch calf muscles.
• Massage arch of foot.
• Take anti-inflammatory medications.
• Replace running shoes every 400 to 600 miles.
• Get fit for shoes at specialty store to find the correct type of running shoe for your foot mechanics, looking at cushioning, stability and motion control.
• Use appropriate devices, such as arch supports, heel cups or customized orthotics.
• Get a gait analysis done to correct running form.

The best method for preventing plantar fasciitis is stretching. The plantar fascia can be stretched by grabbing the toes, pulling the foot upward and holding for 15 seconds.

To stretch the calf muscles, place hands on a wall and drop the affected leg back into a lunge while keeping the heel of the back leg down. Keep the back knee straight for one stretch and then bend the knee slightly to stretch a deeper muscle in the calf. Hold the stretch for 15 seconds and repeat three times.

Achilles tendonitis

Achilles tendonitis is characterized by pain with heel strike, pain when the foot lands on a curb, when running up the stairs or with a sudden change of direction. Pain may be more prominent in the morning with the first few steps out of bed. This is because the calf muscle is shortened in sleeping positions.

Causes of Achilles tendonitis:

• Excessive hill running or stair climbing.
• Tight calf muscles.
• Flat feet (overpronator).
• Incorrect shoe type.
• Overused running shoes.
• Change in shoes or running surface.
• Training errors (increasing mileage or intensity too quickly).
• Poor running form.
• Increasing weekly mileage too quickly.
• Transitioning too quickly from treadmill to outdoor running.

Treatment for Achilles tendonitis:

• Modification of training schedule.
• Stretching calf muscles.
• Physical therapy.
• Ice.
• Using appropriate devices, such as heel lifts, insoles or arch supports.
• Massage.
• Anti-inflammatory medications.
• Avoiding hills.

To help prevent Achilles tendonitis from occurring, proper stretching—such as leaning into a wall with your back leg straight or knee slightly bent—as well as proper shoe maintenance should be used.

Runners’ knee

When a person has runners’ knee, the pain builds up gradually and is usually located beneath or around the kneecap. The pain is aggravated by squatting and going up and down stairs. Stiffness in the knee after prolonged sitting is also a symptom of this injury.

Causes of runners’ knee:

• Weak thigh and hip muscles.
• Flat feet (overpronator).
• Tight hamstrings and quadriceps muscles.
• Change in shoes or running surface.
• Overused running shoes.
• Incorrect shoe type.
• Poor running form.
• Increasing weekly mileage too quickly.
• Transitioning too quickly from treadmill to outdoor running.

Treatment for runners’ knee:

• Avoiding painful activities.
• Applying ice.
• Taking anti-inflammatory medications.
• Stretching calf, hamstrings, quadriceps and hip flexors.
• Strengthening quadriceps, hip abductors and hip extensor muscles.
• Physical therapy.
• Correcting foot and/or shoe issues.
• Replacing running shoes every 400 to 600 miles.

Efforts to prevent runners’ knee from happening begin with strengthening. Hip strengthening is very important for runners in avoiding injury.

To strengthen the hip abductors, lie on your side, keep your hip and knee in a straight line and kick leg up towards the ceiling keeping the leg in line with the body. To strengthen the hip extensors, lie on your stomach, squeeze your butt muscles and lift your leg off the ground.

A runner should perform strengthening slowly and with good control. Repeat 15 to 20 repetitions and do three sets.

Iliotibial band (ITB) syndrome

This type of injury is characterized by pain on the outside of the knee while running. A runner may also experience pain on the outside of the hip or leg. With this injury, a runner may notice the pain more on slower runs than fast runs, running hills or going up or down stairs.

Causes of Iliotibial band (ITB) syndrome:

• Running on a banked surface or changes in running surface.
• Flat feet (overpronator).
• Training errors (increasing mileage or intensity too quickly).
• Overused running shoes.
• Weak hip abductor and hip extensor muscles.
• Tight hip muscles (especially iliotibial or IT band muscle).
• Incorrect shoe type.
• Poor running form.
• Transitioning too quickly from treadmill to outdoor running.

Treatment for Iliotibial band (ITB) syndrome:

• Modifying training schedule.
• Strengthening hip abductors and hip extensor muscles.
• Applying ice.
• Taking anti-inflammatory medications.
• Massaging lateral (outside) knee.
• Stretching hip muscles (IT band).
• Replacing running shoes every 400 to 600 miles.
• Getting fit for shoes at specialty store for correct shoe type.

Stretching your IT band can help prevent this injury. To stretch this muscle, stand with the affected leg towards a wall, cross the unaffected leg in front of the affected leg, place arm on the wall and drop hips towards the wall. You should feel the stretch on the side of the hips or side of the knee. Hold the stretch for 15 seconds and repeat three times.

Shin splints

As the name suggests, a shin splint injury is pain in the shin while running. The pain first starts after running, but then progresses to a persistent pain. If you continue to have pain, you should visit your doctor.

Causes of shin splints:

• Insufficient control of foot mechanics (incorrect shoe type).
• Change in running surface or banked surfaces.
• Overused running shoes.
• Flat feet (overpronator).
• Tight calf muscles.
• Training errors (increasing mileage or intensity too quickly).
• Weak hip muscles.
• Poor running form.
• Transitioning too quickly from treadmill to outdoor running.

Treatment for shin splints:

• Rest.
• Decrease mileage and cross train with biking or swimming.
• Apply ice.
• Take anti-inflammatory medications.
• Getting fit for shoes at specialty store for correct shoe type.
• Replace running shoes every 400 to 600 miles.
• Stretch calf muscles.
• Strengthen hip abductors and hip extensors.
• Modify training schedule – avoid hills.

The best way to help prevent shin splints is to practice good shoe maintenance. Most importantly, a runner should wear shoes that are appropriate for his or her foot type and training intensity. You may need prescription orthotics if the foot mechanics cannot be controlled with a shoe alone.

A running shoe needs to have good shock absorption in order to decrease the stress on the shins. Running shoes lose 30% to 50% of their shock absorption ability after about 250 miles. Shock absorption is greatly reduced when running in wet shoes. To assure adequate shock absorption when running every day, a runner should alternate shoes. Running shoes need to be replaced every 400 to 600 miles to help prevent injuries like shin splints.

Stress fractures

Stress fracture injuries cause persistent pain, most commonly in the shin, but at times in the foot, hip, thigh or pelvis. Causes and treatments for stress fractures are similar to the ones that apply to shin splint injuries. However, stress fractures are more severe than shin splints and require serious management.

Some runners may be immobilized in a walking boot or be required to use crutches to allow the stress fracture to heal. Sometimes surgery is required if the stress fracture is severe enough or is in an area of high risk. Cardiovascular training must focus on non-weight-bearing activities like swimming.

The best approaches to preventing stress fractures are proper training, proper shoe maintenance and not running on excessively hard surfaces. A physician should evaluate if you suspect you have a stress fracture during your training.