Common Running Injuries and How to Prevent Them

The 3 Root Causes of Most Running Injuries

Despite the variety of running injury presentations, most overuse injuries share three root causes:

1. Training load spike — Increasing mileage, intensity, or frequency faster than the body's tissues can adapt. This is responsible for the majority of running injuries in recreational runners.
2. Biomechanical inefficiency — Overstriding, excessive hip drop, or foot misalignment that concentrates stress on specific structures with every stride.
3. Inadequate recovery — Insufficient sleep, nutrition, or rest days that prevent tissue repair between sessions.

Addressing these three factors prevents more injuries than any specific intervention targeting individual injury types.

Based on: van Gent RN, Siem D, van Middelkoop M, et al. "Incidence and determinants of lower extremity running injuries in long distance runners." Br J Sports Med. 2007;41(8):469–480. PubMed ↗

The 5 Most Common Running Injuries

1. Patellofemoral Pain Syndrome (Runner's Knee)

What it is: Pain around or behind the kneecap, typically described as a dull ache that worsens with prolonged sitting, going downstairs, or sustained running. It is the most common running injury, accounting for approximately 17–18% of all running injuries.

Cause: Abnormal tracking of the kneecap (patella) relative to the femoral groove, usually due to weak hip abductors and quadriceps, increased Q-angle, or excessive foot pronation. Overstriding and running downhill aggravate it.

Prevention: Hip abductor strengthening (clam shells, lateral band walks), quadriceps strengthening (leg press, single-leg squat), cadence increase to reduce knee flexion angle, shoe assessment for excessive pronation.

Management: Reduce running volume by 50% immediately. Ice and NSAIDs for acute pain. Most cases resolve in 4–8 weeks with appropriate strengthening and load modification. Persistent cases require physiotherapy assessment.

2. Shin Splints (Medial Tibial Stress Syndrome)

What it is: Pain along the inner lower leg, typically in the lower two-thirds of the tibia. The pain is diffuse (spread over 5 cm or more) — distinguishing it from the localised, sharp pain of a stress fracture.

Cause: Repetitive traction stress on the tibial periosteum from the soleus and deep flexors, caused by running volume increases beyond tissue adaptation capacity. Overpronation and running on hard surfaces aggravate it.

Prevention: Follow the 10% mileage increase rule. Strengthen calves and tibialis posterior. Avoid dramatic surface changes (road to track immediately). Ensure running shoes have not exceeded 700 km.

Management: 5–7 days complete rest, then gradual return at 50% previous volume. Cross-train with swimming or cycling to maintain fitness. If pain is sharp and highly localised (rather than diffuse), seek imaging to rule out tibial stress fracture.

3. Plantar Fasciitis

What it is: Pain in the heel and arch of the foot, characteristically worst in the first steps of the morning. The plantar fascia — a thick band of connective tissue running from the heel to the toes — becomes inflamed and degenerates under repetitive load.

Cause: High training volume, tight calves and Achilles (reducing ankle dorsiflexion), weak foot intrinsic muscles, sudden change to minimalist footwear, obesity, and excessive standing on hard floors.

Prevention: Daily calf stretching (particularly soleus), foot intrinsic strengthening (short-foot exercises, towel scrunching), gradual transition to any new shoe with reduced heel drop, avoiding barefoot walking on hard floors when volume is high.

Management: Reduce volume; stretch calves and plantar fascia morning and night; night splints if pain persists. Full resolution typically requires 6–12 weeks. Cases persisting beyond 3 months require physiotherapy and potentially shockwave therapy.

Based on: Lopes AD, Hespanhol LC Jr, Yeung SS, et al. "What are the main running-related musculoskeletal injuries?" Sports Med. 2012;42(10):891–905. PubMed ↗

4. IT Band Syndrome (Iliotibial Band Syndrome)

What it is: Sharp or burning pain on the outside of the knee, typically developing after a consistent distance into a run (often 3–5 km) and forcing the runner to stop. The iliotibial band — a thick fascial band running down the outside of the thigh — repeatedly compresses against the lateral femoral condyle during the knee flexion cycle.

Cause: Weak hip abductors and glutes allowing excessive hip adduction, which increases IT band tension. Sudden mileage increases, downhill running, and camber of roads all aggravate it. More common in runners with a narrow running gait.

Prevention: Hip abductor and glute strengthening (hip thrusts, clam shells, single-leg deadlifts), avoid banking runs on cambered roads, run on flat surfaces during mileage build phases, avoid sudden mileage spikes.

Management: Rest immediately when the characteristic lateral knee pain develops — continuing through it worsens the condition. Foam rolling the lateral thigh provides temporary relief but does not treat the underlying cause. Hip strengthening is the primary long-term fix.

5. Achilles Tendinopathy

What it is: Pain, stiffness, and sometimes swelling in the Achilles tendon — typically 2–6 cm above the heel insertion point (mid-portion) or at the insertion itself. Morning stiffness that improves with gentle movement is characteristic. Acute Achilles rupture presents as sudden severe pain and inability to push off — seek emergency medical care immediately.

Cause: Repetitive loading of the Achilles beyond its adaptation capacity. Risk factors: sudden mileage increase, transition to lower heel-drop shoes, inadequate calf strength, overweight, fluoroquinolone antibiotics.

Prevention: Progressive calf and soleus strengthening (particularly eccentric heel drops), gradual shoe transitions (8–12 weeks minimum for heel drop reductions), avoid rapid mileage spikes.

Management: Reduce volume immediately. Heavy slow resistance calf training (eccentric heel drops, 3 × 15 reps) is the most evidence-based treatment for mid-portion Achilles tendinopathy. Avoid complete rest — load management is more effective than immobilisation. Most cases require 8–16 weeks of structured rehabilitation.

Universal Prevention Strategies

To structure your training to avoid overuse injuries, use the Running Pace Calculator to determine appropriate pacing for each session type, and follow our Running Form guide to address biomechanical causes.