Being a runner is awesome. But it can also be a pain. Nearly 80 percent of runners suffer from running injuries. And, I can tell you after being injured for more than a year with my hamstring tear, it’s not fun.
I wish we had a crystal ball to tell us what to do when we experience pain. But we don’t. Instead, we have physical therapist Joe Norton of Washington D.C.-based Joe Norton PT, a practice specializing in runners. Joe’s a (father) runner knocking on the door of a Boston-qualifying time who, after being helped through several injuries by physical therapists during his collegiate career, wanted to do the same for others.
His knowledge is straightforward, science-backed, and can likely you save you from hurting yourself, and yes, taking time off running.
Common Causes of Running Injuries
What is the most common running injury?
The knee is the most common site for running-related injuries followed by the lower leg then the foot. In my clinical experience, patellofemoral (kneecap) is the most common running issue I see. This is followed by medial tibial stress syndrome (shin splints) and hip pain.
What are common causes of running injuries?
A 2002 review of 2002 running injuries found that 80 percent of the injuries were overuse based. Running creates stress on the body. If the stress exceeds the body’s capacity the result is often pain.
Most people’s cardiovascular and muscular fitness improves more quickly than the conditioning of their passive structures (cartilage, ligaments, tendons, bone). As a result, they are more susceptible to overuse injuries.
How to Prevent Running Injuries
Are there risk factors for running injuries?
Identifying risk factors that may predispose runners to injuries can help to educate and plan for strategies to mitigate these injuries. These risk factors consist of 4 major categories: lifestyle, training, biomechanics, and running form.
Previous injury is consistently noted as a risk factor for developing a future injury. Most studies will note females are injured more frequently than males. Also, novice runners and those returning to running after a layoff have a higher likelihood of injury.
Age is often associated with injury rates. However, the research is conflicting as to what age group is at risk. Some studies indicate younger runners are more likely to sustain an injury; whereas other studies associate older runners.
Runners who change more than one of the variables in their velocity, distance, or frequency are more likely to be at risk of injury. Also, runners who progressed their mileage by 30 percent or more for more than one week in a row increased their injury risk.
In my practice, I recommend a training plateau following a progression of mileage within a training to provide the body time to adapt to the additional workload. Certain pathologic conditions necessitate this slow progression. For example, shin splint injuries may take up to three weeks to recover from a change in training. In my runners who have bony injuries like shin splints, I advocate for only adding one variable every 2-3 weeks. In the 2 to 3 weeks the bone will adapt and become stronger from this new stimulus.
The strength and flexibility risk factors are widely varied and met with multiple confounding factors in research. When it comes to strength this should be something assessed on a case by case basis for each runner.
Like strength, range of motion is not strongly associated with common running injuries. In fact, there is evidence suggesting limited hip internal rotation is protective against injury because the tissues are more compliant and the range of motion less exposing to vulnerable structures.
Well-known biomechanist Irene Davis has a saying, “runners should land softly and well-aligned.” In this statement, she is nicely reducing the vast evidence on running form and injury. Running injuries are linked to high ground reaction forces as well as poor pelvis and lower extremity alignment while running.
If you’re uninjured and happy, do not mess with your running form. This invites new and different stresses to your body which will take time to condition your tissues.
How can runners avoid running injuries?
- Have a coach, PT or a specific plan. Running is simplistic and that is a part of its appeal. However, too often runners get the “disease of more.” They feel good and want to run more miles, workouts, races, etc., OR they want to achieve a personal best or complete a certain race distance, so they keep pushing themselves. This leads to poor judgment. Having an outside, objective voice to provide recommendations and guidance keeps us training appropriately.
- Strength train. Although no studies have been specific to runners; in a systematic review of athletes’ resistance training was found to reduce overuse injuries by 50 percent.
- Sleep. Get on a schedule and get it done! Naps can be effective if you are not getting enough rest at night.
Related: 10 reasons to get a running coach
When to Stop Running Due to a Running Injury
Can you self-diagnose your running injury?
The location of pain will be the first indicator. Some conditions like an Achilles or patellar tendon will be very localized to their anatomical area. Conversely, when pain is more diffuse and near a joint, then the joint may be implicated.
The second clue is the behavior of the pain: when does the pain occur AND what makes it go away.
- Tendons and muscles warm-up and improve with activity.
- Bones get worse with activity.
- Joints like some mobility but may have a threshold of how much.
- Hamstrings and calves will be more stimulated with speed activities as they are associated with faster running velocity.
When should you stop running because of a running injury?
As most running injuries occur gradually, using time and symptom intensity can help to differentiate. I utilize the traffic light model.
Red light pain:
Pain that is >6/10 is a red light. Stop this activity! If the pain is severe and you are unable to walk then go see a professional, an PT or MD. Most PTs can see patients without a referral and are very capable of diagnosing injuries.
Yellow light pain:
Pain that is less than or equal to 5/10 means to proceed with caution. This pain should subside in 24 hours and improve in 2 weeks with similar activities. If the pain is severe but you can continue to walk and it does not interfere with your lifestyle, work or sleep then give it 3 days of rest. If it improves then try running at 50 percent volume at a light intensity. If no improvement after this then follow up with a healthcare provider.
Green light pain:
Pain that is < 2/10 and goes away in 24 hours or less is safe. Definitely do not increase any training variables when you have symptoms unless advised by a coach or healthcare provider.
Focus on getting good sleep and eating a balanced diet as these are the primary drivers of recovery. If you respond well to ice, heat, massage, compression wraps, or something else then do that as well. Most aches and pains with running will resolve on their own as long as the training plan is stable, and recovery is optimized.
Again, if there is no change in the pain after 2 weeks then see a healthcare provider to get a specific diagnosis and plan.
How can you find the right medical help for your running injury?
I’m biased, but runners should see professionals who work with a lot of runners. In my experience, most runners can continue to run but need some modification in training load, recovery strategy, or running form.
Healthcare providers who are unfamiliar with the sport or population tend to have negative beliefs about the sport that are not grounded in research. Often these providers direct runners to stop running, which is the last thing most joints, and tendons need in order to optimize their condition.
How to Treat Your Running Injury
How should you treat your running injury at home?
In treating a tendon, we need to perform a strength-based exercise program. This may be an isometric exercise or it could be some form of heel raises. The type of exercise and dosage depends on the pain response and stage of rehab.
Most joints get better, at least initially, from mobilization. This may be a stretch or a self joint mobilization. Eventually, the surrounding muscles and coordination of movement need to improve to resolve the issue.
Muscles enjoy pressure and massage. They respond happily to compression and foam rolling. However, muscle tightness usually implies a weakness or coordination issue. For example, a calf strain is a common muscle injury in runners. It is typically due to decreased strength. So, it feels better when rubbed but will not stay better unless strengthened. When in doubt on how to manage an injury apply PEACE and Love.
Try not to use an anti-inflammatory unless you cannot participate in your daily activities or sleep. It will decrease your pain but interfere with the chemicals needed to repair or recover.
I’m a big advocate for light exercise and massage. Performing some light mobility drills will help relax and promote blood flow to the sore areas. Although not always scientifically backed, I find relief in myself and clientele with foam rolling or lacrosse ball massages.
See a medical professional.
What are common mistakes runners make in treating a potential injury?
The most common mistake is thinking rest will be their solution. A quote I like from physical therapist David Pouter is, “After all the studies tendons need tension load, muscles need to contract, brains and nervous system need stimulating, joints need moving.”
Running injuries are training load errors. The only way to get better is to address the training load. Complete rest will not get you to the training load you desire.
Stretching is the second most common. It’s rarely the long-term solution or in the plans to get an injured runner better.
Related: 5 worst mistakes runners make
Running and the desire to improve is risky. My hope is that these smart tips will empower you to keep moving forward and mitigate these risks. Happy running!