UPDATED September 6, 2023: Almost as certain as death and taxes are running-related injuries for runners. Soon after starting this site, I suffered from three major running injuries in as many years that has taken me away from the sport for a duration of that time.
I’m not alone. Nearly 80 percent of runners suffer from running injuries. This is because running is a high-impact sport that puts repetitive stress on our bodies. All types of runners from beginner runners, recreational runners, seasoned runners, elite runners, and even professional runners deal with injury. And, I can tell you after being injured for close to three years with a hamstring tear, plantar fascia tear, and hip labral 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 doctor of physical therapy 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 save you from hurting yourself, and yes, taking time off running.
In this article, I will cover:
- What are the most common injuries while running
- What are the most common causes of running injuries
- How to tell if you should run with a running injury
- How to prevent running injuries.
Related: How I Stopped Being Injury Prone
What are the most common running injuries?
Overuse injuries are the most common injuries while running starting with knee injuries then the lower leg, and foot, according to
Norton. Here are the most common running injuries :
- runner’s knee
- patellofemoral pain syndrome
- medial tibial stress syndrome (shin splints)
- achilles tendinitis
- stress fractures
- muscle strains
- ankle sprains
- plantar fasciitis, and
- iliotibial band syndrome (IT band syndrome)
Related: The Best Recovery Shoes for Runners
What are the common causes of running injuries?
A 2002 review of 2002 running injuries found that 80 percent of the injuries were overuse-based (aka overrunning). Running creates stress on the body. If the stress exceeds the body’s capacity the result is often pain. This is because 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.
That said there are four major risk factors that lead to a running-related injury:
- lifestyle habits
- and running form.
Previous injuries are 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 some studies indicate younger runners are more likely to sustain an injury.
Factors such as high stress, little sleep, poor nutrition, and improper footwear can all lead to injury.
Related: How to Cope with Fear of Reinjury
As noted, overuse is the biggest reason why runners get injured. Specifically, runners who change more than one variable in their running routine (velocity, distance, or frequency) are more likely to be at risk of injury. Also, runners who with a sudden increase in volume (30 percent or more) for more than one week in a row have an increased risk for injury.
Norton recommends a training plateau following a progression of mileage within 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.
Related: Mobility Routine for Runners
Sometimes just the way our bodies are made and move can lead to injury. For instance, having flat feet, high arches, hammer toes (like I have), or a CAM deformity in the hip (like I also have) can lead to running injuries. Equal strength and range of motion of each side of your body can help protect you from injury in spite of these body formations.
You also want functional range of motion–not too much or too little. Limited range of motion has been linked to injuries but so has too much (especially with internal rotation). For example, evidence suggests limited hip internal rotation is protective against injury because the tissues are less exposed to being over-worked.
Related: How to Cope with a Running Injury
Well-known biomechanist Irene Davis has a saying, “runners should land softly and well-aligned.” In this statement, she summarizes 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.
Related: How to Fix Running Form
How do you know what running injury you have?
You can tell what running injury you have by looking the location and the behavior of the pain.
- Some conditions like an Achilles or patellar tendon will be very localized to their anatomical area.
- When pain is more diffuse and near a joint, then the joint may be implicated.
- Inflammation of soft tissues warms up and improves with activity.
- Muscle or tendon strains and tears and 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.
How can you tell if a running injury is serious?
If you have trouble walking or putting weight on the area, then your running injury is serious.
If your running injury does not improve after several days of rest, ice, and heat, then it is serious and you should see a physical therapist or healthcare professional.
Is it OK to run through pain?
In most cases, you do not want to run through pain especially if it is a sharp pain or acute pain. If the pain increases while running or stays about a level 3/10 while running, then you should not run. Also, if you change your gait while running to lessen the pain, you should not run. This change can likely lead to another injury due to the compensation.
When should you stop running?
You should stop running if:
- the pain causes you to change the way you run
- the pain worsens as you run, or
- the pain is above a level 3/10 as you run.
When should you stop running because of a running injury?
Sometimes it can be very confusing if you should stop running as you try to heal a nagging injury. Norton uses a traffic light model to help runners determine if they should stop trying to run through an injury.
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, a 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.
- You may try running at 50 percent volume at a light intensity if the pain is improving.
- No improvement after taking precautions at home means you should follow up with a healthcare provider.
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 to Treat Your Running Injury
If you are dealing with a pain form running, here are some at-home treatment of running injuries:
In treating a tendon, you 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 about 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.
Norton is 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.
Related: Benefits of Massage for Runners
See a medical professional.
If you don’t improve in a week, seek help from a healthcare professional! Personally, I think getting imaging for a proper diagnosis sooner rather than later is never a bad call.
What are the common mistakes runners make when treating a potential running injury?
So what should runners NOT do when treating a running injury?
Thinking rest will fix a problem is mistake. It is only PART of the solution. As physical therapist David Pouter puts it: “After all the studies tendons need tension load, muscles need to contract, brains and nervous system need stimulating, joints need moving.”
Stretching is rarely the long-term solution and can often make injuries worse in the case of a soft tissue tear. If stretching hurts, stop doing it! If you feel tight muscles, try using a foam roller instead.
Related: How Sleep Prevents Running Injuries
5 Best Ways to Prevent 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 for your regular running routine, 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.
- Warm-up and cool-down. Warming up with dynamic stretching and mobility work and cooling down allows your body to get ready to work and recover. Don’t skip it! It’s a few minutes that act as insurance against injuries.
- Eat well. Fueling before, during, and after your runs gives your body what it needs to work hard and heal, so you build back stronger
If you want guidance with your running, including staying injury-free, check out my run coaching services. Also, be sure to check out my free training plans: