UPDATED December 21, 2022: Almost as certain as death and taxes are running injuries for runners. Soon after starting this site, I suffered form two major running injuries that took me out of the sport for several years.
I’m not alone. Nearly 80 percent of runners suffer from running injuries. And, I can tell you after being injured for more than two years with my hamstring tear and plantar fascia 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
Common Running Injuries & Causes
What is the most common running injury?
The knee is the site of one of the most common running injuries followed by the lower leg and then the foot, according to Norton.
In his clinical experience, patellofemoral (kneecap) is the most common running injury followed by leg injuries of medial tibial stress syndrome (shin splints) and hip pain.
Related: The Best Recovery Shoes for Runners
What injuries can you get while running?
Overuse injuries are the most common injuries while running. These common running injuries include runner’s knee, shin splints, Achilles tendonitis, stress fractures, muscle strains, ankle sprains, plantar fasciitis, and IT (iliotibial) band syndrome.
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.
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 (overrunning).
How to Prevent Common Running Injuries
Are there risk factors for common running injuries?
Yes. Identifying risk factors that may predispose runners to injuries can help to educate and plan for strategies to mitigate these injuries. According to Norton, 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.
Related: How to Cope with Fear of Reinjury
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.
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.
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 exposed to vulnerable structures. (Read about common injuries for female runners here.)
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 can runners prevent common 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: How Sleep Prevents Running Injuries
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.
- 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 do you tell if a running injury is serious?
In most cases, you can tell if a running injury is serious if it does not improve after several days of rest, ice, and heat. If you have trouble walking or putting weight on the area, then your running injury is serious.
Is it OK to run through pain?
In most cases, you do not want to run through 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?
As most common running injuries occur gradually, using time and symptom intensity can help to differentiate. Norton uses 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, 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 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?
Norton suggests the following 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.
What are the common mistakes runners make when treating a potential running injury?
The most common mistake is thinking rest will be their singular solution. A break from running is often only part of the equation.
A quote Norton likes 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 most often 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 mistake runners make when faced with a running injury. It’s rarely the long-term solution or in the plans to get an injured runner better. There are some cases, for instance in the situation of a soft tissue tear, in which stretching exacerbates the problem.
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: