Running is one of the most accessible and effective forms of exercise, but it also comes with a notable risk of injury. Whether you’re new to running or building mileage for performance goals, understanding the most common injuries—and the factors that increase your risk—can help you make informed decisions about your training.
This article explores frequently seen running-related injuries from a physiotherapy perspective, focusing specifically on risk factors rather than treatment.
Running injuries are highly frustrating and very treatable with the proper advice and guidance.
1. Runner’s Knee (Patellofemoral Pain)
Overview:
Runner’s knee refers to pain around or behind the kneecap, often aggravated by activities like running downhill, squatting, or prolonged sitting.
Key Risk Factors:
- Sudden increases in training volume or intensity
- Poor lower limb alignment (e.g. excessive inward knee movement)
- Weakness or poor control in the hip and thigh muscles
- Repetitive loading without adequate recovery
2. Iliotibial Band Syndrome (ITBS)
Overview:
This condition involves irritation of the iliotibial band, typically causing pain on the outer side of the knee.
Key Risk Factors:
- High weekly mileage, especially with downhill running
- Running on cambered or uneven surfaces
- Limited hip strength or control
- Repetitive movement patterns without variation
3. Achilles Tendinopathy
Overview:
Pain and stiffness in the Achilles tendon, often worse in the morning or at the start of activity.
Key Risk Factors:
- Rapid increase in running load or speed work
- Limited ankle mobility
- Calf muscle weakness or fatigue
- Stiff or overly rigid running footwear
- Age-related tendon changes
4. Shin Splints (Medial Tibial Stress Syndrome)
Overview:
Characterised by pain along the inner border of the shinbone, commonly seen in newer runners.
Key Risk Factors:
- Sudden increase in training intensity or duration
- Running on hard surfaces
- Poor shock absorption through the lower limb
- Inadequate recovery between sessions
- Foot mechanics that increase load on the tibia
5. Plantar Heel Pain (Plantar Fasciopathy)
Overview:
Pain under the heel or arch of the foot, often most noticeable with the first steps in the morning.
Key Risk Factors:
- Prolonged standing combined with running
- High body load or sudden changes in activity levels
- Limited ankle flexibility
- Poor foot strength or support
- Inappropriate footwear for training demands
6. Stress Fractures
Overview:
Small cracks in bone caused by repetitive stress, commonly affecting the shin, foot, or hip.
Key Risk Factors:
- Rapid increases in mileage without adaptation time
- Low energy availability or inadequate nutrition
- Reduced bone density
- History of previous stress injuries
- High-impact loading with insufficient recovery
7. Hamstring Strains
Overview:
Strains or tears in the hamstring muscles, often occurring during faster running or sprinting.
Key Risk Factors:
- Sudden introduction of speed work
- Muscle fatigue or inadequate conditioning
- Imbalances between muscle groups
- Poor running mechanics under load
Understanding the Bigger Picture
While each injury has its own characteristics, several shared risk factors consistently appear across conditions:
- Training Errors: Sudden spikes in distance, intensity, or frequency
- Load Management: Insufficient recovery relative to workload
- Biomechanics: Movement patterns that increase stress on specific tissues
- Strength and Control Deficits: Particularly in the hips, core, and lower limbs
- External Factors: Footwear, running surface, and environmental conditions
The Role of Physiotherapy Assessment
Identifying risk factors early can make a meaningful difference in how running-related injuries develop or recur. A physiotherapy assessment provides a structured way to evaluate how your body responds to running demands.
This may include reviewing your training history, assessing movement patterns, and identifying areas of reduced strength, mobility, or control that could be contributing to increased load on certain tissues. Importantly, it allows for a more individualised understanding of risk, rather than relying on general advice alone.
Seeking an assessment can be particularly useful if you are:
- Experiencing persistent or recurring discomfort
- Increasing your training volume or preparing for an event
- Returning to running after a break or previous injury
- Unsure whether your current training habits are appropriate for your capacity
Final Thoughts
Running injuries rarely occur due to a single cause. More often, they result from a combination of factors that accumulate over time. By recognising these risk patterns early—and considering a physiotherapy assessment where appropriate—runners can better understand their own vulnerability and make more informed decisions about training habits.
