-- Marathon Running Information, Coaching and Advice from Coach Joe English

Training: what are the most common running injuries?

Coach Joe English

Coach Joe English

There are many sources of information about running injuries on the Internet and in other publications, but something that I haven’t seen is a short introduction to the most common injuries. What I’d like to do in this article is sketch out for you readers the typical problems that I see and the basic causation for each of them.

This is then the introduction, or the 10,000 foot view, of running injuries if you like.

Runners have the ability to hurt themselves. This is unfortunate, but it is the truth. Running injuries come typically from four sources:
1) increasing the amount or intensity of running too quickly,
2) lacking the strength in certain muscles to support or protect particular joints,
3) wearing the wrong, or worn-out, shoes on our feet, and
4) traumatic injuries, such as falling or twisting an ankle.

With the exception of traumatic injuries, which are almost out of our hands to control, the first three types of injuries are all somewhat avoidable. As runners, we need to ensure that we’re not doing too much running – especially at first; we must make sure that we’re building our leg strength to protect our knees, shins and hips; and we should pay close attention to what’s on our feet.

The most common symptoms of running injuries and their technical names are:
– Pain in the outside of the knee (IT Band Syndrome)
– Pain in the front, inside or back of the knee (Runner’s Knee)
– Lower-shin pain (shin splints or stress fractures)
– Heel and foot pain (Plantar Fasciitis)

There are lots of other things that could make my list too. What I base this on however is looking at runners as a population each season. Every season I will see one or two other odd injuries, such as an Achilles Tendon problem, a metatarsal stress fracture (pain under the middle toes), or a hip problem. But the injuries on the list above are common enough that I include stretching, strengthening and training schedule elements designed specifically to fight them.

This is not intended to be a medical guide, but rather an explanation of what’s happening with these injuries. Whenever you have an injury, talk to your coach, a sports medicine doctor or your family doctor. It’s important that all of these problems get treated early to keep them from becoming more serious problems. With that said, I do not include the basics for dealing with pain below, because they are the same for all injuries: rest, ice, elevation, and compression. These are a first line of defense for dealing with pain. I’ll try to focus on the cause and some specific things that can help eliminate these problems.

So what are they in brief?

IT Band Syndrome
Most common among women runners, IT Band problems appear early in the season and need to be corrected quickly. The pain associated with IT Band Syndrome manifests itself in the outer side of the knee, from the middle of the knee upwards. Usually the pain is worst right around the bony knob on the outside of the knee. If you’re sitting right now and you put your right fingers on the outside of your right knee, you’ll feel the bump that I’m talking about.

IT Band Syndrome is hard for a lot of people to understand, because the problem isn’t really with the knee. It is caused by weakness of the hip muscles. The muscles in the hip and outer side of the leg run down toward the knee and attach to a tendon that runs right next to the bump in the knee. If the hip muscle isn’t strong enough, the tendon basically moves around and rubs on this bump. The rubbing causes inflammation and pain. Usually the pain gets worse throughout a run. Without tending to IT Band Syndrome, a runner will be out of commission and unable to run quickly.

There are two ways to deal with IT Band Syndrome. First, you can try an IT Band strap, which is a brace the goes around the leg above the knee. The brace tries to hold the tendon in place to keep it from rubbing on the knee. Second, the runner needs to add strengthening exercises to the hip to make the hips stronger. These exercises can be weight lifts in the gym or leg lifts done on the floor – or both. Usually most runners are able to take some time off, start strength exercises, add an IT Band Strap and they’re back in business. That’s if the problem was caught early. If the problem wasn’t addressed early, it will take much longer for the runner to get back in the game.

Runner’s Knee
This problem is obviously so common that they named the injury after us runners. The pain with Runner’s Knee (or patella-femoral stress syndrome) is typically felt in the middle of the knee below the knee cap, the lower inside of the knee, or sometimes all the way around in the back of the knee. Here a weak quadriceps muscle is often to blame. If the quadriceps are not strong enough, the knee will not move in its correct tracking motion and the knee cap is allowed to move around causing pain.

The other cause of Runner’s Knee can be shoes that are allowing the foot to over-pronate (twist inward). As the old song goes, “the foot bone is connected to the ankle bone. The ankle bone is connected to the shin bone. . .” and so on. Basically as the foot rolls inward, it twists the lower leg, which then puts stress on the knee.

Treatment for Runner’s Knee is again a combination of getting the right gear and strengthening the leg muscles. If you’re having this problem, make sure that you have new shoes and that they are not allowing you to pronate. Often adding additional cushioning to the shoe will help here as well to reduce the impact on the knee. Strength exercises should target the quadriceps muscle and could also include leg lifts lying on your back.

In most cases, with a short reduction in training, getting into new and more cushioned shoes, and adding strength exercises will help clear up Runner’s Knee. Again, if this problem is allowed to go on for a long time, it will be much harder to clear up and could require significant time off running.

Lower Shin Pain
I’m being careful here not to call this section “shin splints”, because shin splints can be a catch-all for a lot of lower leg pains. Let’s be clear that there are a couple of different injuries that often crop up in the lower leg: 1) “shin splints” which are pains along the lower 1/3 of the shin, usually evenly distributed along the inside of the shin and 2) lower-leg stress fractures, which are usually very specific and very painful in one spot anywhere along the shin. Typically if you press directly on a stress fracture, you’ll have excruciating or exquisite pain (very intense pain), whereas shin splints are more distributed along the whole lower 1/3 of the shin.

Shin problems can come from several different sources, including ramping distance too quickly; wearing shoes that are not providing enough cushioning; or weak and inflexible calf muscles. It is very important to take note of the appearance of lower shin pain and do something about it quickly. A case of shin splints left untreated may develop into a more serious stress fracture, which is an actual break in the bone itself. Stress fractures are very dangerous and take a long time to heal. In fact, stress fractures in certain bones can be career ending for runners – so it is essential that these not go untreated.

When lower shin pain begins, make sure first that you have properly cushioned shoes and begin stretching your calves (both the upper and lower calf muscles) very well. I often see runners knock out early shin pain by doing these things and switching to running on softer surfaces (such as a track, dirt path or grass) for a week or two. Compression in the form of a lower-shin brace can help alleviate the pain, but I don’t like to see people wearing these braces long-term, because it often means that they are not dealing with the underlying problem – eventually those problems get worse.

Plantar Fasciitis
Pain in the heel and the bottom of the foot is one very common for runners. Often the sign of Plantar’s will be a sharp pain when you roll out of bed in the morning. The problem here comes from an inflammation of the tissue in the bottom of the foot. The repeated pounding on the foot is often the cause, but inflexible muscles and tendons are also often to blame. This is again a problem that needs to be corrected quickly and early to keep it from getting out of hand.

The first thing to do is to stretch regularly and vigorously – the feet, calf muscles and Achilles tendons. Having flexibility in the feet and lower leg is key to reducing the impact on the feet. Second, again, check that shoes are cushioned or move to a more cushioned shoe. A impact absorbing pad can also be added into the shoe under the heel to take some of the impact. Third, adding strengthening exercises for the feet will help build the muscles in the region to make them stronger.

When Plantar Fasciitis is really bad, it can be very painful and hard to treat. A few of the treatment options include sleeping in a sling brace, changing to softer shoes and surfaces, and taking time off of running. One thing that can provide a bit of relief is massaging the ball of the foot from side to side before getting out of bed in the morning. This helps loosen and relax the foot before you put your weight on it.

As you’ll see from this list, there are some common threads among the solutions. Often stretching and strengthening key areas is critical. Second, making sure that shoes have adequate cushioning is important. Third, switching to softer surfaces for a week or more and taking time off will often help knock these out early.

If any of these problems become serious, remember to see a doctor. Sports Medicine doctors and physical therapists have wonderful tools for loosening tissue, reducing swelling and fixing biomechanical problems. They can often have you on your way back to the track sooner than later.

I hope this introduction has been helpful.

Related Article:
How much should my legs hurt after a long run?

Coach Joe English, Portland Oregon, USA
Managing Editor, Running Advice and News


7 responses so far, want to say something?

  1. 1. David June 14th, 2007 at 8:12 am

    Interesting blogs. I’m adding you to my “blogs I read” list. I’m at

  2. 2. Kelly Mitchell August 15th, 2007 at 5:46 pm

    I love this article. I’m training for the Honolulu Marathon and everytime I ask someone in my group about knee pain, I get a glazed look and told perhaps I should stop running and join the walkers group. NOT AN OPTION for an overachiever. So I am going to work on developing my quads further and hip conditioning to provide better support for that knee. Curious… do you think glucosamine would help the swelling? Aloha! Kelly

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  4. 4. Judith is feeling pain and suffering... March 3rd, 2008 at 7:07 pm

    I would like to add something to the shin pain area:

    Shin Exercises (examples):

    Walking on heels, and walking on toes: Probably the single easiest way to strengthen your shins is to walk on your heels.

    Toe taps: Standing or sitting, tap the floor with the foot for 2 minutes.

    Heel raises: Stand on one leg with a chair turned backwards in front of you. Holding onto the chair back, raise up on your toes keeping your knee straight. Hold for 1 second. Slowly lower to the ground. Repeat 10 times. Toe raises: Same as heel raises only stand on heels and raise toes.

    Toe points with ankle weights: Place a weight on your foot. While sitting; flex your foot and then point your toes. Do three sets of 10 with each foot. (you can start these with no weights.)

    Exercise bands: Anchor an exercise band to an object on one end and loop the other end around your foot. Move your foot up and down and side to side against the band.

    ALWAYS… warm up prior to exercise and stretch well after exercise.

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