As mindful runners, we can take all the proper precautions to make sure that we’ll never have to worry about hurting ourselves, but the reality is that no one is immune to injury. Let’s take a quick look at the five most common running injuries, how they manifest themselves and the best ways to treat them.
The symptoms: Plantar fasciitis, an inflammation in the bottom of the foot, is perhaps the peskiest problem that plagues the running wounded. The common characteristic of this condition is a sharp, tight, painful sensation at the base of the heel that can be anywhere from annoying to excruciating.
The feeling has been described as comparable to stepping heel first onto a nail. Eventually, the pain might go away as the day or a run is carried out, only to return afterward or again the next day. It’s a vicious cycle for sure.
The causes: Overtraining, overuse, and improper or worn-out footwear can cause pain in your heel, but the root of the problem lies in tight and weakened muscles in the foot. If your feet are weak, the heel takes on an excessive load and can’t handle the training you are trying to do.
The fix: Orthotics and stability shoes oftentimes serve as effective Band-Aids and can help eliminate symptoms in a short period of time, but they’re not a permanent fix. And while I’m not against these quick fixes, by no means are they the only—or the best—way to make the pain in your heel go away. In the short term, avoiding bare feet, stretching and strengthening the calves, rolling your feet around on a golf ball, and icing the affected area will provide some much-needed relief relatively quickly. If possible, see if Active Release Technique, a movement-based treatment for soft-tissue injuries that helps to break up scar tissue and restore normal function, is available where you live. Long term, diligent stretching combined with strengthening the muscles in and around the feet will address the root of the problem and help offset a recurrence.
The symptoms: Any time you see “itis” at the end of a word, it means there’s inflammation involved, so Achilles tendinitis is simply inflammation of the Achilles tendon. Because the lower legs are so far away from your heart, there’s very little blood flow to the area, which means the healing process for an injury such as Achilles tendinitis is often slow.
A closely related cousin to plantar fasciitis, Achilles tendinitis manifests itself as pain at the back of the lower leg just the above the heel at the Achilles tendon—the thick band of tissue that attaches the calf muscles to the heel bone. Runners who suffer from Achilles tendinitis will often complain of swelling and pain close to the heel, which is oftentimes sharp and can be incapacitating.
The causes: Sometimes tight calves are the culprit. Tight lower legs put a lot of strain on the Achilles tendon, and over the course of many months of hard training, this overuse injury can develop. Aside from tight calves, unsupportive footwear can overburden the Achilles tendon over time, or a quick increase in volume and/or intensity can have the same effect much more quickly, so it’s important to pay attention to both your feet and your training—especially when you’re training hard!
The fix: Resting, icing, and stretching will all help to temporarily relieve symptoms, and aids such as orthotics, heel lifts, and highly structured shoes are short-term solutions. If possible, see if Active Release Technique, a movement-based treatment for soft-tissue injuries that helps to break up scar tissue and restore normal function, is available where you live. Long term, however, it’s worth your while to pay close attention to stretching and strengthening the lower legs. Calf raises, single-leg deadlifts, single-leg squats, and box jumps are great lower-leg-strengthening exercises. Also, heed what’s on your feet; your shoe choices can definitely help or aggravate the situation. And finally, keep an eye on your training. Don’t do too much, or go too hard, too quickly.
IT Band Syndrome
The symptoms: Your iliotibial (IT) band is a tendon that connects your knee to your hip. IT band syndrome (ITBS) results when this tendon becomes inflamed. ITBS has been compared to the feeling of somebody stabbing you in the side of the knee when you run, especially when going downhill. This annoying and painful injury can quickly become crippling if not addressed and corrected.
The causes: The short answer is: lots of things. Running downhill and always running on the same side of the road are common culprits. Both put a lot of stress on the side of the knee and cause friction between the IT band and the femur. Over time, the IT band tightens and may swell, pain emerges, and the pain eventually intensifies to the point where it keeps runners from running.
The fix: Massaging the quadriceps and hamstring muscles around the area, and using a foam roller on the affected area will help loosen things up, while a regimen of icing and taking an anti-inflammatory will assist in reducing inflammation. If possible, see if Active Release Technique, a movement-based treatment for soft-tissue injuries that helps to break up scar tissue and restore normal function, is available where you live. Avoid aggressive downhill running, and if you always run on the same side of the road, switch directions every so often. Finally, strengthen your hips, quads and hamstrings and glutes, but only after you’ve been able to alleviate pain.
The symptoms: Feel a constant ache underneath your kneecap when you run? You likely are experiencing runner’s knee, or patellofemoral knee syndrome. The main symptom is pain just below the kneecap that usually worsens as the intensity of exercise increases.
The causes: As with the other common running injuries listed here, the answer varies depending on the runner. Everything from uneven running surfaces and poor shoe selection to weak quads and hips, as well as unaddressed biomechanical flaws, can contribute to this common injury. In most cases, runner’s knee can be traced to the inability of the tissues surrounding the knee to recover in between runs.
The fix: If your knee continues to hurt, don’t run. If there’s inflammation, work on reducing it with the anti-inflammatory/icing regimen. Long term, switching up the surfaces you run on, strengthening the knee, making sure you’re running in the proper, not worn-out footwear, and perhaps employing some simple form fixes such as shortening your stride and striking the ground directly underneath your center of gravity, will help keep your cranky knee from getting even angrier.
The symptoms: The umbrella term “shin splints” can refer to a number of ailments that involve pain in the shin area. At their worst, shin splints can turn into a stress fracture along the tibia, and searing pain will be felt with every stride; in less severe cases, the muscles in the shin area may be tender and inflamed, and pain lessens a few miles into the run. Either way, shin pain is a surefire way to make your running experience markedly unenjoyable.
The causes: Shin pain can most often be traced back to a sudden spike in training volume and intensity. This is why, for example, it is a common complaint among brand-new runners beginning a training program and young athletes at the start of high school track or cross-country season. When you run, your lower legs take all of the initial impact forces, which then run through the rest of your body. Newer runners’ lower legs aren’t yet strong enough to handle this stress, which is why it’s important to develop a solid base before increasing mileage or introducing speed work. Combine that inexperience with regular running on hard surfaces and worn-out or improper footwear and you have a recipe for disaster. And as with many of the aforementioned injuries, tight muscles don’t help matters either. The less mobile the muscles surrounding your shin are, the more stress there is on the entire area.
The fix: Rest, ice, and anti-inflammatories will help reduce the tenderness and inflammation. As you ease back into running, pay attention to your training, as well as to your equipment and environment. Increasing volume and intensity too quickly will almost always lead to trouble. The training plans in this book are designed to up your volume and intensity methodically and slowly, which eases you into the stress that running a lot asks of your legs. Running on soft surfaces such as trails or grass will help reduce the impact on your lower legs, and paying close attention to the mileage on your running shoes will ensure that you’re not trotting on tired treads.
Originally published on July 10, 2014. Updated on October 1, 2018.