The Top 6 Running Injuries Seen by Physiotherapists

  •   June 1, 2015
  •  Leanne Loranger, PT

For many Canadians running is the leisure activity of choice. With the warmer weather, many people move their exercise programs outside. Some may even participate in weekend fun runs, fundraising races, and more serious running competitions and marathons. But even if you are running inside, on a treadmill, all that running comes with the risk of injury.

Running injuries often affect the legs, knees and feet.


1. Shin Splints (Tibial Stress Syndrome)
Inflammation of the muscles at the front of the leg, between the knee and the ankle. Shin splints can be the result of several issues. Among runners, shin splints are thought to be caused by overuse, running on hard surfaces or on hills and poor foot and ankle control that leads to over-pronation when running (excessive inward ankle rotation).2


2. Front of the knee (Patello-Femoral Syndrome)
Pain at the front of the knee, often caused by a combination of changes in the cartilage lining on the back of the knee cap (patella), pressure between the knee cap and the thigh bone (femur), or misalignment between the knee cap and the thigh bone.1  

3. Outside of the knee (Iliotibial Band Syndrome)
Pain on the outside of the knee caused by friction between the bones of the knee joint and the thick ligament on the side of the thigh (Iliotibial band). Thought to be made worse by weakness of the hip muscles as well as running downhill and running excessive distances in a week.4

4. Knee joint (Meniscal Injuries)
Although more common with sports that involve twisting motions through the knee (such as football or soccer) than with running alone, meniscal problems can be the result of repeated small injuries that lead to the breakdown of the cartilage lining of the knee joint which in turn causes inflammation.5 Although often not caused by running, meniscal injuries can be made worse by running, especially running excessive distances in a week.


5. Heel pain (Plantar Fasciitis)
Heel pain that is caused by repetitive minor trauma to the thick ligament on the bottom of the foot that supports the foot’s natural arch. Excessive weight, weakness of the small muscles of the foot that support the arch, poor footwear, running and especially a sudden increase in running distance/intensity are all thought to contribute to plantar fasciitis.3

6. Ankles (Achilles Tendinopathy)
Inflammation of the thick tendon at the back of the ankle. The Achilles tendon is the attachment for the muscles that help you to push off when running, walking and climbing stairs. Repeated minor trauma to the tendon that doesn’t heal properly can lead to inflammation, pain and stiffness.6

As you can see, many of these injuries are either thought to be directly caused by or are made worse by overuse, especially unfamiliar overuse (for example when you set out to run a marathon by well, running a marathon rather than gradually working up to that distance). This results in injury and inflammation.

How to prevent running injuries

Take a break!
Often runners are reluctant to seek treatment,7 perhaps because they don’t want to be told to put their training on hold, however that is exactly what needs to happen in order to fully recover from the injury.

Listen to your body.
Some authors have suggested that more experienced runners are less likely to suffer an injury because they are more likely to pay attention to their bodies7 and because they have built up their ability to run over time.

Check your shoes.
There are many schools of thought on the subject of which type of shoe is best for running and remarkably little evidence to support a specific recommendation. Anecdotal evidence does however seem to suggest that if you are struggling with a running injury, it might be time to replace your old running shoes.8

Increase your distance over time.
An increase in the distance run in a week seems to be associated with an increased risk of injury. When increasing your distance, good practice is to do so gradually and to be cautious about how many consecutive days you spend running.7,8

Cross Train
Maintaining flexibility and strength will help to prevent injury by maintaining a balance between muscles used for running and their counteracting muscles. When injured or on off-days some activities to consider include: cycling, swimming, water jogging and cross country skiing as well as weight training. Not all of these activities will be appropriate for every injury, for example cycling may aggravate an Iliotibial Band Syndrome.4 Your physiotherapist will be able to give you specific advice about what activities will allow you to be active without aggravating your injury.

How physiotherapy can help:

  • Provide advice on exercise and stretching.
  • Help address muscle strain and imbalance.
  • Apply anti-inflammatory modalities such as ice or ultrasound.
  • Provide advice for your return to running including recommendations about footwear and other supports.
  • Provide advice for home management of the condition, both during the acute phase and to help prevent future injury.

Find a physiotherapist to treat your running injury.


  1. Patellofemoral Pain. Available at:  Accessed on May 21, 2015.
  2. Shin Splints (Medial Tibial Stress Syndrome). Available at:  Accessed on May 21, 2015.
  3. Plantar Fasciitis. Available at:  Accessed on May 21, 2015.
  4. Fredericson M, Wolf C. Iliotibial band syndrome in runners: Innovations in treatment. Sports Med 2005; 35(5): 451-459.
  5. Knee Cartilage Injuries (including meniscal tears). Available at  Accessed on May 21, 2015.
  6. Achilles Tendinopathy. Available at Accessed on May 21, 2015.
  7. Fredericson M, Misra AK. Epidemiology and aetiology of marathon running injuries. Sports Med 2007; 37(4-5): 437-439.
  8. Yeung EW, Yeung SS. A systematic review of interventions to prevent lower limb soft tissue running injuries. Br J Sports Med 2001; 35: 383-389.