Common Running Injuries And How To Prevent Them

Running is a physically demanding activity that works your entire body but impacts your lower body with every footstrike. When you run your weight-bearing joints, specifically the knees and hips experience pressure around 3 times your body weight when walking and approximately 5 times your weight when running. Although reported running injuries range in each study a broad review of the literature notes that the average runner experiences from 2.5 to 12.1 injuries per 1000 hours of running.  It’s not surprising then that hip and knee pain is a common trend among runners. Although sometimes debilitating, these pains can often be managed with conservative treatments like RICE ( rest, ice, elevation, compression), stretching, strengthening exercises and modifying the frequency and intensity of your runs. 

Common Running Injuries Runners Face

Knee Injuries

The knees are the major shock absorbers for the body while running and they also play an important role in locomotion or propelling you forward as you run. Because of this function, the kees are often injured or irritated by running. 

1. Patellofemoral Pain Syndrome (PFPS) 

Also known as runner’s knee is the most common knee injury. Runner’s Knee affects the point between your patella (kneecap) and the femur (thigh bone), more specifically the cartilage behind the kneecap. Symptoms of runner’s knee include Mild swelling, pain or soreness when you complete any activity that puts pressure on the knee, such as running, stairs, kneeling and squatting. Your knee may pop and crack (known as crepitus) a lot more when you bend and straighten the knee. 

 How To Treat Runner’s Knee:
  • Take a break from running
  • Reduce mileage
  • Cross-train with activities that don’t aggravate your knee
  • Apply ice for 15 minutes five times a day
  • Compress the knee with an ACE wrap or compression sleeve 
  • Take an anti-inflammatory like Aleve 
  • Quad and hamstring stretching 
  • If the pain persists or worsens, follow up with a doctor
How To Prevent Runner’s Knee:
  • Keep the muscles around your knee and hip strong with strength training 
  • Stretch and roll daily
  • Shortening your stride can take the pressure off your knees. Aim for 170-180 foot strikes per minute

2. Patellar Tendonopathy 

Or patellar tendonitis is a common soft tissue pain from running.  It is typically called Jumper’s Knee because it affects people who do a lot of sports that require excessive jumping or landing on the knee – such as with running. The patellar tendon connects your kneecap to your tibia( lower leg bone). When the attachment is stressed repetitively it becomes inflamed and irritated. Symptoms for patellar tendonitis include a stiff or swollen knee. The tendon may look thicker and swollen along the front of your knee. To be sure, compare it to the unaffected side. You may have pain in your knee while walking or running along with pinching or burning sensation on the bottom of the kneecap. 

How To Treat Patellar Tendonitis: 
  • Stop running until you can do so pain-free; cross-train instead
  • Apply ice for 15 minutes five times a day
  • Using a Chopat strap AKA  patellar tendon strap can reduce pain

If the pain persists or worsens, follow up with a doctor.

How To Prevent Patellar Tendonitis: 
  • Strength training to balance muscle tension in your hamstrings and quadriceps 
  • Stretch your quads and hamstrings 
  • Foam roll daily

3. Illiotibial Band Syndrome (ITBS) 

Another common knee injury from running is Iliotibial Band Syndrome (ITBS) and is in line to overtake PFPS as the most common knee pain from running. This injury affects the outer hip to the knee which is where your iliotibial band (ITB) runs from your ilium of the hip to the tibia or your lower leg bone.  Your knee extends and flexes when you run, which causes the IT band (outer hip to knee area) to run against the femur, leading to friction and pain in the outer knee joint. Symptoms of ITBS include swelling and inflammation with lateral knee pain that comes when you are using the knee and goes away when you stop using it.

How To Treat ITBS:
  • You can run unless pain forces a change in your form; Reduce your mileage and cross-train
  • Foam roll your ITB on the soft part of your outer thigh
  • Do ITB stretches 
  • If you overpronate when you run/walk, wear motion-control shoes 
  • See a doctor if it persists
How To Prevent ITBS:
  • Strengthen your glute and core (abdominal) muscles 
  • Foam roll or stretch your ITB daily
  • A shorter, quicker stride can help. Aim for 170-180 foot strikes per minute

4. Osteoarthritis ( OA)

OA is a form of wear and tear arthritis. Running increases the wear on the hyaline cartilage which protects the ends of your bones. Once this cartilage begins to degrade your bones will rub on each other and cause pain. OA will also present with stiffness, warmth and swelling after impact activity like running. 

How To Treat OA:
  • Continued movement helps preserve the knees
  • Take an anti-inflammatory or Tylenol 
  • Run on soft surfaces 
  • Add in non-impact activities such as swimming or biking 
  • Follow up with a specialist for other conservative options 
How To Prevent OA:
  • Weight loss
  • Reduce impact activity 
  • Strength training

5. Other Soft Tissue and Bone Injuries 

Running can elicit a variety of injuries to the knee including meniscal pathology, subchondral fractures, chondral lesions, among others. The key for knee pain is that if it fails to respond to conservative treatments like RICE and over the counter (OTC) medications then you should stop running or the activity that causes the pain and follow up with a specialist. 

Common Hip Injuries In Runners

The hip is our largest ball and socket joint in the body and is surrounded by large ligaments and muscles. Running can not only stress the ball and socket joint itself but also the hips support structures. Hip pain is common in runners because it is easy for hips to become tight. This can leave them less flexible under the pressure and impact of running, leading to stress and strain. Eventually, this can lead to pain and injury.

1. Muscle Strain and Tendonitis

Muscle strain and tendonitis occur when muscles in the hips are overused. You may feel aches, pains, and stiffness in your hips, especially when you flex your hip or climb the stairs.

How To Treat Muscle/Tendon Strain:
  • Stretch before and after your run, focusing on the muscles around the hip joint 
  • Foam roll
  • Take a break from running and cross-train with non-impact exercise 
  • If you overpronate when you run/walk, wear motion-control shoes 
  • Ice the affected area for 20 mins, 3-4 times a day
  • Over the counter (OTC) non-steroidal anti-inflammatory medications (NSAIDs) like ibuprofen if allowed can be helpful 
  • See a doctor if it persists
How To Prevent Muscle/Tendon Strain:
  • Strengthen your glute and core (abdominal) muscles 
  • Stretch your hip and gluteal muscles regularly, especially the hip flexors (think runners lunge) 
  • A shorter, quicker stride can help. Aim for 170-180 foot strikes per minute

2. Bursitis 

Bursae are fluid-filled sacs that cushion the bones, tendons, and muscles protecting each other from shear forces. Repetitive motions, such as running, put pressure on your bursa, causing them to become painful and inflamed. This leads to bursitis, which is characterized by swelling, redness, and irritation.

How To Treat Bursitis:
  • Stretch before and after your run, focusing on the muscles around the hip joint 
  • Foam roll
  • Take a break from running and cross-train with non-impact exercise 
  • If you overpronate when you run/walk, wear motion-control shoes 
  • Ice the affected area for 20 mins, 3-4 times a day
  • Over the counter (OTC) non-steroidal anti-inflammatory medications (NSAIDs) like ibuprofen if allowed can be helpful 
  • Physical therapy 
  • See a doctor if it persists
How To Prevent Bursitis: 
  • Strengthen your glute and core (abdominal) muscles 
  • Stretch your hip and gluteal muscles regularly, especially the hip flexors  runners lunge) and IT band ( figure 4 stretch) 
  • A shorter, quicker stride can help. Aim for 170-180 foot strikes per minute
  • Running on a softer surface like a track 

3. Iliotibial Band Syndrome (ITBS) 

Iliotibial Band Syndrome (ITBS) is the same IT band that can give you knee pain. This injury affects the outer hip to the knee which is where your iliotibial band (ITB) runs from your ilium of the hip to the tibia or your lower leg bone. You may feel or hear a clicking or popping noise when you move. Symptoms of ITBS include swelling and inflammation with lateral hip pain that comes when you are using the hip and goes away when you stop using it.

How To Treat ITBS:
  • You can run unless pain forces a change in your form; Reduce your mileage and cross-train
  • Foam roll your ITB on the soft part of your outer thigh
  • Do ITB stretches 
  • If you overpronate when you run/walk, wear motion-control shoes 
  • Rest, Ice 
  • OTC medications like Ibuprofen as discussed above 
  • See a doctor if it persists
How To Prevent ITBS:
  • Strengthen your glute and core (abdominal) muscles 
  • Foam roll or stretch your ITB daily
  • Stretch the other large muscles around the hip to avoid imbalance 
  • A shorter, quicker stride can help. Aim for 170-180 foot strikes per minute

4. Labral Cartilage Tears

  • Your labrum is the ring of cartilage in the socket portion of the hip that helps cushion and stabilizes the ball. Tears in the labrum can occur from repetitive motions like running or jogging. Often times these tears present with a clicking, catching or locking when you move. You may feel and hear it. You may experience stiffness and limited mobility. 
How To Treat a Labral Tear: 
  • If you suspect you have a labral tear, make an appointment with a doctor 
  • Stop running and ice the joint
  • Use OTC medications like Tylenol or ibuprofen if allowed 
How To Prevent a Labral Tear: 
  • Maintain a healthy weight 
  • Stretch regularly
  • Cross-train and allow your hip to rest 

5. Other Soft Tissue and Bone Injuries 

Running can elicit a variety of irritations in the hip including but not limited to iliopsoas (hip flexor muscle) tightness and snapping, avascular necrosis, subchondral fractures, chondral lesions, among others. The key for hip pain elicited by running is that if it fails to respond to conservative treatments like RICE and over the counter (OTC) medications then you should stop running or the activity that causes the pain and follow up with a specialist. 

Ankle Injuries

Runners are extremely susceptible to ankle injuries because the ankles are important in all 3 axis of rotation in addition to shock absorption.  Ankle strain, tendonitis, and stress fractures are the most common injuries that runners sustain in the ankle joint. Injuries to the ankle often require a hiatus from running while the injury heals and you rehab the joint.  If your ankle pain fails to improve with RICE and other conservative treatments it is important to follow up with a medical professional. 

Exercises to Prevent Running Injuries

To prevent injuries from running, always start slow.  Take small bites when approaching a new training program, whether it be running itself or a strength and conditioning program to help manage your endurance. 

Here are some exercises that can help prevent injuries 

Single-Leg Squat (helps improve pelvic stability, gluteal strength, overall balance)

  • Stand on one foot. Bending at the knee, sit your hips back as if you are going to sit in a chair behind you. Aim for your upper leg to be parallel or lower to the ground. Do not let your knee pass your foot. 
  • Return to a standing position. Repeat 12 reps before switching to the other leg.

Standing Calf Raises/ Calf Stretch

  • Start on your tiptoes on the edge of a step (make sure you are well balanced), gradually lower one heel below the step.
  • Using the other leg, raise yourself back to the starting position.
  • Do three sets of 15 reps of each exercise twice a day.

Gluteal and Hip External Rotator Strengthening

  • Kneel on the floor with your hands on the ground, knees below your hips and hands beneath shoulders.
  • Lift one knee off the floor and way out to the side
  • Hold for 1-2 seconds and lower as slowly as you can. 
  • Perform 10  times, then repeat on the other leg.

Side Leg Raises (for gluteal strength) 

  • Lay on your right side with your legs extended out and stacked on each other.  Head can be supported with hand or on a pad/pillow.
  • Engage your left glute muscles and slowly lift up your leg keeping your foot in a neutral position.
  • Lower leg to starting position. Do 12 reps. Repeat on the other side. May use a resistance band for higher intensity.

Plank (core building)

  • Begin in push up position and lower down to your forearms, making sure shoulders are over elbows and palms are flat on the floor.
  • Make a straight line from your head to your heels, hold this position for 20-60 seconds.
  • Do not drop your hips, make sure to squeeze your glutes to protect your low spine. 

Side Plank (core building)

  • Put one elbow on the ground with your side on the ground.
  • Extend both legs out so that your body is in one straight line, balancing on the outside edge of your bottom foot.
  • Keep your waist up and lifted, and don’t sink into your bottom shoulder. Reach your upper hand to the ceiling.
  • Hold for 20-60 seconds before repeating on the opposite side.

Runners Lunge 

  • Place one leg forward, knee bent at 90 degrees. Do not let your knee pass your foot. 
  • Place the other leg behind you, toe to the ground, heal in the air. 
  • Hold a static stretch for 15- 30 seconds. Do not bounce
  • Repeat on the other side, repeat as many times on each side as feels good.

Forward Stretch

  • While protecting your low back, keep your knees straight and lean forward
  • Hold for 15-39 seconds
  • Stand up slowly, one vertebra at a time. 
  • Repeat one more time for a full stretch