Why Running Injuries Occur and The Best Management
Running is one of the most accessible forms of exercise and a great way to stay fit. It has grown significantly in popularity over the years, particularly now with many running events selling out and requiring a ballot to enter. Unfortunately, like most activities and sports, there does carry a risk of injury. We have been helping treat more runners in the clinic over the recent years, and especially at times leading up to key events such as the Melbourne marathon. Some studies have shown that roughly 1 in 4 runners may sustain a running-related injury in a given period, with rates climbing sharply as training volume and competitiveness increase — from around 15% in novice runners to over 60% in competitive runners.
The good news is that most running injuries are able to be diagnosed quickly and — most importantly — manageable with the right approach. In this blog, we will run through the most common running injuries, what actually causes them, how to treat them based on current evidence, and how to reduce your risk of getting sidelined in the first place.
The Most Common Running Injuries
1. Runner’s Knee (Patellofemoral Pain Syndrome)
Patellofemoral pain syndrome (PFPS) is one of the most frequently diagnosed running injuries. It is pain that occurs in the patellofemoral joint- where the kneecap joins the end of the thigh bone. It typically affects females more than male runners.
Common symptoms include:
- Aa diffuse, aching pain around or behind the kneecap;
- ain that builds with activity and can also be aggravated with squatting, stairs, or prolonged sitting.
2. Shin Splints (Medial Tibial Stress Syndrome)
Medial tibial stress syndrome (MTSS) causes pain along the inner border of the shin bone and is one of the most common overuse injuries in runners, with reported incidence ranging from around 14% to 20% in running populations.
Common symptoms include:
- dull and aching pain along the medial shin;
- worsening pain with activity;
- improves with rest.
3. Achilles Tendinopathy
Also known as Achilles tendinitis, this condition involves injury to the tendon at the back of your heel. The tendon gets injured when it is overworked (too much load) and compressed. Because in most cases it is not an inflammatory condition, we no longer call it tendinitis. It is important to also note that there are different types. Injury to the tendon can commonly occur in its’ middle (mid-portion), where it attaches on the bone (insertional) or in the surrounding sleeve (tendon sheath). Treatment of an achilles injury will vary depending on the location and type. Achilles tendinopathy can make up around 7-9% of running-related injuries.
Common symptoms include:
- Pain, stiffness in the achilles tendon- usually quite localised;
- Thickness or occasionally a lump forming in the tendon;
- Pain may felt on initial movement and after rest;
- The pain may settle initially when running, but then build up again after increase loads or going up hills.
4. Plantar Fasciitis
Plantar fasciitis, also an overuse injury is pain coming from the thick soft tissue which connects our heel to our toes. It is been reported range from 4-10% of running-related injuries Common symptoms include stabbing heel pain on direct pressure, and often even difficulty putting the heel on the ground. This is typically worst with the first steps in the morning, or initial walking after rest.
5. IT Band Syndrome (Iliotibial Band Syndrome)
Iliotibial band syndrome (ITBS) occurs when the iliotibial band (thick connective tissue running from the lateral hip down below the knee joint) becomes irritated, inflamed and/or tight. This irritation can occur when the band is rubbing on the lateral femoral condyle (the outside and end of your thigh bone at the knee joint). It is often reported as the second most common running injury.
Common symptoms include:
- sharp pain on the outside of the knee;
- pain that typically builds and worsens with prolonged running;
- pain can be worse with downhill running, up and down stairs, or flexing the knee (particularly at 30 degrees)
6. Stress Fractures
Stress fractures (more broadly termed bone stress injuries), occur when there is repeated overload on the bone and leads to pain. Some of the sites a runner may get a stress fracture can be the tibia (main shin bone), navicular (foot), femoral neck (hip) or fibula (smaller shin bone). They can represent 10–20% of all sports medicine injuries, and running is thought to be responsible for up to half of all bone stress injuries seen in younger athletes. Usually symptoms will build with activity (get worse during a run) and may present as sharp and localised pain, which then settles with rest. As it progresses, people may experience night-time pain, morning stiffness and pain also with other weight-bearing activities (walking).
These injuries are typically classified as:
- Low-risk (e.g. postero-medial tibia or fibula) — generally heal well with load modification
- High-risk (e.g. femoral neck, navicular or anterior tibia) — carry a higher risk of non-union and need closer medical management
7. Hamstring Strains
While hamstring strains are commonly seen in sprinting athletes and kicking sports, the same underlying principles apply to middle and long-distance runners, particularly those doing faster interval or hill sessions where the hamstring is loaded at high speed. Often runners will feel an incident. This may a sharp pain, pull or even ‘cramp’ feeling in the back of the thigh during either a fast stride or pushing off motion. The pain if often then aggravated with striding or bending down.
8. Ankle Sprains
Ankle sprains do occur and are especially common in trail and off-road running. The most common sprain we treat is the lateral ankle sprain, where the foot rolls out (inversion injury) and causing damage to the ligaments on the outside ankle. This can occur when a runner steps uneven terrain, in hole, off a curb or stepping on an object (eg. stick, rock).
What Causes Running Injuries
The most common cause of running injuries is overuse. This is where you do too much and too quickly- and the soft-tissues doesn’t cope with the load you are putting on your body. Although we will discuss this, there are other contributing factors which can lead to injury, and are important to address when treating these injuries.
Biomechanical Factors
Running is a skill that requires ideal movement and strength across multiple joints of the body- particularly the lower limb. Some factors that could contribute to injury include:
- Muscle Weakness. Weakness in the hips may lead to increased tension along the ITB, or affect our thigh/knee control and placing increased load under the patella. Weakness in the calf musculature may contribute to increased load on the Achilles tendon. Also when our muscles or tendons are weaker, this may result in more load on our bones.
- Joint stiffness. In particular reduced ankle range of motion (dorsi-flexion) has been linked to increased risk of lower limb injuries.
- Poor control. Poor control is usually related to the above factors but can also develop in isolation. Particularly for runners, we look at distal control (the foot/ankle) assessing if there is any excessive pronation or supination, and proximal control (particularly core and hips) assessing if there is any excessive thigh adduction and internal rotation.
- Technique. In regards to injury, some common technique issues we see relates to foot placement- usually over-striding (increasing the braking force through the legs) or landing too close to the bodies midline (resulting in more hip adduction and internal rotation).
Previous History Of Injury
One of the most consistent findings across running injury research is that a previous injury is one of the strongest predictors of a future one. Importantly it should be noted, that an old injury increases your risk of not just the same injury but also another running-type injury. Unfortunately, we cannot change history- but there are still things you can do to reduce your risk, which we talk about later.
Footwear
Footwear is always a largely debated topic, and some of factors where footwear may contribute to running injuries is when they are ill-fitted, too old or not suitable for your running style. It may surprise you, but sometimes people aren’t wearing the right sized runners- particularly if the size is too small or tight, this won’t allow the foot to naturally move during running. We can sometimes hang on to our favourite runners too long, and they longer provide the support or cushioning required for the km’s you’re demanding from them. Also at times too many runners may choose a style or brand based on trends and colour, rather than what actually feels comfortable and is suitable to their running.
So what is the best footwear for runners? There is not strong enough evidence to recommend one specific type of running shoe over another to prevent a running injury. Some studies have found that softer-cushioned shoes were associated with a lower injury risk than firmer shoes, and there is definitely a trend for runners to be more cushioned. We recommend always trying on a few different brands, and go by comfort and size as important factors when choosing.
Surface Conditions
Running surface — road, trail, track or treadmill — changes the loading pattern and impact forces through the lower limb, and sudden changes in surface (for example, moving from a treadmill to trail running) are commonly cited as a contributing factor to injury, largely because they represent an unfamiliar loading stimulus the body hasn’t adapted to. Uneven or technical trail surfaces also carry a materially higher risk of acute injuries like ankle sprains, as noted above.
Lifestyle Factors
Beyond training itself, broader health factors influence injury risk. Higher BMI, smoking, low aerobic fitness and even chronic disease or allergy history have all been associated with increased injury risk in large runner cohort studies. Sleep, recovery, nutrition and — for female athletes in particular — energy availability and menstrual health, also play a meaningful role, especially in relation to bone stress injuries.
Load and Training Errors
As we said, often the most important factor for running injuries is overloading. Rapid changes in training volume or intensity are generally seen with overuse injuries. The tricky thing though is injuries or symptoms may not present straight away. For many runners we treat, their symptoms may present up to 3-4 weeks after they have done a rapid spike in their running loads.
These days, there are multiple app’s and downloadable running programs to guide training for long distance (10km, marathon and 1/2 marathons) and for people new to running (couch to 5km’s). There is also the popular “10% rule” (don’t increase weekly mileage by more than 10%) which has been a mainstay of running advice. However, the research here is more nuanced than the folklore suggests:
- Systematic reviews have found no strong evidence that a strict 10% weekly cap specifically prevents injury.
- Metrics like the acute:chronic workload ratio have shown limited predictive value in several running-specific studies.
- Recent large-scale research instead points to sudden spikes in a single session — for example, a long run substantially longer than your recent longest run — as a more meaningful risk factor than gradual weekly increases.
The practical takeaway is less about rigid percentage rules and more about avoiding abrupt, large jumps in any one run. It is great to follow a running plan or guide, but it is important always to be flexible and listen to your body each week. Where we often see mistakes being made, is where you may miss a session or week and try to play catch up. If you haven’t been sleeping or not feeling well, then don’t do a planned strenuous run just take it easy.
What is the Best Management for Running Injuries
Initial Approach
The old “rest completely” model has largely been replaced by relative load management — modifying, rather than eliminating, activity where possible. Protecting the area, optimising loading (rather than complete rest), ice for pain relief, and appropriate compression can help manage the initial phase, but the overarching principle is to keep some form of tolerable loading going wherever it’s safe to do so, since tissues (tendon, bone and muscle) generally recover and adapt better with graded loading than with complete rest.
You should be assessed by a medical professional if:
- Pain persists beyond a few days of modified activity
- Pain is present at rest or disturbs sleep
- There’s focal bone tenderness or swelling (a possible red flag for stress fracture)
- An injury doesn’t improve despite appropriate load reduction
- You notice any change in sensation, significant swelling, or an inability to weight-bear normally after an acute injury like an ankle sprain
Addressing All Contributing Factors
Although most runners can track their running loads, it is also important to then address all the potential factors that may have led to injury. This is where a proper assessment helps. A skilled physiotherapist, experienced with running injuries will be able assess for weakness, stiffness, poor control, footwear, running technique and also assess your training loads. Some manual therapy or supports (taping, brace) may be indicated for short-term symptom relief.
Rehabilitation Exercises
For most running injuries, exercise will be important for recovery. The specific exercise should match the injury and from what’s found during assessment. It is well known exercise is medicine, and there is strong evidence for different conditions including:
- Progressive eccentric calf loading for Achilles tendinopathy
- Combined hip and knee strengthening for PFPS
- Hip abductor strengthening for ITBS
- Plantar fascia-specific stretching and progressive loading for plantar fasciitis
It’s important to note that everybody responds differently to exercise- so these programs should be prescribed not just copied from social media.
Long-Term Management Strategies
Because a prior injury is one of the strongest predictors of a future one, long-term management isn’t just about resolving the current issue — it’s about addressing the underlying contributing factors (strength deficits, training load patterns, footwear, biomechanics) so the same injury doesn’t recur. A structured, graded return-to-running program, rather than jumping straight back into previous training volumes, is a key part of this.
How to Prevent Running Injuries
Proper Warm-Up and Cool-Down
A dynamic warm-up that gradually elevates heart rate and prepares the muscles and tendons for the loads of running — rather than static stretching alone — helps the body transition into higher-intensity work. A cool-down supports recovery and gives you an opportunity to notice any niggles early, before they become bigger problems.
Strength Training and Conditioning
All runners should be doing other exercise- not just running. There is evidence to show that supervised strength programs do show a meaningful protective effect and can reduce injury risk. I know I am biased, but there is a strong argument for working with a physiotherapist to design a program specific to your needs, rather than following a generic online routine.
Choosing the Right Footwear
While no single “best” running shoe exists for injury prevention, some evidence suggests that softer cushioning may reduce loading rates and injury risk for many runners. Beyond the shoe itself, gradually transitioning if you change shoe type or style (including highly cushioned “super shoes”), replacing worn-out shoes, and prioritising comfort over trends are all sensible, evidence-aligned strategies.
Gradual Training Progression
Rather than fixating on a strict 10% weekly rule, current evidence suggests the bigger risk lies in large single-session spikes — for example, a long run that’s substantially longer than anything you’ve done recently. Build volume gradually, spread increases across multiple runs rather than one big session, and be especially cautious after a break from training, illness, or injury.
Listening to Your Body
Given that a previous injury roughly doubles the risk of a new one, early recognition of niggles — and a willingness to modify training in response — is one of the most protective habits a runner can build. Persistent or worsening pain, pain that changes your running gait, or pain that doesn’t settle with a few days of reduced load are all signals worth acting on early, ideally with professional input, rather than waiting for a minor issue to become a major one.
How SportsFit Can Help
If you’re currently managing a running injury, our team at SportsFit Physio and Health can help with a thorough, evidence-based assessment tailored to your training and goals. We see many runners from Glen Iris, Malvern East and Ashburton, helping them getting back to running along Gardiners Creek or around Central Park. What sets us apart is our experience in treating runners, ability to do a thorough running assessment and video analysis, and use of AxIT strength testing to get accurate results for more tailored exercise programs.
Brad Harrigan
APA Sports & Exercise Physiotherapist
