7 Common Running Injuries and How You Can Treat Them

I am going to start off by saying that I’ve had a lot of first-hand experience with injuries in my 30+ year career in running and triathlon. According to Ironman University, 65% of endurance runners experience at least one injury each year. I am using the information I learned from Ironman University to help you recognize and prevent common running injuries, but I am also going to give you my own perspective and what worked for me personally. What works for one athlete might not work for another, but at least I can arm you with information so you can make your own informed decisions. I am not a doctor, PT, AT, or chiropractor, but I sure do have a ton of experience with all of these professionals and their approach to treating and healing injuries. I hope you find my insights helpful.

1. Plantar Fasciitis - Usually this is pain on the bottom of the heel, although I have heard of it showing up in different parts of the bottom of the foot. It is usually worse in the morning. The cause is a pulling on the fascia which causes inflammation and micro tears in the inflamed tissue. Conventional treatment: ice, OTC anti-inflammatories, roll the bottom of your foot with a tennis ball, foam roller or fascia bar. Prevention:strengthen the glutes, hip flexors, and quads. My experience and opinion: I've seen all kinds of foot splints you can get on Amazon to wear while sleeping for this injury. I have not had plantar faciitis, however, if I did I would definitely shoot the tendons with a PRP injection to promote healing of inflamed tissue. I would also gently massage with a percussion gun to bring blood flow and oxygen to the inflamed areas. (You can get a percussion gun for around $100 now as they have come down in price over the past few years.) I would also get some exercise bands and do extension and flexion exercises to help strengthen any muscles of the foot. I worked with one Athletic Trainer who swore by dipping your foot in hot and cold water with epsom salts. If you can take freezing temperatures, Cryotherapy might help. You can do this either by doing whole body or single area treatments. The idea behind Cryotherapy is to take blood flow away from the extremities for a few minutes then when you leave the chamber the oxygen rich blood rushes back to the arm or leg promoting healing. Lastly, along these lines would be BFR (blood flow restriction) therapy. This is where the PT or AT ties a tight band around your extremity to restrict blood flow to the injured area. When the band is released a rush of oxygen rich blood floods the area promoting healing. This can be a little uncomfortable, but it feels really good when the restriction is released. Prevention: Strengthen glutes, hip flexors, quads, and core. Some barefoot walking and running drills are helpful.

2. Achilles Tendonitis- This is usually caused by poor Achilles strength, weakness in the calf muscles, not enough stretching, intense hill running and speedwork. It can take 6 to 10 weeks for an Achilles injury to heal with successful treatment. Conventional treatment: rest, proper nutrition to include vitamin C, manganese, zinc. Keep doing swim and bike but no running unless it's in the pool. Ice, stretching (gently), foam rolling, eccentric calf strengthening are all helpful. Prevention includes strengthening the calf muscles, doing a run gait analysis to see how your foot is striking the ground, and increasing running volume no more than 10% per week. My experience and opinion: I am not going to give you too much here because I have zero experience with Achilles Tendonitis. If I had this injury, I might have it dry needled and then have it injected with PRP to flood the inflamed area with restorative cells. You could probably do local cryotherapy on the area as well.

3. IT Band Syndrome-This is pain on the lateral side just below the knee. Causes include tight hip abductors, internal rotation of the tibia, weak glute muscles, weak core muscles, over pronation of the foot, and valgus knee. Conventional treatment: Only running up to the point of pain or cross training instead of running; stretching. Strengthening the glutes and core with bridges, jump squats and planks is helpful. Prevention: glute and core strengthening, lateral movements such as lunges and lateral band walk, increasing your running cadence and shortening your stride can help. My experience and opinion: I am a huge fan of the PiYo workout which will stretch and strengthen your glutes, hamstrings, hips, hip flexors, and core. I have seen a few videos on foam rolling the IT Band and they tell you to foam roll the entire band, not just the lateral knee area. The percussion gun will bring oxygen and blood flow to the sore inflamed areas on the side of the knee. You could also try dry needling. I would use the loop bands and practice strengthening the muscles of the hips and glutes by doing traveling side squats, monster walk, etc. If all else fails and you still have pain, I would definitely get a PRP injection, especially if you have a race coming up.

4. Runner's Knee or Patella Femoral Knee- I definitely have a lot of experience with this injury. This is constant pain under the knee cap, Sometimes I have sore quad muscles near that area as well. The cause is usually from weak quad muscles, the patella not tracking when bending the knee, or some osteoarthritis in that area. I developed Runner's Knee when I had foot surgery and was non-weight bearing for 6 weeks. (My quad strength went to crap and it took me a while to build it back.) Over pronation, weak glute and core muscles can also cause this condition. Conventional Treatment: foam rolling the quad muscles, strengthening the inner quad muscles with leg lifts, wall sits squeezing a ball between your knees, stretches, and ice. Lots of docs will put a steroid injection in that area but I don’t recommend doing that too often. Prevention: work on strengthening quads, hips, glutes, and core muscles. My experience and personal opinion: When I had to quit riding my bike for 6-8 weeks my quad strength suffered and that's when my knee started hurting. I think I had to adjust to my new gait and how my newly constructed foot met the ground. I started getting regular PRP injections in my knee cap along with prolotherapy. That has been game changing for me. I met with the PT for several weeks and had him go hard on my quads, glutes, and core muscles. Sometimes I would spend the entire hour working out with a BFR band around my thigh. I also studied how kinesiophobia (fear of the pain when going downstairs for example) can actually make the pain worse. I worked on my mind body connection a lot, stopped obsessing over the pain, decreased my anxiety, and worked hard on strength. My knee is pretty much pain free now.

5. Shin splints-This was the first running injury I ever had in my career. I remember being at track in high school and it hurt so much to run. Shin splints occur by increasing run volume too quickly and usually with athletes new to the sport of running. You don't want to let shin splints go for too long without treating them, because you may end up with a stress fracture from the tendons pulling on the shin bone. Conventional treatment: stop running and do non- weight bearing activities such as swimming or biking. Pool running is a good way to keep your cardiovascular fitness up while mimicking the leg turnover of running. Ice, foam roll, massage are all helpful. Prevention is simply not increasing your run volume by more than 10% a week, strengthening the hips and core, and regular foam rolling. You can also add more calcium to your diet and as a preventive check get a bone density scan to see if there are any deficiencies. My experience and personal opinion: Shin splints are painful and inconvenient but treatable. You just have to let your body heal all the way before you start running again. I would definitely strengthen my soleus, gastrocnemius, and tibialis anterior muscle group with heel lifts with a barbell on my knees and exercises along those lines. I am a huge fan of dry needling, especially on the tendons because this sort of breaks down tissue so it has to repair itself to become stronger. For muscle related shin splints the percussion gun can be helpful for bringing blood flow and oxygen to the affected areas. Lastly, I would also try scraping to break up fascia and promote blood flow to the inflamed areas.

6. Piriformis Syndrome- This is characterized by a deep pain in the glute on one side and it can travel down to the hamstrings. When the piriformis becomes too tight it is thought to squeeze the sciatic nerve. The syndrome can also be caused by overpronation and too much internal or external rotation of the knee while running. Conventional treatment: if there is no change in gait it's ok to keep running, but if you begin to favor that leg, it is probably time to rest and cross train. NSAIDs, foam rolling and stretching can bring relief. Prevention usually involves using resistance bands for hip abduction (traveling side squats, monster walk, plyometric jump squats) Planks and fire hydrants are helpful too. The foam roller and percussion gun can help bring blood flow and oxygen to the inflamed tissues, although they are pretty deep in the glute muscle. My experience and personal opinion: From what I have seen, it can be difficult to differentiate between an upper hamstring injury and piriformis syndrome. Sometimes I think it is misdiagnosed in a lot of cases. I didn't have Piriformis Syndrome, but I tore my hamstring pretty well at one point in my career. The injury took a while to heel with lots of rest. The Navy doc who saw me for my injury said to stop stretching it and that that was only making it worse. Later on, it formed some scar tissue which showed up on an ultrasound before I did Triathlon World Championships. My then doc sent me to the PT and we needled my upper hamstring for about a month 2-3X per week. The needling broke up the scar tissue nicely and I felt a lot more mobility in that area with less pain. The foam roller was key in breaking up scar tissue and brining me relief which would also help with piriformis syndrome. Bottom line, it's really hard to differentiate between upper hamstring insertion pain and piriformis pain because they behave the same in my opinion.

7. Pulled Hamstring. I will be honest this injury super sucks and it is common in aging athletes (40's. 50's). You can pull your hamstrings at the insertion where the glute muscle connects to the tendon and pelvis, or lower at the back of the leg above the knee which is called middle 3rd hamstring pull. The upper hamstring injury takes longer to heal than the lower hamstring. The middle 3rd hamstring injury may require you to take a few days off of running but the upper hamstring injury can take several weeks or months. It's best to avoid hills if you have a hamstring injury or choose swimming and biking until the pain subsides. What causes hamstring pulls? Weak hamstrings, too much stretching, weak glutes, weak hip flexors, weak quads, and weak core. Prevention would be strengthening all of these with hip raises, walking lunges, planks, and dumb bell step ups. You can also strengthen your hamstrings with running up hills or stair climbing. Conventional treatment would be foam rolling, massage, heat therapy, and whatever else makes that area feel good. My experience and personal opinion on this is that you should foam roll but not stretch, walk but not run, and completely let that area rest. I have seen athletes get PRP injection in those upper tendons of the hamstrings with some success. If there is scar tissue then dry needling is a must for breaking that up. This injury can become chronic if you don't rest it. Trust me on that one!

I've had lots of experience with injuries myself and with my athletes. I've seen pretty much everything that can happen with running injuries (and others as well!) I hope I have given you some perspective so you can navigate your injuries armed with as much information as possible. The key to remaining injury free is preventing them from happening in the first place. Strength training helps along with workouts like PiYo and Yoga. Basically, anything that increases your flexibility and mobility is going to prevent injury. Make those part of your weekly routine.

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(Source: Ironman University)

Mary Timoney

Ironman University Certified Coach

USA Cycling Coach

ACSM Personal Trainer