Most runners, whether you’re an experienced athlete or a novice, will experience a running injury at some point. Most injuries are caused by overuse from repeated force over a relatively short period of time. This is typically associated with a change in training in which a sudden increase in speed or mileage occurs.
There are a number of common injuries that can affect the foot, leg or hip during your training which are outlined below.
Foot & Heel Injuries
- Plantar Fasciopathy – (commonly known as Plantar Fasciitis) The Plantar Fascia is a thick band of connective tissue which runs along the base of the foot, between the toes and the heel. This structure is a common cause of heel pain which is usually worse after prolonged rest such as when first getting up in the morning, going up stairs or standing for a long period of time. The pain can radiate into the arch of the foot. It can be treated conservatively in 90% of cases by activity modification and strength training. Click here for more information on this condition.
- Bruised heel –heel pain that does not radiate into the arch and gets progressively worse with use and weight bearing.
- Extensor Tendinopathy – The extensor muscles (Extensor Digitorum Longus, Tibialis Anterior & Extensor Hallucis Longus) and their tendons run along the top of your foot, connecting the muscles in your lower leg to your foot. When the muscles contract, they move the foot upwards in a motion called Dorsiflexion which is essential for human locomotion. Injury to these tendons usually arises from overuse and symptoms develop gradually. Pain tends to be located along the top of the foot and increases with exercise, especially running and is often described as an aching pain. It is more likely to occur if your shoes do not fit properly or are laced too tight. In acute cases, rest and ice may be necessary for initial management. Once walking is pain free, a stretching and strengthening programme can be introduced to start the rehabilitation process.
- Stress fracture –this could be of a Metatarsal (foot bone) usually the 5th in the mid-foot area or of the Calcaneus (heel bone). Pain usually comes on gradually and is persistent. The pain gets worse with impact activity. Management typically comprises of an initial period of rest (crutches or a boot may be required) coupled with activity modification for 4-8 weeks. Despite this, condition can be maintained using fitness machines, water running and cycling (Romani et al., 2002). Stress fractures can also be included in the lower leg section as they can also occur in the tibia (shin bone) – for more information click here.
Lower Leg & Ankle
- Medial Tibial Stress Syndrome – (commonly known as Shin Splints) pain is usually located along the postero-medial border of the tibia (the inside of the lower leg). There is usually a gradual onset of pain which can be worse at the beginning of a run and then eases off but the pain then gets worse with use. The duration of the condition is often prolonged and can take 3-12 months of recovery with good Physiotherapy. At Pure, we can assist you with management advice and a bespoke progressive loading programme to safely return to running. Click here for more information on Shin Splints.
- Achilles Tendinopathy –The Achilles tendon is essential for movement, connecting the heel of the foot to the calf muscles. Achilles Tendinopathy is when the tendon is over-used and pain is usually experienced at the back of the heel/ankle. Symptoms commonly occur when running, gradually improves but then starts again when running increases. The pain can be persistent but often improves when running is stopped, only to resume when running is progressively reintroduced. Strengthening exercises are the most important treatment in Achilles pain and your Physiotherapist can provide a loading programme that – over time, can improve the capacity of your tendon to deal with the stresses and strains of daily life and running (Murphy et al., 2018). For more information on this condition click here.
- Peroneal Tendinopathy – This is a gradual onset of pain on the outside of the ankle which has similar characteristics to Achilles Tendinopathy except for location. It can often be mis-diagnosed as a lateral ankle sprain as the tendons from Peroneus Longus and Peroneus Brevis run behind the Lateral Malleolus (the outside ankle bone) to attach under the foot. With relative rest, self-management and a progressive strengthening programme – provided by your Physiotherapist, these tendons can develop a greater capacity to deal with load. Recovery time may vary depending on the nature and duration of symptoms.
- Ankle sprain – these are injuries affecting the ligaments connecting your leg to your foot which can be either on the inside of your ankle (Medial or Deltoid ligaments) or the outside (Lateral ligaments). These injuries usually occur with inversion (foot turning inwards) or eversion (ankle turning outwards), more commonly known by “rolling your ankle”. There are different grading’s depending on the severity of the injury which your Physiotherapist can diagnose. Treatment is based on rest and graded exercise with early stages aiding the reduction in swelling. Click here for more information on ankle sprains.
- Calf strain – pain usually described in the back of the lower leg with a characteristic ‘pull’ of the muscle. It will be acutely painful, possibly with bruising or swelling to the area. Rest and ice will help initially and then your Physiotherapist at Pure can help you with a graded strengthening programme to assist full recovery. More information can be found here.
- Patellofemoral Pain Syndrome (Runners Knee) – pain is usually felt behind the knee, at the front or the side of the knee. It can be caused by muscular imbalance or weakness of the hips and exacerbated by repetitive force during impact which overloads structures at the front of the knee. Stretching and strengthening the appropriate structures is vital for management of this condition. Your Physiotherapist can use other modalities such as manual therapy for symptom relief. Click this link for a more detailed explanation.
- Patellar Tendinopathy “Jumpers Knee” – This can be common in distance runners and presents as persistent pain below the knee cap. Symptoms are exacerbated with load and increases with demand on the knee extensors (Quadriceps). Prolonged sitting, stairs and squatting can all cause irritation. Selective rest to allow tendon healing and a variety of loading programmes as suggested by Malliaras et al. (2013) are all beneficial. Your Physiotherapist at Pure can help you with advice and create a personalised rehab programme. Click this link for more information.
- Iliotibial band syndrome (ITBS) – another injury known as runner’s knee characterised by pain on the outside of the knee which develops gradually and can arise at specific points of running and knee flexion. The ITB is a thick band of connective tissue which runs from the hip muscles down the outside of the thigh to the knee. Pain can be caused by a weakness or tightness in the hip muscles – causing tension at the side of the knee. This condition can be addressed through stretching and strengthening – all of which your Physiotherapist can advise you on.
The knee is a complex joint and many other injuries may occur including injuries to the meniscus, ligament sprains or rupture for example. Your Physiotherapist will provide a thorough examination to identify the cause of your symptoms. We have a more detailed article on this knee pain – click here to view it.
Patellar Tendinopathy Information Video
Hip & Thigh
- Strains – this usually causes a sudden onset of pain due to damaging muscles or tendons in the thigh. Bruising or swelling may develop initially. Depending on the mechanism of injury various soft tissues can be affected. If the pain is at the back of your thigh it is likely due to a hamstring injury, the front is likely to be your quadriceps muscles and the inside of you thigh (groin strain), the Adductor muscles, particularly Adductor Longus. Pain can range from a dull ache to sharp pain, it will often be worse with walking, moving the leg and spasms may occur. Strains are graded depending on the severity of the injury. Ice and rest may is advised initially for 48 hours and your Physiotherapist can assist you with a graded stretching and strengthening programme to optimise your recovery.
- Gluteal Tendinopathy – symptoms pain are typically reported around the outside of the buttock/side of the hip and can spread partially down the outside of the thigh. The tendons involved are those of the Gluteus Medius and Gluteus Minimus. Symptoms usually develop gradually, subsequent to alterations in load, activity, intensity or frequency – making it common in runners. Pain is typically provoked from activity which cause sprain or compression such as laying on that side, going up/down stairs or loading activity. A personalised strengthening programme coupled with activity modification is the gold standard for this condition. At Pure, our Physiotherapists can equip you with the skills and knowledge to manage your symptoms and establish the right exercises and intensity to develop strength. Click here for more information on this condition.
Assessment & Diagnosis
This list of injuries is not exhaustive and your specific injury may not be included and therefore an assessment with one of our specialist Physiotherapists will provide you with a fast and accurate diagnosis. They can also design a rehabilitation and recovery programme bespoke to your specific needs.
If you have been diagnosed with one of the above injuries, please go to the specific condition section on our website which will provide you with more information on the condition and some further self-management techniques. You can also access the patient resources section of our website where we have created a series of recommended exercise programmes. We advise that you consult with your Physiotherapist before trying any of the exercises.
Malliaras, P., Barton, C. J., Reeves, N. D., & Langberg, H. (2013). Achilles and patellar tendinopathy loading programmes. Sports medicine, 43(4), 267-286.
Murphy, M., Travers, M., Gibson, W., Chivers, P., Debenham, J., Docking, S. & Rio, E. (2018). Rate of improvement of pain and function in mid-portion Achilles tendinopathy with loading protocols: a systematic review and longitudinal meta-analysis. Sports Medicine, 48(8), 1875-1891.
Romani, W. A., Gieck, J. H., Perrin, D. H., Saliba, E. N., & Kahler, D. M. (2002). Mechanisms and management of stress fractures in physically active persons. Journal of athletic training, 37(3), 306.