How to recognise common running injuries, and what to do about each
Five that account for most of what stops runners: what each one feels like, the sensible first response, and the point at which it needs looking at properly.
Almost all of these are load problems
Gradual running injuries share one story. Load went up, or capacity went down, and the gap between the two showed up in whichever tissue was closest to its limit. Mileage jumped for a race block, easy runs stopped being easy, strength work quietly disappeared in the winter, or you came back from a fortnight ill and picked up where you left off.
That is why "rest it" so rarely works on its own. Two weeks off calms the tissue down and does nothing about the reason it was overloaded, so the injury returns at roughly the mileage it appeared at last time. The useful version is reducing load enough to settle symptoms, building the tissue's capacity, then staging the return.
The descriptions below are the typical patterns rather than a way of diagnosing yourself. Several of these overlap, and more than one can be running at once.
Runner's knee
Pain around or under the kneecap, felt on downhills, on stairs, when squatting, and often after sitting for a long time with the knee bent. It usually warms up a little into a run and comes back afterwards. Rarely swollen, rarely dramatic, and very common.
Early response: cut the downhills and the volume rather than stopping, drop deep knee bending for a while, and start hip, glute and quadriceps strength work. This one responds well to strength and badly to waiting.
Get it assessed if it is not improving after two or three weeks of reduced load, if the knee swells, gives way or locks, or if it is stopping you running at all.
ITB syndrome
Sharp or burning pain on the outside of the knee that tends to arrive at a predictable point in a run, often the same distance each time, and can become bad enough to stop you. Downhills and cambered roads make it worse, and the promenade being flat is one reason local runners sometimes get away with more.
Early response: shorten runs to below the distance that triggers it, avoid consistent camber, and build hip and glute strength. Management depends on the cause and assessment findings. Training load and hip or thigh strength may be relevant, while stretching alone is unlikely to answer every case.
Get it assessed if the distance you can run before it bites is shrinking week by week, or it has not shifted after a few weeks of sensible reduction.
Shins, Achilles and heel
The three that runners most often try to train through, and the three where training through it costs the most time.
Shin splints
An ache along the inside edge of the shin bone, sore to press along a stretch of several centimetres, worst at the start of a run and often easing slightly as you warm up. It classically shows up after a jump in mileage, a switch to harder surfaces, or a return to running after a break.
Early response: reduce mileage significantly and keep the aerobic work going on a bike or in the pool. Build calf and foot strength, and rebuild running volume more slowly than feels necessary. Increases of roughly ten per cent a week are a reasonable rule of thumb, not a law.
Get it assessed if the pain narrows to a single sore point on the bone rather than a spread along it, becomes sore to touch at rest, or wakes you at night. That pattern can indicate a bone stress injury, which needs a different plan and sometimes imaging.
Achilles pain
Stiffness and pain in the tendon above the heel, worst for the first steps in the morning and at the start of a run, sometimes easing as you get going and returning later. The tendon can feel thickened, and hills and speed work usually aggravate it.
Early response: keep running at a reduced volume if the pain stays low and settles within 24 hours, drop the hills and the fast sessions, and start progressive calf loading. Tendons respond to load rather than rest, but they respond to the right amount of it, and complete rest tends to leave you weaker than when you started.
Get it assessed if it is not improving over a few weeks, if morning stiffness is getting worse rather than better, or if you felt a sudden snap or a sensation of being kicked in the back of the leg, which needs urgent assessment the same day.
Plantar heel pain
Pain under the heel, worst for the first steps out of bed or after sitting, easing as you move about and often returning towards the end of the day. Sometimes described as standing on a stone. It is a tissue-overload problem more often than an inflammation one, which is why the older advice to rest and ice it rarely finishes the job.
Early response: reduce running volume, keep off hard flat floors in bare feet, and start calf and foot strength work. Supportive footwear during the day helps some people considerably.
Get it assessed if it has been going for more than a few weeks, if it is spreading rather than settling, or if there is numbness or pins and needles in the foot alongside it.
The first fortnight, in general terms
Reduce, do not stop. Take the volume down to a level that keeps symptoms low, drop the hard sessions, and flatten the route. Complete rest lets the tissue lose the capacity you are about to need, and starting again from nothing is a longer road than easing off.
Judge it by what happens afterwards. Low-level discomfort during a run that settles within 24 hours is generally acceptable. Pain that builds through the run, changes your gait, or is worse the next morning means the dose was too high, so drop it further and build again more gradually.
Keep the aerobic work going in whatever form the injury allows, and keep or start strength work. Two or three sessions a week of calf, hip and glute work is the single most useful habit for staying in one piece across a training year.
Then rebuild deliberately. Add distance or intensity, not both in the same week, and hold each step long enough to know it was tolerated before taking the next one.
Signs that need medical advice rather than a training tweak
- Get urgent medical advice for a calf that is swollen, warm, red and painful, particularly after a flight, an illness or a spell of inactivity. Go to an urgent treatment centre if you felt a sudden snap in the back of the leg and cannot push off, or if you cannot weight-bear after an injury.
- See a GP for pinpoint bone pain that worsens with every run, is tender to touch at rest and disturbs your sleep, since bone stress injuries are managed differently and sometimes need imaging. Numbness, pins and needles or weakness in the leg or foot also belong with a clinician rather than a training plan.
- It is also worth a GP conversation if injuries keep arriving alongside changes to your periods, your weight or your energy levels. Low energy availability affects bone and tissue health in runners at every standard, not only at the sharp end.
Book an assessment
If it has been grumbling for more than a few weeks, an assessment is usually quicker than another month of guessing. Evening and Saturday appointments sit either side of most training weeks.
Call Deborah WhatsApp Running injuries treated here Call, text or WhatsApp 07305 447682