Common running injuries, and how physiotherapy gets you running again
Shins, Achilles, knees and heels tend to complain when training changes faster than the tissue adapts. The fix is rarely rest alone, which is why the plan matters.
Usually a niggle that graduated
Running injuries rarely announce themselves. Most start as something you notice in the first mile and forget about by the third, then something that turns up earlier each week, then something that is still there walking to the car afterwards. By the time it stops you running it has often been talking for a month.
The common sites are predictable: the front of the knee, the outside of the knee, the shins, the Achilles and the underside of the heel. Hips, calves and hamstrings make up most of the rest. Sudden injuries happen too, usually a calf or hamstring that goes mid-effort, but the gradual ones are far more common.
The pattern of the pain tells you more than the location does. Pain that eases as you warm up and returns afterwards behaves differently from pain that builds through a run, and both behave differently from a sharp, pinpoint pain on a bone that gets worse every session.
Load going up faster than capacity
A recent change in training load is one common contributor to gradual running pain, alongside strength, recovery, previous injury and other factors assessed case by case. Mileage jumped for a race block. Sessions got faster. Hills appeared. Two easy runs became two hard ones without anyone deciding they would.
Capacity is the other half, and it moves too. Strength work that stopped in November, a stressful few months, poor sleep, a change in surface from grass to promenade concrete, or a return after illness all lower what you can absorb while the training plan carries on as though nothing changed.
Cadence, footwear and technique get discussed a lot and do matter at the margins, but they are usually secondary to how the mileage was built. Changing shoes rarely rescues a training block that went up 40 per cent in a fortnight.
What an assessment and treatment involve here
The aim is not only to settle the sore tissue. It is to work out why the load was too much, fix that, and stage the return so the same injury does not arrive again in eight weeks.
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Assessment
Your training over the last few months, not just the last week: weekly mileage, sessions, surfaces, shoes, races on the calendar and what changed before the symptoms started. Then strength and range testing through the foot, calf, knee and hip, plus watching you move and, where it is useful, run.
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Hands-on treatment
Soft tissue work and joint mobilisation where they help settle symptoms and restore movement. Useful, and rarely the thing that fixes a running injury on its own. It buys comfort so the loading work can happen.
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Loading and a return-to-run plan
Strength work for the tissue that failed, progressed on a schedule, and a staged return to running with actual numbers in it: how far, how often, how hard, and what to do about a session that hurts. Most runners keep running through some of this rather than stopping entirely.
Typical aims are a return to your usual mileage without symptoms, and a clearer idea of the load your body currently tolerates. Timescales depend heavily on the tissue involved: tendons and bone take longer than muscle, and you will be given an honest range rather than the one you want to hear.
What to do before you are seen
Reduce rather than stop. Cutting mileage, dropping the hard sessions and flattening the route usually keeps you running while things settle. Complete rest lets a tendon lose the capacity you will need back, and starting from zero is a longer road.
Use pain as the guide. Discomfort that stays low during a run and settles within a day is generally tolerable. Pain that builds through a run, makes you change your gait, or is worse the following morning means the dose was too high.
Keep the aerobic work going in a way the injury allows: cycling, the pool, the cross-trainer. Keep any strength work you already do, because losing it now costs you later.
Two exceptions to all of that. Sharp, pinpoint pain on a bone, and pain that wakes you at night, are worth stopping running for until they have been assessed. The full guide covers what each of the common injuries usually needs.
Running symptoms that need a GP or urgent care
- Get urgent medical advice for a calf that is swollen, warm, red and painful, particularly after a long flight, an illness or a spell of inactivity, since that can be a blood clot rather than a training injury.
- Go to an urgent treatment centre if you felt a sudden snap or a sensation of being kicked in the back of the leg and cannot push off properly afterwards, or if you cannot put weight through the leg after an injury. Those need assessing before any rehabilitation starts.
- See a GP if you have pinpoint pain on a bone that worsens with each run and is sore to touch, especially alongside night pain, since bone stress injuries need a different plan and sometimes imaging. Also worth a GP conversation if you have had persistent injuries alongside changes to your periods, weight or energy levels, because low energy availability affects bone and tissue health in runners of any standard.
Book an assessment
Evening and Saturday appointments sit either side of most training weeks, so treatment does not compete with your running or your job. No GP referral needed.
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