Running Injury Prevention

Running Injuries 

Running is a popular sport that offers numerous physical and mental health benefits, but it can also present significant risk for overuse injuries due to the repetitive nature of the activity. Some of the more Common running o injuries include Achilles tendinopathy, patellar tendinopathy, PFPS , shin splints (MTSS), iliotibial band syndrome (ITBS), Gluteal tendinopathy and plantar heel pain.

The vast majority of overuse injuries will be caused by an imbalance between the load we have been putting on that body therefore what we have been asking the body to tolerate and adapt to vs what it can actually cope with. Getting this balance right can reduce the need for months of physiotherapy, sports therapy or other care.  

Common Overuse Injuries in Runners:

1. Achilles Tendinopathy

Achilles tendinopathy is characterized by pain, stiffness and sometimes thickening in the Achilles tendon at the back of the ankle. Symptoms are often delayed with pain being worse after running after having had a period of inactivity such as being sat for a while or waking up in the morning.

Specific Activities that have higher Achilles tendon loading

• Compression from tight shoes

• Uphill running

• Forefoot running

• Speed work

• Plyometrics

2. Patellar Tendinopathy (Runner's Knee)

Runner knee is characterized by pain and tenderness on the patella tendon often described as aching. Similar to other tendinopathy’s symptoms are often worse after periods of overloading and can sometimes take multiple days for the increased pain to settle.

Specific Activities that have higher patella loading

• Downhill running

• Plyometrics

3. Shin Splints (Medial Tibial Stress Syndrome - MTSS)

Shin splints refer to pain along the shinbone due to impact forces caused by overloading the tibia and the surrounding muscles. MTSS is a spectrum condition meaning we can have mild, moderate or severe changes to the bone such as swelling of the periosteum, bone edema or at worst a stress fracture. MTSS progress through the spectrum and worsen if it continues to be overloaded. 

Activities that increase tibial loading

• Running on harder surface such as road vs grass

• Minimalist footwear (increase ground reaction force)

• Plyometrics

• Heel strike

4. Gluteal tendinopathy 

Gluteal tendinopathy is categorized by a deep aching and occasionally sharper pain on the lateral portion of the hip around the greater trochanter. There is often discomfort to lay on that side as well as pain post activity, 

Activities that increase gluteal loading

• Cross over gait

• Increase in uphill running

5. Plantar Heel Pain (Plantar Fasciitis)

Plantar fasciitis is characterized by pain under the arch of the foot and in the heel, with pain often being worse for the first few steps in the morning.

Activities that increase plantar loading

• Hill running

• Minimalist footwear

• Footwear with a high toe drop

It is important to note that in activities/ footwear / techniques  having increased load on a particular tissue does not make it inherently bad. We must only be aware of the increase and apply that knowledge to the individual situation.

The Role of Training Errors in Running Injuries

• Spike in Volume or Intensity: Many runners jump from a comfortable weekly mileage to significantly higher levels without allowing their bodies time to adapt. This overloads tendons, muscles, and joints. Increasing your volume by no more than 10% per week is a good guide to use.

• Change in Terrain or Speed: Shifting from flat surfaces to hilly routes will load the supporting muscle around the foot, knee and hip more than they do in a typical flat run. To combat this there should be a reduction in mileage to account for the increased demand.

 Speed work will often result in higher loading on tissue at a more lengthened state as well as higher peak forces which you may not be accustomed to. 

• Footwear Changes: A sudden change in footwear, especially switching to more minimalist or maximalist shoes, can alter foot biomechanics. Contrary to popular belief, the injury risk often stems from the abrupt change in load on the muscles and tendons, not the footwear itself. Gradual adaptation is key when transitioning to new footwear styles.

Peer-reviewed studies emphasize that gradual load progression and avoiding sudden shifts in running intensity or environment are critical in preventing overuse injuries (Jordaan & Pritchard, 2020).

The Fundamentals of Recovery: Why It's Critical

Overuse injuries aren’t just the result of faulty training—they also stem from inadequate recovery. In fact, many runners under-appreciate how factors such as sleep, nutrition, hydration, and stress management play a role in recovery from training load.

1. Sleep

Sleep is crucial for tissue repair and overall recovery. A study published in the British Journal of Sports Medicine indicates that athletes who sleep less than seven hours per night are at greater risk of injury (Samolsky Dekel, et al., 2022). Sleep facilitates muscle repair and the replenishment of glycogen stores, critical for energy during runs.

2. Nutrition

Proper nutrition is key for recovery. Protein intake supports muscle repair, while carbohydrates help refuel glycogen. Omega-3 fatty acids and other micronutrients also play a role in reducing inflammation. Nutrient-rich diets with adequate hydration ensure optimal muscle function and prevent cramping or fatigue during training.

3. Hydration

Dehydration can impair muscle function, reduce strength, and lead to premature fatigue. Ensuring proper hydration supports muscle elasticity, which can lower the risk of tendon injuries.

4. Stress Management

Chronic stress elevates cortisol levels, impairs tissue repair, and hampers recovery from physical exertion. Balancing mental and emotional stress with recovery is as crucial as managing training load.

Focusing on Fundamentals, Not Feel-Good Treatments

Runners often invest time in feel-good Physiotherapy treatments like stretching, foam rolling, and massage, believing they will prevent injury. While these methods can offer short-term relief or enhance flexibility, research suggests they do not significantly reduce injury risk (Goom, 2021).

Instead, runners should focus on fundamentals such as:

• Strength training: Building strength, particularly in the hips, core, and lower legs, significantly reduces the risk of overuse injuries.

• Biomechanical efficiency: Improving running form to avoid excess strain on muscles and joints.

• Gradual load progression: Incremental increases in volume and intensity, with a focus on recovery.

Conclusion: Prioritize Recovery and Smart Training

Running overuse injuries often stem from poor load management and inadequate recovery. Runners need to focus on proper training techniques, avoid sudden changes in volume, intensity, and terrain, and ensure they are prioritizing recovery through sleep, nutrition, and hydration. While feel-good treatments may provide temporary relief, it’s the fundamentals—strength training, biomechanics, and proper load progression—that truly prevent injury and keep runners on track.

By addressing these factors, runners can enjoy their sport injury-free and continue progressing towards their goals.