A Runner’s Guide to Symptoms, Treatment, and Prevention of Common Running Injuries

Updated 2020.

Why does running hurt so much?

As the weather becomes nicer, the runners are coming out of their houses to rack up miles, de-stress, and train for longer races. Even a jogging hobby, however, can result in numerous injuries if proper preventative care isn’t taken. 

Running injuries are typically classified as “overuse” or misuse injuries. There are many different factors regarding high-impact running that might be causing your joints some trouble. We caught up with Core’s very own Dr. Raymond Metz Jr., MD (a running hobbyist himself) to get some of our patient’s often-asked questions answered. In addition, in the video below, Dr. Metz discusses what you can do to prevent injury and stay healthy while running.

What typically causes pain from running?

There are a number of other reasons your legs might be affected by running such as:

• An abrupt increase in weekly mileage
• Previous injury or an incomplete recovery
• Ignoring early symptoms
• Gear: Older running shoes
• Weight: Higher BMI
• Gender: Men are 1.5x more likely to be injured
• Terrain: Hardness of surface may influence injuries

What are some running red flags?

• Sharp pain when running
• Pain that persists after you stop running
• Pain that makes it difficult to walk
• Swelling in a joint

When should I  see a doctor about the pain I am experiencing?

“I recommend seeing a physician about any injury that lasts longer than a week or if any of the red flags are present,” says Dr. Metz.  

If your running injury isn’t showing any sign of improving after using some basic first aid techniques at home, it might be time to come in. 

Do you have any tips for avoiding injury?

“I recommend drinking water before, during, and after running. Most people will never burn enough calories or sweat enough to truly need a high-calorie sports drink. Those drinks are loaded with extra sugar that people don’t need,” says Dr. Metz. “Water is all that is needed up to an hour of vigorous exercise. After an hour, it’s ok to start working in some electrolytes and carbs.”

Dr. Metz also recommends:

• Getting a full night of sleep
• Listening to your body
• Warming up through dynamic stretching before and after a run
• Putting ice on any inflamed areas
• Gradually planning to increase your mileage

What are some common running injuries, and what can I do?

Plantar Fasciitis

Symptoms: Pain and local tenderness beginning at the heel and radiating to arch, heel pain with the first step of the day, sore at the beginning of a run that decreases during a run.

Causes: High arches or flat feet, tight calf muscles, improper shoe wear, over or under pronation, strength imbalances, leg length discrepancy.

Solution: Ice massage after running, have shoes evaluated, orthotics, stretching calf muscles, night splint in extreme cases, Astym® or Graston®, Dry Needling.

Shin Splints

Symptoms: Soreness along inside or outside of shin/tibia, pain at the beginning of a run that decreases during a run, soreness afterward.

Causes: Overpronation, running in old shoes, running on concrete or asphalt, training errors, poor hip/core strength.

Solution: Adjustment to running form, strengthening exercises for hip and lower leg muscles, correct overpronation, replace old shoes, run on softer surfaces, Astym®, Graston®, Dry Needling.

Achilles Tendinitis

Symptoms: Pain with possible swelling, heat, and redness over the tendon, stiff and painful after running/activity, calf muscles may feel tight.

Causes: Tight calf muscles, running steep hills, increasing mileage too quickly, improper shoe fit, general overuse, poor hip/core strength.

Solution: Decrease mileage, ice, calf stretching, shoes with shock-absorbing features, calf strengthening.

Iliotibial Band Syndrome

Symptoms: Sharp or irritating pain along the outside of the knee, better at the beginning of run but becomes progressively worse, pain often makes you stop running.

Causes: Tight or weak hip musculature, bowed legs, overpronation, leg length discrepancy, hard downhill running, excessive speed work, running on banked surfaces, crossover gait pattern.

Solutions: Rest, stretching, ice, run on soft surfaces, shoes with ample heel support and rearfoot cushioning, strengthening to correct muscle imbalances, adjustment to running form, Astym®, Graston®, Dry Needling.

Patellofemoral Pain Syndrome

Symptoms: Deep, dull ache under the kneecap, worse when ascending/ descending stairs, worse with downhill running, stiffness after prolonged sitting with the knee bent.

Causes: Direct traumatic injury, imbalance of quadricep muscle strength leading to improper tracking of the patella in the trochlear groove, poor flexibility, poor core strength, overuse, excessive pronation, weak hip musculature.

Solutions: Ice, correct muscle imbalance, taping of the patella (knee cap) to assist with tracking, stretching.

Physical Therapy Options

What is Physical and Occupational Therapy?

Physical/Occupational Therapists are the movement experts who treat people of all ages and abilities, helping them improve and maintain function and quality of life. Individual treatment plans are created to work towards and achieve the patient’s goals to improve their mobility, function, fitness, sports performance, recover from surgery, minimize the need for surgery, or decrease pharmaceutical use.

While opioid painkillers do mask pain, they don’t solve the root of the problem. The CDC does not recommend painkillers be the first course of action.

Patients should choose physical therapy when:

1. The risks of opioid use outweigh the rewards
2. Patients want to do more than mask the pain
3. Pain or function problems are related to low back pain, hip or knee osteoarthritis or fibromyalgia
4. Opioids are prescribed for pain.
5. Pain lasts 90 days or longer