Common running injuries: shin splints, runner's knee, plantar fasciitis and Achilles pain

TUREFF• •0

Most running injuries are overuse injuries. They do not come from a single fall or twist, but from asking a tissue to do a little more than it can recover from, again and again. The good news is that the same thing that causes them, how much load you add and how quickly, is the thing you can control. This is general information to help you recognise common problems; it is not a diagnosis. If pain persists, see a doctor or physiotherapist.

Shin splints (medial tibial stress syndrome)

Where: along the inner edge of the shinbone, usually over a few centimetres rather than one spot.
Typical pattern: aching during or after runs, common in beginners and after a sudden increase in running, or a switch to harder surfaces.
Watch for: pain in one small, very tender spot on the bone, pain that is there when walking or at rest, or pain at night. These can point to a stress fracture and need a medical assessment, not more running.

Runner's knee (patellofemoral pain)

Where: around or behind the kneecap.
Typical pattern: worse on downhills, stairs, squatting, or after sitting for a long time with knees bent.
Often linked to: rising mileage too quickly, lots of downhill running, and weakness in the hips and thighs. Strength work for glutes and quadriceps is a common part of treatment.

Pain on the outside of the knee, especially a sharp pain that starts at a predictable point in a run, can be a different problem (often iliotibial band irritation) and is worth getting assessed.

Plantar fasciitis (plantar heel pain)

Where: the underside of the heel, sometimes along the arch.
Typical pattern: sharp pain with the first steps in the morning or after sitting, which eases as you move and returns later.
Often linked to: increases in running or standing time, tight calves, and sometimes worn-out shoes. It can take a long time to settle, so start addressing it early.

Achilles tendon pain

Where: the tendon at the back of the ankle, above the heel, or where it attaches to the heel.
Typical pattern: stiffness first thing in the morning and at the start of a run, which may ease as you warm up.
Often linked to: sudden increases in hills, speed work or mileage, or a quick switch to lower or minimal shoes.
Get urgent help if you feel a sudden snap or a sensation like being kicked in the back of the leg, or cannot push up onto your toes. That can be a tendon rupture.

Load management: the main prevention

Increase gradually. Raise weekly distance or time in small steps, and only add one thing at a time: more distance, or more speed, or more hills, not all three.
Plan easier weeks. Every few weeks, cut back for a week to let your body consolidate.
Keep most running easy, at a pace where you can talk.
Respect rest days and sleep, when repair actually happens.
Change one thing at a time: new shoes, surfaces and plans all shift load.
Do strength training twice a week. Calf raises, squats, lunges, step-ups and hip exercises make tissues more resilient.

What to do when something hurts

A useful rule of thumb many physiotherapists use: mild discomfort that stays mild during a run, settles soon afterwards and is no worse the next morning may allow you to keep running at a reduced load. Pain that increases as you run, changes the way you run or walk, or is worse the next day is a signal to stop and rest.

Reduce or pause running, and swap in pain-free activities such as cycling or swimming to keep your fitness.
Return gradually, starting below where you were when the pain started.
Do not rely on painkillers to run through pain.

When to see a professional

Pain lasting more than a week or two despite rest.
Pain at rest or at night, swelling, or pain in one bony spot.
Pain that keeps coming back every time you build up.
Any sudden injury, numbness, or inability to put weight on the leg.

A doctor, sports physiotherapist or podiatrist can find the cause and set out a return-to-running plan. Have you dealt with one of these injuries? Share how you recovered, or ask about your own niggle, in the comments.