Everything You Need to Know About Running Injuries
Are you experiencing pain when you run?
Not sure if you should run through the pain or stop?
Maybe you’ve tried resting but the relief is only temporary. Once you start back to running your pain comes back again.
When you’re a runner, having an injury can be frustrating. It can be hard to know who to turn to for advice and how to get back to running again without pain.
There’s a lot of mixed information out there about running injuries and what to do about them. If you’re reading this, you’re probably a runner who is experiencing or has experienced pain and you’re looking for some answers.
Running injuries are unfortunately very common. The research tells us that up to 80% of runners will experience a running injury each year.
In this blog, I’m going to break down everything you need to know about running injuries so that you can determine what next steps you might need to take to get back to running without pain.
Read on to learn more about:
What Are the Main Causes of Running Injuries?
Running injuries are complex. It’s pretty rare to have only one cause of your injury, unless you happen to twist your ankle, step in a hole, or have some type of accident. Most running injuries are overuse injuries that tend to come on gradually. The pain might come on earlier during your run or linger for the rest of the day after you finish running. You might notice more pain the day after a run or it might start affecting other activities besides running.
The most common cause of running injuries is a training error. This is a broad term for introducing something new to your training too quickly. Your body likely hasn’t had time to adapt, and now some of your tissue is overworked and irritated. Examples of training error include increasing your mileage too quickly, introducing too many speed sessions, or not taking enough recovery time between hard sessions.
Another area that we need to consider is “life stress”. To our body, stress is stress - whether it’s the training stress from a long run or the life stress of an extra long work day. This stress can add up over time and affect our body’s ability to adapt to the loads we are placing on it.
When trying to determine the cause of a running injury, we need to take into consideration everything that’s been going on in your life and training over the last few weeks to months. We often end up finding a “perfect storm” of events happening in your life and training that lead to pain or injury from running.
Want to learn more about what causes running injuries? I wrote a blog about it here.
What Are Common Running Injuries?
There are many different types of injuries that runners experience. The first type is a tendon or soft-tissue injury. These types of injuries typically result in pain that may warm up and feel better as you run but will often feel worse the next day. The second type is a bone injury. Bone injuries often feel worse with running and other high impact activities.
There are many other less common types of injuries, but the main ones seen in runners can include:
Achilles Tendinitis: Also known as Achilles tendinopathy, this is when you get pain in the back of your heel with running. The pain can sometimes “warm up” as you run, but will often become worse after you stop running, or even the next day. Your heel pain may get worse with speed work or hills.
Plantar Fasciitis: This is a common reason for foot pain with running. The plantar fascia is a band of tissue that runs along the bottom of your foot. Often runners will experience pain in the bottom of their heel or arch of their foot. They often report increased pain in the morning for their first few steps.
Patellofemoral Pain: Patellofemoral pain (PFPS) is so common in runners that they nicknamed it Runner’s Knee. This is a pain in and around the knee cap when running. It can also hurt to squat or go down stairs.
IT Band Syndrome: This typically presents as pain is on the outside of the knee. It can be worse with running, cycling or any repetitive bending motions of the knee.
High Hamstring Tendinitis: This can present as pain in the back of the leg or lower buttock when running. Because the hamstring tendon attaches to our sit bone, it can be painful to sit for long periods too. Often speed work and hill sprints can make this pain worse.
Gluteal Tendinitis: Buttock or glute pain with running is commonly seen in runners who have gluteal tendinitis. Other terms for this include gluteal bursitis or greater trochanteric pain syndrome. The pain can be felt on the outside of the hip and can often radiate into the buttock or down your leg.
Bone Stress Injuries: Stress fractures and stress reactions are both forms of bone stress injuries. There are many common areas where runners may get bone stress injuries, including the foot, shin, hip and pelvis. Pain that gets worse with more running, becomes constant throughout the day, or starts to affect your ability to sleep at night are all signs that you may have a bone stress injury.
Shin Splints: Pain along the inside of your shin when running is often described as shin splints. This type of injury is thought to be similar to a bone stress injury and may require some modifications to your training.
Should I Run Through the Pain?
This is one of the most common questions I get from the runners that I work with. Runners are some of the toughest people I know and they’re willing to put up with a lot in order to get their run in. When they start to notice pain that is affecting their ability to run, it can be a cause for concern.
Often they don’t want to see a health care provider because they’re afraid that they’ll be told to stop running.
The good news is that a large portion of running injuries don’t require a total break from running. Sometimes we need to modify your running to a more tolerable level. This is where the following guidelines come into play:
If your pain is tolerable when running (i.e. less than 4/10 on the pain scale) and it remains stable or improves during your run, you are likely okay to continue. After you finish your run, any pain in the area shouldn’t last longer than a couple of hours. You also shouldn’t experience any increases in pain the day after your run.
If your pain is getting worse the more you run, or you have to change the way you are running (i.e. you start limping), then you need to stop running. You may be doing too much or you may have a running injury that requires more rest.
The best way to determine if you should continue running with pain is to speak to a health care provider who works with runners. They can properly assess your symptoms and movement patterns and give you more guidance on whether or not it is safe to run through pain.
How to Prevent Running Injuries
This is the million dollar question. Every runner wants to know what they can do to prevent running injuries. Unfortunately, it’s not always simple. But there are a lot of things that you can do to help reduce your risk of getting injured.
Build Your Training Gradually
A lot of runners run into issues because they try to do too much too soon. This could look like a sudden jump in mileage or too many hard sessions in a row when your body is simply not ready to handle this new training load. If you want to reduce your risk of getting injured, be more conservative with your training progressions and give yourself time to adapt before adding anything new.Volume First, then Speed
I get it, simply running a lot can get boring. Often runners are tempted to start adding intervals, hill sprints, and other high intensity training before they’ve built up their volume. In reality, 80% of your training week should be done at a relatively easy effort while only 20% of the week should be high intensity. Focus on building up the total amount of running you want to do first before introducing higher intensity days.Slow Down
A lot of runners I work with think that they need to be going hard all the time. This is commonly why they start to feel run down, burnt out, and often run into injuries.
Your easy run days should be done at conversation pace. That means if you’re running with a friend, you should be able to maintain a conversation the whole time. You shouldn’t be gasping for air between every word.
By taking your easy days easy, you’re giving your body a chance to recover and be ready for any upcoming harder sessions. You’ll likely also find that you can tolerate longer runs at this easier pace, which will allow you to more comfortably build up your mileage and running stamina.Be Flexible
While it’s great to be able to hit every single training session on paper, sometimes you need to be able to adapt. If you’re going through a particularly stressful week or you haven’t been sleeping as well as usual, now is not the time for high intensity work. You may be better off cancelling that workout and heading out for a few easy miles instead. Your ability to adapt your training plan based on your current needs will help you to reach the start line feeling healthy and happy.Prioritize Recovery
Recovery should be a part of your training plan. That may mean a day of complete rest every week. It may mean planning an extra easy run day before your next hard training session. It also means prioritizing sleep, nutrition and hydration after those hard sessions.
In order for our bodies to adapt to the load we place on them during a hard workout, they need to rest and recover. This is where the adaptation occurs that allows our tissue to get stronger.Be Realistic
This is an important rule of thumb for runners who are returning after a long break from running, whether because of injury or otherwise. It is tempting to compare ourselves to our previous performances and expect to be hitting those paces right away. By not accepting the reality of where our current fitness is, we often end up overreaching in workouts. This is a recipe for injury.
Being realistic about your current running ability will help you to improve your fitness in a more sustainable way. Eventually, with consistent training at a more tolerable level, your body will adapt and you can get back to those faster paces again.
Is My Running Form Causing My Injury?
Believe it or not there is no perfect running form. Even the elite runners have varying different styles of running. With that being said, how you run may be impacting how you load certain tissues in your body.
If you are experiencing pain when you run, a running gait assessment can be helpful to determine if you may be putting extra stress on that area of your body when you run. Often there are simple cues and drills that you can do to help improve your running form.
One common finding during a running assessment that has been connected with increased injury risk is over-striding. When you land with your foot well in front of your body, you are introducing a lot of braking forces into the mix. This can increase the load in areas such as the knee, hip and shin. It can also reduce your efficiency.
Remember that running injuries are complex and your running form is not likely to be the ONLY cause of your pain. While addressing your form can be helpful in certain situations, the best treatment approach for running injuries often requires several different strategies.
What about my foot position?
A lot of runners have heard that running with a heel strike is bad. From what the research tells us, our foot position often doesn’t matter quite as much as where our foot is landing relative to our body (see above about over-striding).
Throughout a race, we may even end up shifting our foot strike pattern as we become more fatigued. This has even been shown in elite marathoners! They may start out landing more on their midfoot or forefoot, but towards the end of the race they shift to a rear foot or heel-striking position. This has not been shown to have any negative effects on performance or injury.
Another common foot position that gets talked about is over-pronation. Did you know that pronation is a normal part of the running gait cycle? As we land on one foot, our foot has to naturally roll in to absorb the loads of running. It then rolls out to provide a rigid lever for us to push off of. So don’t fear pronation! It is a normal and natural part of your running stride.
Can Physiotherapy Help with Running Injuries?
The short answer is YES! Read on to learn more about HOW.
Physiotherapists are trained to assess the cause of injury, observe your movement patterns, and come up with a treatment plan to help you recover.
One of the most important parts of their assessment is to understand the history of your injury. They’ll ask questions such as “how did this start?” and “what makes it worse/better?” to find out more about the nature of your injury. This helps them to determine what the injury diagnosis could be before they move on to a movement assessment.
By going through a movement assessment, physiotherapists will pick up on any muscle weakness, joint stiffness, or balance issues that may be contributing to your injury.
Once a full assessment has been completed, your physiotherapist should take the time to explain to you what their diagnosis is, what you can do for it, what they can do for it, and how long it may take to get better. They’ll create a treatment plan specific to your needs that may include exercises, activity modification, and/or hands-on treatment.
You should expect to see small improvements to your symptoms over time. At your follow up appointments, your physiotherapist will have a plan to progress your exercises and other treatments to help you reach your goals.
Some physiotherapists have completed extra training specific to running injuries and assessing running gait. If you are a runner with an injury, try to seek out a physio who works with runners regularly. They understand the specific needs of a runner. They can work with you to more specifically modify your training or provide cues to help you work on your running form.
The Rehab to Racing Approach to Running Injuries
At Rehab to Racing, I believe that understanding your injury and how your body responds to training is essential to becoming a better runner. I focus on teaching you about how your injury may have come about and what you can do to manage your pain and symptoms between our sessions. When possible, I’ll also help you to modify your training so that you can continue running while you rehab your injury.
My role as your physiotherapist is not to fix you, but rather to be your guide throughout the rehab process. I don’t believe in creating dependency in my patients. I want you to feel confident in your treatment plan and understand how to adapt your training to avoid recurrence of your injury. Once you are running pain-free and you understand how to progress your training safely, my job is done.
By providing virtual physiotherapy I can connect with runners from all over the province of Ontario. Plus, all of the tools and strategies I offer can be delivered really well through a virtual platform. The majority of running injuries don’t need any hands-on treatment to get better, so you’re not missing out on any special treatments when you participate in virtual physiotherapy. Plus, you can join our sessions from virtually anywhere!
I want to help you find long term solutions to your running injury so that it doesn’t just pop back up again once you’re fully back to training. My hope is that you will take some of the tools you learn from me in physio and incorporate them into your training so that you can reduce your risk of injury and become a more resilient runner.
A testimonial from one of Emma’s running physio patients:
“For years my knee bothered me and eventually it got to the point I had to stop competing, and that’s what led me to meeting with Emma. From the first appointment, she was incredible by not only documenting my full running history but also took the time to understand what my goals were with returning to running. The virtual appointments worked great and I’m happy to say I’ve been able to return to a regular running routine thanks to Emma!”
- Lewis K.
More About Emma Vaillancourt, Running Physio & Coach
Emma Vaillancourt is a Registered Physiotherapist in the Province of Ontario, Canada. As a runner herself, she has a special interest in the assessment and treatment of running injuries. She started Rehab to Racing as a way to provide virtual care for runners, focusing on finding the true cause of injury and working with runners to come back from their injury even stronger.
Emma is also a trained Athletics Ontario Endurance Coach. She approaches her coaching with a focus on long term development and finding joy in the process of training. After all, a happy runner is a successful runner! Emma works with runners of all age levels and abilities as well as all distances. She also works with runners who are returning to training after injury. Her goal is for you to remain healthy and happy throughout her training programs, while still finding success at whatever race distance or goal you have.
Interested in working with Emma? Book a complimentary discovery call today!
These articles are not designed to replace medical advice. If you have an injury I recommend seeing a qualified health professional.
