The Five Most Common Running Injuries (And How to Treat Them!)

According to a report by the Sports Council, jogging is the most popular sport in Singapore. With this in mind, and the fact that the 2015 Standard Chartered Singapore Marathon is fast approaching, we’ve compiled a list of the most common running injuries. So whether you’re a regular runner or a running rookie, this article should boost your chances of staying injury free throughout your training.


5 most common running injuries


1 - Runner’s knee

Patellofemoral pain syndrome (PFPS), also known as “runner’s knee”, is the irritation of the cartilage on the underside of the kneecap. Symptoms include an aching pain in the knee joint, particularly at the front of the knee around and under the kneecap. There is often tenderness along the inside border of the kneecap with swelling sometimes occurring after exercise. Knee pain accounts for 40% of all running injuries.

Runner’s knee typically flares up as running intensity increases, during or after long runs. It may also be worse after extended periods of sitting, or while descending hills and stairs.

Anyone with biomechanical factors that put extra load on the knee is vulnerable to runner’s knee, with risk factors including over pronation of the foot (foot rolls inward excessively) and weak muscles around the hip and knee. This reduced muscle strength can result in incorrect tracking of the kneecap over the femur bone resulting in damage or irritation of the underlying cartilage. External factors such as running surface and improper footwear can also contribute to the problem.

Treatment and rehabilitation is based around reducing pain, identifying the causes and strengthening or re-training muscles which may have contributed to the injury.


2 - Plantar Fasciitis

As we discussed in one of our previous blogs, plantar fasciitis refers to an inflammation in the plantar fascia, which causes pain under your heel and often radiates into the arch of your foot. This painful sensation can range from annoying to excruciating and can account for up to 15% of all running injuries.

It usually has a gradual onset of pain, with tenderness felt under and on the inside of the heel. Pain is usually worse on your first few steps in the morning but eases as the foot warms up. Pain then tends to return later in the day or after exercise.

Runners with very high or very low arches are usually more vulnerable. Other runners at risk would be those with extreme pronation or supination (foot rolls outward excessively), those wearing improper footwear and those who increase their running distance too quickly.

Recovery time can range from three months to a year, but six months is more likely the norm.


3 - Achilles Tendinitis

Achilles tendinitis is an overuse injury causing pain, inflammation and/or degeneration of the achilles tendon - the thick band of tissue that attaches the calf muscles to the heel bone. It makes up about 10% of all running injuries.

Symptoms can be either acute or chronic. An acute case may develop over a few days, is usually more painful and can limit activity. Chronic injuries will come on gradually over a few weeks, not necessarily preventing activity.

The achilles tendon may be painful and stiff at the start of run and first thing in the morning. As the tendon warms up the pain will go away, only for it to return later in the day or towards the end of a long run.

An increase in activity, either running distance, running speed or a sudden change to running up hills can all contribute to this condition. Tight and/or weak calf muscles or over pronation of the foot can be risk factors, as these put increased strain on the achilles tendon.

If you deal with an acute case properly, a few days rest with the correct treatment might be sufficient healing time. If you keep running as usual, you could develop a chronic case that is a difficult condition to treat and may take more than six months to go away.


4 - Iliotibial band syndrome

Your iliotibial band (ITB) is a thick band of fascia that runs from muscles at your hip joint and connects to the outside of your knee. When you run, your knee flexes and extends, which causes the ITB to rub on bony points on the hip and knee. ITB syndrome results in pain usually on the outside of the knee or sometimes the outside of the hip, which is caused by friction of the ITB on these bony points causing inflammation. ITB syndrome can be responsible for up to 12% of all running injuries.

ITB syndrome has a gradual onset. It comes on at a certain time into a run and progressively worsens until often the runner has to stop. After some rest the pain may go, only to return when you begin running again. Running, particularly downhill running, normally aggravates the pain. Pain may also be felt when flexing and extending the knee, which may be made worse by pressing the tender bony point on the outside of the knee.

It may develop in runners who suddenly increase their running distance. A naturally tight ITB may make someone more susceptible to this injury, while weak hip muscles are also thought to be a significant factor. Other risk factors include a leg length difference, runners who over pronate, and poor foot biomechanics.


5 - Shin splints

Shin splints is the common name often given to pain over the inside lower part of the tibia or shin bone. Also known as medial tibial stress syndrome, it is as a result of forces from the muscles of the lower leg pulling on the tissue surrounding the bone resulting in inflammation and pain. This makes up about 15% of running injuries.

There is usually pain at the start of exercise which often eases as the session continues, only to worsen later in the training session or afterwards. Symptoms are often worse the next morning.

Shin splints are common among new runners and those returning after an extended layoff. They're a sign that you've done too much, too quickly.

Biomechanical factors, such high or low arches, over pronation and over supination of the feet can increase the stress on the soft tissues of the lower leg, resulting in pain and inflammation. Other risk factors include running in improper footwear, running on hard surfaces and a lack of lower limb muscle flexibility.

Left untreated, the muscles will continue to pull, causing further stress to the shin bone. This may cause a crack to form in the bone, resulting in what is known as a stress fracture. The pain will progress to the point where it is noticed more during the run, and will result in a longer time away from running. It's possible to prevent a stress fracture by responding to the developing problem: stop running and see a physiotherapist.




Top tips to reduce the risk of injuries


Wear correct/proper footwear

Many runners get excited about starting a training program however they make the mistake of grabbing their favourite pair of old sports shoes and then wonder why they get foot or knee pain two weeks into their program. Its recommended that you replace your running shoes every 500 miles (that’s every 800 kilometers), if not sooner! You should make sure you get a good pair of running shoes BEFORE you start your training program.

Picking the right shoe is key to ensuring comfort, performance, and remaining injury free when you run. So it’s probably worth dropping into a specialty running shoe store, where the staff can help you figure out which shoe is right for you. Things to consider when buying a new pair of running shoes include the type of running, the terrain type, what sort of support your foot needs, the heel to toe drop of the shoe, any current injuries and of course the fit and feel of the shoe. Unfortunately for your bank balance, you usually do get what you pay for when it comes to running shoes.

We have previously written a blog article as a guide to buying a running shoe - to read it, click here.


Warm up and cool down

Always take time to warm up and stretch, as cold muscles are more prone to injury. Warm up with very light jogging for 5 minutes. Research has shown that dynamic stretching is more beneficial before exercise. Then slowly go through some dynamic stretching for 5 minutes. Post exercise stretching can help to reduce muscle soreness and to keep muscles long and flexible. Be sure to stretch after each training practice to reduce your risk of injury. Research has shown that static stretching, holding each stretch for 30 seconds and repeating 2- 3 times, is most beneficial after exercise. Cool down and static stretching should last about 10 minutes.


Increase Slowly

Many people get so excited by training that they go from 3 months on the sofa to attempting a marathon in 4 weeks – this is a recipe for disaster. Make sure you increase your running times by small amounts only - a 5 -10% increase in either distance or time each week is plenty, and it can help you to stay pain free. One of the biggest predictors of injury in runners is rapidly increasing training volume – the more training you do, the greater the risk. Also, you don’t give time for your body to adapt to all the training you do. Don’t be a fool, stick to the 10% rule!


Biomechanical running analysis

Running injuries are often produced or exacerbated due to poor technique, poor biomechanics or the weakness of specific key muscle groups, amongst other things.

At PhysioActive we offer a professional running assessment service where runners of any skill level can come and get their running style analysed. Our running analysis consultation is a biomechanical video assessment of your running, combined with specific musculoskeletal screening tests to assess: running technique, biomechanics and gait pattern when running, shoe wear pattern and key muscle group strength. After evaluating the results we will provide you with the following service: Advice on proper running technique, footwear, an exercise program optimal to you, a DVD recording of you running and a written report. Benefits of this service include: improved running performance, prevention of injuries, optimization of physical condition and optimal training load for your individual goals.


Come get a check-up

One of the biggest predictors for injury is past injury history. A previous injury may have left some scar tissue, reduced range or led to muscle weakness that will greatly increase the risk of injury when you resume training.

At PhysioActive we do more than just treat your sports injury. During the assessment and treatment we do not only focus on the cause of the injury, but also on the sport specific physical demands, skills and movement patterns that are needed for your sport. Our sports physiotherapists incorporate manual therapy, electrotherapy (including ultrasound and shockwave therapy), sports taping and exercise therapy using our cardio, weight machine and free weights in our multi-modal approach to treatment.

To be able to safely and fully return to sports it is essential to regain optimal strength, mobility, stability and coordination. Physiotherapy will help you to achieve these goals and to speed up your recovery.


Suffered an injury?

Please get in touch with us today and book a physiotherapy session with a member of our team.


Thanks for reading!

This post has been written by physiotherapist Liam Mc Ginley.

Tendon injuries in children - What are they and how do we fix it?

The last thing we want our active and growing children to experience is growing pains. Growing pains can be a very broad term, but it generally refers to injuries experienced by adolescents as they advance in both height and weight during puberty. Typically the injury and pain is not caused by a single ‘strain’ or ‘sprain’, but a gradual and insidious onset.

Common injuries that affect tendons in children:

Osgood schlatters disease (pain at the front of the knee)

Osgood schlatters disease

Sever’s disease (heel and Achilles pain)

Sever’s disease (heel and Achilles pain)

Traction apophysitis – rectus femoris (front of the hip joint)

Traction apophysitis – rectus femoris (front of the hip joint)

These conditions all have a few things in common:

  1. All lower limb based
  2. Linked to muscles that provide power when running

The injury process for these conditions is based at the tendon to bone attachment at the site of the growth plate. It relates to the excessive pull of the muscle from the bone, via the tendon. This creates a microtrauma close to the growth plate, a structure that is busy building new bone. This process will only become a problem when the rate of tendon injury is faster than the body's ability to heal the structure. This is often the case in very active children, who are playing multiple sports throughout the week. The tendon simply does not have adequate time to heal itself.

Causes of tendon injuries in children:

Unfortunately its not as simple as just a ‘growth spurt’. The following factors will lead to an increased chance of experiencing these injuries:

  1. Tight muscles

As we grow, our skeleton grows slightly faster than the muscles that attach to it. Essentially, our bones grow quicker than our muscles. This leaves us with tight muscles, relative to the longer bones. This will increase the physical pull and tension from the muscle into the tendon, attaching onto the bone.

  1. Poor biomechanics

Any number of biomechanical faults will increase the load on different tendons.

  1. Sports specific repetition

Simply put, the more sports played, the higher the risk of sustaining such injuries. I often see children who engage in 6-7 sessions per week of running/weight-bearing activity. This is not to say that children should stop doing this amount of activity - my advice to patients and their parents is to listen to your body. If you start to feel any isolated ache or pain in the hip, knee or foot, then seek treatment to remedy the situation. If not, lengthy delays in returning to sports are often required - patients need to be most diligent when monitoring excessive running loads before and after growth spurts.

  1. Weight gain

Part of growing is also increasing your body weight. This will naturally place extra gravitational load through all structures in the body. Continued sports and exercise while this weight is increasing is one of the risk factors for growing pains.


  1. Reduce inflammation around the tendon to bone attachment

This is crucial in the early stages to reduce pain and to reduce the excessive inflammation that can slow healing. Taping is also very helpful. Icing and anti-inflammatories are  commonly used, but have a debatable effect, as shown by literature.

  1. Activity modification

It may be as simple as reducing the amount of exercise that involves running, jumping and other power-based sports. This allows time for the body to heal the affected structures, while corrective massage and strength exercises take hold.

  1. Massage

Reducing the tension on the tendon to bone structure is paramount. This will include a mix of therapist massage and self massage at home with a foam roller and release ball.

  1. Stretch program

Massage mixed with a stretch program will provide the best way to lengthen muscle. This will be a mix of static (very short duration only) and dynamic stretches.

  1. Strengthening to correct biomechanics

Depending on what the physiotherapist assesses as the main muscles that need strengthening, an individual plan will be provided to target the muscles that need the most work. This could include gluteal, core, quads or calf muscles. This will all then come together with exercises that are specific to your sport, to best train the body to return to full fitness.

Overall, the treatment is very successful for children with tendon injuries. If managed correctly, no long-term effects should be experienced. If there's a delay to the treatment or poor management early in the process, lengthy time on the sidelines can be a common and frustrating part of tendon injuries in children.

Problems with tendon injuries in children?

Please get in touch with us today and book a physiotherapy session with Joel and the team.

Thanks for reading!

This post has been written by PhysioActive physiotherapist Joel Bates.

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