Common running injuries: prevention and treatment

An accessible and effective form of exercise, running benefits cardiovascular fitness, muscle and bone health, mood, and overall mental wellbeing. However, the repetitive impact involved can place considerable demands on the body, particularly when your training increases more quickly than your muscles, tendons, joints, and bones can adapt.

Many running injuries are related to overuse rather than a single accident. Sudden increases in distance, pace, or hill work, inadequate recovery, muscle weakness, and worn or unsuitable footwear can all contribute. Preparing properly, listening to your body, and responding to pain early can reduce the risk of a minor problem becoming a persistent injury.

It’s also important, if you do suffer an injury, to seek specialist assessment and advice as soon as you can. Proper, timely diagnosis and treatment can help you get back on the road, track, or treadmill as safely and quickly as possible. 

What are the most common running injuries?

The most common running injuries affect the knees, feet and ankles, hamstrings (the muscles at the back of the thighs), and the tibia (shinbone). Some occur suddenly, such as an ankle sprain or hamstring tear, while others develop gradually as repeated loading exceeds the body’s ability to recover.

1. Runner’s knee

“Runner’s knee” is a term used to describe more than one condition. Here, we use it to refer to iliotibial band friction syndrome, or ITB syndrome. This typically causes pain on the outside of the knee.

The iliotibial band is a strong band of connective tissue that runs down the outside of the thigh. Repeated bending and straightening of the knee can irritate the tissues where the band passes the outer part of the joint. The pain may feel sharp, burning, or achy and often begins after running for a distance. It can be particularly noticeable when running downhill, tackling longer distances, or when taking the stairs.

Runner’s knee is commonly associated with a rapid increase in distance, new hill training, regularly running on cambered surfaces, and inadequate strength or control around the hips and knees. Fatigue can also affect the way the leg moves towards the end of a run.

2. Anterior knee pain

Anterior knee pain, also called patellofemoral pain, causes discomfort around or behind the kneecap. It’s sometimes also referred to as runner’s knee, which is why it can be confused with ITB syndrome.

The pain is usually an achy area rather than one precisely defined sore spot. It may be worse when running downhill, climbing stairs, squatting, or sitting with your knees bent for a long time. Some people also notice stiffness, clicking, or a grinding sensation.

The kneecap moves within a groove at the end of the thigh bone as the knee bends and straightens. If the quadriceps at the front of the thigh, together with the hip and gluteal muscles, are not strong or well coordinated enough for your current training load, more stress may be placed on the joint around the kneecap. A sudden increase in running, repeated hills, and changes in movement patterns can all contribute.

3. Patellar tendonitis

Patellar tendonitis affects the tendon connecting the kneecap to the shinbone and usually causes pain in a specific area immediately below the kneecap.

Symptoms tend to develop gradually. The tendon may feel painful or stiff after rest and become sore during or after running, jumping, sprinting or hill training. In some cases, it may also feel thickened or tender to touch.

Patellar tendonitis develops when repeated loading exceeds the tendon’s ability to adapt and repair. High training volumes, a sudden increase in speed or intensity, reduced ankle mobility and insufficient strength around the hips and knees may increase the strain.

4. Ankle sprain

An ankle sprain occurs when one or more of the ligaments supporting the ankle are overstretched or torn. The severity can range from a mildly stretched ligament to a complete tear. For runners, a sprain can happen when the foot rolls unexpectedly on a kerb, pothole, tree root, or uneven section of trail.

Symptoms include:

• pain

• swelling

• bruising

• reduced ankle movement

• difficulty weight bearing

• weakness and instability in the ankle

Seek prompt assessment if your ankle looks deformed, you cannot bear weight, there’s marked tenderness directly over a bone, or the pain and swelling are severe. An X-ray or other imaging may be needed to rule out a fracture or more extensive injury.

5. Achilles tendon strain

The Achilles tendon connects the calf muscles to the heel bone and plays an essential role in pushing the foot off the ground. Although runners may describe their symptoms as an Achilles “strain”, gradual running-related pain is more commonly caused by Achilles tendinopathy, where the tendon becomes painful and less able to tolerate load. Achilles problems often follow a sudden increase in distance, speed work, or hill sessions. 

Symptoms include:

• pain and stiffness at the back of the ankle or heel

• tenderness when the tendon is touched

• swelling or thickening

Stiffness may be most noticeable first thing in the morning or during the first few minutes of a run. Running uphill, accelerating, or climbing stairs can make the pain worse.

6. Stress fractures of the foot

A stress fracture is a small crack in a bone caused by repeated loading rather than by a single major impact. In runners, the metatarsal bones in the middle of the foot are commonly affected, although bone stress injuries can also develop in the heel, ankle, or shin.

Symptoms include: 

• pain concentrated in a specific spot

• pain when walking or resting, in addition to when running

• swelling and tenderness 

Risk increases when mileage or intensity rises too quickly, particularly without enough recovery. Changes in running surface or footwear, poor bone health, and insufficient energy intake to support the training load can also increase the risk of bone stress injuries.

You should seek medical advice quickly if you suspect you have a stress fracture. 

7. Shin splints

Shin splints cause pain and tenderness along the front or inner edge of the shinbone. The discomfort is often spread over a broader area than the very localised pain associated with a stress fracture.

The pain may begin during a run and initially ease with rest. As the problem progresses, it can start earlier, last longer, and interfere with walking or other everyday activities.

Shin splints are usually associated with repetitive impact and commonly follow a rapid increase in running distance or frequency. Hard surfaces, hills, changes in footwear, and insufficient strength or conditioning in the calves and feet may also contribute.

Reducing the aggravating training load and temporarily swapping some runs for lower-impact exercise can help symptoms settle. Calf, foot, and lower-leg strengthening, appropriate footwear, and a gradual return to running can help reduce recurrence. Pain that becomes very focal, persists at rest, or continues to worsen should be assessed to rule out a stress fracture.

8.Hamstring injury

The hamstrings are a group of muscles and tendons that run down the back of the thigh. A hamstring strain or injury happens when some of the muscle fibres are overstretched or torn.

Acute strains are more likely during sprinting, fast acceleration, or a sudden increase in pace. 

Symptoms can include:

• sharp pain at the back of the thigh

• weakness

• tenderness

• swelling

• bruising

• feeling or hearing a pop (in the case of more severe injuries)

Distance runners can also develop proximal hamstring tendinopathy. This causes a more gradual, deep pain near the lower buttock and may be aggravated by running, uphill work, or sitting for long periods.

How to prevent running injuries

It’s not possible to prevent every injury, but good preparation and recovery can substantially reduce avoidable overload:

• increase your training gradually – avoid sudden jumps in distance, pace, frequency, or elevation. Introduce one major change at a time and rebuild cautiously after illness, injury, or a prolonged break

• warm up before you run – begin with 5 to 15 minutes of brisk walking, easy jogging, and dynamic movements. Don’t rely on static stretching alone as your injury-prevention strategy

• include regular strength and conditioning – exercises targeting the calves, quadriceps, hamstrings, glutes, and hips improve the body’s capacity to control and absorb running loads. Balance and single-leg exercises can also support knee and ankle stability

• wear suitable, comfortable footwear – replace shoes once they’re significantly worn, and introduce new shoes gradually. Be equally cautious when changing running surface, adding hills or moving from road to trail running

• make recovery part of your programme – alternate harder sessions with easy or rest days, get sufficient sleep and avoid repeatedly training through significant fatigue. Your body becomes stronger during the rec

  overy between runs, not simply by accumulating more miles

• fuel your training appropriately – eating enough to meet the demands of your training supports muscle recovery and bone health. Persistent fatigue, unexplained weight loss, recurrent injuries or menstrual changes should not be ignored, as low energy availability can increase the risk of bone stress injuries

• respond to pain early – don’t try to run through pain that’s worsening, changing your stride, or continuing after the session. Early assessment and an appropriate adjustment to training are generally easier than managing a problem once it has become chronic

How Welbeck can help

Running injuries can be difficult to diagnose without specialist assessment, particularly when different conditions cause pain in the same area.

At Welbeck, our consultants across orthopaedics, sports medicine, and pain medicine work collaboratively, bringing together individual expertise in bone, tendon, ligament, muscle, and persistent pain conditions. This multidisciplinary approach allows treatment to be tailored to the injury, the runner and their goals — whether that means returning to a weekly social run or preparing for an international ultramarathon.

Where imaging is appropriate, MRI scans are available in-house, alongside X-ray and ultrasound. This can help identify injuries such as stress fractures and more significant damage to muscles, tendons or ligaments, while supporting a prompt and accurate diagnosis.

Treatment may involve activity modification, medication, targeted injections, rehabilitation, or surgery (minimally invasive wherever possible), depending on the condition and its severity. 

Our consultants also work closely with an established network of external physiotherapists, helping patients move smoothly from diagnosis and treatment into a structured recovery programme and safe return to running.