Why running injuries are so common
Running is accessible and popular. According to some estimates, around half of recreational runners experience an injury each year, most of them related to overuse rather than a single accident. These injuries tend to build up gradually when mileage and intensity increase faster than the body’s ability to adapt. Underlying factors like tight hips, weak glutes, poor running mechanics, old footwear and running exclusively on hard surfaces can also add strain to the lower limbs. Rest alone rarely solves the problem because it does not address why the pain started in the first place. Lasting relief requires understanding the root causes and helping the body move and adapt better over time.
Running-related injuries are seldom isolated to the painful spot. The body works as a chain from the feet through to the hips and trunk, so limited hip mobility, weak core muscles or poor foot control can all affect the way force is distributed with each step. Strengthening, mobility and gait retraining are therefore key components of injury rehabilitation. With the right guidance, most runners can recover fully and return to running stronger and more resilient.
Below are seven of the most common running injuries, with tips on how a physiotherapist can help you recover and prevent future flare-ups.
Patellofemoral pain (runner’s knee)
Runner’s knee describes pain around or behind the kneecap that often worsens when running downhill, going up or down stairs, or sitting for long periods with the knees bent. It is usually caused by repetitive load and can be linked to muscle imbalances or poor alignment that cause the kneecap to track slightly off course. Weak hip abductors and poor control through the thigh allow the knee to roll inward with each stride, increasing pressure at the patellofemoral joint. A physiotherapist can assess how your hip, knee, and foot work together, test muscle strength and flexibility, and evaluate your running technique. Treatment may include strengthening the glutes and quads, improving hip and ankle mobility, taping the kneecap to guide it into a better position and gradually returning to running with gait cues and cadence changes. Many runners benefit from exercises such as single-leg squats, step-downs, and side-lying leg raises to improve dynamic knee control.
Iliotibial band (ITB) syndrome
The IT band is a thick band of connective tissue running from the hip to the outside of the knee. When it becomes irritated, runners feel sharp or burning pain on the outside of the knee that typically builds during a run and eases with rest. ITB syndrome often occurs when the band rubs repeatedly against the outer part of the knee due to poor control of the hip or knee, a rapid increase in mileage or running on a sloped surface. Physiotherapy focuses on reducing irritation and addressing the underlying causes. Hands-on techniques may reduce tension in the IT band and surrounding muscles, but the long-term solution involves strengthening the hip abductors and external rotators, improving foot and ankle stability and adjusting running technique. Cross-training and gradually returning to running on varied terrain can also help prevent recurrence.
Medial tibial stress syndrome (shin splints)
Shin splints describe aching or sharp pain along the inside border of the shin, often triggered by high-impact running or a sudden increase in training volume. The pain may build during exercise and ease with rest. If left unaddressed, shin splints can progress to a stress fracture, which requires longer rest. A physiotherapist will look at your training history, running mechanics and footwear. Treatment may include relative rest from high-impact activity, taping or orthotics to reduce load, specific calf and foot strengthening exercises and gradually returning to running with shorter, more frequent runs. Exercises like calf raises, toe-taps and balance work can help strengthen the lower leg and improve shock absorption.
Stress fractures
Stress fractures are different from the usual post-run ache. They tend to feel more specific, often as a deep pain in one spot that becomes more noticeable the longer you run. In some cases, it can start to hurt when walking or even when resting, which is a sign it needs proper attention.
They happen when the bone has been asked to absorb more load than it can recover from. That might come from a sudden jump in mileage, too much speed work, not enough rest, changes in footwear, low energy availability or underlying issues with bone health. Common areas for runners include the shin, foot, femur and pelvis.
This is not the type of injury to simply “run through”. A stress fracture usually needs a clear diagnosis, and imaging may be required to confirm what is going on. Early management often involves reducing impact for a period of time so the bone can heal properly.
Physiotherapy is useful because recovery is not just about waiting for the pain to settle. A physio can help you maintain fitness with suitable cross-training, review your training load, check for strength or mobility issues, and plan a gradual return to running. As symptoms improve, they can introduce progressive strengthening and controlled impact work, so the bone, muscles and tendons are prepared before you start building mileage again. Footwear, running surfaces and recovery habits may also need reviewing to reduce the risk of the same issue returning.
Plantar fasciitis
Plantar fasciitis causes sharp or stabbing pain under the heel or arch, particularly with the first steps in the morning or after periods of rest. It is often linked to tight calf muscles, poor ankle mobility, excessive pronation (the foot rolling inward) or a sudden increase in mileage. Physiotherapy aims to reduce irritation of the plantar fascia while addressing contributing factors such as weak foot muscles or calf tightness. Treatment usually starts with calming things down, then rebuilding the foot’s ability to cope with load again. That might mean working through the calf, ankle and sole of the foot to reduce stiffness, then adding exercises that strengthen the smaller muscles that support the arch.
A physiotherapist can also look at whether your footwear is helping or making things worse. For some runners, a temporary change in shoes or added support can make day-to-day movement more comfortable while the irritated tissue settles.
Once symptoms are improving, the focus shifts to getting the foot ready for impact again. That might include calf raises, balance work, controlled hopping or other progressive exercises that prepare the plantar fascia for running. Reformer or mat-based foot-strengthening work can also help improve arch control, so the foot is better able to absorb and manage load when you return to training.
Achilles tendinopathy
With Achilles problems, the first sign is often stiffness rather than pain. You might feel it at the back of the heel or lower calf when you first get up in the morning, or during the first few minutes of a run.
Some runners find it loosens off once they are moving, which can make it easy to dismiss. The problem is that it often returns, either later in the day or after training, especially if hills, speed work or extra mileage have been added too quickly.
It is usually a sign that the tendon is struggling with the amount of load being placed on it. Hill running, speed work, a quick jump in mileage, tight calves, poor ankle mobility or a change in shoes can all play a part.
The first step is usually to calm the tendon down without stopping all movement completely. A physiotherapist can help you adjust your training load, reduce the movements that are irritating it, and introduce strengthening at the right level. Calf raises are often part of the plan, but the timing, range and difficulty need to be right for the stage of recovery.
As symptoms settle, the focus shifts to rebuilding the tendon’s capacity. That might include progressive calf strengthening, ankle mobility work, balance exercises and a gradual return to running. A physio may also look at your cadence, stride, footwear and hill work to see where extra strain is coming from. The aim is not just to get rid of the ache, but to make the tendon more prepared for the demands of running again.
Hamstring strain
A hamstring strain is usually easier to spot than a slow-building niggle. It often comes on suddenly, with a sharp pain, a pulling or gripping sensation at the back of the thigh. Runners may notice it during sprint work, hill sessions, faster intervals or when pushing off quickly to change pace.
The severity can vary. Sometimes it feels like a mild twinge, and you can still walk fairly normally. Other times, it can be painful to put weight through the leg, bend the knee or lengthen the hamstring.
In runners, hamstring strains are often linked to a mix of fatigue, previous injury, poor warm-up, limited hip mobility or a strength imbalance between the hamstrings, glutes and quads. It is also common for the hamstring to take on too much work if the glutes are not contributing properly.
Physiotherapy helps by first working out what kind of strain you are dealing with, rather than treating every hamstring injury the same way. In the early stages, the focus is usually on settling the irritation and getting you moving comfortably again, without asking too much of the muscle too soon.
Once it starts to feel less sore, the rehab can move on to the next stage. That might mean adding more loaded hamstring work, building back into single-leg exercises, and checking how the leg copes with faster running again. The goal is to make sure the muscle is not just pain-free, but strong enough for the pace, hills and sudden changes of speed that often cause the problem in the first place.
Exercises may include bridges, controlled hamstring loading, single-leg work and later-stage eccentric exercises, where the muscle strengthens as it lengthens. A physio will also look at running form, trunk control and training load, so you are not simply returning to the same pattern that caused the strain in the first place.
The aim is not just to get you pain-free. It is to make sure the hamstring is ready for the speed, hills and repeated loading that running demands.
How physiotherapy supports recovery and prevention
Physiotherapists are trained to look beyond symptoms and consider how the whole body moves. When dealing with running injuries, they assess joint mobility, muscle strength, flexibility, balance and running mechanics. They also consider external factors like training load, surfaces, footwear and rest. Research suggests that injury prevention programmes for runners often include strengthening the core and hip muscles, individualising training volume and incorporating alternative exercise and recovery strategies. Runners also benefit from shock-absorbing insoles, appropriate footwear and graduated running programmes. Gait retraining, such as adjusting foot strike or cadence, can reduce landing impact and help prevent injuries. Physiotherapists can advise when and how to make these changes so the body has time to adapt.
At Ten, we take this a step further; our Circle of Care integrates physiotherapists, Reformer Pilates instructors, clinical exercise specialists and massage therapists, all of whom share information about your assessments and progress. This means your recovery plan doesn’t happen in a silo; it evolves as you regain strength and confidence. You might start with hands-on physiotherapy to settle symptoms and restore mobility, move into tailored Pilates sessions to build strength and control, and finish with progressive conditioning to return you to running stronger than before.
Staying injury-free
You cannot prevent every running injury, but you can reduce the chances of the same problems coming back. A few simple habits can make a big difference, especially if you are building mileage, training for an event or returning after time out.
- Build gradually: Increase weekly mileage by no more than about 10% and include rest days to allow tissues to adapt. Avoid making several changes at once, such as speed, distance and terrain.
- Strength train: Include hip, glute, core and calf strengthening in your routine. There is evidence that strengthening the core and hip muscles reduces injury risk in female cross-country athletes.
- Mix surfaces and activities: Vary your terrain to reduce repetitive stress. Cross-training with activities like cycling, swimming or Reformer Pilates can maintain fitness while reducing impact.
- Check your footwear: Make sure your running shoes still suit how you run and are not worn out. If your calves, shins or feet keep flaring up, a physio can help review whether different shoes or temporary insoles may help.
- Pay attention to early warning signs: A small niggle is easier to manage than pain that has been building for weeks. If it keeps coming back or starts changing how you run, get in touch with one of our team before pushing through.
Expert advice – Francesco Rizzo – Physiotherapist
“Most running injuries build up over time through a mix of training load, strength, mobility and recovery. A physio can help identify what is driving the issue, then guide you through the right mix of strength work, mobility, gait advice and return-to-running planning.
The earlier you deal with a niggle, the easier it usually is to manage. With the right support, recovery is not just about getting back to running, but coming back with better control, more confidence and fewer setbacks.”
