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  • Writer's pictureMurray Kovesy

How to Break Free of Running Related Injuries

Updated: Jan 9, 2020

A long enjoyable relationship with running is often determined by how well you prevent and recover from sporting injuries. For many athletic sports people injuries play a major role in the longevity and success of their careers. Knowing when to reduce mileage, do strengthening exercises, stretches, change exercise routine or to get checked by a physical therapist is a fine art and a hard decision to make at times.

Running does provide great benefits however when your body does not perform the way you want enjoyment can swiftly turn into frustration. Everybody has experienced this frustration with injuries or niggles throughout their training. For a lot of these cases knowledge is power. Having knowledge in basic anatomy and biomechanics is a great way to better understand and manage your injuries. This doesn’t mean you have to enrol at university to study anatomy and physiology but just understanding the basics can help tremendously. Instead of throwing in the towel or hanging up the runners owe it to yourself to better understand and uncover the underlying cause of your injury to prevent ongoing injuries. Take action of the situation to avoid less time in rehab and more time winning in your field.

Seeing a physical therapist is integral part of prevention, recovery and management of sporting injuries. Myotherapy and Remedial Massage is important in treating calves, hamstrings, quads, glutes and hip flexors. Sports massage and deep tissue massage specifically targets these set of muscles. Running injuries like ITB Syndrome, Shin Splints, Plantar Fasciitis and Achilles Tendonitis are all treatable with Myotherapy and Remedial Massage.

Running is a quick and easy exercise to keep fit to energise your busy day. Weight bearing helps maintain bone density. With the absorption of vitamin D by being outside, running is essential for strong bone health. Running is a high impact activity as we know putting strain on your joints and ligaments. With each step the body will absorb three times your body weight. This means that if you have muscular imbalances, poor biomechanics or have previous injuries it can accentuate weight bearing forces leading to long term irreversible damage to your joints.

Degeneration or gradual wear and tear of your joints is a natural progression of aging. However high impact running especially on hard surfaces like concrete or bitumen can accelerate this process leading to inflammation and degeneration of articular cartilage. Whenever possible look to run on grass or a dirt track to soften the load. Make sure the surface is even with no camber on the road. A sloped surface creates a functional leg-length discrepancy putting excess stress to one side of the body.

Muscular imbalances and faulty biomechanics within your body can cause ongoing injuries. Basically when one muscle group is tighter or more over developed than its counterpart it causes misalignment within the body where overtime can lean to stress related musculoskeletal injuries. There can be multiple causes like patella tracking dysfunction due to a weak vastus medias and tight Iliotibial band, weak glutes, over dominate quads, over pronated ankles, flat feet, tight hamstrings due to anterior pelvic tilt the list goes on. Running with tight muscles can lead to long term muscular adaptions and chronic muscle shortening in the body. Now this is not good as it will inevitably affect not only your performance but your recovery too. Although running related injury’s all have different names like Iliotibial Band Syndrome, Shin Splints, Plantar Fasciitis and Achilles Tendonitis they are all caused by overuse and stress in time. What might start out as just a niggle can eventually progress to an injury if ignored and not addressed early.

Your recovery is the key to long term health and wellbeing. First identifying what muscles are tight and introducing a stretching routine including a warm up and cool down routine. This is an important habit to create and stick to. A physical therapist can help identify and assess troublesome areas and advise of steps to take. Having regular physical therapy treatment is essential for better recovery and long term injury prevention. Strength training, stretching and regular foam-rolling are all important tools to use. With any high intensity running program your recovery sessions and days off are just as important just is a structured nutritional plan. With recovery from any soft tissue injuries the RICER protocol is used in the first 48 – 72 hours. Rest, Ice, Compression, Elevation, Referral to professional is used when sharp pain, swelling or inflammation is involved.

It is important when you are injured to use other forms of exercise. Swimming is a great activity to counteract stress on your joints. Being in a non-weight bearing environment, water provides time for joints to recover reducing inflammation and perfect for achy muscles. Swimming actively removes the build-up of toxic bi-products stored in your muscles like lactic acid which is a major cause of delayed onset muscle soreness (DOMS). It also provides an alternative opportunity to work your cardiovascular system which will improve your lung efficiency and ability for your heart to pump oxygen to working muscles. Another great option is using an elliptical trainer which is less stress on your joints. Remembering with any exercise stress, small micro tears take place in the muscles. These micro tears will repair and adapt giving greater strength. However going into your next training with inadequate recovery time these micro tears can turn into larger muscle tears. You need proper sleep and protein for muscular tissue to fully recover between training sessions.

Top 5 Common Sporting Injuries

Iliotibial Band Syndrome

Definition: ITB Syndrome otherwise known as runner’s knee is an overuse inflammatory condition most commonly seen in runners causing lateral knee pain. The ITB is a thick band of fascia descending laterally from the pelvis to the femoral condyle of the knee.

Cause: Continuous rubbing and friction over the lateral knee causes inflammation and pain with exercise. Activities involving repetitive flexion and extension of the knee such as running, cycling and weight lifting involving squats and deadlifts aggravate the condition. Other aggravating factors include running with worn out shoes, running on a sloped banked surface, running on concrete surface, over-pronation of foot, overtraining without adequate warm up and cool down and anatomical thickness of the ITB.


  • Diffuse lateral knee pain most commonly when the foot strikes the ground

  • Snapping of the tendon over the lateral knee at 30-40° of knee flexion

  • Weakness and spasm of hip and tensor fascia lata muscles as they contribute to the ITB


  • Ice to reduce pain and inflammation

  • Reduce running mileage and avoid doing squats

  • Go to physical therapy to identify biomechanical and gait issues with running

  • Treatment of muscles involved tensor fascia, glutes, quadriceps, hamstrings and ITB once inflammation has settled

  • Use of a foam roller over the ITB to release at home

  • As a last resort use of Nonsteroidal anti-inflammatory drugs (NSAIDs) in acute stage

Prognosis: Although ITB syndrome is often acute in nature and revolves with decreased exercise it can reoccur and progress to a chronic condition if not addressed in its early stages.

Shin Splints

Definition: Shin Splints also referred to Medial Tibial Stress Syndrome is pain anywhere in the anterior portion of the tibia bone. It most commonly affects running and jumping sports often when exercise intensity is increased too quickly. It causes inflammation to the periosteum of the tibia where tendons of muscles attach to the bone.

Cause: Biomechanical irregularities of the ankle and foot and muscular imbalances overload and put stress on the tibia. When muscles of the lower leg tighten and fatigue their ability to provide shock absorption diminishes putting undue stress on the tibia. Other aggravating factors include running with worn out shoes, flat arches or poor arch support, running uphill, running on hard surfaces, over-pronation of foot and excessive training with inadequate recovery.


  • Pain in the anterior lower leg which can refer a dull ache to the anterior ankle and big toe.

  • Localised touch tenderness and muscular trigger points of tibialis anterior

  • Decreased ankle mobility and pain in dorsiflexion and plantarflexion


  • Use of RICER when acute, inflamed with possible swelling present

  • Depending on severity rest from running altogether for 3 weeks

  • Use of swimming and/or elliptical machine to allow recovery when permitted

  • Seeing a physical sports therapist or sports podiatrist early to assess muscle imbalances and biomechanics

  • Having massage of lower leg muscles of tibialis anterior, soleus, gastrocnemius, tibialis posterior and hamstrings

  • Orthotics and arch support for proper alignment of ankle and foot

Prognosis: If left untreated and exercise in not reduced shin splints can progress into tibial stress fracture. Tibial stress fractures require a minimum of six weeks rest. Compartment syndrome can occur where there is compression in the muscle sheaths and associated decreased blood flow. Muscle compartment syndrome can be quite serious and if not treated properly and ignored continually may require surgical intervention.

Definition: Plantarfascitis or jogger’s heel is a repetitive strain injury to the band of fascia that is attached from the calcaneus or heel bone to the sole of the foot causing inflammation and sharp stabbing pain. It often affects middle aged people who are overweight and on their feet for long hours with work and also young highly active athletes.

Cause: With overuse and aging, muscles supporting the arch of the foot slowly become weaker reducing shock absorption and increasing stress on the plantar fascia. Aggravating factors include being overweight, being pregnant, over training, flat arches, improper shoe support and being on your feet for long periods.

Symptoms: Characteristically there is pain with the first step in the morning or after a long period of immobility. Sharp pain is localised to the medial side of the calcaneus.


  • The use of RICER when acute. A handy hint is using a frozen plastic water bottle to roll along the plantarfascia for self release ice massage

  • Rolling on a spikey ball to manually release the connective tissue and stimulate healthy blood flow

  • Getting new runners every 600 – 700 kms with proper arch support and avoid wearing high heels

  • Physical therapy for myofascial release to breakdown scar tissue of the plantar fascia and release of muscles of the lower leg including achilles tendon, gastrocnemius, soleus and tibialis anterior

  • Taping to support the arch of the foot with weight bearing and correct biomechanical issues

  • Having a tailored weight loss program to take pressure of heel to prevent reoccurrence of injury

Prognosis: In some cases plantar fasciitis can be associated with a heel spur. A heel spur may not cause pain but in some cases may cause chronic pain and degeneration and may need surgical intervention if recovery is not successful.

Find out more about Plantar Fasciitis in the blog Plantar Fasciits Heel That Foot Pain

Achilles Tendonitis

Definition: Achilles Tendonitis is an overuse inflammatory condition commonly seen in runners and other jumping sports with repetitive movements. In the chronic stage it is termed Achilles Tendinopathy which includes both inflammation and micro-tears causing associated weakness to the tendon.

Cause: Injuries to the Achilles tendon are often the result of gradual wear and tear from repetitive overuse or ageing. Aggravating factors include over-training, inadequate rest periods, foot over-pronation, poor eccentric strength of tendon under loading, immobility of ankle joint or past ankle injuries, running on hard surfaces and improper footwear.

Symptoms: Mild to severe pain and tenderness of the Achilles tendon with associated swelling, inflammation and warm to touch. Often tenderness is more noticeable in the morning and after periods of immobility.


  • Reduce swelling and inflammation with RICER, using ice for 20 minutes per hour during the acute stage

  • The use of orthotics to take pressure off the tendon during healing stage and correct flat or over pronated feet

  • Short term use of an ankle brace or straping to restrict ankle-mobility, improve healing and support for the tendon

  • Physical therapy including soft tissue release of calve muscles. Realignment of any scar tissue or adhesions of tendon. The use of myofascial dry-needling is effective in healing introducing new blood flow for quicker recovery

  • With improvement start rehabilitation strength program with emphases on eccentric loading for long term injury prevention

  • Exercises program for improved proprioception, agility and strength relevant to specific sport

  • Continual stretching of calve and use of foam roller for manual release of calve and Achilles complex

Prognosis: Due to poor blood supply the Achilles tendon is slow to heal. It can take a few weeks to sometimes months to heal. Achilles tendonitis if not treated early can progress to a more serious injury like a partial tear or complete rupture of the Achilles tendon. While a partial tear presents similar symptoms as a Tendinopathy, a complete rupture causes pain and sudden loss of strength and movement. It can take 6 to 12 months for rehabilitation and return to sport. Surgery is most likely for a tear of this nature.

Murray Kovesy BHSc - Clinical Myotherapist

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