Most running injuries aren’t bad luck. In my experience the vast majority are overuse injuries: a tendon, bone or joint asked to handle more load than it has been prepared for, usually because the training went up too fast. That’s good news, because it means most of them can be prevented, and the ones that do happen can usually be managed without losing months of running.
This guide covers the running injuries you’re most likely to meet, what causes them, how to tell soreness from a real problem, when to stop and see a professional, and how to get back to running without ending up straight back on the couch. I’m a coach, not your doctor, so treat this as a map rather than a diagnosis. If something in here sounds like what you’re feeling, the right physio will get you to the answer faster than any blog post.
In this guide:
- The most common running injuries
- What causes running injuries
- Soreness vs injury: how to tell the difference
- Whether you can keep running with a niggle
- When to see a physio or doctor
- What to do in the first few days
- Knee, shin, heel and Achilles pain: a quick guide
- How to prevent injuries when running
- Cross-training while injured
- How to return to running after an injury
- Whether running damages your knees
- Frequently asked questions
What are the most common running injuries?
The most common running injuries are Achilles tendinopathy, shin splints (medial tibial stress syndrome), runner’s knee (patellofemoral pain), plantar fasciitis and ITB syndrome. Almost all of them sit below the hip, and almost all of them build up over weeks rather than happening in a single step.
A 2021 systematic review by Kakouris, Yener and Fong in the Journal of Sport and Health Science pulled together the research on running-related injuries and found an average injury incidence of 40.2% across the studies it included. In other words, a big chunk of runners get hurt in any given study period. These were the conditions that came up most often:
| Injury | Incidence | Prevalence |
|---|---|---|
| Achilles tendinopathy | 10.3% | 6.6% |
| Medial tibial stress syndrome (shin splints) | 9.4% | 9.1% |
| Patellofemoral pain (runner’s knee) | 6.3% | 16.7% |
| Plantar fasciitis | 6.1% | 7.9% |
| Iliotibial band syndrome | Not in top five | 7.9% |
| Ankle sprain | 5.8% | Not in top five |
Incidence is how many runners picked up the injury during a study. Prevalence is how many had it at the moment they were asked. That’s why runner’s knee looks modest on one measure and huge on the other: it’s an injury that tends to hang around.
Ultra runners get hurt in slightly different places. The same review found the ankle (34.5%), knee (28.1%) and lower leg (12.9%) were the most frequently injured sites among ultramarathoners. If you’re building towards Comrades, that’s worth knowing, because the downhills and the sheer time on your feet load those areas hard.
New runners carry the highest risk. A 2015 meta-analysis in Sports Medicine by Videbæk and colleagues found novice runners picked up 17.8 injuries per 1,000 hours of running, compared with 7.7 per 1,000 hours for recreational runners. Put another way, on average a novice gets injured more than twice as often for every hour they run. That’s why the first few months of running are when patience pays off most.
What causes injuries in runners?
Running injuries are mostly caused by load outpacing adaptation: doing more, faster or more often than your body has been prepared for. The usual culprits are big jumps in weekly distance, adding speed work and volume at the same time, too little recovery, and a history of the same injury.
Your body gets stronger in the recovery between sessions, not during them. Every run puts a small amount of stress on muscles, tendons and bone. Give them time and they come back a bit tougher. Stack the next run on top before they’ve recovered, and again, and again, and the tissue starts losing the race. Eventually something complains.
Here are the factors I’d look at first when a runner tells me they’re hurting:
- A sudden jump in training. More kilometres, an extra session, a new hilly route, a first track workout. A study of 874 novice runners by Nielsen and colleagues (Journal of Orthopaedic and Sports Physical Therapy, 2014) found that those who increased their weekly distance by more than 30% over a two-week period seemed more vulnerable to distance-related injuries. The authors were careful to call this exploratory, but the direction is clear.
- A previous injury. A 2015 systematic review in PLoS ONE by van der Worp and colleagues found a history of previous injury was a risk factor for new running injuries. If you’ve had Achilles trouble before, your Achilles is the first place I’d expect to hear from when you overdo it.
- Changing your kit or surface. A new shoe with a different heel-to-toe drop, a switch from trails to tar, or running on a camber can shift load onto tissue that isn’t used to it.
- Not enough recovery. Back-to-back hard days, short sleep, a stressful work month. Your training plan doesn’t know about any of that, but your body does.
- Weakness. Calves, hips and quads that can’t absorb the forces of running hand that job to something less suited to it.
Notice what’s missing from that list: “running is bad for you”. It isn’t. The dose is what goes wrong.
Is it soreness or an injury? How runners can tell the difference
Normal training soreness is general, usually on both sides, feels better as you warm up and improves day by day. An injury tends to be in one specific spot, often on one side, gets worse as you keep running, and changes the way you move.
This is the most useful skill a runner can learn, because catching an injury early is the difference between a few easy days and a few lost months. Use this as a rough guide:
| Usually soreness | Usually a warning sign |
|---|---|
| Spread across a muscle group | One spot you can point to with a finger |
| Both legs | One side only |
| Eases once you’re warm | Gets worse the further you run |
| Dull, achy, stiff | Sharp, burning or stabbing |
| Better each day | The same or worse each day |
| Running form unchanged | You’re limping or changing your stride |
| No swelling | Swelling, bruising or tenderness when you press on it |
Pay particular attention to bone. An NHS patient leaflet from Gloucestershire Hospitals describes stress fracture pain as usually being in a very specific spot, tender when you press directly on it, worse with impact such as running and jumping, and easing with rest. It also notes that stress fractures don’t always show up on X-rays. Pinpoint bone pain that hurts to press is not something to run through.
Can you keep running with a niggle?
Sometimes, yes. Many tendon niggles can be managed while you keep running, as long as the pain stays mild, doesn’t build during the run and isn’t worse the next day. Sharp pain, pain that changes your stride, bone pain and anything that keeps getting worse are reasons to stop.
Complete rest isn’t always the answer. In a 2007 randomised trial in the American Journal of Sports Medicine, Silbernagel and colleagues let one group of people with Achilles tendinopathy keep running and jumping, using a pain-monitoring model, while another group rested from those activities. Both groups improved, and the researchers found no negative effects from continuing to load the tendon.
That’s not a licence to run through anything. The trial used a structured programme with a set way of monitoring pain. What it tells you is that a sensible, monitored amount of load can be part of recovery. In practice, if you’re carrying a niggle:
- Keep the runs short and easy. Drop the intervals, the hills and the long run until it settles.
- Run on flat, forgiving surfaces.
- Check how it feels the next morning, not just during the run. Next-morning stiffness or pain that is worse than before tells you that run was too much.
- If it’s not clearly improving within a week or two of backing off, get it looked at.
The one niggle I’d never “manage” on your own is shin pain that’s getting sharper or more localised. Shin splints that you keep running on can progress towards a stress reaction and then a stress fracture of the tibia. A week off now is a lot cheaper than six weeks off later.
When should a runner see a physio or doctor?
See a physio or doctor if pain is getting worse rather than better, hasn’t improved after a week or two of reduced training, makes you limp, wakes you at night, or sits in one tender spot on a bone. Go to a doctor or emergency department straight away for suspected broken bones, chest pain, fainting or dizziness while running.
The NI Direct sports injuries guidance (Northern Ireland’s official government health information) says most minor injuries can be looked after at home, but you may want to see your GP if your symptoms don’t get better over time, and go to an emergency department as soon as possible for a severe injury such as a broken bone or dislocation. It also notes that GPs may refer you on to physiotherapy if symptoms are severe or don’t improve within a few days or weeks.
I’d add a few runner-specific reasons not to wait:
- Pinpoint pain on the shin, foot or hip that hurts to press
- Pain that’s there at rest, not just when you run
- Swelling, heat or a joint that locks, catches or gives way
- Numbness, tingling or pain that shoots down the leg
- Any chest pain, unusual breathlessness, palpitations or dizziness. These are never a training problem. Stop and get checked.
Choose someone who works with runners. A physio or sports doctor who understands training load will help you modify your running rather than simply telling you to stop.
What to do when you first get injured running
In the first few days, protect the injured area and calm it down, then start moving it again as soon as pain allows. Long periods of complete rest tend to leave tissue weaker, not stronger.
The old advice was RICE (rest, ice, compression, elevation). A widely cited British Journal of Sports Medicine editorial by Dubois and Esculier updated that to PEACE and LOVE for soft-tissue injuries such as strains and sprains:
PEACE: the first few days
- Protect: unload or restrict movement for one to three days, then minimise rest, because prolonged rest can weaken tissue. Let pain guide you.
- Elevate: raise the limb above heart level where you can.
- Avoid anti-inflammatory modalities: the authors argue inflammation is part of repair. Anything to do with medication is a conversation for your doctor or pharmacist, not your coach.
- Compress: a bandage or tape to limit swelling.
- Educate: understand your injury and take an active role in recovery rather than relying only on passive treatments.
LOVE: the days and weeks after
- Load: bring movement and normal activity back early, as symptoms allow, without aggravating pain.
- Optimism: the authors note that positive expectations are linked to better outcomes, while fear and catastrophising can get in the way.
- Vascularisation: start pain-free aerobic exercise a few days after injury.
- Exercise: restore mobility, strength and balance.
The editorial also points out there’s no high-quality evidence that ice helps soft-tissue injuries heal. If ice makes it feel better, that’s fine, but don’t think of it as the treatment.
Knee, shin, heel and Achilles pain in runners: a quick guide
Where it hurts gives you a strong clue about what’s going on, but it’s not a diagnosis. Use this to understand the common patterns, then get a proper assessment if it doesn’t settle quickly.
| Where it hurts | Common culprit | First thing I’d look at |
|---|---|---|
| Inside edge of the shin | Shin splints | Recent jump in volume or a new hard surface |
| In and around the kneecap | Runner’s knee | How fast you built up, quad strength, shoes |
| Outside of the knee | ITB syndrome | Hip and glute strength, hip mobility |
| Bottom of the heel | Plantar fasciitis | Calf tightness, worn-out shoes |
| Back of the heel or above it | Achilles tendinopathy | Change in shoe drop or running surface |
| One tender spot on a bone | Possible stress fracture | Stop running and get it assessed |
Shin splints
Shin splints usually show up as a dull ache along the inside of the lower leg, and they’re one of the classic new-runner injuries. In my experience the cause is nearly always the same: building up too quickly, sometimes with the wrong shoes or very hard surfaces added in.
Runner’s knee
Runner’s knee (patellofemoral pain) is pain in and around the kneecap, typically when you’re exercising and after sitting for a long time with your knees bent. It’s the most prevalent running injury in the Kakouris review, at 16.7%.
ITB syndrome
ITB syndrome causes pain on the outside of the knee, sometimes spreading up or down the leg. It often starts once you’re running and stops when you stop. Weak glutes and hips and tight hip flexors and quads are common contributors, so hip strength and mobility are usually part of the fix.
Plantar fasciitis
Plantar fasciitis is heel pain on the underside of the foot, typically worst with the first steps in the morning or after sitting. Deal with it early.
Achilles tendon pain
Achilles pain often follows a change: new shoes with a lower drop, more hills, a new surface or added speed work. A quick trick I recommend is to fold a sock and place it under your insole in both shoes for a heel lift of about 3-4mm, which takes some strain off the tendon while it settles. Keep it in for at least a week, even if the pain goes.
Stress fractures
A stress fracture is a small crack in a bone caused by repeated load. The Gloucestershire Hospitals leaflet says one takes about six weeks to heal and lists menopausal women and people who suddenly increase their activity among the higher-risk groups. If you’re dealing with one in the lower leg, my guide to getting back to running after a fibula stress fracture will help with the next steps once you’ve been assessed.
How to prevent injuries when running
The best way to prevent running injuries is to increase your training gradually, strength train every week, introduce speed work carefully, and give your body the sleep and food it needs to adapt. None of it is glamorous. All of it works better than any gadget.
Build your kilometres gradually
My rule of thumb is to avoid increasing your weekly distance by more than 10% from one week to the next, and to avoid any single run making up more than 30% of your weekly total, particularly early in a build.
Here’s a worked example. If you’re running 30km (19 miles) a week, the 10% guideline caps next week at 33km. Under the 30% guideline your longest run that week should be no more than about 10km. If you want a 16km long run, you need a weekly total of about 53km to support it, or you need to accept that the long run is carrying a lot of your load.
I’ll be straight with you: the 10% rule is a guardrail, not a guarantee. When Buist and colleagues tested a 13-week programme built on the 10% rule against a standard eight-week programme in 532 novice runners (American Journal of Sports Medicine, 2008), injury rates were almost identical: 20.8% vs 20.3%. What the research does point to is that big jumps are risky, like the more than 30% over two weeks in the Nielsen study. So use 10% to stop yourself doing something silly, then pay attention to how you’re actually responding.
Strength training for runners
Strength training is one of the best-supported injury-prevention tools we have. A 2014 meta-analysis in the British Journal of Sports Medicine by Lauersen and colleagues, which looked at sports injuries in general rather than running alone, found strength training reduced injuries to less than a third (relative risk 0.315). Proprioception (balance) training also helped. Stretching showed no clear benefit.
For runners, that means calf raises, single-leg work, squats, lunges, hip and glute exercises, and some core work, done consistently. You don’t need a gym. You need to do it every week, including the busy ones.
Treat speed work as extra load
Adding intervals, hills or a first track session is a jump in training load just like adding kilometres, so it deserves the same caution. Introduce one new hard element at a time and see how your body responds before adding the next.
Running cadence and injury
Taking slightly shorter, quicker steps reduces the load on your knees and hips. In a 2011 study in Medicine & Science in Sports & Exercise, Heiderscheit and colleagues found that subtle increases in step rate substantially reduced loading at the hip and knee, with a 10% increase producing a substantial drop in energy absorbed at both joints. If you’re prone to knee pain, a small cadence increase on easy runs is worth a try. Make the change gradually.
Shoes and surfaces
Your shoes should be comfortable and suited to you, and they should be replaced before they’re dead. I’m a big believer in getting assessed by a professional who understands running, so you’re not guessing. The bigger danger is change: switching to a very different shoe or surface overnight. Introduce new shoes, trails or track work gradually.
Sleep, recovery and fuelling
You adapt when you recover. Short sleep, a run of hard days and under-eating all chip away at that. The 2023 International Olympic Committee consensus statement describes Relative Energy Deficiency in Sport (REDs) as a syndrome of harmful health and performance outcomes caused by eating too little for the training you do. If you’re picking up repeated bone injuries, talk to a sports doctor about fuelling as well as training.
If you’re over 50, my complete guide to running over 50 covers recovery and how to adjust your training as you get older.
Mobility work is a simple daily habit that helps you keep moving freely between runs. Get my free mobility routine for runners, which you can do at home every day.
If you’d rather not work all of this out yourself, that’s exactly what Coach Parry membership is for: structured plans that build gradually, with live strength sessions every week.
Cross-training when you’re injured from running
Cross-training lets you keep your fitness while an injury heals, as long as it’s pain-free. Cycling, swimming, pool running and the elliptical trainer all keep your heart and lungs working with far less impact than running.
The trick is matching the activity to the injury. Different injuries tolerate different activities, so ask your physio what’s safe for yours. The rule is simple: if it hurts the injury, it’s the wrong choice.
This fits with the LOVE part of the BJSM framework, which recommends starting pain-free aerobic exercise a few days after injury to boost blood flow. It’s good for your head too. Keeping some routine makes the time off feel a lot shorter. Keep up your strength work as well, adapted around the injury.
How to return to running after an injury
Return to running gradually: start with short, easy runs, often with walking breaks, and only build when each step causes no pain during the run or the next day. Remember that a previous injury is a known risk factor for the next one, so the comeback is when you’re most vulnerable.
The NI Direct guidance says recovery from sports injuries can take a few weeks or months, and advises building activity up gradually rather than rushing back. The Gloucestershire Hospitals leaflet gives a similar order for stress fractures: once you can walk without pain, build activity gradually, starting with low-impact exercise and moving to high-impact work only when you’re pain-free. If pain returns, cut back and let it settle.
Here is how I’d structure the comeback:
- Get the all-clear. Pain-free walking and everyday movement first. For bone injuries, wait for your doctor or physio to sign off.
- Start with run-walk. Short running intervals with walking breaks in between. This is the same principle behind the walking-heavy start of my learn-to-run programme, which is designed for beginners and for runners coming back from long layoffs or injury.
- Keep the first runs short. After a marathon or an ultra my first run back is never more than 20 minutes, and coming back from injury deserves at least the same respect.
- Check the next morning. If it’s no worse, move on to the next step at the next session. If it’s worse, drop back a step.
- Build time before speed. Get back to your normal easy volume before you reintroduce hills, intervals or a proper long run.
- Keep the strength work. Whatever rehab exercises got you here, keep doing them. They’re your insurance.
Be realistic about your race plans, too. If an injury has taken weeks out of a big build, the goal might need to change.
Does running damage your knees?
For recreational runners, the research says no. Running at a recreational level is associated with a lower rate of hip and knee osteoarthritis than not running at all.
A 2017 systematic review and meta-analysis by Alentorn-Geli and colleagues in the Journal of Orthopaedic and Sports Physical Therapy found hip and knee osteoarthritis in 3.5% of recreational runners, compared with 10.2% of sedentary controls and 13.3% of competitive runners. That’s a strong answer to everyone who tells you you’ll wreck your knees. The higher figure in competitive runners is a reminder that very high training loads over many years carry their own risk. For most of us, sensible running looks good for joints.
Running injury FAQs
Should I stretch to prevent running injuries?
Stretching isn’t a proven injury-prevention tool. In the Lauersen meta-analysis, stretching showed no clear benefit, while strength training cut sports injuries to less than a third. Stretch if it helps you feel good, but don’t let it replace your strength work.
Should I ice a running injury?
Ice can ease pain, but there’s no high-quality evidence that it helps soft-tissue injuries heal, according to Dubois and Esculier in the British Journal of Sports Medicine. Use it for comfort if you like, and focus on gradually reloading the injured area.
How long does a running injury take to heal?
It depends on the tissue and how early you caught it. A minor niggle can settle in days with reduced training. The NHS Gloucestershire leaflet puts a stress fracture at about six weeks to heal, and tendon problems can take longer. The sooner you back off, the shorter the time out.
Train smarter and stay injury-free
Every injury in this guide has one thing in common: it’s easier to prevent than to fix. Build gradually, do your strength work, keep your easy runs easy and listen when your body raises its hand. Do that and you’ll spend a lot more of your year running and a lot less of it on the bike in the garage.
If you want a plan that does the thinking for you, with sensible progression, strength training and recovery already built in, join Coach Parry. Membership gives you every Coach Parry plan from 5km to ultra, weekly live strength sessions and access to our coaches when life, or a niggle, gets in the way.
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