Running is one of the most effective and accessible forms of exercise, but like any repetitive sport, it can place stress on the muscles, joints, and connective tissues. Most running injuries develop gradually over time rather than from one sudden event. In many cases, they are linked to training errors such as increasing mileage too quickly, inadequate recovery, poor footwear, or biomechanical imbalances.
The good news? Most common running injuries respond very well to conservative treatment when addressed early. Below are five of the most common running injuries, how to recognize them, and evidence-based treatment options that may help support recovery and return to running.
1. Runner's Knee (Patellofemoral Pain Syndrome)
What It Is
- Runner’s knee is one of the most common overuse injuries in runners. It refers to irritation of the tissues around the kneecap (patella), often caused by repetitive stress, muscle imbalances, or poor tracking of the kneecap during movement.
Common Symptoms
- Dull, aching pain around or behind the kneecap
- Pain when running downhill or downstairs
- Discomfort after prolonged sitting
- Clicking or grinding sensations in the knee
Treatment: Treatment for runner’s knee focuses on reducing irritation around the kneecap while improving the strength and mechanics of the muscles that support the hip and knee. Weakness in the glutes and quadriceps is commonly associated with poor patellar tracking, which can increase stress through the knee joint during running. Initial management may include temporarily reducing running volume, avoiding hills or downhill running, and gradually rebuilding strength through targeted rehabilitation exercises.
Helpful therapies may include:
- Acupuncture: May help reduce pain sensitivity, inflammation, and muscle tension surrounding the knee joint while supporting recovery.
- Trigger Point Injection Therapy: Can help release tight muscular trigger points in the quadriceps, tensor fasciae latae (TFL), or gluteal muscles that may be contributing to abnormal tracking and tension around the knee.
- Hyaluronic Acid Injection Therapy: In cases involving cartilage irritation or early degenerative changes, hyaluronic acid injections may help improve joint lubrication, reduce friction within the knee, and improve comfort during movement.
- Strength and Mobility Rehabilitation: Hip, glute, and quadriceps strengthening combined with ankle and hip mobility work is often essential for long-term symptom improvement and prevention of recurrence.
2. Shin Splints (Medial Tibial Stress Syndrome)
What It Is
- Shin splints refer to irritation of the muscles, tendons, and bone tissue along the inner edge of the shinbone (tibia). They commonly occur in beginner runners or runners who increase training intensity too quickly, or in individuals who overpronate (meaning their weight distribution is on the medial part of the foot rather than midline). Low bone density is another established risk factor.
Common Symptoms
- Aching pain along the inside of the shin
- Tenderness to touch
- Pain that worsens during or after running
- Mild swelling in the lower leg
Treatment: Shin splints are often a sign that the tissues of the lower leg are not tolerating current training demands. Treatment focuses on reducing repetitive stress while improving lower leg strength, mobility, and shock absorption mechanics. Continuing to train through worsening shin pain may increase the risk of developing a tibial stress fracture, making early intervention important.
Helpful therapies may include:
- Shockwave Therapy: Extracorporeal shockwave therapy may help stimulate tissue healing and improve circulation in chronically irritated tissues along the shin.
- Acupuncture: Can help reduce pain and inflammation while improving muscular recovery in the calves and lower leg.
- Trigger Point Injection Therapy: Tight calf muscles can increase tension through the tibia and surrounding fascia. Trigger point therapy may help release chronic muscle tightness and improve lower leg mobility.
- Biomechanical Assessment: Evaluating footwear, running form, cadence, and training progression can help identify contributing factors and reduce recurrence risk.
- Progressive Strengthening: Calf strengthening and gradual load exposure are important for rebuilding tissue resilience over time.
3. Achilles Tendinopathy
What It Is
- The Achilles tendon connects the calf muscles to the heel bone and helps generate force during running. Repetitive loading can lead to tendon irritation, degeneration, and stiffness over time.
Common Symptoms
- Pain or stiffness at the back of the heel
- Symptoms that are worse in the morning
- Tenderness or thickening of the tendon
- Pain during push-off while running
Treatment: Achilles tendinopathy develops when repetitive loading exceeds the tendon’s ability to recover. Unlike an acute inflammatory injury, chronic tendon pain often involves degeneration and reduced tendon capacity, meaning treatment should focus on improving tendon strength and load tolerance rather than complete rest alone.
Helpful therapies may include:
- Shockwave Therapy: Research suggests shockwave therapy may stimulate tendon healing, improve circulation, and reduce chronic tendon pain in persistent Achilles tendinopathy cases.
- Platelet-Rich Plasma (PRP) Injection Therapy: PRP uses concentrated platelets derived from the patient’s own blood to deliver growth factors that may support tissue healing and tendon regeneration in chronic or stubborn cases.
- Acupuncture: May help reduce pain, improve local blood flow, and decrease muscle tension in the calf muscles.
- Progressive Tendon Loading Programs: Eccentric calf raises and heavy slow resistance exercises are considered one of the most evidence-based treatments for Achilles tendon rehabilitation.
- Training Modifications: Temporarily reducing speed work, hills, and plyometric activity may help decrease strain while the tendon recovers.
4. Plantar Fasciitis
What It Is
- Plantar fasciitis occurs when the thick band of connective tissue along the bottom of the foot becomes irritated. It is especially common in runners with tight calves, limited ankle mobility, or prolonged standing demands.
Common Symptoms
- Sharp pain at the bottom of the heel
- Pain with the first few steps in the morning
- Tightness in the arch of the foot
- Symptoms that worsen after prolonged activity
Treatment: Plantar fasciitis is often related to repetitive strain through the connective tissue on the bottom of the foot. Limited ankle mobility, calf tightness, prolonged standing, and sudden increases in training load can all contribute to irritation. Treatment focuses on reducing tissue stress while improving mobility and foot strength.
Helpful therapies may include:
- Shockwave Therapy: Commonly used in chronic plantar fasciitis cases, shockwave therapy may help stimulate healing within the plantar fascia and reduce persistent heel pain.
- Acupuncture: Can help decrease pain sensitivity, reduce inflammation, and improve tissue recovery.
- Trigger Point Injection Therapy: Tight trigger points within the calves and intrinsic foot muscles may contribute to increased tension through the plantar fascia and can be addressed through targeted injections.
- Platelet-Rich Plasma (PRP) Injection Therapy: In long-standing cases that have not responded to conservative care, PRP may help stimulate tissue repair and regeneration.
- Mobility and Strengthening Exercises: Calf stretching, intrinsic foot strengthening, and ankle mobility exercises are important for reducing strain and improving long-term function.
- Footwear Support: Supportive shoes or orthotics may help redistribute load and reduce irritation during recovery
5. IT Band Syndrome (Iliotibial Band Syndrome)
What It Is
- The iliotibial (IT) band is a thick band of connective tissue that runs along the outside of the thigh. Repetitive friction and tension can cause irritation near the outer knee, particularly in runners who suddenly increase mileage or engage in excessive downhill running.
Common Symptoms
- Sharp or burning pain on the outside of the knee
- Pain that worsens with repetitive bending
- Symptoms during longer runs or downhill running
- Tightness along the outer thigh
Treatment: IT band syndrome is commonly associated with repetitive friction and excessive tension along the outer thigh and knee. Weakness in the gluteal muscles and poor pelvic control during running can increase strain on the IT band over time. Treatment aims to reduce irritation while improving hip strength and movement mechanics.
Helpful therapies may include:
- Acupuncture: May help decrease pain and muscular tension along the lateral thigh and hip while promoting recovery.
- Trigger Point Injection Therapy: Trigger points within the glutes, tensor fasciae latae (TFL), and lateral quadriceps can contribute to excessive tension through the IT band and may respond well to targeted treatment.
- Shockwave Therapy: In chronic cases, shockwave therapy may help improve soft tissue healing and reduce persistent irritation around the lateral knee.
- Hip and Glute Strengthening: Strengthening the gluteus medius and surrounding stabilizing muscles is one of the most important components of long-term recovery and prevention.
- Running Retraining: Adjustments to cadence, stride length, and downhill running volume may help reduce repetitive stress on the IT band.
When Should You Seek Treatment?
Some muscle soreness is normal when starting a running routine, but pain that is sharp, persistent, worsening, or affecting your gait should not be ignored. Addressing injuries early can help prevent compensation patterns and prolonged recovery timelines.
If you are dealing with a running injury, therapies such as shockwave therapy, acupuncture, trigger point injection therapy, platelet-rich plasma (PRP) therapy, and hyaluronic acid injections may help support recovery depending on the condition and severity of symptoms.
The goal of treatment is not simply to reduce pain, but rather to help you return to movement safely, confidently, and sustainably so you can continue enjoying the long-term benefits of running.
Curious about the root cause of your pain and what you can do about it? Book an appointment today with one of our Naturopathic Doctors, Acupuncturists, or Osteopaths to get to the bottom of your pain, and get back to running in a sustainable way.
References
Mulvad, B., Nielsen, R. O., Lind, M., & Ramskov, D. (2018). Diagnoses and time to recovery among injured recreational runners in the RUN CLEVER trial. PLOS ONE, 13(10), e0204742.
Lopes, A. D., Hespanhol Júnior, L. C., Yeung, S. S., & Costa, L. O. P. (2012). What are the main running-related musculoskeletal injuries? A systematic review. Sports Medicine, 42(10), 891–905.
Nielsen, R. O., Rønnow, L., Rasmussen, S., & Lind, M. (2014). A prospective study on time to recovery in 254 injured novice runners. PLOS ONE, 9(6), e99877.
Arnold, M. J., & Moody, A. L. (2018). Common running injuries: Evaluation and management. American Family Physician, 97(8), 510–516.
Tu, P. (2018). Heel pain: Diagnosis and management. American Family Physician, 97(2), 86–93.
Kjær, M., Petersen, J., Dünweber, M. R., et al. (2025). Dilemma in the treatment of sports injuries in athletes: Tendon overuse, muscle strain, and tendon rupture. Scandinavian Journal of Medicine & Science in Sports, 35(Suppl. 1), e70006.
Cooper, M. T. (2023). Common painful foot and ankle conditions: A review. JAMA, 330(15), 1478–1488.
Duong, V., Oo, W. M., Ding, C., Culvenor, A. G., & Hunter, D. J. (2023). Evaluation and treatment of knee pain: A review. JAMA, 330(16), 1568–1580.
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