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Running workouts can place significant strain on our bodies.

As a result, we often experience discomfort and tenderness after a running workout. However, having to stop training because of an injury is the last thing any runner would want.

When discomfort or tenderness occurs, such as hamstring stiffness or knee pain, it can be difficult to understand exactly what is happening and what is causing it.

Approximately 60% of runners will experience an injury serious enough to force them to stop training for several weeks or months.

One of the most important factors in preventing injuries during running workouts is wearing appropriate running shoes.

Proper running shoes are the most important protective equipment runners have for preventing injuries, so choosing the right running shoes is extremely important.

It is also very important to follow an appropriate training programme and training volume, allow for proper recovery, and follow strengthening and stretching programmes in order to prevent potential injuries.

Injuries sustained during running workouts may be either acute or chronic (due to strain and overuse), but both types of injury must be treated at the appropriate time in order to achieve the best possible outcome.

Acute pain

Sudden injuries are sometimes the result of high-impact trauma. These include fractures, sprains and muscle strains. Immediate treatment includes immobilising the limb, applying ice and avoiding weight-bearing. Every athlete should take the appearance of severe swelling or persistent acute pain seriously. If the injured limb cannot be used, or if a ligament or muscle tear or joint dislocation is suspected, immediate medical assistance should be sought.

Chronic pain due to overuse

Overuse injuries result from repetitive low-intensity strain, usually caused by incorrect technique over a prolonged period. They are the most common injuries of this type among runners, and many factors can contribute to the development of overuse syndromes.

These include:

• Training on unsuitable surfaces, such as concrete.
• Training shoes that are in poor condition.
• Foot deformities, such as flat feet.
• Muscle weakness and poor flexibility.
• Excessive training.
• A sudden increase in weekly running distance.
• Poor physical condition.
• A sudden transition from treadmill running to outdoor running.

Of the factors listed above, a sudden increase in training is the most common cause of injury.

How do we know that we are training excessively? Key signs that indicate we may be overdoing it:

• Persistent mild pain and a feeling of fatigue.
• Sleep disturbances.
• An increased heart rate—more than 10 additional beats per minute.
• Cold symptoms and a sore throat.
• Headaches.
• An increased frequency of minor injuries.
• A lack of desire to exercise or run again.

Treatment of chronic injuries (overuse syndrome).

Runners often feel that they are in excellent physical condition on some occasions, while at other times they feel so exhausted that they cannot perform and experience severe pain. Whether you feel extremely fatigued or have mild tenderness in a part of your body, the simplest way to improve the symptoms is to reduce the strain by decreasing the intensity and duration of your workouts and listening to your body according to the level of pain. Sometimes, this may mean stopping running workouts completely or initially reducing their intensity to 50% and then progressively increasing or decreasing the intensity and distance depending on the symptoms.

Other methods of treating overuse injuries include:

• Ice therapy for 20 minutes at a time, three to four times a day.
• Compression of the swollen area.
• Elevating the affected limb whenever possible.
• Taking simple pain-relieving medication, such as paracetamol or an anti-inflammatory medicine.
• Identifying the cause of the injury—for example, atrophy or weakness of a particular muscle—and strengthening it.
• Physiotherapy and following a sports-injury rehabilitation protocol for injury prevention, treatment and recovery.

You should inform your doctor or physiotherapist if the pain persists despite reducing your training, if it continues for more than two weeks, or if it improves with rest but returns when you resume running workouts.

The 6 most common injuries sustained during running workouts

Below you can find the six most common running-related injuries and their treatment.

The objective is to develop a treatment plan that allows each athlete to return to training as quickly and safely as possible.

1. Plantar fasciitis.
2. Achilles tendinitis.
3. Patellar chondropathy (runner’s knee).
4. Iliotibial band syndrome.
5. Shin splints or medial tibial stress syndrome.
6. Stress fractures.

Plantar fasciitis

The first symptom of plantar fasciitis is pain in the sole of the foot, extending from the heel to the toes. The area is particularly sensitive first thing in the morning and after remaining seated for a prolonged period. This tenderness may be present at the beginning of each running workout, but it may also appear later during the workout.

The most common causes are:

1. High foot arches.
2. Flat feet.
3. Worn-out footwear.
4. Unsuitable footwear.
5. Calf-muscle stiffness.
6. An incorrect training programme, such as a sudden increase in distance or intensity.
7. Poor physical condition.
8. A sudden transition from treadmill running to outdoor running workouts.

Treatment

1. Reducing training and replacing running with cycling or swimming.
2. Ice therapy for 20 minutes, two to three times a day.
3. Stretching the calf muscles and hamstrings.
4. Massage and plantar fascia stretching.
5. Non-steroidal anti-inflammatory medicines.
6. Replacing footwear every 1,000 kilometres.
7. Selecting suitable shoes after visiting a specialist centre for footwear guidance and recommendations.
8. Using appropriate equipment, such as custom-made anatomical insoles, heel lifts and corrective insoles.
9. Plantar-pressure analysis and ergometric testing.

The best way to prevent plantar fasciitis is through stretching. The plantar fascia can be stretched using a foam roller and a specialised plantar-fascia stretching programme.

Achilles tendinitis

Achilles tendinitis is characterised by pain during running workouts, uphill training, climbing stairs or sudden changes in direction. The pain may be more severe in the morning and during the first few steps after getting up from a seated position or after sleeping. This occurs because the calf muscles shorten while we are asleep.

Main causes:

1. Excessive training on stairs or hills.
2. Weak calf muscles.
3. Flat feet.
4. Unsuitable footwear.
5. Worn-out footwear.
6. A change of footwear or running surface.
7. Incorrect training, such as a sudden increase in distance or intensity.
8. Poor physical condition.
9. A sudden increase in weekly running distance.
10. A sudden transition from treadmill running to outdoor workouts.

Treatment of Achilles tendinitis

1. Modifying the training programme.
2. Stretching the calf muscles and hamstrings.
3. Physiotherapy.
4. Ice therapy.
5. Using appropriate equipment, such as anatomical insoles, heel lifts and orthotic insoles.
6. Massage.
7. Non-steroidal anti-inflammatory medication.
8. Avoiding uphill training.

Patellar chondropathy (runner’s knee)

In this condition, the pain gradually increases and is concentrated around the kneecap. The pain becomes worse when performing a deep squat and when going up or down stairs. Knee stiffness after remaining seated for a prolonged period is also a symptom of this condition.

The most common causes of runner’s knee are:

1. Weak hip and thigh muscles.
2. Flat feet.
3. Stiff hamstrings and quadriceps.
4. A change of footwear or running surface.
5. Worn-out footwear.
6. Unsuitable footwear.
7. Poor physical condition.
8. A sudden increase in weekly running distance.
9. A sudden transition from treadmill running to outdoor training.

Treatment of patellar chondropathy

1. Avoiding strain.
2. Ice therapy.
3. Non-steroidal anti-inflammatory medicines.
4. Stretching the calf muscles, hamstrings, biceps femoris and hip flexors.
5. Strengthening the quadriceps, hip abductors and hip extensors.
6. Physiotherapy.
7. Plantar-pressure analysis and the use of anatomical insoles based on its results.
8. Replacing footwear every 1,000 kilometres.

Iliotibial band syndrome

This injury is characterised by pain on the outer side of the knee and hip during running workouts and even while walking. The runner may experience pain along the outer side of the thigh. The pain may also occur during slow-paced running, uphill training or when going up and down stairs.

The most common causes of iliotibial band injury are:

1. Running on routes with substantial elevation changes or uneven terrain, or suddenly changing the training terrain.
2. Flat feet.
3. An incorrect training plan, such as a sudden increase in distance or intensity.
4. Worn-out footwear.
5. Weak hip abductors and hip extensor muscles.
6. Stiff hip muscles, particularly the tensor fasciae latae muscle.
7. Unsuitable footwear.
8. Poor physical condition.
9. A sudden transition from treadmill running to outdoor running workouts.

Treatment of iliotibial band syndrome

1. Modifying the training plan.
2. Strengthening the hip abductors and hip extensor muscles.
3. Ice therapy.
4. Non-steroidal anti-inflammatory medicines.
5. Massage therapy on the outer side of the knee and the area around the greater trochanter of the hip, as well as the use of a foam roller.
6. Stretching the iliotibial band.
7. Replacing footwear every 1,000 kilometres.
8. Undergoing plantar-pressure analysis and using specialised anatomical insoles based on its results.

Shin splints or medial tibial stress syndrome

Shin splints cause acute pain along the front of the shin during running workouts. Initially, the pain appears after a running workout, but it progressively develops into persistent acute pain in the area. If the pain continues, you should consult your doctor.

The most common causes of shin pain are:

1. Unsuitable running shoes.
2. A sudden change in running terrain or running on uneven surfaces or hills.
3. Worn-out running shoes.
4. Flat feet.
5. Stiff calf muscles.
6. An incorrect training plan, such as a sudden increase in distance or intensity.
7. Weak hip muscles.
8. Poor physical condition.
9. A sudden transition from treadmill running to outdoor training.

Treatment of medial tibial stress syndrome

1. Rest.
2. Ice therapy.
3. Significantly reducing running distance or replacing running with cycling or swimming.
4. Non-steroidal anti-inflammatory medication.
5. Undergoing plantar-pressure analysis and using specialised insoles made according to its results.
6. Replacing running shoes every 1,000 kilometres.
7. Stretching the calf muscles and hamstrings.
8. Strengthening the hip abductors and hip extensor muscles.
9. Optimising training and avoiding uphill running.

Stress fractures

Stress fractures cause persistent pain, primarily along the front of the shin, but sometimes also in the foot, hip, thigh or pelvis. The causes and treatment of stress fractures are similar to those of medial tibial stress syndrome.

However, because stress fractures are much more serious than shin splints, they require careful treatment. Some runners may need to have the limb immobilised in a walking boot or use crutches, depending on the location of the fracture, until the stress fracture has healed. In some cases, surgical treatment may also be required if the fracture is sufficiently severe or located in a high-risk area, such as the femur.

Cardiorespiratory training should focus on activities that do not place strain on the injured limb, such as swimming, whenever possible.

The best approach to preventing a stress fracture is to follow an appropriate training programme designed by a coach, use suitable running shoes and replace them when necessary, avoid sudden increases in the intensity and distance of running workouts, and avoid running long distances on hard surfaces.

Your doctor should assess you immediately if you suspect that you have sustained a stress fracture during training and provide the appropriate instructions where necessary.