As any runner can tell you, pounding the pavement is not all runner’s high—there are aches and pains that come along with it. Running injuries can run the gamut from annoying to sidelining, which is why it’s important to accurately identify what’s going on.
“Runners get a whole long potential list of things that can hurt in the legs as you start to run,” says John M. Vasudevan, M.D., an assistant professor of clinical physical medicine and rehabilitation in the sports medicine department at Penn Medicine, tells SELF. “Some things are muscular, some things are tendons, and some are with bone, and many can present similarly.”
Running is a high-impact exercise, meaning your entire body takes a bit of a beating when you run for a prolonged period of time.
If you're a beginner runner, your body isn't used to the repetitive motion, and you're likely to end up with some aches. That doesn't always mean you're actually injured, Reed Ferber, Ph.D., researcher at the University of Calgary and director of the Running Injury Clinic, tells SELF. "Running hurts—you need to prepare yourself for that," he says. "But if the pain gets better, or goes away as the run goes on, that’s a good thing."
It takes your body some time (maybe even a few months) to adapt to the new stress you're exposing it to.
But if the pain persists, gets worse throughout your run, or goes away while you're running but comes back with a vengeance when you stop, those are signs you could have an actual injury. Ferber says the best thing to do is stop running and go see a health care provider to figure out what's going on before you cause any permanent damage from your running injuries.
There are a lot of ways you can sprain, strain, tweak, and tear yourself when you run, but below, we've laid out five common injuries for beginner runners. Here’s what you need to know about each so you can run for the long haul.
1. Runner’s knee
What it is: "Patellofemoral pain syndrome, more commonly referred to as runner’s knee, is a dull, achy pain that originates underneath your kneecap and is typically felt during running, especially uphill, walking down stairs, or when moving from a sitting position to a standing position," John Gallucci, Jr., M.S., D.P.T., president and CEO of JAG Physical Therapy, tells SELF.
This is the most common running injury, especially for new runners, Ferber says. He notes that for some people, the pain may start at the beginning of the run, subside throughout, and then pick up again as soon as you stop running.
What causes it: "It's a grinding injury," Ferber says. There's cartilage under your kneecap and also along your thigh bone, and a layer of fluid in between the two works as cushioning, Ferber explains. He says to think of the kneecap as a train, and the thigh bone (femur) as the train track. When the hips are weak, the thigh bone loses its stability and moves underneath the kneecap. "The railroad track starts moving. Those pieces of cartilage start to rub together, and that’s what causes the pain," Ferber explains.
How to treat it: This is something most runners can deal with and will attempt to run through, Dr. Gallucci says. But (surprise!) that's not a good idea. "If not properly managed, patellofemoral syndrome can progress into a more severe injury that could require surgical intervention, such as a fissuring or fracturing of the patella," he says.
Initially, you should stop running and try to limit inflammation—taking anti-inflammatory medications such as ibuprofen can help.
How to prevent it: After you’re pain-free, work on strengthening your hips, says Ferber, who coauthored a study on the benefits of treating runner's knee with hip and core exercises. In the study, people with knee pain who completed six weeks of core and hip strength training reported an earlier resolution of pain and gained more strength than those who performed knee-focused rehab. Here are the specific exercises he recommends.
2. Shin splints
What it is: Medial tibial stress syndrome, more commonly known as dreaded shin splints, causes pain on the inside surface of the shin, "especially when walking, running, and pulling the foot upward or stretching it downward," says Nicholas M. Licameli, P.T., D.P.T. The pain can occur on the inner or outer side of the shins.
What causes it: "There’s a muscle that attaches to the back of the shin bone, and that muscle wraps around the inside of the ankle bone and helps to control the foot when it pronates [rotates inward and downward], and also helps during push-off to propel you forward," Ferber explains. Shin splints happen when there's repetitive trauma to the connective tissue that attaches this muscle to the tibia bone, says Dr. Gallucci. The tissue breaks down, becomes inflamed, and sometimes scar tissue forms during the healing process, "which produces pain and tightness."
How to treat it: Because shin splints are an overuse injury, you may need to stop running for a few weeks to rest the area, says the American Academy of Orthopedic Surgeons. Ice and compression can help you feel better too.
How to prevent it: Getting running shoes with more cushioning is a good start, but shoe choice is just a minor part of this, Ferber says. "The true fix is strengthening." He tells patients to follow a heel raises program (check it out here) to strengthen the calves and ankles.
3. Plantar fasciitis
What it is: Plantar fasciitis causes a stabbing pain on the bottom of the foot near the heel. "It's usually a little bit stiff at the beginning of a run, and then the pain goes away. Then it's a little stiff when you finish," says Ferber. "But it hurts first thing in the morning. That first step out of bed is excruciating at the heel. It can take 15 to 30 steps to get it warmed up and to go away, and then you kind of forget about it."
What causes it: The plantar fascia is a thick band of connective tissue that runs along the sole of the foot from the toes to the heel. Its job is to support your arch, Ferber says. "It gets stretched every time the foot comes down, and runs back out as the foot pronates," he explains. It's designed to be thick enough to withstand these forces, but too much repeated tension on the fascia can cause irritation and inflammation.
Since the fascia is connected to so many parts of your foot and leg, there are many things that can contribute to plantar fasciitis. Poor running mechanics, flat feet, weakness of the hips, weakness of the core, poor control of pelvic positioning, and nerve irritation in the lower back can all contribute to this inflammation and pain, Dr. Licameli says. Tight calf muscles or even inflexible toes can strain this connective tissue, too, adds Ferber.
How to treat it: "We say to stretch and do heel raises to make sure the muscles crossing underneath the foot are good and strong. That takes the load off the plantar fascia," Ferber says. "Plus, a good arch support (just an over-the-counter orthotic) will take some stress off." Dr. Licameli also suggests strengthening your hips and core.
How to prevent it: Those same strengthening exercises are helpful for prevention, too. "And always warm up properly," Dr. Licameli says.
4. Achilles tendinitis
What it is: This type of tendon injury causes inflammation and pain in your Achilles tendon (along the back of your heel), especially when walking, running, raising up on your toes, and stretching your calf muscles, Dr. Licameli says. It's an aching, dull pain, usually right where the muscle transitions to tendon, Ferber says.
The pain can also be deeper in the thickest part of your tendon, which is more common as you age. “You lose blood supply in the mid part of the Achilles tendon and it becomes brittle. It starts happening in about your 40s," Ferber explains.
What causes it: Any weakness or tightness in the calves, glutes, or hamstrings can affect the Achilles tendon. We use our calf muscles and glutes to propel us forward, and if they're not their jobs, smaller things like tendons have to take over, which can end up causing a lot of strain. Dr. Licameli adds that having weak hips or core or flat feet can all impact how much strain is on the Achilles tendon.
It also tends to be more common when people increase their activity suddenly, whether it’s running more miles or increasing speed.
How to treat it: You may need to rest from high-impact activity until the pain resolves. Icing the affected area can also help you feel better. But again, strengthening and stretching the muscles at play is key here. Often it's the hips or calves that need to be strengthened, but issues with the feet are core are common too.
How to prevent it: Continue stretching and strengthening those muscles. Since there can be so many different causes, you need to figure out the main one in order to properly treat it—that's why it's so important to see a professional to help you get to the bottom of it, Ferber says.
5. Stress fractures
What it is: Stress fractures exist on a continuum: “It starts with a stress reaction, where the bone is already being outpaced in its ability to recover, but has not yet turned into a fracture,” Dr. Vasudevan says. “This can progress even further to what may appear to be a hairline fracture, and if it progresses even further, it can be flat out an obvious fracture that you see on an X-ray.” Runners are most likely to experience these in their tibia (shin bone), metatarsals (long bones in your foot), and fibula (the thinner bone alongside the tibia).
Pain is the most common symptom you’d experience with a stress fracture, and it’s often localized to a specific point. The pain is different from what people generally experience with shin splints because it actually gets worse the longer you exercise, whereas with shin splints, the discomfort can improve as your body warms up, Dr. Vasudevan says. He uses what he calls the 24-hour rule to help his patients identify if a stress fracture might be at play: “Does someone's pain get worse during or in the aftermath of an activity and fail to get better or return to baseline within 24 hours?” he says. “If that continually happens, especially if it happens earlier and earlier into the run and hurts more and more for each episode, that's usually a bad sign.” Pain or abnormal gait while just walking is a red flag too.
What causes it: Stress fractures occur when your bones are unable to adequately repair themselves after experiencing repetitive stress, like through running, says Dr. Vasudevan.
While many people new to running might think the dreaded stress fracture is an injury reserved for more experienced—and higher mileage—runners, it can actually hit beginners too, says Dr. Vasudevan. Stress fractures are more likely to occur when there is a change to a running routine, such as more miles, a different terrain, or a higher intensity, he says. That means a beginner who is just getting started, and ramps up too soon, can be at risk.
Nutritional factors—not getting enough calories to fuel your activity, or not getting the right balance of calories (you might need protein, for instance)—can play a role too, says Dr. Vasudevan. So can hormones: A condition called relative energy deficiency is sport (RED-S, formerly known as female athlete triad), which includes not enough calories, menstrual irregularities, and lowered bone density, can increase risk of stress fractures.
How to treat it: Stress fractures are not something you can run through—it can make the problem worse and possibly set you up for an actual fracture. Depending on the severity of the stress reaction or fracture, you might be looking at three to six weeks off running, which you may spend in a walking boot, Dr. Vasudevan says. Once you’re pain-free, you should return back to running gradually—think walk-run periods and a lesser total weekly mileage.
How to prevent it: Strengthening your glutes and core can help improve your biomechanics when running, says Dr. Vasudevan. You’ll also want to make sure you’re not increasing mileage too rapidly or suddenly changing your running terrain. Fueling your activity properly is important too.
Originally Appeared on SELF