No Matter How Careful You Are, These 15 Common Running Injuries Can Sneak Up on You
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No matter how careful you are, running takes a toll on your body: A 10-minute mile consists of 1,700 steps, each one producing ground reaction forces two and a half times your body weight on average. That’s a huge load for you to absorb—and probably why 20 percent of runners are likely to experience an injury while training for an event, according to research in the journal BMJ Open Sport & Exercise Medicine.
Plus, a recent survey of 1,147 runners suggests that during the pandemic, runners are running more but with less intensity, and still experiencing more injuries. Knee issues, IT band syndrome, ankle instability, and back pain are among the most common to plague runners, a 2020 analysis in the Journal of Clinical Medicine found.
If you’re feeling pain that falls at a 6 or 7 on a scale of 1 to 10, pain that’s interfering with your daily life, or pain that lingers for more than two weeks, get yourself to a doc, says Cat Fitzgerald, D.P.T., a physical therapist at Custom Performance in New York City. To troubleshoot tweaks and twinges at home, try these remedies from Fitzgerald, Jay Dicharry, M.P.T., a biomechanics researcher, and Jordan Metzl, M.D., a sports medicine physician at the Hospital for Special Surgery in New York City.
PIRIFORMIS SYNDROME
What it feels like: A literal pain in the butt—more specifically, pain, cramping, and tingling in the glute muscles that may extend down the back of the leg and into the foot.
Why it happens: Weak glutes (due to too much sitting) or repetitive movement (like running) fatigue the piriformis muscle, which is responsible for external rotation of the hip joint, which can result in compression of the nearby sciatic nerve.
The fix: Floss the sciatic nerve to relieve compression: Sit on the side of a bench or chair so knees are bent at 90-degree angles and your left leg can move forward and back. Tilt head back, keep left knee bent, and point left foot; extend left leg and flex the foot; return leg to starting position then tilt chin to chest. Hold for 2 to 3 seconds. Tilt head back, bend knee, and point the foot to return to the starting position. Do 2 sets of 10 reps.
SHIN SPLINTS
a.k.a medial tibial stress syndrome
What it feels like: A nagging pain concentrated in the front or outside of your leg along the shin bone (tibia); it usually pops up during and after exercise and when you press on the affected area on the lower leg.
Why it happens: Repetitive stress on the shinbone and the connective tissues causes microscopic tearing of the muscle away from the bone, generally as a result of activity load (i.e. upping your mileage too quickly) and body mechanics (especially overstriding).
The fix: Protect yourself by strengthening your feet, ankles, calves, and hips, which support your shins with specific exercises. And learn to control the eccentric deceleration of your foot to the ground: Loop a mini band around your feet and step feet apart until you feel resistance on the band. Flex one foot so toes lift up off the ground, then slowly lower toes back to the ground. Do 3 sets of 10 reps on each foot.
LOWER BACK PAIN
What it feels like: Muscle-related pain on either side of the lower part of your spine; you may feel spasms or pain on one side of your spine or the other, especially when you twist or move.
Why it happens: Tightness in the hamstrings and front of the hips, and weakness in the muscles that surround your back—your core, hips, glutes, and hamstrings—rotate your pelvis forward, making it impossible to engage and stabilize your core and putting the burden on your lower back instead.
The fix: Foam roll your major running muscles to release the pressure on your lower back: Grab your favorite foam roller and focus on your lower back, glutes, quads, IT bands, hamstrings, and calves for 20 seconds each, then repeat that sequence three times for a total of 60 seconds of rolling on each body part.
ANKLE PAIN
What it feels like: A sharp, shooting pain or a constant, dull ache along either side of your ankle.
Why it happens: Weakness anywhere up and down the kinetic chain (above or below the hip, and especially the gluteus medius muscle) can cause instability and vulnerability at the ankle as you repeatedly load the joint; rolling the ankle, usually inward, can lead to partially or fully torn ligaments.
The fix: Rest, then build your ankle stability with pass backs: Stand on the floor holding a five- to 15-pound weight, or a full gallon jug of water and shift weight to one leg. Pass the weight back and forth from one hand to the other while aiming to keep stable at the ankle joint. The faster you go, the harder this gets. Aim for 2 minutes total on each foot, taking breaks as needed.
BLISTERS
What it feels like: A burning sensation that may be accompanied by pain, redness, or itching.
Why it happens: Friction, usually caused by your shoes or socks rubbing against your skin; anything that intensifies rubbing can start a blister, including a faster pace, poor-fitting shoes, and foot abnormalities such as bunions, heel spurs, and hammertoes.
The fix: Drain the blister using a sterilized needle, then cover with a tight, clean bandage; wear synthetic, moisture-wicking socks to avoid blisters in the future.
IT BAND SYNDROME
What it feels like: An aching, burning pain on the outside of the knee (sometimes spreading up the thigh to the hip) that occurs five to seven minutes into every run.
Why it happens: Overuse, wearing worn-out shoes, pelvic imbalances, and weak glutes can cause the leg to turn inwards, irritating the iliotibial band, a thick band of connective tissue that runs from the outside of your hip to the outside of the knee and helps stabilize and move the knee joint.
The fix: Strengthen the gluteus medius muscles with hip hikes to keep the pelvis level: Stand sideways on a step, hanging one leg off. Keeping core engaged and standing leg straight, allow the hanging leg to slowly lower toward the ground by dropping your pelvis on that side. Once you’ve dropped your pelvis as far as possible without bending your standing leg, use the hip muscles in the standing leg to raise your pelvis back up. Do 2 or 3 sets of 12 reps on each side.
PLANTAR FASCIITIS
What it feels like: A sharp stab or deep ache in the heel or along the arch of the foot, especially in the morning, after sitting for long periods of time, or during the push-off phase of your gait.
Why it happens: Drastic or sudden increases in mileage, poor foot structure or overpronation, tight calves, excessive uphill running, and inappropriate running shoes can overload the plantar fascia (the connective tissue that runs from your heel to the base of your toes); that stress can cause tiny tears in the plantar fascia, causing heel pain and inflammation.
The fix: Strengthen the foot muscles, specifically in the arch, with toe yoga: Remove your socks and shoes and stand tall on both feet. Splay your toes and feet out so weight is distributed evenly. While keeping toes two to five down, lift just your big toe. (It’s harder than it sounds!) Hold for 2 seconds while keeping the small toes relaxed. Lower and repeat 20 times. Then switch and keep your big toe down while lifting toes two to five up. Try not to let the foot pronate (roll inward) on this one. Hold for 2 seconds. Lower and repeat 20 times.
ACHILLES TENDINITIS
What it feels like: Dull, nagging, or sharp pain anywhere along the back of the tendon but usually close to the heel; you may notice limited ankle flexibility.
Why it happens: Tight or fatigued calf muscles (from not stretching properly, increasing mileage too quickly, or overtraining) transfer too much of the burden of running to the Achilles; under too much stress, the tendon tightens and is overworked, which causes irritation or inflammation.
The fix: Perform isometric calf raises for pain relief, then eccentric calf raises to build strength: Place toes on a raised stair or step and let heels hang off. Shift the majority of your weight on one side, lift onto your toes, keeping the crease of the ankle joint in line with the second toe, and hold that position for 10 seconds. Repeat five times, then repeat on the other side. Then lift both heels and lower one foot slowly until heel drops below the stair or step; do 3 sets of 10 reps on each leg.
RUNNER’S KNEE
a.k.a. patellofemoral pain syndrome
What it feels like: Aching pain around or behind the knee cap, especially when running downstairs or descending steep hills.
Why it happens: Abnormal mechanics caused by problems up- or downstream from the knee—think: weak posterior hip muscles, like the gluteus medius—rotate the leg inwards, forcing the patella to bump against the femoral groove; this is (surprise!) exacerbated by overuse.
The fix: Activate your glutes and relearn hip extension with grasshopper exercises: Lie on stomach and rest chin on hands. Spread knees apart as far as you can on the floor and bring toes together in the air so both sets of toes are pointing up at the ceiling. Lift thighs up off the ground as high as you can (it will only be a few inches, max), while keeping torso on the ground. Lower back down. Do 3 sets of 15 reps.
BLACK TOENAILS
What it feels like: Nothing, really, or it may feel swollen and sore to the touch.
Why it happens: Repetitive trauma during the push-off phase of your gait, when the toes on your trailing foot are extended up and hit the toe box of your shoe, causes microtrauma that adds up over the duration of your run and can lead to bleeding under the nail.
The fix: In most cases, do nothing. Just let it grow out. In more extreme cases with constant pain, don’t treat it at home; see a doc who can drain it within the first few days. If the nail falls off, use an antibiotic ointment and a bandage to prevent infection. Otherwise, keep your toenails short, clipping them regularly, and make sure there’s a thumb-width distance from the tip of your longest toe to the end of your shoe.
HAMSTRING STRAIN
What it feels like: Pain at the top of the hamstrings near the glutes while running, especially if you’re running uphill or doing speedwork.
Why it happens: Overly dominant quads pull the pelvis into a forward tilt, which over-lengthens the hamstrings, and/or weak hips and glutes put too much load on the muscle, which can cause microtears in the hamstrings that subsequently develop scar tissue, leading to chronic stiffness and discomfort.
The fix: Increase the amount of load your hamstrings can handle with bridge walk-outs: Lie faceup on the ground with knees bent, feet flat on floor, arms resting at sides. Press through heels to lift hips up towards ceiling without overarching your back, then walk feet out until knees are almost straight or as far as you can, then walk them back in. Slowly lower back down and repeat. Do 3 sets of 8.
STRESS FRACTURE
What it feels like: Aching or burning localized pain somewhere along a bone; the area will hurt if you press on it, and the pain will get progressively worse as you run on it; common areas for runners include feet, shins, and hips.
Why it happens: Too much loading force on the bone, typically due to overuse or ramping up your mileage too quickly.
The fix: Learn how to rest! Stress fractures can take four to eight weeks to heal, depending on the severity. Continuing to run on one will only elongate the healing process (or worsen the injury). Use this time to do low-impact cross-training, such as swimming or biking, with clearance from your doctor.
Remember: If you’re feeling pain that falls at a six or seven on a scale of one to ten, that’s interfering with your daily life, that alters your gait, or that lingers for more than two weeks, get yourself to a doctor.
PAIN ON TOP OF FOOT
What it feels like: Irritation on the top of your foot, or a sharp pain that shoots up through your foot into your toes.
Why it happens: Shoes that are too small or too tight around the forefoot cause irritation on the top of the foot or neuromas, inflamed or swollen nerves near the metatarsals.
The fix: loosen your laces or look for shoes with a wider toebox for more room in the forefoot, and use Yoga Toes to stretch and separate your toes out of that crunched position
HIP BURSITIS
What it feels like: Sharp or aching pain on the outside of the upper thigh or hip; it may also hurt when you apply pressure to that area (like when sleeping).
Why it happens: Repetitive friction over the greater trochanter of the hip bone causes the bursa, a fluid-filled sac that reduces friction between the surfaces of a bone and soft tissue, in that area to become inflamed; it’s almost always due to overuse or biomechanical issues.
The fix: Release the compression in the area with a sartorius stretch: Start seated, legs loosely bent in front of you. Point both knees to the left, bent at a 90-degree angle, and lean back on left elbow. Squeeze glutes and push hips forward, working to lower right knee to the ground. Hold for 20 to 60 seconds, then repeat on the opposite side.
SHOULDER PAIN
What it feels like: Aching or cramping of the shoulder muscles.
Why it happens: You’re holding too much tension in your upper body and/or you’re running with poor posture due to weakness in the upper body or lower back (likely due to sitting too much!) which forces your upper trapezius and levator scapulae muscles to take on too much work.
The fix: Work on your scapular strength to pull your shoulders away from your ears with scapular push-ups: Start in a high plank position with your hands under your shoulders and your feet together, body forming a straight line from head to heels. Without bending your elbows or dropping your hips, let your shoulder blades pinch together (your chest will move a little bit towards the floor), and then actively pull them apart. Do 3 sets of 5 reps.
Credits: Video: David Monk; Coach Jess wears Asics Women’s Sakura Tank ($30); Athleta Lightening Camo Tight (Similar: Athleta Elation Camo 7/8 Tight, $89); Adidas Women’s Ultraboost 19 ($140), and her own Garmin watch.
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