Common Injuries from Running: Causes and Prevention
The Trail Run That Cost Me Two Months
Last summer I sprained my ankle on a trail run during a vacation. I was wearing my regular road running shoes because I had not packed my trail shoes. The trail was wet. I rolled my ankle on a root I would have cleared easily in proper trail shoes and went down hard. The ankle swelled immediately and I could not put weight on it. I am lucky to have a sister who is a physio therapist so I knew that I needed to see some one right away.
The early intervention window matters more than most runners realize, and research backs this up. A 2024 review in the International Journal of Physical Medicine and Rehabilitation confirmed that athletes who begin rehabilitation within days of an injury recover faster and with fewer complications than those who delay treatment.
That experience changed how I think about injuries entirely. I am not a “push through it” runner anymore. If something is painful in a way that alters how I run, I see a physiotherapist before my next training run. Not in two weeks. Not when I have time. Before the next run. That single change has kept me healthier in the past year as they can give such specific exercise to prevent future injury.
- About 50% of runners get injured every year according to multiple large scale studies
- The knee, ankle, and calf are the three most frequently injured areas
- Having a previous injury doubles your risk of getting injured again
- See a physiotherapist early, not after weeks of hoping it goes away
- Most running injuries are preventable through strength training, proper warm ups, and gradual mileage increases
- Wear the right shoes for the surface, trail shoes on trails, road shoes on roads
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The Numbers The 7 Most Common Injuries When to See a Physio Prevention That Works FAQ Quick Answer Last Updated: April 2026How Common Are Running Injuries, Really?
The numbers are worse than most runners expect. A 2025 study in Research in Sports Medicine surveyed 303 runners and found that 53 percent had sustained an injury in the previous year, with patellofemoral pain syndrome (runner’s knee) being the most common at 15 percent. A separate one year prospective study tracking 224 recreational runners found a cumulative injury incidence of 46 percent, with the knee and Achilles tendon/calf as the most frequently affected areas. A systematic review covering multiple large studies found the overall injury incidence to be approximately 40 percent and prevalence approximately 45 percent.
The single most important risk factor is previous injury. Runners with a history of injury are twice as likely to sustain a new running related injury compared to runners with no injury history. Other significant risk factors include running more than 30 miles per week, increasing weekly mileage too quickly, inadequate recovery between hard sessions, and running more than six days per week. Most running injuries are overuse injuries caused by controllable training variables, which means most are preventable.
The 7 Most Common Running Injuries
Each injury below includes what it is, how to recognize it, what causes it, how to treat it, and the approximate recovery timeline. For every single one of them, the advice is the same: see a physiotherapist sooner rather than later.
Runner’s Knee (Patellofemoral Pain Syndrome)
What it feels like: A dull, aching pain around or behind the kneecap that gets worse going up or down stairs, squatting, or sitting with your knee bent for a long time. The most common running injury by prevalence at approximately 17 percent of all running injuries.
What causes it: Weak quadriceps and hip muscles that allow the kneecap to track poorly in its groove, sudden increases in mileage, running on cambered surfaces, or shoes that have lost their cushioning and support.
Recovery: 4 to 8 weeks with physiotherapy focused on hip and quad strengthening. Do not just rest and wait. The underlying weakness will still be there when you return.
Achilles Tendinopathy
What it feels like: Pain and stiffness in the Achilles tendon, typically worst in the morning and at the start of a run. The tendon may feel thick or swollen compared to the other side. Accounts for approximately 10 percent of all new running injuries.
What causes it: Sudden increases in mileage or intensity, tight calf muscles, switching to a shoe with a lower heel to toe drop without a transition period, or running on hills more than your tendons are adapted to.
Recovery: 6 to 12 weeks of eccentric calf loading exercises prescribed by a physiotherapist. This is the one injury where the specific rehab protocol (heavy slow resistance or eccentric heel drops) makes a major difference in outcomes. The Achilles has limited blood supply and heals slowly, which makes early intervention even more important.
Shin Splints (Medial Tibial Stress Syndrome)
What it feels like: Pain along the inside edge of the shinbone (tibia), usually over a broad area rather than one specific point. Hurts during and after running and is tender to press. The most common lower leg injury in runners at approximately 9 percent of new injuries.
What causes it: Increasing your running volume or intensity too quickly, starting a running program on hard surfaces, flat feet or overpronation, and worn out shoes. Common in new runners whose bones and muscles have not yet adapted to the repetitive loading of running.
Recovery: 2 to 6 weeks with reduced volume and a gradual return. Important: if the pain is sharp and localized to one spot rather than spread along the shin, get assessed for a stress fracture. A physiotherapist can help differentiate between the two.
Plantar Fasciitis
What it feels like: Sharp, stabbing pain in the heel or arch of the foot, worst with the first few steps in the morning or after sitting for a long period. Pain typically improves after moving around but returns after prolonged standing or running.
What causes it: Tight calf muscles, high arches, flat feet, sudden increases in training load, and shoes with inadequate arch support. Spending long hours on your feet in flat shoes (like casual sneakers) outside of running can also contribute.
Recovery: 6 to 12 weeks with calf stretching, plantar fascia specific exercises, proper insoles, and sometimes night splints. Can become chronic if not addressed early, which is another reason to see a physiotherapist as soon as symptoms appear rather than waiting.
IT Band Syndrome
What it feels like: Pain on the outside of the knee that typically starts after a consistent distance (always at mile 3, for example) and gets worse until you stop. The iliotibial band is a thick band of connective tissue that runs from the hip to the outside of the knee.
What causes it: Weak hip abductors (particularly the gluteus medius), running on cambered roads where one leg is always slightly lower than the other, sudden increases in downhill running, and a tight IT band.
Recovery: 4 to 8 weeks with a physiotherapy program focused on hip strengthening, particularly clamshells and lateral band walks. Foam rolling the IT band itself is less effective than strengthening the hip muscles that control it.
Ankle Sprain
What it feels like: Sudden, sharp pain on the outside of the ankle after the foot rolls inward. Immediate swelling and bruising. Difficulty putting weight on it. This is the injury I dealt with last summer when I ran trails in road shoes. Ankle sprains account for approximately 6 percent of new running injuries.
What causes it: Running on uneven terrain, trail running in shoes that lack lateral stability and traction (road shoes on trails are a recipe for this), weak ankle stabilizer muscles, and previous ankle sprains that were not fully rehabilitated. Once you sprain an ankle, you are significantly more likely to sprain it again if you do not rebuild the proprioceptive awareness and strength around the joint.
Recovery: 4 to 8 weeks for a mild to moderate sprain, potentially longer for a severe sprain. Physiotherapy should start within the first week, not after two weeks of hoping it resolves. Balance training and progressive loading are essential for full recovery and prevention of reinjury. And wear proper trail shoes on trails.
Stress Fracture
What it feels like: A sharp, localized pain in one specific spot (usually the shin, metatarsals, or heel) that gets worse with activity and improves with rest. Unlike shin splints, the pain is in one precise location rather than spread along the bone. There may be localized swelling and the spot is very tender to press.
What causes it: Training load that exceeds what the bone can adapt to. This usually means too much mileage too fast, inadequate recovery, low bone density (more common in female runners), and insufficient caloric intake. Stress fractures are the injury that most often requires complete rest from running.
Recovery: 6 to 12 weeks of no running, followed by a gradual return to running protocol supervised by a physiotherapist or sports medicine physician. This is not something you can self manage. Imaging (MRI or bone scan) is often needed to confirm the diagnosis. See a professional immediately if you suspect a stress fracture.
When to See a Physiotherapist (Hint: Sooner Than You Think)
Most runners wait too long. The typical pattern goes like this: something starts hurting, you ignore it for a run or two, then you take a few days off, then you try running again and it still hurts, then you take a week off, then you try again, and by the time you finally book a physiotherapy appointment you have been dealing with the issue for a month and the problem has become chronic.
Research consistently shows that early physical therapy intervention leads to better outcomes. A 2024 review confirmed that athletes who start rehabilitation within days of an injury recover faster, develop fewer compensatory movement patterns, and have a lower rate of reinjury. Your body starts developing compensation patterns the moment you are injured. The longer those compensations persist, the more ingrained they become. Early physiotherapy addresses the root cause, prevents compensation, and gets you back to running faster.
✓ See a Physio Immediately If
- Pain changes your running gait or causes you to limp
- Sharp, localized pain in one specific spot (possible stress fracture)
- Any sudden injury (sprain, acute muscle tear)
- Pain that gets worse over several runs despite rest
- Swelling, bruising, or inability to bear weight
✗ Probably Safe to Monitor for a Few Days
- General muscle soreness after a hard workout that fades within 48 hours
- Mild tightness that improves as you warm up and does not return
- DOMS (delayed onset muscle soreness) from a new exercise
- Light stiffness in the morning that resolves within minutes
The Prevention Strategies That Actually Work
Strength Training (Most Important)
Research consistently shows that runners who incorporate strength training two to three times per week experience fewer overuse injuries, particularly at the knee and Achilles. Stronger calves improve running economy and tendon tolerance. Stronger hips reduce knee stress and IT band loading. Stronger glutes improve pelvic stability and reduce compensatory patterns. This does not mean heavy bodybuilding. It means targeted exercises like calf raises, single leg squats, hip bridges, clamshells, and lateral band walks done consistently with progressive load. Twenty minutes twice a week is enough to make a meaningful difference.
Gradual Mileage Increases
The 10 percent rule (increase weekly mileage by no more than 10 percent per week) is a simplified guideline, but the principle behind it is well supported. A prospective study of 874 novice runners found that sudden weekly mileage increases of more than 30 percent were associated with higher injury rates for certain injury types. The key is not the specific number but the concept: give your body time to adapt to each increase in load before adding more.
Dynamic Warm Up Before Every Run
A proper dynamic warm up before running prepares your muscles, tendons, and joints for the demands of the workout. Five minutes of leg swings, walking lunges, high knees, and butt kicks is enough for most runs. Never do static stretching before running. Save that for after. See our complete warm up guide for the full routine.
Wear the Right Shoes for the Surface
I learned this the hard way. Road shoes on trails significantly increase your ankle sprain risk because they lack the lateral stability and traction that uneven terrain demands. Trail shoes on roads wear down the lugs faster but are otherwise fine. If you run both surfaces regularly, own a pair of each. See our shoe review hub for current recommendations, or take the Shoe Finder to match your foot to the right shoe. Runners dealing with foot pain may also benefit from aftermarket insoles that provide better arch support than factory insoles.
Adequate Recovery
Your body rebuilds during rest, not during the run itself. Runners who consistently sleep less than 7 hours and train through high stress often deal with lingering tendon irritation and slower recovery. Build rest days into your training plan. Alternate hard and easy days. Take a full deload week every 3 to 4 weeks. These are not signs of weakness. They are the training strategy that every experienced coach builds into their programs.
Cross Training
Mixing running with low impact activities like cycling, swimming, or pool running maintains cardiovascular fitness while reducing the repetitive loading on the same tissues. One or two cross training sessions per week can significantly reduce cumulative load on the legs while still building the aerobic base you need for race day.
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FAQ
How common are running injuries?
Should I see a physical therapist for a running injury?
What is the most common running injury?
Can I run through pain?
How do I prevent running injuries?
Should I use the RICE method for running injuries?
Do running shoes cause injuries?
Quick Answer
The Three Things That Matter Most
1. See a physiotherapist early. Not after two weeks of hoping it gets better. Not after you have tried every foam roller and YouTube stretch. Within the first week. Early intervention shortens recovery, prevents compensation patterns, and reduces your risk of reinjury. This is the single most impactful piece of advice in this entire article.
2. Strength train consistently. Two sessions per week targeting hips, glutes, and calves is the most evidence supported injury prevention strategy for runners. It works better than stretching, foam rolling, or any piece of gear.
3. Respect the terrain. Road shoes on roads. Trail shoes on trails. I learned this one the hard way. A pair of trail shoes costs $130. Two months of physiotherapy and lost training costs a lot more.
Sources: Research in Sports Medicine, “Incidence and running characteristics associated with running related injuries in runners,” 2025. Desai et al., “Recreational Runners With a History of Injury Are Twice as Likely to Sustain a Running-Related Injury,” J Orthop Sports Phys Ther, 2021. Francis et al., “A systematic review of running-related musculoskeletal injuries in runners,” J Sport Health Sci, 2021. Napier et al., “Running towards injury? A prospective investigation,” Sports Medicine Open, 2023. Mauglonh, “The Impact of Early Physical Therapy Intervention on Recovery Outcomes,” Int J Phys Med Rehabil, 2024.