Runner’s injury guide

Updated September 21, 2026. Evidence checked against current systematic reviews and clinical practice guidelines.

The direct answer

Knee pain, Achilles pain, shin pain, plantar heel pain and other lower-leg problems are common in runners. The name of the injury matters less at first than the pattern. Stop running and arrange an assessment if pain changes your stride, is sharply focused over a bone, keeps getting worse, or is present while walking or resting. After an acute injury, an inability to bear weight, a visible deformity, numbness or a cold or discoloured foot needs urgent medical care.

Diffuse muscle soreness after an unfamiliar workout can usually be watched for a day or two if it improves steadily and you can walk normally. A list on the internet cannot diagnose the painful spot. Use this guide to decide what to do next, not to label the injury yourself.

What should I do?How common?7 injury patterns Lowering risk FAQ Research

The trail run that cost me two months

Last summer I went for a trail run while on vacation. I had only packed my regular road shoes. The trail was wet, my foot caught awkwardly on a root and I rolled my ankle hard. It swelled almost immediately and I could not put weight on it.

My sister is a physiotherapist, so I knew enough not to test it with another run. I had it assessed. Recovery still took about two months.

I cannot claim that trail shoes would definitely have prevented the fall. I can say that road shoes were a poor match for a slick, uneven trail, and I should have adjusted the run to the conditions and the gear I had. The lasting lesson was simpler: if pain changes the way I run or walk, I do not try to prove I can push through it.

First, decide how quickly you need help

These are screening clues, not diagnoses. If you are unsure, a sports medicine physician or physiotherapist can examine the area and help you choose a safe next step.

Monitor briefly

General muscle soreness after a new or harder workout
Soreness on both sides rather than one sharp spot
Normal walking and no swelling
Clear improvement from one day to the next

Book an assessment

Pain changes your stride or makes you limp
One small, sharply tender spot over a bone
Pain while walking, resting or at night
Symptoms worsen or do not settle after reducing the aggravating load

Get urgent care

You heard a crack or the area looks deformed
You cannot bear weight after an acute injury
The foot is numb, tingling, cold, blue or grey
Pain or swelling is severe or rapidly worsening

Do not use “it warmed up” as a clearance test. Some tendon and bone problems hurt less once you are moving. If the pain returns later, becomes more focused or changes your gait, stop testing it and get advice.

How common are running injuries?

There is no honest single percentage. Studies use different definitions of “injury,” follow runners for different lengths of time and include everyone from beginners to competitive athletes. One large systematic review reported an average incidence of about 40% and an average prevalence of about 45%. Those figures are useful for scale, not for predicting your personal odds.

Previous injury is one of the more consistent warning signs. In a one-year study of recreational runners, people with an injury history were roughly twice as likely to report another running-related injury. That does not mean reinjury is inevitable. It does mean that finishing rehabilitation and rebuilding training load deserve more attention than simply waiting for pain to disappear.

Why lists differ: Knee problems often lead prevalence tables, while calf, Achilles and shin problems can rank highly in studies counting new injuries. The runner’s age, experience, weekly training and the study’s definition all change the order.

Seven common running injury patterns

Use the descriptions to recognise patterns worth discussing with a clinician. Similar symptoms can come from different tissues, so avoid choosing a treatment only because one paragraph sounds familiar.

1. Patellofemoral pain, often called runner’s knee

Typical pattern: An ache around or behind the kneecap, often aggravated by running, stairs, squats or sitting with the knee bent for a long time.

What commonly helps: Education, a sensible adjustment to painful training and progressive knee-targeted exercise form the core of current best-practice care. Hip exercise, taping, prefabricated foot orthoses or running retraining may be added when they fit the runner.

Get assessed sooner if: the knee locks, repeatedly gives way, becomes markedly swollen, or the pain followed a collision or twist.

2. Achilles tendinopathy

Typical pattern: Pain and stiffness in or near the Achilles tendon, commonly noticeable during the first steps in the morning and with faster running, hills or repeated calf loading.

What commonly helps: Adjust the loads that provoke symptoms, then rebuild the tendon’s capacity with progressive calf and tendon loading. Current guidance does not require one magic heel-drop routine. The right exercise can be isometric, eccentric, concentric or heavy and slow, depending on the person and stage of rehabilitation.

Get assessed sooner if: you felt a sudden pop, have new weakness pushing off, or cannot perform a single-leg heel raise. Those signs can point to a rupture rather than gradual-onset tendinopathy.

3. Medial tibial stress syndrome, or “shin splints”

Typical pattern: Exercise-related pain and tenderness along a broader section of the inner shin. It often appears after a jump in running load or when a newer runner is adapting to repeated impact.

What commonly helps: Reduce the aggravating running load, keep pain-free conditioning where appropriate and return gradually. A clinician may also look at calf capacity, training history, running mechanics and footwear comfort.

Get assessed sooner if: pain is concentrated in one small spot, hurts during walking or at rest, or is getting worse. Those features raise concern for a bone stress injury.

4. Plantar heel pain

Typical pattern: Pain under the heel, often near its inner edge. The first steps after sleep or sitting can be the worst. Some runners find that it eases while moving, then complains again later.

What commonly helps: Care is usually a combination rather than one product: plantar fascia and calf stretching, progressive foot and lower-leg exercise, and short-term taping or foot orthoses when appropriate. Insoles can help some runners, but they are not a stand-alone cure.

Get assessed sooner if: there is numbness, burning, marked swelling, recent trauma or pain that does not fit the usual first-step pattern.

5. Iliotibial band syndrome

Typical pattern: Pain on the outside of the knee that may appear at a repeatable point in a run. Downhill running and a recent increase in volume are common parts of the story, but there is rarely one cause.

What commonly helps: Temporarily adjust the runs that provoke it, then build hip and lower-limb capacity. A 2024 review found hip-abductor strengthening was common in successful conservative programs, although the small studies do not establish one perfect protocol.

Get assessed sooner if: the knee is swollen, locks, gives way, or remains painful during ordinary walking.

6. Ankle sprain

Typical pattern: A sudden roll or twist followed by pain, swelling and sometimes bruising, usually around the outside of the ankle.

What commonly helps: After fracture and other serious injury are ruled out, current guidance favours external support when needed, progressive weight-bearing and structured exercise for motion, strength, balance and return to activity. Severe sprains may need a brief period of immobilization.

Get assessed sooner if: you cannot take a few steps, tenderness is directly over the ankle bones, swelling is severe, or the ankle repeatedly gives way. A brace can support some stages of recovery, but it does not replace an assessment or rehabilitation.

7. Bone stress injury

Typical pattern: Increasingly focal bone pain that first appears with running and may progress to pain while walking, at rest or at night. Common locations include the tibia and metatarsals.

What to do now: Stop impact exercise and arrange a medical assessment. The location and severity affect treatment, and imaging may be needed. Continuing to “test” a suspected bone injury can make it worse.

Look beyond mileage: Training load matters, but so do bone health, recovery and energy availability. Recurrent bone injuries, unintended weight change, disrupted menstrual function, low libido or persistent fatigue are reasons to discuss low energy availability and REDs with a qualified clinician. This can affect runners of any sex.

What can actually lower your injury risk?

No warm-up, shoe or strength routine makes a runner injury-proof. The better goal is to reduce avoidable spikes in stress, notice symptoms early and build enough capacity for the training you want to do.

Watch the size of a single long run. A 2025 study following 5,205 runners found a higher rate of overuse injury when one run exceeded the longest run from the previous 30 days by at least 10%. The study did not support the familiar week-to-week “10% rule.” Treat this as a practical warning against sudden long-run jumps, not as a guarantee that 9% is safe.
Change one big stressor at a time. Mileage, speed work, hills, terrain and racing all add load. When several rise together, it becomes harder to see what your body is not tolerating.
Strength train for capacity and performance. Calf, knee, hip and trunk strength can support running and forms part of rehabilitation for several injuries. Be wary of promises that two generic sessions a week will prevent every injury. A 2024 meta-analysis did not find a significant overall reduction from exercise-based prevention programs, although supervised programs looked more promising.
Warm up for the run you are about to do. Start easy and add progressive movements or strides before faster work. Our running warm-up guide gives you a short routine without claiming that stretching alone prevents injury.
Eat and recover for the work. Adequate energy, carbohydrate, protein, calcium and vitamin D all matter to training and bone health. Persistent fatigue, repeated injuries or signs of low energy availability deserve professional attention.
Choose comfortable shoes and respect the surface. There is no universally injury-preventing shoe. Comfort, secure fit, adequate traction and a gradual transition when changing shoe type are more defensible than matching a shoe to a supposed gait category.
Finish the rehabilitation. Pain settling is not always the same as restoring strength, balance and tolerance. Previous injury is a clear reason to make the return to full training deliberate.

About shoes: If your current pair is uncomfortable or does not suit the surface, use the free Running Shoe Finder as a starting point. It can narrow the options, but it cannot diagnose pain or guarantee that a shoe will prevent injury.

Useful next steps

Frequently asked questions

Can I run through pain?

Do not run through sharp or worsening pain, pain that changes your gait, focal bone pain, or pain that continues during walking or rest. Mild, diffuse muscle soreness after a hard or unfamiliar session is different, especially if it improves each day. If you cannot tell which pattern you have, pause the run and get assessed.

What is the most common running injury?

Patellofemoral pain is frequently near the top, but there is no permanent number-one diagnosis across every group of runners. Studies that count new injuries can produce a different order from studies asking who currently has pain. Knees, lower legs, ankles and feet consistently account for a large share.

When should I see a physiotherapist or sports medicine doctor?

Book an assessment when pain changes your movement, becomes more focused, worsens, recurs, or does not respond to a sensible reduction in the aggravating activity. Suspected fracture, tendon rupture, a serious acute injury or symptoms involving circulation or sensation need urgent medical assessment rather than a routine rehabilitation appointment.

Should I use RICE?

There is no single acronym that fits every injury. Immediately after an acute sprain, protecting the area, compression and elevation may help symptoms. Ice can reduce pain for some people, but it is not a complete treatment. The timing of weight-bearing and exercise depends on what was injured and how severely, so get guidance when the injury is more than mild.

Does strength training prevent running injuries?

It is useful for strength, running performance and rehabilitation, but the injury-prevention evidence in endurance runners is mixed. The strongest recent review did not find a significant overall reduction from exercise programs. Supervised programs looked more promising, possibly because runners completed them more consistently. Strength train because it builds capacity, not because anyone can promise it will make you injury-proof.

Do running shoes cause injuries?

Usually the answer is not that simple. Poor fit, inadequate traction or a sudden switch to a very different shoe can create problems for an individual runner, but no shoe type explains running injuries as a whole. Start with comfort, secure fit and the demands of your surface. Change gradually when the new pair feels meaningfully different.

Research and clinical guidance used

Systematic review of running-related musculoskeletal injuries, Journal of Sport and Health Science, 2021.
Prospective study of previous injury and new running-related injury, Journal of Orthopaedic & Sports Physical Therapy, 2021.
Large prospective study of running-distance increases and overuse injury, British Journal of Sports Medicine, 2025.
Systematic review and meta-analysis of exercise-based prevention programs, Sports Medicine, 2024.
Best-practice guide for patellofemoral pain, British Journal of Sports Medicine, 2024.
Achilles pain, stiffness and muscle-power deficits clinical practice guideline, Journal of Orthopaedic & Sports Physical Therapy, 2024.
Heel pain and plantar fasciitis clinical practice guideline, Journal of Orthopaedic & Sports Physical Therapy, 2023.
Lateral ankle sprain clinical practice guideline, Journal of Orthopaedic & Sports Physical Therapy, 2021.
IOC consensus statement on Relative Energy Deficiency in Sport, British Journal of Sports Medicine, 2023.
Systematic review of conservative treatment for iliotibial band syndrome in runners, 2024.

Medical note: This article is educational and has not been medically reviewed. It cannot diagnose an injury or replace care from a qualified professional. Emergency symptoms should be assessed through local urgent or emergency services.

7 Common Running Injuries: Signs & When to Stop

The direct answer

The trail run that cost me two months