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Summer has finally arrived and for many people that means it’s prime time to get back to running outdoors. I, being a passionate runner myself, want to start our blog series on running. Our hope is to provide some helpful information and tips to help you stay healthy and avoid injury while you’re out there training for the next big race, or just out for your evening jog! The first topic in our running series is going to discuss the most common running related injuries to help give you a better idea of how your training load may be affecting your pain.

Running is one of the most common recreational sports worldwide and injury rate can be as high as 66%, with over half of these injuries due to overuse.  Luckily, these injuries can be treated very effectively with conservative care and physical therapy! Back when I was in graduate school for physical therapy I decided to give the barefoot running fad a try with the lofty expectation of running an ultramarathon. Unsurprisingly, this didn’t go well for me and I developed pain in my achilles tendon and knees. I went through this frustrating cycle of running causing pain, resting and feeling better, and trying to get back to running, which again caused pain. In one of my classes I learned the true cause of these injuries and how they need to be treated, and they finally started to get better. I still have never run my ultramarathon, but I have been able to compete in other races pain-free and we are hoping that this information can help you do the same.

So, what are the most common running injuries? Let’s delve into the top three.

#1: Achilles Tendonitis

Achilles tendinopathy (formerly referred to as tendinitis) is a complex, but common, problem. In the early stage overuse causes inflammation of the tendon at the attachment to the heel, causing stiffness, pain especially with first steps in the morning or after prolonged inactivity, and a limited ability to do normal activities. This inflammation subsides after a few days of rest and the tendon begins healing, however this process is commonly incomplete and requires further care to fully heal.

So, for anyone who has experienced chronic achilles tendon pain, you probably know that if you aren’t exercising you feel pretty good! After all, not irritating an unhealed injury feels pretty good. But once you start running again this pain cycle seems to repeat itself; increased pain and swelling for a couple days that settles with rest but is continually re-aggravated with exercise. It’s a frustrating process because to regain full function without pain the tendon needs to be exercised in a very specific way. Check out our post next week that highlights this process!

#2: Plantar Fasciitis

Plantar fasciopathy (previously known as fasciitis) is a very similar problem to achilles tendinopathy, however it occurs in the plantar fascia. The plantar fascia is a very thick, strong band of connective tissue on the bottom of your foot that goes from your heel to your toes and helps to stabilize your foot, provide muscle attachment, and generate propulsion during the push-off phase of the gait cycle. Plantar fasciitis is caused by microtearing of the plantar fascia that initially results in inflammation but then, like achilles tendonitis, the inflammation settles, and the fascia can begin healing. Also, like achilles tendonitis, this process tends to require further care beyond the point where pain has subsided to allow for full healing. Keep in mind that chronic plantar fasciopathy is NOT the result of inflammation, so anti-inflammatory medications, injections, ice, etc. typically will have little to no benefit!

#3: Patellofemoral pain syndrome (Runner’s Knee)

Patellofemoral pain syndrome (PFPS), or commonly called Runners Knee, is caused by a couple of factors that act together to cause pain and stiffness around your kneecap. Runner’s Knee is classically related to poor strength and stability in the hips and quadriceps muscles. Weakness in these areas causes your knee to collapse inward (as seen in the photo below) because you do not have the adequate strength to support your body weight. When you run, the amount of force that your legs must sustain can be upwards of 6-7x your body weight with every step!  You can imagine that if your knee is not in the appropriate alignment excess strain will be placed on the knee joint and the kneecap and will start to cause inflammation around the kneecap that causes pain.

There is also a thick band of connective tissue on either side of your kneecap that works to prevent your kneecap from dislocating by keeping it centered in front of your femur. Pain and inflammation around the kneecap can cause these tissues to get stiffer which can cause increased compression of your kneecap on your femur as seen in the image above. Keep in mind that this does not occur all at once; the knee joint is an incredibly strong joint and running as actually been shown to make you less likely3 to develop knee arthritis and does not4 cause progression of pre-existing arthritis! Runner’s Knee is a very mechanical problem, meaning that by correcting your knee and hip alignment and improving strength you can decrease the irritation on the patellofemoral joint and run without pain!

So, there you have it! Achilles tendinopathy, plantar fasciopathy, and patellofemoral pain are the three most common running related injuries and typically occur from overuse and starting/progressing an exercise program too quickly. Ignoring these conditions can lead to ongoing pain that will affect your ability to run. Therefore, if you are struggling with any of these injuries seek out the help of a physical therapist! A skilled PT can help you identify the underlying source of your pain and provide you with the information you need to get back to running.

Next week we will discuss the three most common causes of these problems and share the most common quick fixes so you can stay active and enjoy this Oregon summer!

  1. van Mechelen W (1992). Running injuries. A review of the epidemiological literature. Sports Med;14(5):320-35. Review. PubMed PMID: 1439399.
  2. Messier SP, Martin DF, Mihalko SL, Ip E, DeVita P, Cannon W, Love M, Beringer D, Saldana S, Fellin RE, and Seay JF (2018). A 2-year prospective cohort study of overuse running injuries: the runners and injury longitudinal study (TRAILS). Am J Sports Med; 1.
  3. Alentorn-Geli E, Samuelsson K, Musahl V, Green CL, Bhandari M, Karlsson J (2017). The association of recreational and competitive running with hip and knee osteoarthritis: a systematic review and meta-analysis. JOSPT, 47(6); 373-390.
  4. Lo GH, Musa SM, Driban JB, Kriska AM, McAlindon TE, Souza RB, Petersen NJ, et al. (2018). Running does not increase symptoms or structural progression in people with knee osteoarthritis: data from the osteoarthritis institute. Clinical Rheumatology,