Most new runners at some time have an injury. Most injuries involve the lower limb, inparticular but not exclusively the knee, shin and feet. Other injuries can include the hip and lower back, but the 5 most common in runners are the following:

Patello-femoral joint pain (PFJP)

Patello-femoral joint pain (PFJP) or anterior knee pain affects 30% of all runners and is one of the top five problems presenting to runners. This is due to a multitude of factors which can be related to the running itself, or problems with the knee.

The patella bone itself and its surrounding tissues can cause problems in runners. Muscles can be unstable (mainly due to a muscle imbalance), the patella shape maybe abnormal, the alignment of the patella may be abnormal, damage to the surrounding static tissues around it (retinaculum), abnormal alignment of the leg and foot mis-alignment during running are just a few causes of PFJP.

All of the above could be problematic, but the running itself can also exacerbate the problems. Changes in training methods, being the most common, including a change in the frequency, duration, and intensity can flare up PFJP. Changes in shoe wear, camber, and timing of changes in training are other examples.

Symptoms normally are localized anterior knee pain, very rarely is pain felt at the back or sides of the knee.

Treatment options include rest, anti-inflammatory drugs, physiotherapy, joint injection, surgery and correction of the aggravating factor.

Iliotibial band syndrome (ITBS)

The ilitibial band is a muscle down the outer side of the leg and at times this band frictions on a piece of bone/fatpad just above the knee. Specifically, the outer knee pain affects runners 3-5cm above the knee itself. Again, there are several factors which could bring on this type of knee pain. This includes muscular imbalance, weakness of particular muscle groups, poor alignment of legs or an aggravating factor involving the running itself, such as changes in the running style or training.

The pain is normally sharp and worsens with continued running. At times, most runners have to stop because the pain is so sharp. This particular injury can also affect cyclists. Again, the constant bending and straightening of the knee causes frictions the ITB.

Treatment of ITBS normally involves rest and anti inflammatory drugs. Physiotherapy involves ultrasound treatment, strengthening of several different muscle groups, massage, stretching and mobilisations of the soft tissue. The other thing is to identify the trigger, which again is normally related to a change in the duration, frequency or intensity of the run. Again, change in show wear, camber, change in running routine should also be examined.

Achilles tendon injuries

The Achilles tendon is the powerhouse for runners and sprinters. It can account for up to 20% of all running injuries. It is the strongest tendon in the body, and a continuation of the calf muscle as it inserts in the back of the heel bone. Pain is normally located at the muscular-tendonal junction in most runners (the site at which the calf muscle itself converts into tendon which is normally half way down the back of the leg.

The tendon itself can have several types of injury, including the strain of tendon fibres itself, degeneration of the tendon fibers, inflammation of the sheath of the tendon, partial or full rupture of the tendon.

Causes of Achilles pain can again be multitude. Sometimes, the calf muscle itself maybe just tight or fatigued and give trouble. Again, a change in the type of running itself can trigger this problem. Other rarer causes should also be examined, such as nerve problems from the lower back and circulatory problems.

Treatment should consist of rest, anti inflammatory drugs, physiotherapy which may include stretching, massage, ultrasound or electrotherapy treatment, and strengthening exercises. Again, the trigger (if one) should be identified.

Shin Splints

Shin splints is a generic term for pain at the front of the shin. It actually encompasses a range of different problems that can occur at the shin bone itself, at the muscle interface, pressure build up within the muscle, nerve pain and circulatory problems.

The bone problems include stress fracture (which tends to be very localized) or inflammation of the tissue surrounding the bone (which normally affects the lower 1/3 of the shin). The muscular problems include inflammation of the tendons, a build up of pressure within the muscles (which can affect all the muscle groups at the front, side and back of the shin). Commonly, pain can either be localized to one specific point or generally over a diffuse area.

Shin pain also again triggered with the type of running or change in running which simply overloads the muscle or bone around the shin area. A change in duration, frequency, intensity, camber, shoe wear are just some of the potential triggers. Faulty biomechanics (the alignment of the legs and feet) should also be examined.

Treatment depends on what the actual cause is. Careful examination is required, with the potential of some scans to identify whether it is bone or muscular pressure.

Shin splints should not be ignored, as serious pathology can often lead to prolonged treatment and recovery.

Feet Pain

Pain around the feet is by far the most common complaint in runners. Common Feet pain in runners includes stress fractures of the Navicular bone (inside the arch of the foot), stress fractures of the metatarsal bones (2nd, 3rd metatarsal), plantar fasciitis (pain under arch and heel), and blisters.

Anyone of these can cause pain, normally located at the site of origin. Stress fractures normally give rise to pain during the run, and worsen as the run continues. The pain continues to a lesser extent until the next day, and then eases, until the run again.

Investigations for stress fracture may have to include a bone scan, as at times, a normal x ray may not pick it up. Stress fractures normally take up to six weeks to heal, but this doesn’t mean you can’t train. Non weight bearing exercises, such as swimming, cross training, cycling can help to maintain fitness.

Treatment depends on the problem, but once again, look for that trigger to ensure it doesn’t happen again.

In summary
Any injury lasting more than 3 weeks, or worsens with runs requires medical attention and as such, you should go and see a Physiotherapist or G.P, who has experience with runners. It’s important to see the right people, as injuries can be misdiagnosed at times, which leads to even longer recovery times.

Dr. Abrahams’s top tips for avoiding running injuries:

*Make slow and gradual changes when increasing your runs
*Ensure you alternate your training days
*Wear appropriate shoe wear
*Always listen to your body
*Make sure you stretch regular, not just before the run
*Drink plenty of fluids daily
*If in doubt, consult your Physiotherapist or doctor.

Dr Solomon Abrahams is owner of Anatomie Physiotherapy clinics and consults from 4 Wimpole Street, London.
He works and treats professional sports players and lectures at several Universities in London.
He can be contacted at

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