5 common running injuries we see in Physio - and how to avoid them

Top 5 most common running injuries we see at Four Physio

1. Shin Splints (Medial Tibial Stress Syndrome)

One of the most common complaints among new runners is pain along the inside of the shin, commonly known as shin splints or medial tibial stress syndrome (MTSS).

This injury occurs when the tibia (shin bone) and the surrounding muscles are exposed to more loading than they can currently tolerate. It often develops after a sudden increase in running volume, intensity or frequency.

Common symptoms include:

• Pain along the inner border of the shin during or after running.

• Tenderness when pressing on the shin.

• Symptoms that are often worse after longer runs.

2. Runner's Knee (Patellofemoral Pain Syndrome)

Runner's knee refers to pain around or behind the kneecap and is one of the most frequent overuse injuries in recreational runners.

It is commonly aggravated by:

• Running downhill.

• Stairs.

• Squatting.

• Prolonged sitting.

While many people assume the knee is the problem, contributing factors often include reduced strength or control around the hips, lower limb loading strategies, training errors, or running mechanics.

3. Lateral hip pain

Pain on the outside of the hip is frequently caused by gluteal tendinopathy or irritation of the greater trochanteric bursa. This tends to develop when the gluteal muscles and tendons are repeatedly loaded beyond their current capacity.

You may notice:

• Pain on the outside of the hip while running.

• Discomfort lying on the affected side at night.

• Pain walking uphill or climbing stairs.

Improving gluteal strength, pelvic control and gradually progressing training loads are key components of recovery.

4. Distal Iliotibial Band (ITB) Friction Syndrome

ITB friction syndrome causes pain on the outside of the knee, particularly during longer runs or downhill running. Rather than the ITB itself being "tight," the condition is generally related to excessive compression and loading of tissues on the outside of the knee.

Contributing factors may include:

• Rapid increases in running volume.

• Poor load management.

• Reduced hip strength and control.

• Running mechanics that increase stress on the lateral knee.

Treatment focuses on improving load tolerance rather than simply stretching the ITB.

5. Achilles Tendinopathy

The Achilles tendon experiences some of the highest forces in the body during running. If these forces increase faster than the tendon can adapt, pain and stiffness can develop.

Typical symptoms include:

• Morning stiffness in the Achilles.

• Pain during the first few minutes of running.

• Tenderness or thickening of the tendon.

With appropriate strength training and gradual return to loading, most runners recover well without needing to stop running completely.

How to prevent running injuries

The majority of running injuries occur because the body's capacity has not yet caught up with the training load being placed upon it. Three key principles can dramatically reduce your injury risk.

1. Increase your running gradually

Your heart and lungs adapt relatively quickly, but your tendons, muscles and bones require much longer.

As a general guide:

• Increase your total weekly running volume by no more than approximately 10% per week.

• Alternatively, avoid increasing your longest run by more than 10% compared to your previous longest run.

• Build a consistent running base before introducing speed sessions, hill repeats or interval training.

• Include regular recovery days to allow your body to repair and adapt between runs.

Remember that recovery is when your body actually becomes stronger.

2. Build strength before you need it

Running places forces of two to three times your body weight through the lower limbs with every stride.

Preparing your tissues to tolerate these loads is one of the most effective forms of injury prevention.

A well-designed strength programme should progressively develop:

• Foot strength.

• Calf capacity using heavy strengthening exercises and isometrics.

• Plyometric capacity (your body's ability to store and release energy efficiently).

• Progressive exposure to running loads.

Stronger muscles and tendons are better able to absorb forces, helping reduce stress on joints and surrounding tissues.

3. Optimise your running technique

Running technique can influence how efficiently your body absorbs and produces force.

One important goal is encouraging your foot to land underneath your centre of mass while minimising unnecessary braking forces and promoting a relatively short foot-ground contact time. This helps improve running economy (efficiency) and can reduce excessive loading through certain tissues.

However, running technique is highly individual. Factors such as cadence, stride length, trunk position, hip control and lower limb alignment all interact differently from one runner to the next. Rather than applying generic cues, an individual running assessment allows technique changes to be tailored to your body, goals and injury history.

How physiotherapy can help

If you're experiencing pain while running, or want to prevent injuries before they occur - a physiotherapist can help identify the underlying factors contributing to your symptoms.

At Four, our running assessments look beyond where the pain is. We assess factors such as:

• Running technique.

• Lower limb strength and capacity.

• Mobility.

• Balance and movement control.

• Training history and load management.

• Footwear and return-to-running strategies where appropriate.

From there, we develop an individualised rehabilitation plan that may include progressive strength training, mobility work, running load modification and personalised running technique coaching. The aim is not only to help you recover from your current injury, but also to improve your running efficiency and reduce your risk of future problems.

Final thoughts

Starting running should be enjoyable - not something that ends with an injury. Most beginner running injuries are preventable by progressing your training gradually, building strength alongside your running and ensuring your running technique supports efficient movement.

If pain is stopping you from reaching your goals, don't ignore it. Addressing issues early is often the quickest path back to comfortable, confident running.

Whether you're training for your first park run, 10 km event, half marathon or simply running for your health, investing in injury prevention now can help keep you running consistently for years to come.