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Running injuries

The simplest way to avoid a running injury is to not run but if you are like me and the other 10 million+ runners in the UK you will know that not running is not the preferred option. Unfortunately there is a reasonably high chance of picking up a running injury at some point in your running career but if you are armed with the knowledge of factors that may contribute to these injuries then you can minimise your chance of picking one up and know what to do if you recognise the symptoms.

ITB Friction Syndrome

Iliotibilial Band (ITB) Friction syndrome is a condition that regularly affects athletes of sports that involve repetitive movements such as running and cycling. Pain will often be felt on the lower aspect of the outside of the knee. It comes about as the iliotibial Band, which is a thick tendon that runs down the outside of the thigh, to the bony bit on the outside of the leg below the knee. Symptoms arise when this tendon repeatedly compresses the soft tissue around the knee and usually arise as result of weakness and/or poor biomechanics. 

In practical terms, as with other overuse running injuries, the pain often comes on after going too far, too fast or too steep (can be up or down) than you (and specifically your soft tissues/tendons) are used to.

An important part of an accurate diagnosis is examining the 

Patellofemoral Pain Syndrome (PFPS)

The most common running injury is Patellofemoral Pain Syndrome. The patella is the kneecap and it sits at the end of the femur which is the thigh bone. Patients usually point to an area at the side of the knee cap, often on the inside of the knee or will put the palm of the  hand over the kneecap when describing where the pain is, it is not usually a deep pain in the knee. It is usually only mild and may come  on gradually in the beginning. In my sports physio clinic, patients will often report they had tried to rest it, test it, rest it, test it but will struggle to get back to their pre-injury form. Functional restrictions include pain going up or down stairs and pain when walking or squatting down.

After taking a general medical history, the physiotherapy assessment will include taking a full run history leading up to the time of injury. It can take some digging but there is usually a culprit. Around the time of the Virgin London Marathon (Also Paris and Brighton amongst many other Spring marathons) I often see an influx of runners in January and March. It often corresponds with running 10 miles for the first time having only just started their training program and also March when the training plan hits the big mileage. This is usually a time when the legs are tired and tight and the long runs can be taking 3 hours or more. There can be some anatomical causes but below is a list of preventable causes.


Common Causes:

  1. Increase in training load: usually further, faster or steeper than normal

  2. Returning to running after a break

  3. Not recovering properly - can be as a result of poor sleep, nutrition, hydration, jet lag, illness..

  4. Weakness in core / legs

  5. Running on tired, tight legs


There are numerous evidenced based treatment options, these are a selection of some of my preferred methods.

Physiotherapy Treatment options:

  1. Education on training load

  2. Lower limb and core strengthening program

  3. Running assessment for gait retraining

  4. Hands on treatment for spinal/pelvis/SIJ/hip/lower limb mobility and pain relief

  5. Taping for symptom modification

  6. Return to running program


Return to Running Program

If time is not an issue then a return to running program can be relaxed and take place over 6 weeks or more. After carrying out a running assessment with gait retraining (if required) I use the following guide of 3 runs a week, 1 rest day after each run. 

  • Week 1: Run 2 minutes walk 1 minute. Repeat 8 times (24 mins)

  • Week 2: Run 3 minutes walk 1 minute. Repeat 6 times (24 mins)

  • Week 3: Run 5 minutes walk 1 minute. Repeat 4 times (24 mins)

  • Week 4: Run 15 minutes walk 1 minute. Repeat 2 times (31 Mins)

  • Week 5: Run 30 mins

  • Add 10% each week until your reach your desired run time

Do not progress to the next stage unless you are running comfortably  - which means pain levels of 3/10 maximum before, during and after running.