When running becomes part of your regular fitness routine, you might not realize that even with the best injury prevention measures, running can still lead to unexpected aches and pains. The worst part? Most of these injuries take weeks to become noticeable, and then several more weeks to heal. How can you avoid running-related injuries, and how should you treat them once they occur?
1. Achilles Tendinitis
Symptoms: The Achilles tendon is the largest tendon in the human body, formed by the tendons of the soleus and gastrocnemius muscles in the calf. Symptoms of Achilles tendinitis usually develop gradually and include pain and stiffness in the Achilles tendon, especially when you first get out of bed in the morning. As your body warms up and becomes more active, the pain often decreases—sometimes it even disappears entirely while running. However, the pain returns once you stop running, and may be worse than before. You might also hear a creaking or cracking sound when moving or touching the tendon.
Causes: Achilles tendinitis occurs when the tendon is subjected to excessive stress over a short period, leading to tiny tears and inflammation. It’s often caused by overtraining or a sudden increase in activity, such as excessive trail running. If you have flat feet, your risk of developing Achilles tendinitis increases because your tendon endures greater pressure while walking or running.
Prevention: Beginners should always stretch after running, start with a low frequency, and increase weekly mileage by no more than 10%. Strengthen the calf muscles with exercises like toe raises or heel drops. Incorporate low-impact cross-training activities such as cycling or swimming.
Treatment: At the first sign of pain, follow the RICE protocol (Rest, Ice, Compression, Elevation). Rest is key to treating tendinitis, but prolonged inactivity can lead to joint stiffness. Gently rotate the injured ankle and stretch the calf and ankle to maintain flexibility.
If self-care doesn’t help, seek medical treatment. Continuous micro-tears in the tendon during activity can eventually lead to a rupture due to excessive strain. A doctor may insert a temporary support under the heel to reduce tendon pressure. Other treatments include specialized heel inserts in shoes for cushioning and support, night splints, and several weeks of physical therapy to aid recovery and healing.
2. Ankle Sprain
Causes: Usually caused by twisting the ankle, resulting in swelling and pain around the joint. Runners sometimes step into a pothole without noticing, leading to a sprain. Running on soft or uneven surfaces can also frequently cause ankle sprains.
Treatment: Stop running immediately after twisting your ankle. If the pain subsides completely after a few minutes of walking, you can resume running. If the pain persists, stop running. Apply ice and elevate the ankle as soon as possible to reduce pain and swelling. Ice the swollen area for 20 minutes every 4–6 hours, continuing for 2–3 days if the pain persists. After icing, wrap the ankle with an elastic bandage for support. If swelling continues after 2–3 days, get an X-ray to rule out a fracture.
3. Black Toenail
Symptoms: Long-distance runners are particularly prone to black toenails, which occur when the nail rubs against the front of the running shoe. A blood blister forms under the nail, eventually causing it to wear away and fall off. Initially, the toe turns black, the old nail falls off, and a new one grows in. Marathon trainers and those who frequently run downhill are most susceptible, as their toes constantly rub against the shoe's front. Hot weather can also contribute, as heat causes the feet to swell more.
Causes: Blood blisters form due to friction and don’t receive oxygen, making them slow to heal.
Prevention: Ensure your running shoes fit properly—at least half a size larger than your regular shoes—to provide enough space for your toes. Keep your toenails trimmed and your feet dry during long runs. Choose moisture-wicking socks instead of cotton. Tighten the front of your shoes when running downhill.
Treatment: If the black toenail isn’t painful, it’s best to leave it alone. The first day is the most painful, but it improves daily. The damaged nail will gradually fall off and be replaced by a new one—don’t remove it yourself. If you notice redness, swelling, or signs of infection, see a doctor.
4. Blisters
Symptoms: While not a serious injury, blisters can cause intense pain that may halt your run. They can appear anywhere on the foot. Some blisters are painless, while others are extremely painful.
Causes: Foot blisters are usually caused by friction, primarily between the skin and socks. Moisture from sweaty or wet feet can also lead to blisters, as can running shoes that are too small or tied too tightly.
Prevention: First, make sure your shoes fit well. Running shoes should be at least half a size larger than your regular shoes to accommodate foot swelling during running. Leave enough space for your toes. Choose moisture-wicking, synthetic running socks instead of cotton ones—they help keep feet dry and prevent friction-induced blisters. Opt for seamless, smooth socks. Some runners wear double-layered socks to reduce friction between the skin and sock. Applying lubricants like petroleum jelly to blister-prone areas can help, but don’t overdo it to avoid slipping in your shoes. Avoid cutting calluses with razors or files—they protect against blisters. Some runners use tape on blister-prone spots, but ensure it’s smooth and not too tight.
Treatment: If the blister isn’t painful, leave it alone—the skin protects it naturally. It will eventually break and drain. For painful blisters, sterilize a needle by boiling it for 5–10 minutes, let it cool, and carefully puncture the blister to drain the fluid. Apply antibiotic ointment and cover it with a bandage or tape to prevent infection and cushion the area. During a marathon, get treatment at a medical station—you may continue pain-free.
5. Skin Chafing
Symptoms: Caused by repeated friction, especially between skin and skin or skin and loose fabric. Common symptoms include intense stinging or burning sensations, with the affected area often becoming red, swollen, and rough.
Causes: Skin chafing often occurs around bra edges (especially for women), nipples (especially for men), inner thighs, and underarms. Moisture from sweat or rain worsens the condition, and ill-fitting bras can also cause chafing.
Prevention: Short runs are less likely to cause chafing. Before long runs, apply a thin layer of lubricant like petroleum jelly to prone areas. Wear moisture-wicking synthetic clothing instead of cotton, which stays damp and irritates the skin. Cotton is also rough and can damage skin through friction. Women should choose synthetic sports bras with smooth seams. Loose clothing can cause chafing, so opt for snug running attire. Some runners wear cycling-style shorts to prevent inner thigh chafing. Staying hydrated is also crucial to avoid dehydration, which can worsen chafing.
Treatment: Apply A&D ointment to the affected area and wipe it off after 24 hours. Apply petroleum jelly or other lubricants before running.
6. Iliotibial Band Syndrome
Cause: Iliotibial band syndrome is common among runners, presenting as sharp or burning pain in the knee or hip, with most sufferers feeling pain on the outside of the knee. The iliotibial band is a strip of tissue that runs along the outside of the thigh, extending from the top of the hip bone to the outside of the knee. During running, it helps stabilize the knee and hip. When the iliotibial band becomes tight, increased friction against the bone leads to inflammation on the outside of the knee or in the band itself, causing pain. Overtraining is the most common cause of iliotibial band syndrome, but running on inclines, insufficient warm-up or cool-down, and certain physical abnormalities can also contribute.
Prevention: Like most running-related injuries, iliotibial band syndrome can recur if the root cause isn’t identified and addressed. If you’ve had this condition before, make sure your running shoes fit well and suit your gait. It’s best to have a physiotherapist assess whether you have any underlying issues that could lead to the syndrome, such as hip problems, which are common among those with iliotibial band syndrome. Incorporating strength training into your routine—such as single-leg balance and lateral leg lifts—can be especially helpful in preventing it.
Treatment: Rest as much as possible, reduce your running mileage, and apply ice frequently to reduce inflammation. Anti-inflammatory medications like ibuprofen can help reduce swelling, but they should be taken after meals. You can continue running, but stop as soon as you feel pain. Avoid running on hills and stick to flat surfaces. At the first signs of iliotibial band syndrome—such as tightness in the band or a stabbing pain on the outside of the knee—you can curb the issue with strength and flexibility exercises. Training 2–3 times a week can be very effective. Consider getting a deep tissue massage from a physiotherapist or using self-massage tools. Try leg lift exercises to strengthen the hips and perform more stretches for the iliotibial band and quadriceps. Make sure both legs get equal attention—some people only stretch the injured leg and end up developing the syndrome in the other one.
7. Muscle Cramps
Muscle cramps can be painful and annoying. The main cause is dehydration, so it’s essential to stay well-hydrated before, during, and after your run.
Prevention: Before Running: An hour before you run, drink 450–700 ml of water or other caffeine-free fluids. After that, avoid drinking more to allow your body to flush out excess fluid and prevent the need to urinate during your run. If you want to ensure adequate hydration, you can drink an additional 100–200 ml just before starting. For long runs, consider taking some salt beforehand—just pour a bit into your hand and wash it down with water.
During Running: The golden rule for hydration during a run is to drink 170–200 ml of fluid every 20 minutes. If you’re running for more than 90 minutes, include a sports drink to replenish electrolytes like sodium lost through sweat. You can take another salt supplement halfway. Another cause of muscle cramps is electrolyte imbalance, so replenishing electrolytes is key.
After Running: Don’t forget to rehydrate or drink a sports drink after your run. If your urine is dark brown, keep hydrating until it turns a light yellow. Proper hydration can help with prevention, but if you experience cramps during a run, try slowly stretching the affected area. Stopping to stretch for 1–2 minutes during the run can prevent the cramps from worsening.
Tips: How to Prevent Cramps During a Race?
Some people cramp towards the end of a race simply because they started too fast. Here are some ways to avoid using up too much energy at the start, depleting your strength midway, and failing to finish:
1. Run the first kilometer intentionally slower than your planned pace for the last kilometer. This is hard because you feel full of energy at the start. But remember, any time you save early will likely be lost—and then some—later on.
2. Choose a good starting position. Don’t start with faster runners, or you’ll subconsciously try to keep up with them.
3. Set a comfortable pace from the beginning. Check your time after the first kilometer—if you’re going too fast, slow down. Adjusting your pace after a kilometer is too late.
4. Remind yourself that even if many people pass you in the first kilometer, you’ll pass even more later on.
5. Practice starting slowly during training. On your weekly long runs, begin the first few kilometers at a slower pace to get used to it.
6. After experiencing a cramp, sports massage can help relieve soreness. Regular massages can keep your muscles in optimal condition and significantly reduce the chances of cramping.
8. Muscle Strain
Symptoms: Muscle strains are a common and troublesome injury among runners. The muscle suddenly feels a burning or tight pain, and the affected limb may be unable to bear weight or move freely. A strain is different from a sprain—the former affects muscles and tendons, while the latter involves ligament tissues.
Cause: Strains in muscles like the quadriceps are often caused by lack of flexibility, overexertion, insufficient warm-up, too much running on hills, or a sudden increase in training mileage.
Treatment: Mild to moderate strains are best treated with the RICE method (Rest, Ice, Compression, Elevation). If there’s no improvement after two weeks, seek medical attention.
9. Runner’s Knee
Cause: Also known as patellofemoral pain syndrome, runner’s knee is often caused by weak quadriceps, tight hamstrings, or a tight iliotibial band. It’s a common issue for long-distance runners, resulting in aching or soreness around or behind the kneecap. Continuing to run or climb stairs can worsen the condition. Sitting for long periods may cause stiffness and pain in the knee, and you might even hear a cracking sound when moving it. Overpronation (excessive inward rolling of the foot) while running can also increase the risk. Uneven terrain and ill-fitting running shoes may contribute to the problem.
Treatment: Applying ice to the knee immediately after running can reduce pain and inflammation. Strengthening the quadriceps through regular exercises—like front lunges and straight leg raises—can help support and stabilize the kneecap. Stretching the hamstrings and iliotibial band is also beneficial. Shortening your stride and landing with less impact without shifting your center of gravity can also ease symptoms. Ensure your running shoes suit your foot shape and aren’t worn out. Replace them every 300–400 km, or consider using arch supports. Stop running as soon as you feel pain and rest for a few days. Avoid cross-training until the pain subsides, then gradually return. If pain persists, consult a doctor for custom orthotics or night splints. Physical therapy can also help stretch the plantar fascia, lengthen the calf muscles, and stabilize the ankle and heel. Therapists may also show you how to use tape to support the bottom of your foot.
10. Plantar Fasciitis
Symptoms: Do you often feel heel pain, especially when you first wake up in the morning? This could be plantar fasciitis. The plantar fascia is a tough band of tissue that supports the arch of the foot and connects the heel to the toes. The stabbing or burning pain caused by plantar fasciitis is usually worse in the morning because the fascia tightens overnight. Warm-ups before running usually lessen the pain to a tolerable level, but it often returns after an hour of running.
Cause: Plantar fasciitis is common among long-distance runners due to the high pressure on the heel and surrounding soft tissues during running. Worn-out or unsupportive running shoes, especially those lacking arch support, can also cause it. Excessive inward rolling of the toes while running is another factor, as is tightness in the calf muscles. People with flat feet or high arches experience greater stress. Wearing high heels can shorten and bend the Achilles tendon, adding pressure to the muscles near the heel and leading to plantar fasciitis.
Treatment: Reduce your running distance until the pain subsides, but don’t stop training altogether. Swimming or cycling can be good substitutes. For self-care, apply an ice pack wrapped in a cloth to the painful area for 15–20 minutes, 3–4 times a day, or after exercising. Stretching the calf muscles can also help. Over-the-counter pain relievers like paracetamol or ibuprofen can reduce pain and inflammation, but they don’t solve the root problem. Try acupressure: while standing, press your heel against a golf ball under the arch of your foot. This can reduce pain and improve blood flow. Do it for half an hour a day—it might hurt the first week, but should improve by the second. If self-care doesn’t work, see a doctor for orthotic devices or night splints. Physical therapy can stretch the plantar fascia, lengthen calf muscles, and stabilize the ankle and heel. Therapists can also teach you how to use bandages to support the plantar fascia.
11. Side Stitch (Rib Cramp)
Cause: A side stitch is a sharp pain below the ribs, usually on the left side, caused by a spasm of the diaphragm. It’s common among beginner runners, often due to breathing too quickly and shallowly. The exact cause is debated, but some runners find eating too close to exercise or starting too fast can trigger it. Studies suggest that consuming sugary drinks before exercise increases the risk. Another study links side stitches to spinal curvature. However, drinking water while running doesn’t increase the risk.
Prevention: If you often get side stitches, avoid eating in the hour before your run. Stick to water for hydration and avoid sugary or carbonated drinks. Warm up properly before running. The most effective prevention method is to avoid shallow breathing. Breathe deeply using your diaphragm—inhale and exhale through your mouth, engaging your belly rather than your chest to take in more air. Cold temperatures can also trigger side stitches, as deeply inhaling cold air before fully warming up is uncomfortable. If you must run in the cold, try breathing through a scarf. Finally, maintain proper posture—don’t hunch, as it restricts deep breathing.
Treatment: First, gently press the affected area with your fingers to alleviate some of the pain. Then, change your breathing pattern. Take a quick deep breath to lower the diaphragm. Pause for a few seconds, then forcefully exhale through pursed lips. If you experience cramping during a run, try altering your breathing or stride. If you always exhale when your right foot lands, try exhaling when your left foot lands instead. If these methods don’t work, stop running, walk briskly for a few seconds while focusing on deep breathing. Resume running only after the side stitch has passed.
12. Shin Splints
Symptoms: This is a common issue among beginner runners, usually caused by overtraining in a short period. Anterior shin splints cause pain on the outer front part of the lower leg, while posterior shin splints result in pain in the soft tissue behind the shinbone.
Causes: It’s often due to tight calf muscles or weak shin muscles, and other factors can worsen the condition. Running on hard surfaces puts extra strain on the front of the lower leg, while excessive inward rolling (overpronation) or outward rolling (oversupination) of the foot increases pressure. These are physical predispositions that can be aggravated by improper footwear. Another contributing factor is overtraining.
Treatment: There are several steps to promote recovery. First, manage the pain by applying an ice pack to the calves for 10–15 minutes, 4–6 times a day after running. Make sure your feet are elevated during icing. Reduce your running distance, or preferably take a few days off. The key is not to run through the pain, as this will only worsen the condition. Remember, like many running-related injuries, shin splints are mainly caused by overuse. While resting, spend time stretching your calves and strengthening the muscles in that area. Avoid overstretching and proceed gradually. Ill-fitting shoes can also cause shin splints—check whether your footwear lacks stability or cushioning. Visit a specialty running store to find shoes that suit your foot shape and gait. Adding heel lifts to your shoes can reduce the range of motion in your calves. Finally, ensure your running posture is correct. If you’re leaning too far forward while running, you may be overextending your calf muscles. If none of these suggestions help and the pain persists, consult an orthopedist to check for possible stress fractures.
Prevention: Shin pain during running may stem from weak anterior calf muscles, which are primarily responsible for flexing and extending the foot. Strengthen them through toe raises or heel raises.
13. Stress Fractures
Symptoms: A stress fracture refers to tiny cracks in the surface of a bone, a serious condition that requires prompt treatment. Stress fractures most commonly occur in the shins or feet. You may gradually feel muscle soreness, stiffness, and needle-like pain. Early diagnosis is crucial because these cracks can worsen and eventually lead to a complete fracture.
Causes: The primary cause is a recent increase in exercise intensity over the past weeks or months. If combined with calcium deficiency or other mechanical issues—such as poor running posture or structural abnormalities—it can lead to fractures. Common stress fractures among runners occur in the tibia (the large inner bone below the knee), femur (thigh bone), sacrum (the triangular bone at the base of the spine), and the metatarsals of the toes.
Prevention: Ensure your running shoes are suitable for your foot shape and running style—ideally, get assessed at a specialty store. Increase your weekly running mileage by no more than 10%, allow adequate rest, and avoid putting excessive stress on any one part of your body. Maintain a healthy, balanced diet with sufficient calcium and vitamin D, and consult a doctor about supplements if needed. Avoid carbonated drinks, alcohol, and smoking to reduce the risk of mineral loss in your lower limbs. Strengthen the muscles around your bones so they can better withstand the stress that could otherwise lead to fractures. The tibia is especially prone to such injuries—simple exercises like toe raises and heel raises can strengthen both tibial and calf muscles.
Treatment: If you show symptoms of a stress fracture, stop running immediately and see a doctor for an X-ray. However, some fractures may not show up on X-rays, so a bone scan might be necessary. Do not train for at least six weeks after a stress fracture. Don’t try to “run through” a stress fracture—it’s a serious injury, and continuing to run will only make it worse. Recommended treatments include rest, anti-inflammatory medication, stretching, and muscle training. Cross-training or water running can be done during recovery. Ensure your diet is sufficiently nutritious, especially with regard to calcium, as deficiency can significantly delay healing.