Runner's pain: when to stop and how to get back to running
Up to half of all runners get injured each year. Most injuries aren't caused by an accident but by an imbalance between training load and the body's capacity to adapt. Understanding where it hurts and why makes it possible, in most cases, to treat the problem without stopping running.
The most common running injuries
For a more detailed explanation of each, see running injuries: the 5 most common.
Pain at the front of the knee: patellofemoral pain.
Pain on the outside of the knee: iliotibial band syndrome.
Shin pain: medial tibial stress syndrome ("shin splints") or, if the pain is in one spot and worsens with impact, a stress fracture.
Achilles tendon pain: Achilles tendinopathy.
Pain under the foot on waking: plantar fasciitis.
Hip or buttock pain: gluteal or hamstring tendinopathy. See hip pain.
Why they happen
rapid increases in volume, pace or elevation;
too little strength training for the legs and hips;
stride patterns that concentrate load in one place, such as the knee caving inwards;
insufficient recovery: too little sleep or too little food for the training volume;
shoes very different from usual, introduced suddenly.
Signs to stop and get assessed
pain that increases during the run instead of easing;
pain at one spot on a bone that hurts when hopping on one foot;
limping during or after training;
pain lasting more than two weeks despite reducing training.
How we treat running injuries at Clínica Myalgia
Medical consultation with ultrasound: accurate diagnosis of the tendon, muscle or bone involved.
Biomechanical running analysis: a study of your stride to identify the pattern overloading the injured area.
Physiotherapy with progressive loading and a week-by-week return-to-running plan, without stopping running whenever possible.
Made-to-measure insoles when the foot contributes to the overload.
How to increase training safely
Increase weekly volume gradually and include a lighter week every three or four.
Don't increase volume, intensity and elevation at the same time.
Introduce new shoes gradually, alternating with your old ones.
Sleep enough and eat enough for your training volume.
Strength for runners
Two strength sessions a week reduce injury risk and improve running economy. The core exercises are squats, deadlifts, lunges, calf raises and hip work. More than doing lots of exercises, what matters is using a challenging load and increasing it over the weeks.
How to return to running after an injury
The return happens in stages, and you only move on when the previous stage causes no pain the next day:
Simple pain-free tests: brisk walking for 30 minutes, single-leg squats and hopping on the spot.
Alternate walking and running: for example, 1 minute running and 1 minute walking, on alternate days, increasing running time over the weeks.
Continuous running on flat ground, at a comfortable pace, before going back to intervals, uphills and downhills.
Back to your usual plan, keeping up strength training twice a week.
Mild pain while running (up to 3 on a scale of 0 to 10) can be acceptable, as long as it disappears after the session and doesn't increase the next morning. If it does, go back to the previous stage.
Frequently asked questions about running pain
Do I have to stop running?
Not always. Many injuries allow you to continue with less volume and intensity, as long as the pain stays low and doesn't increase the next day.
Will changing my trainers fix the pain?
Rarely on its own. Shoes can help, but the cause usually lies in training load and how the body absorbs it.
Is running bad for your knees?
In people without injury, running regularly and progressively does not increase the risk of knee osteoarthritis.
When should I have a running analysis?
If you have recurring injuries, if you're going to increase volume a lot (for example, preparing for a marathon or a long trail race) or if you want to improve efficiency.
Dr. Miguel Reis e Silva
Doctor at Sport Lisboa e Benfica
Medical Director and Founder of Clínica Myalgia
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