Common Running Injuries and How Physiotherapy Treats Them

Running is Ireland's fastest-growing recreational sport. Parkrun Ireland events attract over 30,000 participants weekly across 140+ locations, and the Dublin City Marathon regularly fills its 22,500 entry places within days of opening. With participation volumes at this scale, running injuries are a significant and predictable public health concern.

This guide covers the most prevalent running injuries, their causes, and how a Chartered Physiotherapist treats them, drawing on peer-reviewed research and the team's clinical experience treating runners in Dublin 15.

How Common Are Running Injuries? (Prevalence Data)

The Most Common Running Injuries: Causes and Physio Treatment

1. Runner's Knee (Patellofemoral Pain Syndrome, PFPS)

Runner's knee is the most common running injury and the number-one reason recreational runners stop training. It presents as anterior (front) knee pain that worsens with prolonged running, downstairs walking, or sitting for long periods.

Cause: Abnormal loading of the patellofemoral joint, often caused by hip abductor weakness, quadriceps imbalance, excessive hip internal rotation (sometimes called "dynamic knee valgus"), and rapid training load increases.

Physiotherapy Treatment: Hip and quadriceps strengthening is the cornerstone of evidence-based PFPS management (Crossley et al., 2016, British Journal of Sports Medicine). A physiotherapist will prescribe a progressive loading programme, address any gait abnormalities such as hip drop, and provide a graduated return-to-run plan. Temporary load reduction is required, but complete rest is rarely necessary.

2. Shin Splints (Medial Tibial Stress Syndrome, MTSS)

Shin splints describes pain along the inner border of the tibia (shinbone), typically in the lower two-thirds. It is common in new runners and in those returning after a break. It should be differentiated from tibial stress fracture, which requires bone imaging to confirm.

Cause: Excessive tibial bending forces from repetitive impact, combined with insufficient calf and tibialis posterior strength. Training volume and surface changes are frequent precipitating factors.

Physiotherapy Treatment: Temporary load reduction, progressive calf strengthening (both soleus and gastrocnemius), tibialis posterior strengthening, and a structured return-to-run programme. Footwear review and training load monitoring reduce recurrence risk.

3. Achilles Tendinopathy

Achilles tendinopathy presents as stiffness and pain at the Achilles tendon, typically worst on waking and after periods of inactivity. It is more common in runners aged 35+ and in those who have increased mileage, changed surface, or added speed work.

Cause: Compressive and tensile overload on the Achilles tendon beyond its current load capacity. Calf weakness and limited ankle dorsiflexion are common contributing factors.

Physiotherapy Treatment: Heavy slow resistance (HSR) loading, progressively loaded calf raises, is the current gold-standard treatment supported by high-quality evidence (Beyer et al., 2015, American Journal of Sports Medicine). Dry needling may be used as an adjunct. A load management plan that allows the runner to continue reduced-volume training often produces better outcomes than complete rest.

4. Plantar Fasciitis

Plantar fasciitis presents as sharp heel pain on the bottom of the foot, typically worst on the first steps in the morning or after prolonged sitting. It is the most common cause of heel pain in runners.

Cause: Repetitive tensile strain on the plantar fascia at its calcaneal insertion. Risk factors include sudden mileage increases, high-arched or flat feet, reduced ankle dorsiflexion, and inadequate calf flexibility.

Physiotherapy Treatment: Intrinsic foot and calf strengthening, calf stretching, load management, and footwear or orthotic assessment. High-load strengthening (heel raises with towel toe extension) has shown superior outcomes to stretching alone (Rathleff et al., 2015, Scandinavian Journal of Medicine & Science in Sports).

5. Iliotibial Band (ITB) Syndrome

ITB syndrome presents as lateral (outer) knee pain that typically begins a predictable distance into a run and often forces the runner to stop. It is most common in runners increasing their mileage for a marathon or half-marathon.

Cause: Compressive irritation of the distal ITB at the knee. Often associated with hip abductor weakness causing a "hip drop" gait pattern on the affected side, combined with excessive weekly mileage.

Physiotherapy Treatment: Hip abductor and glute strengthening, running gait retraining to reduce hip drop and contralateral pelvic tilt, and a graduated return to running. Research does not support foam rolling the ITB as a primary treatment: the ITB is too thick and dense to respond to external compression in the way muscles do.

Common Risk Factors Across All Running Injuries

The most consistent risk factor for running injury across all injury types is training load error: increasing mileage, intensity, or frequency too rapidly. The commonly cited guideline of "no more than a 10% mileage increase per week" is a useful heuristic, though individual capacity varies significantly.

1. 1
   Previous injury: the strongest predictor of future injury across all running studies
2. 2
   Training load errors: rapid volume or intensity increases
3. 3
   Inadequate strength: particularly hip abductors, glutes, and calf complex
4. 4
   Footwear wear: running shoes typically last 500–800 km before cushioning degrades
5. 5
   Running surface: concrete versus trail versus treadmill all place different demands on the lower limb

Sources & Citations