Running should feel freeing, not frustrating. But when pain kicks in, it can throw off your training and motivation. Whether you’re gearing up for a marathon or enjoying weekend jogs, understanding the root cause of your discomfort can make all the difference.
If knee pain, shin splints, or hip stiffness are holding you back, biomechanical issues are likely to blame. The good news? You don’t have to stop running!
Let’s break down three common running injuries—runner’s knee, shin splints, and hip impingement—along with strategies to treat and prevent these injuries, so you can keep moving pain-free.
1. Runner’s knee (patellofemoral joint pain)
What is it? Runner’s knee is pain at the front of the knee, caused by repetitive stress on the patella (kneecap) and its poor tracking along the femur (thigh bone), often exacerbated by activities that involve bending the knee, such as running or squatting.
What causes it?
- Overuse: Jumping into high mileage or intense workouts without proper recovery overloads the knee joint.
- Muscle imbalances: Weak quadriceps (especially the VMO) and tight hamstrings disrupt patella tracking.
- Foot and hip alignment: Flat feet, overpronation (excessive inward rolling of the foot), or excessive hip rotation can alter the movement pattern up/down the kinetic chain, affecting the knees.
How to fix it:
Load vs recovery: If your running intensity, frequency or weekly volume is too high this means your tissues will not have adequate time to recover. This does not mean you have to stop running!!! A slower, more gradual increase in running load will allow your tissues to be repaired and even improve.
Strengthening exercises: Strengthen your quads, glutes, and hamstrings with exercises like squats, knee extensions, and hamstring curls to keep the patella moving properly. Some helpful exercises are squats and squat variations, seated knee extension with a band/weights and hamstring curls.
Stretch and mobilise: Regularly stretch and mobilise tight muscles, particularly the quadriceps, hamstrings, calves, and glutes, to decrease stiffness and prevent imbalances.
2. Shin splints (Medial Tibial Stress Syndrome)
What is it? Shin splints cause pain along the inner shinbone due to excessive pulling on the shin’s protective sheath. This irritation can stem from high-impact training or increase in load on the calf muscles (particularly the soleus muscle). There is also a significantly higher chance of developing shin splints with training with flat, unsupportive footwear on hard, unforgiving surfaces (such as road running).
What causes it?
- Sudden training increases: A rapid boost in mileage or speed overloads the shinbone and surrounding muscles.
- Foot biomechanics: Flat feet or overpronation shift excess impact to the medial structures of the ankle, particularly the tibia instead of instead of shock being absorbed by the medial longitudinal arch.
- Muscle weakness: Weak calves, ankles, or hips lead to poor shock absorption, placing more stress on the shin.
How to fix it:
Load vs recovery: Allow time for healing by reducing running intensity, distance, or weekly volume, or modify by incorporating low-impact cross-training (like swimming or cycling) during recovery.
Strengthening exercises: Work on your calves, tibialis anterior and posterior, foot inverters, and foot muscles, as well as looking up at the knee and the hips to improve lower limb strength. Try calf raises, banded ankle inversion, and tib ant raises.
Improve foot alignment: Strengthening foot muscles and ensuring proper arch support can reduce unnecessary stress on the shins.
3. Hip impingement (Femoroacetabular Impingement – FAI)
What is it? Hip impingement happens when the ball (femoral head) and socket (acetabulum) of the hip joint don’t glide smoothly, leading to stiffness and pain in the hip, groin, glutes, or lower back—especially during running or walking.
What causes it?
- Anatomical abnormalities: Some runners may have bony irregularities (like cam or pincer deformities) that predispose them to impingement. Joint laxity can also lead to the femoral head jolting around in the hip socket and lead to impingement in the area.
- Overuse and repetitive stress: Long periods of running, especially on hard surfaces, can increase the likelihood of impingement.
- Weak or imbalanced muscles: Weak glutes and core muscles can lead to abnormal hip mechanics that increase pressure on the joint.
How to fix it:
Strengthening exercises: Focus on the glutes, core, and hip flexors to help stabilise the pelvis and prevent abnormal stress on the hip joint. Build stability with exercises like glute bridges, crab walks, and banded hip rotations to keep the hip joint in optimal alignment.
Improve mobility and stretching: Stretch your hip flexors, glutes, and surrounding muscles to maintain flexibility and reduce joint stress.
Correct running technique: Running with a neutral hip position and strong core engagement can prevent unnecessary strain.
In conclusion, strength training is your best tool for preventing and addressing running injuries. By strengthening your muscles, modifying your training load, and correcting biomechanical imbalances, you can run stronger, longer, and pain-free.
References
- Alesi, M., et al. (2019). Biomechanical interventions in patellofemoral pain syndrome. Journal of Sports Science & Medicine, 18(3), 538-544.
- Bishop, M., et al. (2018). The effectiveness of strengthening exercises for medial tibial stress syndrome. Journal of Sports Rehabilitation, 27(4), 350-358.
- Cheung, R. T., & Davis, I. S. (2011). The effect of a progressive running program on medial tibial stress syndrome in female runners. Journal of Orthopaedic & Sports Physical Therapy, 41(12), 958-966.
- Davis, I. S., et al. (2017). The effects of strengthening exercises for the quadriceps in individuals with patellofemoral pain. Journal of Orthopaedic & Sports Physical Therapy, 47(1), 29-36.
- Gomoll, A. H., et al. (2012). The role of strengthening exercises in the treatment of femoroacetabular impingement. American Journal of Sports Medicine, 40(3), 538-543.
- Kenny, A. M., et al. (2016). Running mechanics in athletes with femoroacetabular impingement. Orthopaedic Journal of Sports Medicine, 4(8), 2325967116664147.
- Reiman, M. P., & Manske, R. C. (2011). Functional rehabilitation of the hip: A guide to functional exercise for the prevention of hip impingement. Human Kinetics.
- Willy, R. W., & Davis, I. S. (2019). Load management strategies for the prevention of running injuries: A review. Sports Health, 11(4), 343-350.
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