The majority of running related injuries are due to overuse, overload, muscle imbalances and muscle weakness. Prompt recognition of a running related injury and diagnosis by a sports medicine specialist can delay worsening of an injury and lead to more effective recovery. With overuse injuries, it is important to reduce the load on the injured body part by reducing running frequency, duration, and speed or stop running altogether during a rehabilitation period until the injury has healed. Cross training activities can provide similar cardiovascular benefits to running during the rehabilitation period, these may include walking, bicycling, swimming, and weight lifting.

Running injuries

  1. Runner’s knee (Patellofemoral Pain Syndrome)
  2. Shin splints (Medial Tibial Stress Syndrome)
  3. Achilles tendinitis/tendinopathy
  4. IT Band Syndrome (Iliotibial Band Syndrome)
  5. Hamstring strain
  6. Pes anserine bursitis

Runner’s knee

Anterior knee pain that occurs during and after running is one of the most common complaints in runners. Patellofemoral pain will worsen with hill running, especially down hill running, and fast sprinting. The pain is around or behind the kneecap, particularly when bending the knee during activities like running, squatting, or climbing stairs. The pain may be dull or aching, and swelling may occasionally occur. Imaging is usually normal, but may show a lateral tilt of the kneecap or loss of the space under the kneecap. Similar to other running injuries, the primary treatment involves a reduction in running activity, physical therapy for hip and gluteus muscle strengthening, and gradually increasing running. Cryotherapy with ice and anti-inflammatory treatments can alleviate symptoms. In some cases injection therapies can be performed to alleviate symptoms and inflammation.

Causes

This injury is typically caused by overuse, poor running mechanics, imbalanced muscle strength, or excessive training. Tight quadriceps or hamstrings, weak hip muscles, and misalignment of the patella can all contribute to this condition. There would be irritation of the underside of the kneecap and malt racking of the kneecap due to muscular imbalance and weakness.

Healing time

The recovery time can vary but typically takes about 4 to 6 weeks with rest, ice, and proper rehabilitation exercises.

Exercises for healing

Stand and pull one foot toward your glutes, holding it with your hand to stretch the quadriceps. Hold for 30 seconds and repeat.

Straight leg raises: Lie flat on your back, keeping one leg bent and the other straight. Lift the straight leg to the height of the bent knee and hold for 5-10 seconds, then lower it slowly. Repeat 10-15 times.

Prevention

Strengthen hip muscles (such as glute bridges) to improve knee stability. Perform regular stretching for your quadriceps, hamstrings, and IT band to keep muscles flexible and balanced.

Read more on patellofemoral pain syndrome

Shin splints

Shin splints, medically known as medial tibial stress syndrome, refers to pain along the inner edge of the shinbone (tibia). It typically develops from overuse or sudden increases in running intensity or duration. Pain and tenderness along the inner side of the shin, especially after running or physical activity. The pain may be sharp or dull, and in severe cases, it can persist even at rest.

Causes

Shin splints often occur when there is a sudden increase in activity, running on hard surfaces, improper footwear, or running with poor mechanics. Overuse or imbalance in the muscles and tendons of the lower leg also contribute.

Healing time

Recovery time typically ranges from 2 to 6 weeks, depending on the severity of the condition. Rest, ice, and anti-inflammatory medications help speed recovery.

Exercises for healing

Calf stretch: Stand with one foot forward and the other foot extended behind you. Keep both heels on the ground while bending the front knee to feel a stretch in the back calf. Hold for 30 seconds and repeat.

Toe raises: Stand with your feet flat on the ground. Slowly lift your toes while keeping your heels grounded, strengthening the tibialis anterior muscle. Do 3 sets of 15 repetitions.

Prevention

Gradually increase mileage and intensity, avoiding sudden spikes in activity. Strengthen the calf and shin muscles with exercises like calf raises and toe taps.

Achilles tendinitis/tendinopathy

The largest tendon in the human body, the Achilles tendon, is responsible for transmitting force from the calf muscle into the ankle during push off. The Achilles can be injured during an increase in running distance and speed when the tendon is overloaded and cannot heal itself leading to inflammation and microtears within the tendon. Symptoms of Achilles tendinopathy include posterior heel pain, calf pain, swelling within the tendon, typically occurring at the start of running and improves during running but in severe cases may worsen and stop running activity altogether. Prompt diagnosis of the injury can lead to fast recovery and healing. Treatment of Achilles tendinopathy involves reduction in running activity, physical therapy involving concentric and eccentric calf strengthening exercises, gait analysis to identify and treat muscle imbalances in the lower legs. Recovery often lasts months or years in severe cases. Surgery to repair the tendon is performed in severe cases that lead to progressive tearing and degeneration of the tendon.

Causes

This condition is typically caused by repetitive stress on the Achilles tendon due to overtraining, improper footwear, or inadequate warm-up. Tight calf muscles, poor running mechanics, or an increase in intensity without proper preparation can also lead to tendinitis.

Healing time

Recovery time varies but typically takes 4 to 6 weeks for mild cases. Severe cases may require longer recovery, sometimes several months.

Exercises for healing

Eccentric heel drops: Stand on the edge of a step with the balls of your feet on the step and your heels hanging off. Lower your heels down slowly (eccentric motion), then rise back up using both legs. Repeat 10-15 times.

Calf stretch: Place your hands on a wall and step one foot back, pressing the heel down. Hold the position for 30 seconds and repeat 3 times.

Prevention

Stretch and strengthen your calf muscles regularly. Gradually increase running intensity and duration to prevent overuse of the Achilles tendon.

IT Band Syndrome

IT band syndrome occurs when the iliotibial band (a band of tissue running from the hip to the knee on the outside of the thigh) becomes tight or inflamed, leading to pain on the outer side of the knee. The iliotibial band is a connective tissue that spans the outside of the hip/thigh down to the lateral knee, that provides stability to the lateral knee and thigh. Symptoms of iliotibial band include lateral knee pain or lateral thigh pain that starts after increased running distance, speed, training frequency, or hill running. Once iliotibial band pain starts it may persist and worsen with each run, affecting the ability to continue training. Imaging is typically normal and is primarily used to exclude other injuries that can cause lateral knee pain such as a meniscus tear or cartilage wear in the joint. The treatment for iliotibial band pain starts with a reduction in running distance and speed, changing running surface (avoiding hills), cross training, and physical therapy for hip and thigh strengthening program. Modalities such as trigger point therapy, acupuncture and dry needling have shown to alleviate symptoms from iliotibial band syndrome. Surgery is rarely, if ever, performed.

Causes

IT band syndrome is often caused by overuse, particularly in activities that involve repeated knee motion like running. Factors such as muscle imbalances, poor running form, or running on uneven surfaces can also contribute to this condition.

Healing time

It typically takes about 4 to 6 weeks to recover with rest, physical therapy, and anti-inflammatory treatments.

Exercises for healing

IT band stretch: Stand with one leg crossed over the other, then lean toward the side of the back leg to feel a stretch along the outside of the thigh. Hold for 30 seconds and repeat 3 times.

Foam rolling: Roll out the outer thigh with a foam roller to release tightness and improve flexibility in the IT band.

Prevention

Strengthen the hip abductors and glutes to reduce strain on the IT band. Stretch the IT band and quadriceps regularly to maintain flexibility.

Click here to learn more about IT band syndrome

Hamstring strain

The hamstring is a large muscle group in the back of the thigh that is commonly injured during sudden increase in running activity or fast sprinting. These injuries can occur at the top of the hamstring involving the attachment on the pelvis (high hamstring), or down in the midportion of the hamstring muscle in the posterior thigh. Imaging with in-office ultrasound can quickly diagnosis and identify the severity of a hamstring strain. High hamstring strains take longer to heal (6-12 months) compared to midportion hamstring strains. The treatment is generally conservative with activity modification and reduced running, physical therapy and rehabilitation, and occasionally orthobiologic therapies such as PRP for injuries not responding to physical therapy. In rare cases surgery is performed to re-attach a torn hamstring from the pelvis.

Causes

Hamstring strains are usually caused by overuse, insufficient warm-up, or sprinting at high speeds without proper preparation. Imbalances in hamstring and quadriceps strength can also contribute.

Healing time

Recovery time ranges from a few weeks to a few months depending on the severity of the strain, with grade 1 strains requiring around 3 to 4 weeks and grade 3 strains taking several months.

Exercises for healing

Hamstring stretch: Sit on the floor with one leg extended and the other leg bent. Reach forward toward the toes of the extended leg to feel a stretch along the back of the thigh. Hold for 30 seconds and repeat.

Bridges: Lie on your back with your knees bent and feet flat. Lift your hips off the ground while keeping your shoulders down, contracting the hamstrings and glutes. Repeat for 3 sets of 15 reps.

Prevention

Perform dynamic warm-ups before running, such as leg swings and walking lunges. Strengthen the hamstrings and quadriceps equally to avoid muscle imbalances.

Pes anserine bursitis

The pes anserine bursa is a small sac on the inside of the knee joint that can become inflamed and swollen after running activity. Symptoms develop gradually, but cannot also come on more suddenly after fast running or completing a long distance race. Pain will be felt on the inside of the knee, and generally will be tender to the touch below the joint the inside of the knee. Pes anserine bursitis occurs when the hamstring tendons pull on the inside of the knee during running, which inflames the bursa adjacent to the tendon. Imaging may be necessary to exclude a stress fracture in the shin bone, which can mimic pes anserine bursitis. Treatment is conservative involving hamstring stretching, ice and topical anti-inflammatory, and injections of corticosteroid into the bursa in severe cases. Runners may continue to train without restriction if the pain is mild and does not occur while running.

Causes

Pes anserine bursitis is typically caused my repetitive stress and overuse of the area. Other factors may include osteoarthritis, knee alignment issues or flat feet.

Healing time

Recovery time ranges from a few weeks to a few months depending on the severity. It typically will take 6 to 8 weeks.

Exercises for healing

Hamstring stretch: Sit on the floor with one leg extended and the other leg bent. Reach forward toward the toes of the extended leg to feel a stretch along the back of the thigh. Hold for 30 seconds and repeat.

Isometric adductor holds: Lifting your leg up with your knee straight and holding for 30-45 seconds, focusing on the inner thigh muscles.

Prevention

Perform dynamic warm-ups before running, such as leg swings and walking lunges. Consider regular hamstring and inner thigh stretches.

Get convenient, comprehensive care

Whether you have runners knee or pain in your shins after running, the care team at Florida Orthopaedic Institute includes specialists in every aspect of orthopedics. If you’re having discomfort, let us create a customized treatment plan to help you—safely—get back into action and keep active. 

Don’t wait to schedule an evaluation with a specialist at one of our many convenient locations in Central Florida. Call us or request an appointment today.

By: Dr. Jeffrey Kannen & Dr. William Cottrell

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About Florida Orthopaedic Institute

Founded in 1989, Florida Orthopaedic Institute is Florida’s largest physician-led orthopedic group. It provides expertise and treatment of orthopedic-related injuries and conditions, including adult reconstruction and arthritis, foot and ankle, general orthopedics, hand and wrist, orthopedic trauma, shoulder and elbow, spine, interventional pain management, sports medicine, podiatry, physical medicine and rehabilitation, chiropractic services, and physical and occupational therapy, among others. The organization treats patients throughout its surgery centers in North Tampa, South Tampa, and Citrus Park, at several orthopaedic Urgent Care centers and at office locations in Bloomingdale, Brandon, Citrus Park, Gainesville, Lakeland, Northdale, North Tampa, Ocala, Palm Harbor, Riverview, South Tampa, Sun City Center and Wesley Chapel.

July 24, 2025