The 5 Most Common Running Injuries (And What Actually Causes Them
- Julia Cole
- Jul 24
- 4 min read
By Julia Cole, CAT(C), Athletic Therapist – Proactive Therapy, Victoria, BC
Whether you're training for your first 5K or your tenth marathon, injuries can quickly derail your progress. The good news? Most running injuries aren't caused by running itself—they're caused by a mismatch between the demands you're placing on your body and your body's ability to tolerate that load.
As an Athletic Therapist in Victoria, BC, one of the biggest misconceptions I hear is:
"What exercise fixes runner's knee?"Or"What stretch should I do for shin splints?"
The truth is, there is rarely one exercise or one stretch that solves the problem. To recover—and stay healthy—you need to understand why the injury developed in the first place.
Let's look at the five most common running injuries and what the research tells us about them.
1. Runner's Knee (Patellofemoral Pain Syndrome)
Common symptoms
Pain around or behind the kneecap
Pain going downstairs
Pain with squatting
Pain after prolonged sitting
Symptoms that gradually worsen with running
What actually causes it?
Contrary to popular belief, the kneecap usually isn't the primary problem.
Patellofemoral pain develops when the forces placed through the front of the knee exceed what the joint can comfortably tolerate. This often occurs due to a combination of:
Training load increasing too quickly
Reduced hip and lower limb strength
Poor single-leg control
Reduced running capacity
Recovery that isn't keeping up with training
Research consistently shows that strengthening the hip and knee muscles is one of the most effective treatments for patellofemoral pain. While mobility can play a role for some runners, simply stretching tight muscles rarely addresses the underlying issue.
2. Shin Splints (Medial Tibial Stress Syndrome)
Common symptoms
Pain along the inside of the shin
Pain during or after running
Tenderness over a broad area of the tibia
Symptoms that improve with rest but return when running resumes
What actually causes it?
Shin splints occur because the tibia (shin bone) and the surrounding tissues are repeatedly exposed to more load than they can currently tolerate.
Common contributing factors include:
Rapid mileage increases
Returning to running too quickly
Inadequate calf strength
Poor recovery between runs
Changes in training surface or footwear
The solution is rarely complete rest. Instead, evidence supports temporarily modifying training while progressively strengthening the calves and gradually rebuilding running volume.
3. Achilles Tendinopathy
Common symptoms
Pain and stiffness at the back of the heel
Morning stiffness
Pain that eases during the run but returns afterward
Tenderness over the tendon
What actually causes it?
The Achilles tendon adapts to load—but only when that load increases gradually.
Too much running too soon, adding speed work, hill training, or increasing weekly mileage can exceed the tendon's capacity.
Research consistently supports progressive heavy resistance exercise as the cornerstone of treatment. Passive treatments may help with symptom relief, but tendons become healthier by progressively increasing their load tolerance.
4. IT Band Syndrome
Common symptoms
Sharp pain on the outside of the knee
Pain that begins after a certain running distance
Symptoms worse when running downhill
What actually causes it?
Despite its reputation, the IT band itself is rarely "tight."
Current evidence suggests IT Band Syndrome is more closely related to repeated compression of tissues near the outside of the knee combined with training load and movement patterns.
Many runners spend weeks foam rolling or stretching the IT band without addressing the underlying contributors, which may include:
Sudden increases in training
Reduced hip strength
Poor single-leg control
Running volume that exceeds current capacity
Treatment should focus on improving strength, movement quality, and training management rather than aggressively stretching the IT band.
5. Plantar Fasciopathy (Plantar Fasciitis)
Common symptoms
Heel pain with the first few steps in the morning
Pain after periods of sitting
Pain under the heel during longer runs
What actually causes it?
Like tendons, the plantar fascia responds to load.
Repeated stress without sufficient recovery can irritate the tissue, particularly when training volume increases quickly.
Research supports progressive strengthening of the calf muscles and plantar fascia alongside temporary modification of running volume when symptoms are severe.
The Common Thread
Although these injuries affect different parts of the body, they usually have something in common:
The load placed on the tissue exceeded its current capacity.
That load may come from:
Increasing mileage too quickly
Running more frequently
Adding hills or speed work
Returning after time off
Inadequate strength training
Poor recovery
Sleep, nutrition, or life stress reducing your ability to recover
The painful area is often the victim—not the culprit.
That's why simply treating the painful tissue doesn't always solve the problem.
So Should You Stop Running?
Not necessarily.
For many runners, complete rest isn't required and can actually delay your return.
Instead, the goal is to find an appropriate level of running that your body can tolerate while improving the strength and capacity of the affected tissues.
This often means:
Adjusting mileage temporarily
Continuing to run within acceptable symptom limits
Following a progressive strength program
Gradually increasing training again
The best plan is one that allows you to continue moving while respecting your body's current capacity.
How Athletic Therapy Can Help
At Proactive Therapy in Victoria, BC, I don't just look at where your pain is—I look at why it's there.
A comprehensive running assessment may include:
Training history and recent workload
Strength testing
Single-leg control
Hip, ankle, and trunk function
Running mechanics (when appropriate)
Return-to-running planning
Every runner is different, so treatment should be individualized—not based on a generic list of stretches or exercises.
Whether you're training for your first 10K, preparing for a half marathon, or trying to stay healthy throughout soccer season, identifying the true cause of your injury is the first step toward getting back to doing what you love.
If you're dealing with a running injury and aren't sure what's driving it, I'd be happy to help.
Book an Athletic Therapy assessment at Proactive Therapy in Victoria, BC, and let's create a plan that gets you back to running with confidence.
