Physical Therapy for Running Injuries

Running seems simple. Humans start as toddlers, and many keep running for the rest of their lives — for play, sport and exercise. But this natural act can lead to serious injuries.

When people begin running for fitness, they are particularly vulnerable to injury. Four specific periods are the most dangerous:

  • During the first six months of running
  • Resuming running after an injury
  • Increasing the running distance
  • Increasing speed

Throughout all these stages, training errors cause most injuries. Often problems develop due to inadequate stretching, an increase in hill running, insufficient rest between runs and a sudden change in running pace and distance.

Physical therapists often recommend that runners limit weekly mileage gain to 15 percent at most. In fact, they say, it’s often better to run 8 miles on two separate days, than 10 miles in one workout.

Equally important is a proper cool-down, which should include a gentle jog and light stretching.

Still, injuries happen — most often in the hips, knees, ankles and feet.

A runner may develop pain in the kneecap, which affects nearly 25% of runners and is more common in women than men. Sometimes this is caused by poor muscle tone, insufficient/inappropriate shoe support, over training, poor or altered gait mechanics, muscle weakness or tightness, ligament insufficiency or tightness or environmental factors such as the drainage slope of most roads.

Worn-out running shoes can also trigger foot pain. Other problems include groin pain, and back pain that radiates down the leg.

In all these cases, if the injury causes severe discomfort, swelling and loss of motion, a runner should seek medical attention to avoid further injury and to speed recovery. Don’t run through pain, therapists stress, it will only make the injury worse.

Common running injuries include:

  • Runner's knee develops due to inadequate strength in the quadriceps, the large muscle group on the front of the thigh. Inadequate shoe support can also cause problems.
  • Ankle sprains occur when one of the three ligaments supporting the ankle are stretched or torn. Recurring injury can lead to ankle instability.
  • ITBS (iliotibial band syndrome) is a common injury affecting marathon runners. It involves the ITB, a ligament running along the outside of the thigh and stabilizing the knee. Strain and overuse can cause it to thicken and become inflamed and irritated.
  • Shin splints refer to pain along the tibia or shin bone, the large bone in the front of the lower leg. They are primarily seen in runners who are just starting out. Risk factors include overuse or incorrect use of the lower leg; improper stretching and warm-up; overtraining; running or jumping on hard surfaces; and running in shoes that lack proper support. These injuries are often associated with flat feet. About one in eight running injuries is caused by shin splints.
  • Plantar fasciitis is a pain in the arch of the foot, usually caused by tight calf muscles or a problem with foot motion while running.
  • Bursitis of the hip develops due to inflammation of a bursa, a small jelly-like sac area between the hip and the tendon. In early stages, it can cause a sharp, intense pain.

How physical therapy can help

When treating an injured runner, a therapist begins by conducting a physical evaluation and asking questions about the patient’s running habits, equipment, routine and techniques. Sometimes when a therapist analyzes a runner’s gait, he or she can pinpoint problems that can be corrected by changing running habits.
The therapist usually suggests the patient take a break from running or modifies his or her running regimen. This promotes healing and reduces inflammation. To prevent recurrence, most physical therapists work with the patient to teach and develop pre- and post workout routines with stretches, strength work, warm-ups and cool-downs to help the body adapt to the rigors and demands of running.


Specific treatments may include:

  • For the knee: Ice massage and a program of stretching and strengthening of the hamstring, quadriceps and hip musculature. Sometimes therapists will perform manual mobilization of soft tissue and joint structures to overcome restrictions. Modalities such as ultrasound may be applied to address inflammation, break up scar tissue or to facilitate circulation. Supportive or corrective taping techniques may be applied when appropriate and bracing may be considered if external support is deemed necessary. Therapy usually lasts a month or longer.
  • For ankle sprains and pain: Exercises to strengthen muscles, thus increasing stability. Sometimes modifying a runner’s shoe or changing gait or running surface can help. Therapists may also use massage, ice, ultrasound or electrical stimulation to facilitate tissue healing.
  • For Achilles tendon pain: Rest and limiting use are often the best approach. A therapist may also use ice to reduce swelling and apply other treatments, such as ultrasound, moist heat and massage. As healing progresses, stretching and strengthening exercises are added.
  • For foot problems: Special shoe insets called orthotics, or other modifications, are often required so the shoe fits properly and the foot has adequate protection. Therapeutic exercise is again an effective treatment tool with foot problems and may be accompanied by modalities such as manual treatment techniques, ultrasound, ice or heat and electrical stimulation.
  • Shin splints: A therapist may use electrical stimulation, ultrasound or deep tissue massage to reduce inflammation. During the rest and recovery period, ice packs are sometimes used. Gradually, a patient will return to previous activities. Supportive taping may also be applied in an effort to alleviate stress within the effected region.
  • Plantar fasciitis: Ultrasound, ice packs and soft-tissue massage are sometimes used to treat pain, as are arch supports. Calf stretches before and after workouts can also help.
  • Bursitis: Heat and ice help calm inflammation. Then a therapist will work on stretches to restore full hip motion and reduce friction.

It is the initial evaluation and physical assessment process that a therapist will use to determine the origin of the problem from which he or she will formulate the most effective treatment approach based on clinical/practical experience, academics and evidence based support. One must remember that the origin of pain may not be the origin of dysfunction that causes the pain. Successful treatment of any condition or symptoms is dependent upon determining the origin of the dysfunction. Treating may not resolve the problem.