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Running Injuries 101: "Know Pain, Know Gain"

Calling all runners! Studies show that up to 90% of runners will experience injury at some point during their running tenure and as low as 20% actually seek medical care--this does not have to be the case. Runners commonly experience low back, hip, knee and foot pain for a multitude of reasons. Runners strike the ground between 800-1500x/mile with forces from 1.5-5x body weight, so it is important that your running form looks good and you are wearing a properly fitted running shoe. If your running form is not optimal, your running form could be the reason why you are hurting. Seek care from a Physical Therapist who is trained in running injuries and can perform a gait analysis and functional screen to help get you back to pain-free running. Read on to learn more about running injuries and how to prevent them.

What is a running injury?

It’s difficult to define injury, and it varies by sport and by individual. When considering running injuries, the following definition is a good guideline.

“Running related musculoskeletal pain in the lower limbs that causes restriction of running or stoppage of running (distance, speed, duration or training) for at least 7 days or 3 consecutive training sessions, or that requires a runner to consult physician or other healthcare professional.” --Yamato, 2015. Running injuries are not limited to the lower extremity, but can involve your upper extremity too!

It can be easy to let an ache or pain go on for too long before you address it because you’re still able to “push through the pain.” Don’t let a week-long injury become a six month recovery. Listen to your body! Running does not have to be a painful experience, and there is help available. Many Physical Therapists (PTs) are trained to assist you in getting back to running without injury. Learn to leave “no pain, no gain” behind and embrace the “know pain, know gain” mindset.

Common Causes of Injuries

Poor training habits. Overtraining is one of the most prominent issues for runners, especially those who compete in races. It can be tempting to believe that the more you do, the better you’ll get, but with physical training this is almost never the case. There is a point at which your body simply doesn’t have enough downtime to recover, so your training begins to break your body down instead of building it up. An important principle of recovery for the body is optimal nutrition. Many runners aren’t eating enough to sustain their training demands. Be sure to give yourself 1-2 rest days per week (and I mean real rest days, with real rest, not a cross-training day or a power yoga class). And, make sure to get enough calories in per day of protein, carbohydrates, and healthy fats to sustain your training regimen…think good calories like chicken breast or fish and potatoes or rice instead of frozen pizza.

Posture. Many runners will find themselves struggling with muscular weakness, poor flexibility, poor movement patterns, or often a combination of all three. For example, many runners present with hip weakness, which causes the hip to drop when the foot hits the ground. Hip weakness causes excessive load and shearing force on the hips, low back and SI joint resulting in pain. Abnormal arm swing is also a common error that we see. Sometimes, the arms are too rigid or the elbows jut out to the sides causing a more horizontal arm swing. The arms should glide along the sides of the body from hip to heart without crossing in front of your body. Another common mistake seen in running posture is when the runner leans forward from the hips instead of from the ankles, which could cause low back pain. There are many common running form errors that are easily correctable by a Physical Therapist or running coach who is trained in running analysis.

Foot Strike. Any foot-striking pattern can be considered normal (heel, midfoot, toe/forefoot), but runners who heel strike excessively hard or far outside their base of support, are creating an excessive amount of force that is going into your body and up your kinetic chain, which could lead to stress fractures, knee pain, low back pain, or hip pain. Whichever part of your foot hits the ground first, just make sure it hits underneath your body! Having an in-depth running analysis will help you figure out your optimal foot strike position.

Shoewear. It is common to see shoe advertisements claiming they can prevent running injuries, but this is not quite the case. Studies show that while shoes can’t necessarily prevent injury, they can certainly cause injury. Every runner has slightly different running mechanics and foot anatomy, so what works for your training buddy may not work for you. Motion control shoes (think a bulkier shoe, with a stiff sole) are most correlated with injury, but are still appropriate for some situations. Recently the “barefoot” or “minimalist” type shoes have become popular and many runners are successful with this type of shoe. However, you should make sure that this shoe type can support your body. If you are an over-pronator, a minimal shoe may not be ideal for you for running. If you plan to switch to a minimalist shoe, be sure to make a gradual transition. Making dramatic changes in shoe heel height has been correlated with injuries in the foot, ankle and Achilles. In the end, the most important variable to consider when looking for the right running shoe is comfort--find a shoe that you like putting on your foot!

Cadence. The amount of steps taken per minute is your cadence. 180 steps/minute is considered the “ideal” cadence, but anything above 150 is a good number to shoot for. To count your cadence, time yourself running at your normal pace for one minute and count your steps – how many times does your foot hit the ground - this is your cadence. Increase it slowly (no more than 5-10% increase a week) and if you never reach 180, that’s ok. Find a pace north of 150 steps/minute that you’re comfortable with and that helps you reach your goals! Running at an optimal cadence will allow you to be more efficient and it will feel easier to run.

Breathing. Breathing is an important component of running. Many runners are chest breathers (meaning you breath into your upper chest) instead of diaphragm breathers (breathing into your belly and rib cage). Having a strong core is a basic foundation of any athletic activity and it all starts with breathing. Place your hands over your lower rib cage and practice breathing into your hands. This will ensure that you are using your diaphragm.

I have pain, what do I do now?

Treating your own aches and pains is sometimes possible, but is often difficult because the area that hurts is not necessarily the root of the problem. I recommend seeing someone with a trained eye and skill set. If you have pain while running, seek care from a Physical Therapist. Many PTs are trained to perform in-depth gait analysis and other functional screens to help get you back to pain-free running. Physical Therapists are helpful not just for getting you out of pain, but keeping you out of pain. Visit to find a PT in Atlanta to help you on your road to recovery.

I don’t have pain, should I still seek help?

Absolutely! Everyone could use a few tips and tricks in keeping our bodies strong and healthy, especially when participating in exercise. Physical Therapists are also trained to perform wellness assessments, and you don’t have to be in pain to benefit from a running analysis. A PT can help you not only avoid pain and injury down the line, but improve your running performance too! If you have concerns that your running form could use some tweaking or you aren’t sure you are in the correct shoe, reach out to us at One on One Physical Therapy. Don’t be afraid to ask for help in the midst of your training woes. You won’t regret it when you are able to run faster and pain-free.

Dr. Baudo Marchetti is a Board Certified Sports Clinical Specialist at One on One Physical Therapy, a multidisciplinary private practice in Atlanta. For nearly five years she was a full-time sports physiotherapist for the WTA Tour and is a tennis medicine and sports medicine expert. She teaches a Sports Physical Therapy course and assists in teaching orthopedics within the Division of Physical Therapy at Emory University. Learn more by visiting or email Dr. Baudo Marchetti at Special thanks to Carly McMullen, SPT for her assistance in preparing this article.

Carly Faye McMullen is a Doctor of Physical Therapy Student at Emory University in Atlanta, GA. She studied exercise physiology and kinesiology at The University of Florida.

#running #injuries #pain #physicaltherapy

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