Injuries in Runners | SPD - Singapore

Injuries in Runners

Running or jogging is a popular physical activity. According to Taunton et al, a runner is a person who runs at least three days a week covering a distance of not lesser than 3km in each session1

There are an estimated 25 million runners in the world and the number is continuously rising2.

It has been reported that up to 70% of runners sustain injuries requiring medical treatment1. These injuries are primarily due to incorrect training such as running too far, too fast and/or too soon. Changes in running surfaces and equipment, insufficient nutrition and restoration, ignorance of disease or earlier injuries are also reported in up to 80% of injuries in runners3.

Common running injuries
i) Iliotibial band friction syndrome (ITBFS) - The overall incidence of ITBFS has been reported in 22.2% of runners4. It is one of the leading causes of knee pain in runners.

ITBFS results from repetitive friction of the distal portion of the iliotibial band. This is a thick band of fascia on the external side of the knee, extending from the outside of the pelvis over the hip and knee, and inserting just below the knee.

The band is crucial to stabilising the knee during running, as it moves from behind the femur to the front of the femur during activity. The continual rubbing of the band over the lateral femoral epicondyle, combined with the repeated flexion and extension of the knee during running may cause the area to become inflamed.

Common symptoms of ITBFS include pain over the outside of the knee joint, particularly when the heel strikes the ground and a snapping or popping sensation when moving the knee.

Like other overuse injuries, the initial treatment includes rest, applying ice pack on the affected area, elevation of the leg and anti-inflammatory medications. Physiotherapy may be a viable option to avoid recurrence of the injury. The therapist may run a thorough bio-mechanical assessment which includes gait analysis or the running techniques as well as muscle strength and flexibility testing in order to treat the exact cause of the symptoms5.

ii) Achilles tendinopathy (ATP) - A common injury particularly prevalent in distance runners, ATP represents up to 18% of the total injuries in runners5. It is a degenerative rather than an inflammatory condition of the achilles tendon, a fibrous band which connects the calf muscle to the heel bone.

Abnormal bio-mechanics of the foot, limited subtalar and ankle joint mobility and the lack of flexibility as well as weak muscles are the major intrinsic factors of ATP6.

Running shoes with poor arch support and/or rigid heels that do not cushion the heel are the identified extrinsic contributors7. Pain over the back of the heel is the cardinal symptom of ATP along with diffusely swollen tendon.

The initial treatment is aimed at controlling inflammation and correcting training errors, improving flexibility and muscle weakness as well as optimising shoes and insoles. In the later-phase of rehabilitation, heavy load eccentric calf muscle training which often involves heel raised exercises may alleviate the pain8.

iii) Plantar fasciitis – Plantar fasciitis affects mostly males and competitive runners5. It occurs when the plantar fascia, a strip of tough tissue found in the bottom surface of the foot stretching from the heel to the toe bones, becomes irritated, inflamed or torn by repetitive stress placed upon it.

The primary symptom of plantar fasciitis is pain over the sole of the foot that results in difficulties in weight bearing, especially in the first few steps after waking up from sleep9.

The common causes of plantar fasciitis are abnormal foot bio-mechanics (a flat or high arching foot), tight achilles tendon, wearing unsuitable training shoes and incorrect training. Treatments such as rest, ice, compression, elevation and stretching exercises will alleviate the symptoms. In selected cases, steroid injections are required. Optimisation of shoes and in-soles may also be needed10.

Most injuries in runners are predisposed by both extrinsic and intrinsic factors. In the initial phase of injuries, the actions needed to control the symptoms could be as simple as decreasing the intensity, frequency and duration of running, or modification of running techniques.

However, it is essential to determine and correct the cause of the problem before commencing the run. Controlling the anatomical/bio-mechanical inefficiencies of the feet, stretching and strengthening exercises for the leg, wearing proper training shoes, and reasonable training routines will minimise the recurrence of the injuries.

Adapted from article of the same name from EXTRAPAGE in November 2011.


1. Rolf C. Overuse injuries of the lower extremity in runners. Scandinavian journal of medicine & science in sports. 1995;5(4):181-90.
2. Hreljac A. Impact and Overuse Injuries in Runners. Medicine and Science in Sports and Exercise. 2004;36(5):845-9.
3. Fredericson M, Bergman AG. A comprehensive review of running injuries. Critical Reviews in Physical and Rehabilitation Medicine. 1999;11(1):1-34.
4. Taunton JE, Ryan MB, Clement DB, McKenzie DC, Lloyd-Smith DR, Zumbo BD. A retrospective case-control analysis of 2002 running injuries. British Journal of Sports Medicine. 2002;36(2):95-101.
5. Fredericson M, Weir A. Practical management of iliotibial band friction syndrome in runners. Clinical Journal of Sport Medicine. 2006;16(3):261-8.
6. Van Ginckel A, Thijs Y, Hesar NGZ, Mahieu N, De Clercq D, Roosen P, et al. Intrinsic gait-related risk factors for Achilles tendinopathy in novice runners: A prospective study. Gait and Posture. 2009;29(3):387-91.
7. Azevedo LB, Lambert MI, Vaughan CL, O'Connor CM, Schwellnus MP. Biomechanical variables associated with Achilles tendinopathy in runners. British Journal of Sports Medicine. 2009;43(4):288-92.
8. Cook JL, Khan KM, Purdam C. Achilles tendinopathy. Manual Therapy. 2002;7(3):121-30.
9. Pohl MB, Hamill J, Davis IS. Biomechanical and anatomic factors associated with a history of plantar fasciitis in female runners. Clinical Journal of Sport Medicine. 2009;19(5):372-6.
10. Ribeiro AP, Trombini-Souza F, Tessutti VD, Lima FR, Joao SMA, Sacco ICN. The effects of plantar fasciitis and pain on plantar pressure distribution of recreational runners. Clinical Biomechanics. 2011;26(2):194-9.