OrthoNeuro Blog

7 Sep

Common Runners Overuse Injury Treatment Options

by Courtney Gittins
Running can have major benefits such as, improved health, preventing disease, weight loss, stress relief, and more. However, the incidence of running overuse injuries in people of all ages and abilities is increasing significantly. This increase may be partially attributed to the increased frequency of runners pushing themselves to their physical limits. 

overuse injuriesAt a base level, overuse injuries can be related to putting in too many miles and hours of training. Most running injuries are common in elite athletes, or athletes that have recently enhanced the intensity and duration of their workout. Fortunately, most runners overuse injury treatment options do not require surgery.

Common overuse injuries in runners include:

  • Runner's Knee
  • ITB Syndrome
  • Achilles Tendinitis
  • Plantar Fasciitis
  • Shin Splints
  • Stress Fractures
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Runner's Knee (Patellofemoral Syndrome)

Runner's Knee is chronic irritation under the kneecap. The bruising near the bottom of the kneecap is caused by incorrect tracking of the kneecap as you run or workout. It is typically caused by overuse, unstable running shoes, excessive or fast increase in training, poor quadriceps strength and flexibility. Patellofemoral Syndrome is more common in women than men. Pain below the kneecap most commonly begins during running but can also happen when taking the stairs, squatting, or sitting with knees bent for a long time.


  • Sensitivity behind or around the patella (Kneecap)
  • Pain toward the back of the knee
  • Feeling of knee giving out

Treatment is most commonly nonsurgical. Physical therapy is usually suggested and will assist in strengthening and stretching the quadriceps. Orthotics may also be perscribed to help align and stabilize the foot and ankle. Typically, the runner should avoid hard surfaces, and ice after each run. Although surgical treatment is very rare, it has been used in extreme cases. Usually, a debridement is preformed to remove damaged cartilage from surface of the patella.  

Illiotibial Band (ITB) friction syndrome

Your iIliotibial band (ITB) is a band of tissue that runs from the hip down the outside of the thigh, past the knee, and connects to the lower leg. Its' job is to keep the knee joint stable. ITB friction syndrome occurs when band becomes irritated when rubbing over the bony projection near the knee (common in runners and cyclists). It is the most common lateral knee condition.  ITB friction syndrome can typically be determined by a physician with a physical exam but sometimes an MRI may be necessary. Causes of ITB friction syndrome include ankle over usage, tightness with tensor fascia latae (TFL), and tilts in the pelvis from unequal leg length


  • Pain on the outside of the knee
  • sharp, temporary, stinging sensation
  • Pain when heel touches the floor
  • Swelling along the knee

Symptoms typically worsen with excessive training in a short period of time, running downhill, or running on a hilly road. Different treatment options can include stretching the iIliotibial band, ice, reduction in mileage, stop running, or steroid injections.

Achilles Tendinitis

The Achilles is the tendon runs down the back of the heel. It connects the calf muscle to the heel. Achilles tendinitis is the inflammation of the tendon and when left untreated, can lead to the rupturing of the tendon (acute more painful than chronic). The causes of Achilles tendinitis include excessively tight calf muscles, over training, wearing high heels/worn out shoes, training on soft surfaces, and running uphill.


  • Stiffness behind the ankle (esp. when waking up), symptoms frequently go away when running
  • Pain where tendon connects to heal
Treatment include ice, calf stretching, reduction or  of training, and avoiding hills and speed work.

Shin Splints (Medial Tibial Stress Syndrome)

Shin splints are an irritation of the muscles and tendons where they attach to the shin bone. The primary symptom is pain along the interior border of the shin, 5-10 cm above the ankle. Pain can either be felt at the beginning and end of runs or strictly the end. Initially, pain goes away after several minutes of physical activity. However it progresses till the pain becoming more severe, sharp, and makes it difficult to walk. Shin splints are common to new runners who increase their training load too quickly, or are wearing the wrong shoes, or from over usage. The runner's dominant leg is typically the involved side.


  • Sharp pain in front of your leg
  • Pain when pushing on shins
  • Pain that worsens before and after physical activity

Medial Tibial Stress Syndrome is treated with ice and reduced mileage or complete rest depending on the severity of the injury.  Shin splints that go untreated may result in a stress fracture.

Stress Fracture

Stress fractures are hairline fracture of the bones in the lower leg (tibia, fibular, or a bone in the foot).  This injury is very painful and can occur very quickly. It is commonly identified by intense pain from gentle pressure in a pin point area. Stress fractures are more common in women than men and are caused by over usage or low bone density.


  • Warmth and swelling around injury
  • Pain when putting any sort of weight on injured leg

Treatment for stress fractures is cold compression, resting the leg with crutches, boot, or a cast, and over the counter pain medication.  Consult an orthopedic specialist if you believe you may have a stress fracture.

Muscle Tears

Muscle tears are fairly common in explosive sports (sprinting, football) and can occur suddenly or over time. Most common in hamstrings, groin, and calf muscles.

  • Sudden muscle tears: severe pain in muscle, muscle spasms, swelling, muscle cannot be used. Caused by over usage or insufficiently warming up.
  • Gradual muscle tears (muscle knots): symptoms begin as only noticeable after exercise but eventually gets worse and prevents further activity.
Treatment for a muscle tear is ice, elevation, OTC medications, cross-friction massage. These tend to recur in the same location so be sure to stretch very well before speed workouts and when it's cold

 Plantar Fasciitis

Plantar Fasciitis is characterized by pain on the bottom of foot or directly in front of heel. The pain can stem down the arch or up the back of the heel. Pain is worse when getting out of bed in the morning, typically hurts when workout begins but fades away until exercise is done. Plantar Fasciitis is a result of stress and inflammation of the fibrous tissue that is located on the bottom of the foot (plantar fascia). It is caused from over usage, hill workouts, speed work, being overweight, and poor flexibility in either calves or hamstrings.


  • Pain on bottom of foot
  • Consistent pain in the morning
  • Swelling, warmth around injured area

Treatment for Plantar Fasciitis consists of several steps. It begins with stretching the calf muscles and foot. Then purchasing supportive shoes and avoid walking around barefoot while icing the affected area and taking anti-inflammatory drugs. Night splints and anti-inflammatory drugs may also be suggested.

Unsure of what might be causing your pain?  Schedule an appointment with an orthopedic specialist to find out!

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