Whether you are starting your first Couch to 5K, joining a run club or preparing for a race, pain can quickly interrupt your training.
Running injuries do not necessarily mean that you need to stop running indefinitely. Most can be managed by adjusting your training and gradually rebuilding your body’s capacity to tolerate running.
The knee, lower leg, ankle and foot are among the areas most frequently affected. Three conditions we commonly assess are iliotibial band syndrome, plantar fasciitis and Achilles tendinopathy.
Why do running injuries happen?
Running injuries often develop when training demands temporarily exceed the capacity of the affected area.
This may follow:
- Increasing your distance, speed or running frequency
- Adding more hills, intervals or races
- Returning after a break
- Changing footwear or running surfaces
- Increasing training while sleep or recovery is reduced
However, injuries are rarely caused by one factor alone. Previous injuries, strength, running technique, general health, work demands and recovery between sessions can all influence how much running your body can tolerate.
Rest may settle the pain temporarily, but symptoms can return if your capacity has not been rebuilt.
1. Iliotibial band syndrome
Iliotibial band syndrome, or IT band syndrome, is a common cause of pain on the outside of the knee in runners.
What does IT band syndrome feel like?
Symptoms may include:
- Pain or tenderness on the outside of the knee
- Pain that begins after a predictable running distance
- Increasing pain as the run continues
- Pain when running downhill or descending stairs
The condition was historically called iliotibial band friction syndrome because it was believed that the IT band repeatedly rubbed over the outside of the knee.
However, the IT band does not appear to slide back and forth over the knee as once thought. Pain may instead relate to compression and irritation of sensitive tissues beneath it, so the broader term iliotibial band syndrome is now commonly used.
How is IT band syndrome treated?
Management may include:
- Temporarily reducing aggravating running sessions
- Adjusting hills, speed, distance or frequency
- Strengthening the hip, knee and calf muscles
- Gradually rebuilding single-leg and running capacity
- Considering running-technique changes when relevant
Stretching or foam rolling may provide temporary relief for some runners, but should not replace a progressive rehabilitation programme.
IT band syndrome recovery time
Many runners improve over approximately six to 12 weeks, although persistent symptoms can take several months.
Recovery timelines vary, and research into IT band syndrome rehabilitation remains limited.
2. Plantar fasciitis
Plantar fasciitis is a common cause of pain underneath the heel. It involves pain associated with the plantar fascia and is one possible cause of the broader presentation known as plantar heel pain.
Despite its name, plantar fasciitis is not necessarily caused by ongoing inflammation. The term plantar fasciopathy is therefore also used.
Not all plantar heel pain is plantar fasciitis. Heel fat-pad irritation, nerve-related pain and calcaneal stress injuries can cause pain in a similar area and may require different management.
What does plantar fasciitis feel like?
Typical symptoms include:
- Pain underneath or towards the inside of the heel
- Pain during the first few steps in the morning
- Pain when standing after rest
- Pain that may warm up during a run
- Increasing symptoms after longer runs or prolonged standing
These features may suggest plantar fascia-related pain, but diagnosis should also consider the history, location and behaviour of the symptoms.
How is plantar fasciitis treated?
Treatment may include:
- Adjusting running and walking loads
- Plantar fascia and calf stretching
- Progressive calf, foot and lower-limb strengthening
- Taping for short-term relief
- Reviewing footwear
- Foot orthoses when helpful
Orthotics may help some people, but should generally complement rehabilitation rather than replace it.
Shockwave therapy may also be considered when symptoms remain persistent despite appropriate rehabilitation.
Plantar fasciitis recovery time
Plantar fasciitis usually improves over months rather than days.
Some runners improve within six to 12 weeks, while others require many months. Symptoms can also persist or fluctuate for several years, particularly when they have already been present for a long time.
Progress is better judged by changes in pain, function and tolerance to walking and running than by a fixed timeline.
3. Achilles tendinopathy
The Achilles tendon connects the calf muscles to the heel and stores and releases energy during running and jumping.
Achilles tendinopathy occurs when the tendon becomes painful and less tolerant of these loads. It may affect the middle portion of the tendon or its attachment to the heel.
What does Achilles tendinopathy feel like?
Common symptoms include:
- Pain or stiffness at the back of the ankle
- Morning stiffness or pain after rest
- Tenderness or thickening of the tendon
- Pain during running, jumping or calf raises
- Symptoms that warm up during exercise but return afterwards
Unlike an Achilles rupture, tendinopathy usually develops gradually.
How is Achilles tendinopathy treated?
Progressive tendon-loading exercise is the main treatment.
Rehabilitation may include:
- Modifying running volume, speed and hills
- Progressive calf raises with the knee straight and bent
- Increasing resistance and exercise speed over time
- Rebuilding hopping and jumping capacity
- Gradually returning to faster running and sport
Complete rest is not usually required. Some running or alternative aerobic exercise can often continue at an adjusted level.
There is no single best Achilles exercise. Isometric, eccentric and heavy slow resistance exercises can all be useful when appropriately progressed.
Achilles tendinopathy recovery time
Rehabilitation commonly continues for at least 12 weeks, although returning to unrestricted running may take three to six months or longer.
Recovery should be based on symptoms, strength, function and tolerance to progressively demanding exercise rather than time alone.
Can you keep running with an injury?
Pain does not automatically mean that you must stop running. However, continuing the same programme while symptoms progressively worsen is unlikely to help.
Depending on the injury, you may be able to continue with:
- Shorter or slower runs
- Fewer hills
- Run–walk intervals
- Fewer weekly sessions
- Cycling, swimming or other alternative exercise
A physiotherapist can help identify a manageable starting point while you rebuild capacity.
When should you see a physio?
Consider seeing a physiotherapist when:
- Symptoms are not improving
- Pain is worsening from run to run
- Pain changes the way you walk or run
- The same injury keeps returning
- You are unsure how much running is appropriate
- You have lost strength, confidence or function
- You need help preparing for an upcoming event
Seek prompt medical assessment if you cannot bear weight, have substantial swelling or deformity, or experience a sudden ‘pop’ behind the ankle followed by difficulty pushing off.
Pain and swelling in one calf with warmth or redness also require urgent assessment. Call triple zero if these symptoms occur with chest pain or difficulty breathing.
What will a running physio assessment involve?
Your physiotherapist may assess:
- How and when your symptoms began
- Recent changes to your training
- Running volume and intensity
- Joint movement and muscle strength
- Hopping and single-leg function
- Footwear and recovery habits
- Running technique when relevant
Scans are not routinely needed for every running injury. Imaging may be considered when the diagnosis is uncertain, the result would change treatment or a more serious injury needs to be excluded.
Getting back to running
IT band syndrome, plantar fasciitis and Achilles tendinopathy can all be frustrating, but most runners can return to their previous activities.
Recovery usually involves reducing aggravating loads while progressively rebuilding strength, confidence and running tolerance.
Our physiotherapists can assess your injury, help you remain active where appropriate and develop an individualised return-to-running plan.
Book a physiotherapy assessment today and take the first step towards running with greater confidence.
