Common Running Injuries: Why They Happen and How We Rehab Them
Running is one of the simplest ways to stay fit, clear your head and explore Edinburgh. Whether you're training for your first 5K, building towards a marathon, or simply enjoying a few runs each week, running can be hugely rewarding.
But running is also repetitive. Every stride places load through your feet, ankles, knees, hips and muscles. When the amount of load you're asking your body to handle increases faster than your body can adapt, problems can develop.
At Perform Health Co in Bruntsfield, Edinburgh, we regularly work with runners dealing with everything from persistent niggles to injuries that have stopped them running altogether. The good news is that most running injuries don't mean you have to give up running forever.
The key is understanding why the injury has developed, what your body needs to tolerate running again, and how to progressively rebuild your capacity.
Why do running injuries happen?
Running injuries are rarely caused by one single thing.
A common misconception is that an injury must mean something is "wrong" with your running technique. While how you move can be relevant, running injuries are usually much more complex.
One of the biggest factors is training load.
Perhaps you've increased your weekly mileage, added hill sessions, started running more frequently, increased your pace, or suddenly started training for an event. Your cardiovascular fitness might feel ready for the challenge, but your muscles, tendons and bones may need more time to adapt.
The NHS similarly recommends building running intensity and distance gradually rather than increasing training too quickly.
Other factors can include:
A sudden increase in mileage or intensity
Insufficient recovery between sessions
Changes in terrain or hills
Returning to running after a period away
Reduced strength or capacity in certain muscle groups
Previous injuries
Poor sleep, nutrition or general recovery
Training through increasing pain
Trying to do too much too soon
This doesn't mean there is a single "perfect" way to run. Instead, we want your body to become strong and resilient enough to handle your running demands.
1. Runner's Knee
Runner's knee, often used to describe pain around or behind the kneecap, is one of the most common complaints we see in runners.
You may notice pain during running, particularly when increasing mileage, running downhill or after sitting for a long time. It can also become uncomfortable when using stairs or performing squats.
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Knee pain can develop when the load being placed through the knee exceeds your current capacity to tolerate it.
That might happen after increasing mileage, adding more hills or speed work, or returning to running after a break.
Importantly, experiencing knee pain doesn't necessarily mean your knee is damaged. It is often a sign that we need to modify your current training and progressively build your capacity again.
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At Perform Health Co, rehabilitation will usually involve a combination of:
1. Adjusting your running load
We may temporarily modify your mileage, pace, hills or frequency rather than simply telling you to stop running.
2. Building strength
Depending on your assessment, we may work on the strength and capacity of your quadriceps, glutes, calves and other muscles involved in running.
3. Gradually increasing load
As your symptoms settle, we progressively increase the demands placed on your knee.
4. Returning to your goals
The aim isn't simply to get you pain-free walking around the house. We want you to develop the capacity to return to the type of running you actually enjoy.
2. Achilles Tendon Pain
Achilles pain is common in runners and typically presents around the back of the ankle or heel.
It may feel stiff or painful when you first get out of bed, during the beginning of a run, or after training. Symptoms can gradually build rather than appearing suddenly.
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The Achilles tendon is designed to tolerate significant amounts of load. Problems can occur when the load placed through the tendon increases faster than its ability to adapt.
For example, you may have:
Suddenly increased your running mileage
Added more hills
Started sprinting or speed work
Increased your training frequency
Returned to running after time off
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Tendons generally respond well to progressive loading.
Rather than simply resting until the pain disappears, rehabilitation often involves gradually exposing the tendon to increasing levels of resistance.
This might start with calf strengthening and progress towards heavier strength work, hopping, running drills and eventually higher-speed running.
The exact programme depends on your symptoms, your current strength and the demands you want to return to.
3. Shin Pain and "Shin Splints"
Shin pain is another common problem, particularly when runners increase their training quickly.
You may feel aching or tenderness along the inside or front of the lower leg.
The NHS notes that shin pain can occur when too much stress is placed through the leg, particularly after starting exercise again or increasing activity.
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Your bones, muscles and connective tissues need time to adapt to the repeated impact of running.
Increasing mileage rapidly, running more frequently or changing the surface you're training on can increase the overall load.
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Our approach is based around identifying what has changed and gradually rebuilding your ability to tolerate running.
This may include:
Temporarily reducing running load
Strengthening the calf and lower limb
Improving overall leg capacity
Gradually reintroducing impact
Building running volume progressively
Looking at your training programme and recovery
Persistent or severe shin pain should always be assessed because not all shin pain is simply "shin splints." A physiotherapy assessment can help determine what is most likely causing your symptoms and whether further investigation is required.
4. Calf Strains
A calf strain can appear suddenly, often during faster running, sprinting, hills or a change of direction.
You might experience a sharp pain or feeling of being "kicked" in the calf.
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Calf muscles work hard every time you run. They help absorb load and contribute to propulsion.
If the demands placed on them exceed their current capacity, particularly during high-speed running, they can become injured.
This is especially common when runners increase speed work or return to faster running after a period away.
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Early rehabilitation focuses on managing symptoms and maintaining appropriate movement.
From there, we progressively rebuild:
Strength → power → running capacity → speed
This is important because being able to perform a calf raise doesn't necessarily mean your calf is ready to sprint.
We want your rehabilitation to reflect the demands of your sport.
5. Plantar Heel Pain
Pain underneath or around the heel can make running uncomfortable and can sometimes affect everyday activities such as walking.
Plantar heel pain can be particularly frustrating because it may feel worse first thing in the morning or after periods of sitting.
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Like many running injuries, plantar heel pain can be associated with changes in load.
You may have increased your mileage, started running more hills or changed your training routine.
Footwear and training surfaces can also influence the overall demands placed on the foot.
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Treatment is tailored to the individual but can include:
Managing your running load
Strengthening the calf and foot
Progressive loading of the tissues around the foot
Addressing contributing factors
Gradually returning to running
Rather than simply treating the painful area, we look at how your whole lower limb is coping with the demands of running.
6. Hamstring Injuries
Hamstring injuries are particularly common when runners introduce faster running, sprinting or hill sessions.
A strain can cause sudden pain at the back of the thigh and may immediately affect your ability to run.
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The hamstrings have to manage high forces when you run quickly.
If your current strength and capacity aren't prepared for those demands, increasing speed suddenly can increase injury risk.
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Hamstring rehabilitation needs to go beyond simply waiting for the pain to disappear.
We progressively build:
Hamstring strength
Tolerance to lengthening
Running capacity
Speed
Sprinting exposure
The final stage is particularly important for runners who want to return to faster running.
Rehabilitation isn't just about treating the painful area
One of the most important things we explain to runners is that pain doesn't always tell the whole story.
If your knee hurts, for example, that doesn't automatically mean your knee is weak or damaged.
Instead, we want to understand the bigger picture.
At Perform Health Co, our physiotherapy assessments consider things such as:
Your injury history
Have you had similar problems before?
Your training
How often are you running? What has changed recently?
Your strength and capacity
Can your muscles and tissues handle the demands you're placing on them?
Your goals
Are you trying to return to a 5K, marathon, trail running or simply pain-free recreational running?
Your recovery
Are you getting enough time between harder sessions?
This allows us to create a rehabilitation plan that is specific to you rather than giving you a generic list of exercises.
What does running injury rehab look like at Perform Health Co?
Our approach combines physiotherapy, strength and conditioning and progressive rehabilitation to help you get back to the activities you enjoy.
We don't believe rehabilitation should end when you can walk without pain.
The goal is to build your capacity so that you can handle the demands of running again.
Your rehabilitation may progress through several stages:
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We assess your symptoms, training history, movement, strength and the demands you're trying to return to.
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We help you understand why you can safely do now and whether your running needs to be modified.
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Progressive strength work helps your muscles and tissues tolerate increasing loads.
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Rather than going from zero to your previous training level, we gradually increase your running exposure.
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If you're training for a race, we can progressively introduce the specific demands you'll need to handle whether that's distance, hills, speed or increased weekly mileage
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The aim is not simply to get you back running. It's to help you become more capable of handling the training required to keep running.
When should you see a physiotherapist about a running injury?
Not every ache requires treatment. Running can feel challenging, particularly when you're increasing your training.
However, if pain is persistent, getting worse, changing the way you run, or stopping you from doing the activities you enjoy, it's worth getting it assessed.
The NHS recommends seeking professional advice for persistent running-related pain, particularly when symptoms don't improve with appropriate rest and self-management.
Getting an injury assessed early can also help you understand what you can continue doing rather than automatically stopping everything.
Keep running. Build your capacity.
Running injuries can be frustrating, especially when you're working towards a race or simply enjoying being active.
But an injury doesn't necessarily mean you have to give up running.
With the right diagnosis, appropriate load management and progressive rehabilitation, we can help you understand what's going on and build your body back up to the demands of running.
At Perform Health Co, our Edinburgh clinic combines physiotherapy with strength and conditioning to help you recover from injury, improve your movement and get back to doing what you love.
We're based at 168 Bruntsfield Place, Edinburgh, and work with runners of all abilities from people getting started with their first 5K to experienced runners training for their next challenge.
Experiencing a running injury?
Book a physiotherapy assessment with Perform Health Co and let's work out what's stopping you from running at your best.
