Common Running Injuries and How Physiotherapy Helps

Whether you’re training for the BMO Vancouver Marathon, the Vancouver Half Marathon, or simply building up mileage along the scenic Richmond dyke trails, running is one of the most rewarding ways to stay active. But it also comes with a high risk of overuse injuries—especially if you’re increasing distance, intensity, or returning after time off.

At Proactive Health in Richmond, BC, we work with runners of all levels, from beginners to marathon athletes, helping them recover from injuries, improve their biomechanics, and stay pain-free for the long run.

Why Running Injuries Are So Common

Running looks simple, but each step loads your joints with forces 2–4× your body weight. If something is even slightly off in your mechanics, footwear, or training schedule, small problems can quickly turn into painful injuries.

Common causes include:

• Overtraining or rapid increases in mileage

• Limited ankle or hip mobility

• Weakness in the glutes and core

• Flat feet or overpronation

• Running on hard surfaces

• Worn-out or improper footwear

• Biomechanical imbalances that are unique to each runner

This is why individualized assessment is crucial, and why many runners benefit from physiotherapy sooner than they think.

The Most Common Running Injuries

1. Runner’s Knee (Patellofemoral Pain Syndrome)

Runner’s Knee is one of the most frequent overuse injuries in both beginner and experienced runners. It presents as aching or pressure-like pain around or behind the kneecap, especially during stairs, running downhill, squatting, or long-distance training. Some runners also notice clicking, grinding, or a feeling of “pressure” when bending the knee.

This condition occurs when the kneecap doesn’t glide smoothly in its groove, often due to muscular imbalances or subtle alignment issues. Weak glutes, tight quads, or increased mileage can cause the knee to absorb more stress than it should. If the root cause isn’t addressed, symptoms often flare up again with higher running volume.

Often caused by: Weak hip stabilizers, quad tightness, poor kneecap tracking, overpronation, or suboptimal running mechanics.

2. Achilles Tendonitis

Achilles Tendonitis involves irritation or inflammation of the tendon that connects the calf muscles to the heel bone. It often begins with morning stiffness or tightness during the first few steps of a run. Over time, it may progress to sharper pain during hill training, sprinting, or pushing off the toes.

The Achilles tendon takes on significant load with every stride, and when the tissues cannot recover fast enough, the tendon becomes irritated. Tight calves, limited ankle mobility, and sudden training spikes are some of the most common underlying contributors. Chronic cases may involve tendon thickening and require structured rehab.

Often caused by: Tight calves, limited ankle dorsiflexion, rapid increases in training volume, or transitioning to minimalist footwear too quickly.

3. Plantar Fasciitis

Plantar Fasciitis causes sharp, stabbing heel pain—especially noticeable during the first steps in the morning or after prolonged sitting. Pain may ease during movement but tends to return after long runs or extended standing.

This condition develops when the plantar fascia, the thick tissue supporting the arch, becomes overstressed. Flat feet, high arches, worn-out shoes, and overpronation can all make the fascia work harder than it should. Without proper intervention, symptoms may persist for months and significantly impact training.

Often caused by: Flat feet, high arches, poor arch support, tight calves, or gait abnormalities, including overpronation.

4. IT Band Syndrome

IT Band Syndrome presents as sharp or burning pain on the outside of the knee, commonly triggered by repetitive bending during running or cycling. Many runners experience pain at the same point of every run, especially when going downhill or running longer distances.

The irritation occurs when the iliotibial band repeatedly rubs against the femur. Hip weakness and poor running form play major roles, as do overstriding and running on sloped surfaces. Because the IT band absorbs load during each stride, long-distance runners experience this injury more frequently.

Often caused by: Weak glutes, hip instability, overstriding, running on sloped surfaces, or inefficient running mechanics.

5. Shin Splints (Medial Tibial Stress Syndrome)

Shin splints involve dull, aching discomfort or tenderness along the inner edge of the shin bone. The pain may start only at the beginning of a run but can progress to lingering soreness afterward or even pain at rest if not managed properly.

New runners or runners increasing intensity quickly are especially prone to shin splints. Hard running surfaces, worn-out shoes, and inadequate lower-leg strength place extra stress on the shin bones and surrounding tissues. If untreated, shin splints can evolve into more serious stress reactions or fractures.

Often caused by: Overtraining, weak lower-leg muscles, worn-out footwear, overpronation, or running on hard surfaces.

6. Hamstring Strains

Hamstring strains typically begin with sudden pain or a pulling sensation in the back of the thigh during sprinting, acceleration, or fast intervals. Chronic strains may feel like persistent tightness that limits speed, stride length, or overall power.

These injuries result when the hamstrings become overloaded relative to the quadriceps or glutes. Poor warm-ups, reduced flexibility, and muscle imbalances make the hamstrings more vulnerable to strain. Without proper strengthening and gradual return to speed training, these strains frequently recur.

Often caused by: Muscle imbalances, weak glutes, tight hamstrings, inadequate warmup, or sudden bursts of speed.

7. Stress Fractures

Stress fractures are small cracks in a bone caused by repetitive impact and insufficient recovery. They typically present as sharp, localized pain that worsens during running and improves with rest. Pressing directly on the affected spot usually reproduces the pain immediately.

These injuries occur when bone tissue breaks down faster than it can rebuild—often due to rapid mileage increases, training on hard surfaces, or wearing unsupportive footwear. Because stress fractures can worsen if ignored, early diagnosis and load modification are crucial.

Often caused by: High-impact loading, rapid mileage progression, low bone density, improper footwear, or biomechanical issues.

How Physiotherapy Helps Runners Recover and Stay Injury-Free

1. Comprehensive Biomechanical Assessment

We begin with a full biomechanical assessment that looks at your running technique and gait, hip–knee–ankle alignment, foot mechanics such as flat feet or overpronation, and your overall strength and mobility. We also review your training habits, and footwear choices. This gives us a complete picture of how your body moves and helps identify issues that may have been affecting your running performance for years.

2. Individualized Strength Training

Once we understand the root causes, we build an individualized strength plan tailored to your needs. This typically includes exercises that improve stability in the glutes, core, hip stabilizers, calves and feet, and the quadriceps and hamstrings. Targeted strengthening creates a more resilient foundation, reducing strain on your joints and improving your ability to run efficiently and injury-free.

3. Mobility and Flexibility Work

Mobility plays a major role in healthy running mechanics. Tightness in areas like the calves, hips, or quads often forces other parts of the body to compensate, which can lead to pain or overuse injuries. Improving flexibility and joint mobility helps restore smooth, efficient movement and reduces the load on sensitive structures during every stride.

4. Manual Therapy for Pain Relief

Depending on your condition, your physiotherapist may incorporate manual therapy techniques such as soft tissue release, joint mobilizations, myofascial release, dry needling or IMS, or cupping. These hands-on treatments help reduce pain, improve circulation, release tension, and support faster healing so you can return to running with greater comfort.

When You Should See a Physiotherapist in Richmond BC

You don’t need to be injured to benefit from physiotherapy, many runners come in proactively, especially before marathon season.

But you should book a Richmond physiotherapy assessment if you notice:

• Pain that persists for more than a few runs

• Increasing discomfort during or after runs

• Sharp or pinpoint pain

• Swelling, stiffness, or reduced mobility

• Repeated injuries in the same area

• Difficulty increasing pace or distance

Early treatment prevents small issues from becoming chronic problems.

Keeping Richmond Runners Moving Pain-Free

Whether you're preparing for a marathon, returning from injury, or looking to improve performance, physiotherapy provides the tools to run confidently and comfortably.

At Proactive Health, our Richmond physiotherapists specialize in helping runners strengthen their biomechanics, prevent injuries, and get back to doing what they love, one stride at a time.