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Running Injuries
Sixty percent of runners experience an injury severe enough to sideline them from activity. The best way to avoid injury is to prevent it, but if you are dealing with a running injury, it must be managed within an appropriate timeframe to ensure optimal healing.
This guide provides an overview of running injuries and the care available through our sports and exercise medicine physicians. At Cleveland Clinic Sports Medicine, we have specially designed comprehensive programs to help you in your sport every day, or to help you recover from a sports injury as quickly and safely as possible.
All athletes deserve the very best sports-related care and treatment that’s one-on-one and state-of-the-art. At Cleveland Clinic Sports Medicine Center, this involves conditioning to become stronger and faster, maximizing abilities, treating injuries if they do occur, and improving future performance.
Cleveland Clinic Sports Medicine is a unique center within the Department of Orthopaedic Surgery. Both our medical and surgical specialists use the latest diagnostic technology to evaluate your injury and develop a specialized care plan to return you to your activity as quickly as possible.
Running Injuries
Running injuries can be acute – like broken bones or sprains – or chronic. Overuse injuries are the most common injuries in runners. Many factors can contribute to overuse injuries, including terrain, condition of running shoes, individual foot anatomy, improper running form and overtraining.
Achilles Tendinitis
Located in the back of the foot, the Achilles tendon connects your heel bone to your calf muscle, helping you to walk, run and jump. Overuse of the Achilles tendon may lead to Achilles tendinitis, a common running injury that can become chronic and interfere with your walking ability if not treated. Runners who dramatically increase training and have tight, weak calves are most at risk.
What are the Symptoms of Achilles Tendinitis?
Achilles tendonitis is characterized by pain above the heel in the lower leg after activity. Pain may be more prominent in the morning with the first few steps out of bed because the calf muscle shortens in sleeping positions. Symptoms include:
- Leg weakness
- Morning stiffness that lessens throughout the day
- Pain the day after exercise
- Pain when climbing stairs or walking uphill
- Swelling of the Achilles tendon
- Creaking or crackling noise when you press on the Achilles tendon
How is Achilles Tendinitis Treated?
Try modifying your training schedule, stretching your ankles and calf muscles, and changing your running shoes. You can also try rest, ice and anti-inflammatory medication to reduce swelling. Pain lasting more than six months may require surgery. Call your doctor immediately for the following reasons:
- You have sharp pain in the ankle and lower calf area
- You heard a pop when you injured your Achilles tendon
- You cannot walk comfortably
- You have swelling, numbness or tingling
How Can You Prevent Achilles Tendinitis?
- Warm up before exercising or playing sports
- Switch up your exercises
- Slowly increase the length and intensity of your workouts
- Stop and rest when you have symptoms
Hip Labral Tears
Hip labral tears involve the ring of cartilage (labrum) that follows the outside rim of the hip joint socket. Labral tears occur through overuse injuries to the hip joint and labrum. They often go undiagnosed because symptoms are similar to soft tissue injuries, including hip flexor tendonitis and hip bursitis.
What are the Symptoms of Hip Labral Tears?
Hip labral tears can cause pain in the front of the hip, in the groin or on the side of the hip. This pain usually worsens with walking, pivoting or running. The pain also can occur at night and be associated with clicking, catching or locking, and stiffness or limited range of motion in the hip joint.
How are Hip Labral Tears Treated?
A combination of rest, anti-inflammatory medication and physical therapy is the first line of treatment for a labral tear. If these measures do not improve your condition, arthroscopic surgery could be an option.
How Can You Prevent Hip Labral Tears?
Hip labral tears are caused by putting strain on your hips. To prevent this injury, condition the surrounding muscles with strength and flexibility exercises.
Iliotibial Band Syndrome
The iliotibial (IT) band lies along the outside of the thigh from the hip to the knee. When you run, your knee flexes and extends, causing the IT band to rub on the side of the femur. This can cause irritation if you increase your mileage too quickly.
What are the Symptoms of Iliotibial Band Syndrome?
Iliotibial band syndrome (ITBS) is characterized by pain on the outside of the knee while running, or pain on the outside of the hip. With this injury, a runner may notice the pain more on slower runs, running hills, or going up and down stairs. Runners at risk for ITBS may overpronate, have a leg-length discrepancy, or suffer from weak hip abductor and gluteal muscles. It is a stubborn, nagging injury that needs rest.
How is Iliotibial Band Syndrome Treated?
- Modify your training schedule
- Strengthen hip abductors and hip extensor muscles
- Ice
- Take anti-inflammatory medication
- Massage the outside of the knee
- Stretch the hip muscles
How can you Prevent Iliotibial Band Syndrome?
Stretching the IT band can help prevent this injury. To stretch this muscle, stand with the affected leg toward a wall, cross the unaffected leg in front, place your arm on the wall and drop your hips toward the wall. You should feel the stretch on the side of the hips or side of the knee. Hold this stretch for 15 seconds and repeat three times.
Lower Back Pain
The back – especially the lower back – bears much of the body’s weight during running. The most common cause of lower back pain is overstretched or injured muscles that support the lower back. Many times evaluation and treatment by your primary care doctor is all you need. But for severe or persistent pain, evaluation by a spine or pain management specialist is recommended.
Symptoms
Symptoms of lower back pain include pain in the lower back that usually worsens with activity. You also may experience some pain in the buttocks and notice relief when resting. If your back pain does not improve or is associated with fever, chills or unexpected weight loss, call your doctor.
Treatment Options
Treatment involves a period of rest. Anti-inflammatory medications may be recommended to help reduce pain and swelling. Applying heat and ice alternately to the back is helpful to relax the muscles and decrease muscle inflammation.
Surgery for low back pain is only considered when nonsurgical treatment options fail after six months.
Prevention
Prevention is the most important management technique for low back pain. Controlling what factors you can may help you avoid or recover quickly from back problems. Your exercise program should include improving your posture, toning your abdominal muscles and increasing your flexibility.
Plantar Fasciitis
Plantar fasciitis is inflammation, irritation or tearing of the plantar fascia – the tissue that runs along the bottom of the foot. Unsupportive footwear is the primary cause, but a high arch, flat feet, tight calf muscles and training errors can also cause plantar fasciitis.
What are the Symptoms of Plantar FasciiItis?
The primary symptom of plantar fasciitis is pain in the bottom of the foot from the heel into the arch. It is especially painful when you get up in the morning and after you sit for a while. The discomfort may be present at the start of a run, subside during the run, and then recur later.
How is Plantar Fasciitis Treated?
During a flare-up, apply ice for 20 minutes two to three times a day, stretch your calf muscles and take anti-inflammatory medications. In severe cases, a cortisone shot may be necessary.
How can you Prevent Plant Fasciitis?
The best way to prevent plantar fasciitis is stretching. The plantar fascia can be stretched by grabbing the toes, pulling the foot upward and holding for 15 seconds. To stretch the calf muscles, place your hands on a wall and drop the affected leg back into a lunge while keeping the heel down. Hold for 15 seconds and repeat three times. Replace your shoes every 400 to 600 miles, and consider adding arch supports to your shoes.
Runner's Knee
Runner’s knee, or patellofemoral pain syndrome, is a common overuse injury that often happens when your kneecap is out of alignment. It involves pain that builds up gradually and is usually located beneath or around the kneecap. Risk factors for runner’s knee include overpronation and weak quads, hips or glutes.
What are the Symptoms of Runner’s Knee?
Experiencing pain around or behind the kneecap is usually a sign of runner’s knee. Squatting or going up and down stairs can aggravate the pain. You also may experience stiffness in the knee after prolonged sitting.
How is Runner’s Knee Treated?
- Avoid painful activities
- Ice
- Take anti-inflammatory medications
- Stretch the calf, hamstrings, quadriceps and hip flexors
- Strengthen quadriceps, hip abductors and hip extensor muscles.
How can you Prevent Runner’s Knee?
The best way to prevent runner’s knee is strengthening. Hip strengthening is very important for runners. To strengthen the hip abductors, lie on your side, keep your hip and knee in a straight line, and kick your leg up toward the ceiling, keeping your leg in line with your body. To strengthen hip extensors, lie on your stomach, squeeze your buttock muscles, and lift your legs off the ground. Perform strengthening slowly, repeating 15-20 repetitions in three sets.
Shin Splints
A shin splint injury is characterized by pain in the shin while running. Shin splints are common among new runners or those returning to running after an extended absence. Shin splints are a sign that you’ve done too much, too quickly. Other contributing causes include incorrect shoe type, change in running surface, flat feet, tight calf muscles, training errors, poor running form and weak hip muscles.
What are the Symptoms of Shin Splints?
The pain may first start after running but then progress to persistent pain. Pain happens in the front or inside of the lower leg along the shin bone and can be sharp or dull and throbbing.
How are Shin Splints Treated
- Rest
- Ice
- Decrease mileage and cross train with biking or swimming
- Take anti-inflammatory medications
- Stretch calf muscles
- Strengthen hip abductors and hip extensors
- Modify training schedule and avoid hills
How can you Prevent Shin Splints?
Prevent shin splints by finding shoes that are appropriate to your foot type and training intensity, and replace your shoes every 400 to 600 miles. Prescription orthotics may be necessary if foot mechanics cannot be controlled with a shoe alone. You should also increase your mileage gradually.
Sprains & Strains
A sprain is a stretch or tear in a ligament, the band of connective tissue that joins bones. Areas most at risk for sprains include ankles, knees and wrists.
A strain is a twist, pull or tear of a muscle or tendon, the cord of tissue connecting muscle to bone. It can result from overstretching or overcontraction.
What are the Symptoms of Strains and Sprains?
Signs of a sprain include tenderness and pain, bruising, swelling and muscle tightness. Symptoms of a strain include pain, muscle spasm and loss of strength.
How are Sprains and Strains Treated?
Treat a muscle strain or sprain with rest, ice and anti-inflammatory medications. A compression bandage can help reduce swelling.
How can you Prevent Sprains and Strains?
To prevent strains and sprains, warm up and cool down properly. Balance exercises can strengthen the muscles around the ankle.
Stress Fractures
Stress fractures are small cracks in a bone that cause pain and discomfort. They occur when muscles are fatigued and unable to absorb added shock. Training too hard is a common cause of stress fractures.
What are the Symptoms of Stress Fractures?
Runners who over train are at risk for stress fractures. Stress fractures can cause persistent pain in the shin and the foot. Pain can worsen with activity and improves with rest. Other symptoms include:
- Minor pain or weakness in the area where the fracture is located
- Pain deep within the shin, foot, ankle or toe
- Tenderness at the site of the fracture when touched
- Swelling on top of the foot or in the ankle
How are Stress Fractures Treated?
Rest is the most important treatment for stress fractures. Ice the area and take anti-inflammatory medications to relieve pain and swelling. Some runners may be immobilized in a walking boot or be required to use crutches to allow the stress fracture to heal.
How can you Prevent Stress Fractures?
The best approaches to preventing stress fractures are proper training, proper shoe maintenance, and not running on excessively hard surfaces.
Information to Know
Proper warm-up and cool-down strategies
Jumping into or out of a tough workout is a good way to injure yourself. Here are strategies for warming up and cooling down before and after a run.
Warm-up Activities
A proper warm-up prepares your muscles and joints, helping you avoid cramps, muscle pulls and early exhaustion. Warm up by walking, running or cycling at a slow pace. Throw in some bodyweight strength training exercises and dynamic stretches, like squats, glute kicks, high-knee steps, planks, light lunges, jumping jacks and push-ups. One thing to avoid during a warm-up is static stretching, or holding stretches for long periods of time. These stretches decrease your performance and increase your risk of injury. Save them for the cool-down.
Cool-down Activities
Cooling down increases the range of motion of your muscles, improves recovery, reduces risk of injury and improves flexibility.
Try three to five minutes of walking or easy jogging. After your heart rate and breathing return to normal, add in some flexibility activities, like static stretches. Stretching your glutes, calves and hamstrings during a cooldown allows you to take advantage of already warm muscles and helps to avoid muscle cramps and soreness as you recover from your run.
Improving Efficiency Through Gait Analysis
A runner’s unique way of moving their body forward – also known as gait – impacts efficiency and whether or not they are prone to injury. A physical therapist can perform a gait analysis using video and other tests to assess your body mechanics and improve your running efficiency. Gait analysis can also determine the cause of existing injuries and prevent future injury.
What is gait analysis?
A physical therapist assesses the following during a gait analysis:
- Running history
- Training goals
- Foot placement
- Shoe wear
- Strength and flexibility
- Heel strike
- Arm swing
- Hip, knee and foot mechanics
What can you learn from a gait analysis?
A gait analysis can help a physical therapist provide specific strength and flexibility exercises to address your personal body mechanics. You’ll learn ways to change or improve your gait patterns to lower your chance of injury.
Exercise physiology
Exercise physiology is the science behind running. If you are training for a marathon, an exercise physiologist can provide VO2 max testing to identify your aerobic and anaerobic thresholds.
Variation in maximal oxygen uptake (VO2 max) is a measure of the maximum volume of oxygen an athlete can use during intense exercise. VO2 max testing figures out the fuel source you are using when you run. This can identify training zones for maximum performance.
Aerobic training uses oxygen to break down carbohydrates and fat stores. Runners want to increase their aerobic threshold because it will enable them to run faster for longer. The anaerobic threshold is the point at which your body can no longer keep up with oxygen requirements and starts to tap into glucose stores. When you run close to your anaerobic threshold, running should be hard, but not uncomfortable.
Based on these results, an exercise physiologist can prescribe a running program.
Wear the Right Shoes
Finding a good running shoe for your foot and gait is an important part of injury prevention. There is a lot of technology that goes into running shoes, meaning better support for your feet. There are styles designed for specific problems, like high arches or flat feet. Find a sporting goods or running shoe store and work with a shoe expert to find the right pair of shoes for your foot.
Bring your old shoes with you so the experts can see the wear on the soles and help find the appropriate running shoe for you. If you wear orthotics or shoe inserts, bring them and try them with any new shoes.
Running shoes should be replaced every four to six months, depending on how much you run.
Optimizing Nutrition & Hydration
A balanced diet is key to any sport, and proper nutrition and hydration can make or break a run. The right combination of fuel from carbohydrates, proteins and fats will give you the energy you need for a top performance. Whether you are a rookie or a veteran marathon runner, adjusting what you eat before, during or after a race can have a big impact on your performance and recovery.
Carb Up
Carbohydrates are the most important energy source of fuel and can be found in fruits, starchy vegetables, pasta, bread, cereal and rice. Your body converts the sugars and starches in carbohydrates into energy, providing endurance for high-intensity activities, like running.
Protein
Protein, which helps your body repair damaged tissue, can be found in meat, fish, poultry, eggs, beans, nuts and dairy products. Your body also needs a small amount of fat – think nuts, oils and cold-water fish containing Omega 3 fatty acids – to use as an alternative energy source.
Don’t Forget Fluids
Hydration is also an important component of a successful race. Fluid regulates your body temperature and blood volume, maintains blood pressure and helps rid your body of waste products. A combination of sports drinks and water can replenish the fluids you lose through sweat, while giving your body some energy.
You can determine your hydration status by paying attention to the color of your urine. A clear, pale yellow color signifies good hydration, while a darker, concentrated yellow is a sign of dehydration.
Run Smart
Cleveland Clinic’s Run Smart program can optimize your running performance and help prevent injury through sessions customized to personal goals and physical needs. We work with you to perfect your running form, identify weaknesses and recommend footwear.
What’s included?
A physical therapist will conduct a comprehensive evaluation that includes:
- Evaluation. A thorough clinical assessment of your running history, training program, previous and current injuries, anatomical structure, strength, flexibility, range of motion and goals.
- Gait analysis. Our state-of-the-art video software will record you running on a treadmill.
- Review. A review of your running video and discussion of strength and weaknesses. Recommendations are made based on your clinical results, gait analysis, level of training, and performance goals
- Tailored report. A detailed summary, analysis of results and customized recommendations. It may include a treatment plan for injuries, strengthening exercises, flexibility exercises, running technique cues, running drills and training program modifications.
Patient Services
MyChart
MyChart is a secure online tool that provides personalized health information from the privacy of your home at any time, day or night. Learn more or login now.
Virtual Visits
You can now stay connected to your healthcare team through virtual visits, using your smartphone, tablet or computer.
Why go virtual? It's an easy, convenient and secure way to see your provider face-to-face without having to leave home. This saves you travel time, parking fees and time spent in the waiting room — and you can also have a loved one or caregiver join you. If appropriate, you can also get a prescription sent to the pharmacy of your choice.
Many insurance companies cover the cost of virtual visits, so check with your insurance company ahead of time. Interested in getting started? Call your provider to find out what virtual visit options are available.
Virtual Visits with Orthopaedics
New patients with common knee injuries or knee pain.
Established patients scheduling follow-up care appointments such as:
- Post-Surgical & wound check visits
- Fracture care follow-up
- Injection follow-up
- Musculoskeletal injury follow-up
- Per-operative teaching prior to surgery
Ask your physician if a virtual visit follow-up appointment is right for your follow-up care.
Virtual Second Opinions
If you cannot travel to Cleveland Clinic, help is available. You can connect with Cleveland Clinic specialists from any location in the world via a phone, tablet, or computer, eliminating the burden of travel time and other obstacles.
If you’re facing a significant medical condition or treatment such as surgery, this program provides virtual access to a Cleveland Clinic physician who will review the diagnosis and treatment plan.
Following a comprehensive evaluation of medical records and labs, you’ll receive an educational second opinion from an expert in their medical condition covering diagnosis, treatment options or alternatives as well as recommendations regarding future therapeutic considerations. You’ll also have the unique opportunity to speak with the physician expert directly to address questions or concerns.
Appointments
To make an appointment with a sports medicine specialist, call:
- Cleveland Appointments: 216.444.2606
- Akron Appointments: 330.344.2663
- Canton Appointments: 330.489.1362
- Dover Appointments: 330.343.3335
Same-day appointments are available for urgent sports injuries at locations throughout Northeast Ohio.
Why Choose Us?
Why should I choose Cleveland Clinic?
Cleveland Clinic Sports Medicine brings together top orthopaedic surgeons, primary care sports medicine physicians, physician assistants, physical therapists, athletic trainers, registered dietitians, radiologists and exercise physiologists to keep athletes in the game.
Our experts treat athletes of all ages and skill levels. As our patient, you have access to the same specialists who treat Cleveland’s professional sports teams.
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