Common running injuries and how physiotherapy may help

Why running injuries cluster in marathon season

London is a running city. Spring and autumn bring the big marathons and half marathons, and with them a predictable rise in runners coming to our Bloomsbury clinic with sore shins, knees, heels and calves. The pattern is rarely mysterious: most running injuries are overuse injuries, where training load has gone up faster than the body has adapted. A plan that jumps in distance, adds hills or speed work, or squeezes in missed sessions after illness or holiday is the usual trigger. Worn-out shoes, a sudden change of surface or footwear, poor sleep and low energy intake all lower the threshold.

The good news is that most running injuries respond well to a sensible mix of load management and strengthening, and very few require you to stop running altogether.

Shin splints

Shin splints, or medial tibial stress syndrome, cause a diffuse ache along the inside of the shin that is worse at the start of a run, may ease as you warm up and returns afterwards. It is common in newer runners and after sudden increases in mileage. Physiotherapy usually focuses on adjusting training load, strengthening the calf and foot muscles, looking at footwear and running form, and gradually rebuilding distance. A sharp, localised pain on the bone, pain that is worse with every step or at night, or pain that forces you to stop may indicate a stress fracture and should be assessed promptly.

Runner's knee (patellofemoral pain)

Patellofemoral pain is an ache around or behind the kneecap that is worse on stairs, hills, squatting or after sitting for a long time. It is often linked to how the hip, knee and foot share load during running rather than to damage inside the knee. Treatment commonly combines hip and thigh strengthening, running-form adjustments such as a slightly higher cadence, taping for short-term relief and a graded return to volume. Pain at the lower edge of the kneecap with jumping or downhill running is more suggestive of patellar tendinopathy, which needs a loading programme of its own.

Iliotibial band syndrome

ITB syndrome produces a sharp pain on the outside of the knee that typically appears at a predictable distance into a run and eases when you stop. It is a compression problem where the band passes over the outside of the knee, and it is particularly associated with downhill running and increased mileage. Stretching the band itself has limited effect; physiotherapy tends to focus on hip strength and control, stride adjustments and a temporary reduction in distance and hills, followed by a graded build-up.

Achilles tendinopathy

Achilles tendinopathy causes stiffness and pain in the tendon above the heel, often worst first thing in the morning and at the start of a run. It is more common in runners over 35 and after a jump in speed work or hills. The core of treatment is a progressive calf-loading programme over around three months, with training adjusted rather than stopped. Focused shockwave may be considered for cases that have not settled with loading. A sudden snap or an inability to push off the foot needs same-day assessment.

Plantar fasciitis

Plantar fasciitis is pain under the heel with the first steps of the day or after sitting, easing with movement and building again after long runs or time on your feet. Calf and foot strengthening, footwear advice, load management and, where a 3D foot scan suggests foot posture is adding to the strain, custom orthotics from a UK manufacturing laboratory may help spread the load. Focused shockwave may be discussed if heel pain has lasted several months; see our guide on shockwave for heel pain.

How physiotherapy may help

A running-focused assessment looks beyond the sore spot:

• History and training review. What changed in the weeks before the pain started is usually the most useful clue.
• Physical examination. Strength and control of the calf, hip and trunk, ankle and big-toe mobility, and the structures involved.
• Movement and gait. We watch how you walk, squat, hop and, where useful, run. A scan with our 3D posture analyser and a 3D foot scan can add an objective picture of alignment and foot loading; both are tools that inform the plan rather than diagnoses in themselves.
• A plan you can run with. Most runners can keep training in a modified form: reduced distance, flatter routes, walk-run intervals or cross-training, alongside a strengthening programme and a timeline for building back up. Hands-on treatment, taping, dry needling or shockwave may be used where they fit.
• Return-to-running milestones. Clear criteria, such as hopping without pain or completing a set distance with no next-day reaction, help avoid the stop-start cycle.

Outcomes vary from person to person, and tendons in particular need weeks rather than days. If you have a race date, tell us early so the plan can be built around it honestly, including whether the date is realistic.

When to book

Book an initial assessment if a running pain has lasted more than two weeks, is changing how you run, or returns every time you build up distance. Earlier assessment usually means a shorter break from training. Call us for a same-day assessment and imaging through our imaging partner if you have a sharp, localised bone pain, pain that is worse at night, or a sudden snap or giving way; for more severe symptoms, such as a suspected fracture or an obvious deformity, go straight to A&E, and call 999 for life-threatening signs such as chest pain or collapse. Our clinic is in Bloomsbury, a few minutes from Russell Square and Holborn and an easy jog from Regent's Park, and fees are on the fees page.