The five most common running injuries are runner's knee (patellofemoral pain), shin splints, plantar heel pain, IT band syndrome and Achilles tendinopathy. Together they make up close to half of all running injuries in the research. Most aren't caused by "bad" shoes or a single flaw in your form: they happen when what you ask your body to do rises faster than it can adapt. That's good news, because load is something you can change.
Key takeaways
- A 2021 review found that at any one time around 45% of runners report an injury. The knee, shin and foot are hit hardest.
- Novice runners get injured about twice as often per hour of running as experienced recreational runners.
- Most running injuries are overload injuries: tissues are asked to do more than they've been prepared for.
- The famous 10% rule didn't prevent injuries in a trial of 532 new runners. Big jumps in distance seem to matter more than small ones.
- Each injury has a typical pattern, and most respond to adjusting your training and progressive strengthening rather than complete rest.
How common are running injuries?
A 2021 systematic review pulled together studies of running-related injuries. Across studies, around 40% of runners developed a new injury during the study period, and around 45% reported having one at any given time. The knee, lower leg and foot were the most commonly affected areas.
The five conditions that came up most often in prevalence studies were:
| Injury | Share of injuries (prevalence) | Where it hurts |
|---|---|---|
| Runner's knee (patellofemoral pain) | 16.7% | Around or behind the kneecap |
| Shin splints (medial tibial stress syndrome) | 9.1% | Along the inner edge of the shin |
| Plantar heel pain (plantar fasciitis) | 7.9% | Under the heel, worst first thing in the morning |
| IT band syndrome | 7.9% | Outside of the knee |
| Achilles tendinopathy | 6.6% | Back of the heel or lower calf |
How much to trust these numbers: the review's authors warned that studies define "injury" differently and use different methods, so treat the percentages as a rough ranking rather than exact figures.
Who gets injured most?
A 2015 meta-analysis of 13 studies compared injury rates per 1,000 hours of running. Novice runners had about 18 injuries per 1,000 hours, compared with about 8 for recreational runners.
That makes sense. Bone, tendon and muscle all adapt to running, but more slowly than your heart and lungs do. New runners, and people coming back after a long break, often feel fit enough to do more before their legs are ready for it.
The myth: "Follow the 10% rule and you won't get injured"
The 10% rule, never increasing your weekly mileage by more than 10%, sounds sensible. But when it was tested in a Dutch randomised trial of 532 novice runners, it didn't help. Injury rates were 20.8% on a 13-week plan built on the 10% rule and 20.3% on a standard 8-week plan.
What does seem to matter is big jumps. A 2014 study of novice runners found that those who increased their weekly distance by more than 30% over two weeks seemed more prone to "distance-related" injuries, such as runner's knee, IT band syndrome and shin splints, than those who increased by less than 10%. That study was exploratory and the result was borderline, so it's a signal, not a law.
The practical take: avoid big spikes, especially in your longest run, and build gradually, but don't expect a neat percentage to protect you on its own. We explain this in more detail, with a long-run plan, in our Manchester Marathon 2027 guide.
1. Runner's knee (patellofemoral pain)
What it feels like: an ache around or behind the kneecap, worse running downhill, on stairs, squatting, or after sitting for a long time.
Why it happens: the joint behind the kneecap is being loaded more than it can currently tolerate, often after more hills, more mileage or a new gym programme.
What helps: reducing the aggravating load for a while (fewer hills, shorter runs) and strengthening the hips and thighs. See runner's knee and our guide to knee pain when bending.
2. Shin splints (medial tibial stress syndrome)
What it feels like: a diffuse ache along the inner edge of the shin bone, often at the start of a run, easing, then returning afterwards.
Why it happens: the shin bone and the muscles attached to it are struggling with repeated impact. It's common after a sudden increase in running, or when switching to harder surfaces.
What helps: reducing running volume while it settles, then building back gradually, plus calf and foot strengthening. Watch out for pain in one small spot that hurts to touch, hurts when you hop, or aches at night. That can be a stress fracture and needs assessment. See shin splints.
3. Plantar heel pain (plantar fasciitis)
What it feels like: sharp pain under the heel with the first steps in the morning or after sitting, which eases as you warm up.
Why it happens: the thick band under the foot (the plantar fascia) is overloaded, often after a jump in mileage, more time on your feet, or a change of footwear.
What helps: calf and foot strengthening, temporary load reduction, and supportive footwear while it settles. See plantar fasciitis.
4. IT band syndrome
What it feels like: a sharp pain on the outside of the knee that comes on at a predictable point in a run, often worse downhill.
Why it happens: the IT band is compressed against the outside of the knee under repeated load. It's linked with sudden increases in distance and with downhill running.
What helps: reducing the distance and downhill running that triggers it, and strengthening the hip muscles. See IT band syndrome.
5. Achilles tendinopathy
What it feels like: pain and stiffness in the Achilles tendon, worst first thing in the morning and at the start of a run.
Why it happens: the tendon is being loaded faster than it can adapt, often after adding speed work, hills or mileage, or switching to lower-drop shoes.
What helps: progressive calf strengthening, built up to heavy calf raises, while you adjust your running load. Complete rest tends to weaken the tendon further. See Achilles tendinopathy.
Why running injuries keep coming back
Most of these injuries settle with rest, but rest alone doesn't make the tissue stronger. When you return to the same training, the same problem often comes back.
The better approach is to think in terms of load and capacity:
- Reduce load enough that symptoms settle, without stopping completely if you don't need to.
- Build capacity with strength training for the area involved.
- Return gradually, with no big spikes in distance or intensity.
A simple pain guide while running: discomfort up to 3/10 that settles within 24 hours is usually OK. If pain is 4/10 or more, changes the way you run, or is worse the next morning, ease back.
Read more about strength training for runners and how to increase your running mileage safely.
When to see a physio, GP or A&E
Get urgent help (GP, 111 or A&E) if you have:
- pain in one spot on a bone that hurts to touch or when you hop, or aches at rest or at night (a possible stress fracture)
- a sudden snap or pop in the back of the heel with difficulty walking (a possible Achilles rupture)
- a calf that's swollen, red or warm
- a hot, swollen joint with fever
See a physio if pain hasn't improved after 2 weeks of reduced running, keeps coming back when you increase your training, or makes you limp or change how you run.
Physiotherapy for runners at Athos Physio
Our clinic is inside F45 Manchester NQ, at 77 Piccadilly in Manchester city centre. We'll find out which tissue is struggling and why, look at your training history and how you run, and build a custom rehab and strengthening plan that keeps you running wherever possible. You don't need a GP referral, and we work with Bupa, WPA, Vitality and Aviva. Book an appointment, or see our running injury physio.
FAQs
What is the most common running injury?
In a 2021 review, runner's knee (patellofemoral pain) was the most common injury runners reported, at around 17% of injuries. Shin splints, plantar heel pain, IT band syndrome and Achilles tendinopathy followed.
Should I stop running if I'm injured?
Not always. Many running injuries settle with reduced running rather than complete rest, as long as pain stays at 3/10 or below and settles by the next morning. Stop and get assessed if pain is sharp, localised to a bone, or makes you limp.
Do running shoes prevent injuries?
There's no single "right" shoe for injury prevention. Comfort is a reasonable guide. Big changes, such as switching to much lower-drop or minimalist shoes, are best made gradually, as they shift load onto other tissues, such as the Achilles and calf.
Why do new runners get injured more?
Your heart and lungs adapt to running faster than your bones, tendons and muscles. New runners often feel able to run further before their legs are ready. In a 2015 meta-analysis, novices had about twice as many injuries per hour of running as recreational runners.
This article is general information, not a substitute for an individual assessment.
Sources
- Kakouris N, et al. A systematic review of running-related musculoskeletal injuries in runners. J Sport Health Sci 2021;10(5):513–522. https://doi.org/10.1016/j.jshs.2021.04.001
- Videbæk S, et al. Incidence of running-related injuries per 1000 h of running in different types of runners: a systematic review and meta-analysis. Sports Med 2015;45(7):1017–1026. https://doi.org/10.1007/s40279-015-0333-8
- Buist I, et al. No effect of a graded training program on the number of running-related injuries in novice runners: a randomized controlled trial. Am J Sports Med 2008;36(1):33–39. https://doi.org/10.1177/0363546507307505
- Nielsen RØ, et al. Excessive progression in weekly running distance and risk of running-related injuries. J Orthop Sports Phys Ther 2014;44(10):739–747. https://doi.org/10.2519/jospt.2014.5164
Related: Running injury physio · Manchester Marathon 2027 guide · Strength training for runners · Runner's knee · Shin splints · All conditions we treat
Reviewed by Nick Chatziviltsos, PgDip, HCPC-registered physiotherapist (PH114351).