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Overuse injuries in runners

Overuse injuries in runners

50% of runners will sustain an overuse injury every year (Van Gent et al., 2007).
Overuse injuries can be tricky to overcome and highly frustrating, particularly if you have a running event coming up.
The good news is that overuse injuries are largely preventable.

What is an overuse injury?


An overuse injury is one which occurs with excessive and repetitive type activities such as running.

Common overuse injuries seen in runners include:

  • achilles tendinopathy
  • plantarfasciopathy
  • shin splints
  • iliotibial band friction syndrome (lateral knee pain)
  • patellofemoral pain syndrome (knee-cap pain)

Depending on the injury, you may first notice pain during or after running.

How do overuse injuries occur?


Overuse injuries are quite simple to understand. They occur when your running load exceeds your tissue’s capacity for repair. Your tissue includes things like muscles, bones, ligaments, tendons, and cartilage. When we load our tissues whilst running, they require time to recover before they are ready to be loaded again.

Your total load encompasses how far you run, how quickly you run and how often you run. If you increase any of these three variables too quickly, your tissues may become overloaded and painful.

A tissue’s capacity for an applied load can be influenced by your strength, history of previous injury, your age, your nutritional status, certain medications, and other health conditions (Van der Worp et al., 2015).

How do I prevent and manage an overuse injury?


 Everyone will be slightly different when it comes to their risk of developing an overuse injury. Some people can break all the rules and never feel even the slightest niggle with lots of running. If you are new to running, your risk is greater. Here are some ways to reduce your risk of an overuse injury:

  • Don’t push through pain. Pain is a sign that something’s wrong or that you’re asking more from a part of your body than it can provide at the moment.
  • Increase your workouts gradually. Don’t bump up your distance by more than 10% per week.
  • Run on soft, flat surfaces like a football oval.
  • Alternate hard training days with easy days.

Already injured? Depending on your injury, you may initially require complete rest from running or a reduction in your load. Your Physiotherapist is the best person to help you with this decision, however the following may be helpful to guide you:

  • For pain that comes on immediately with running: It is likely you require complete rest for a short period. In some cases, instant pain can be the sign of a stress fracture. This type of injury requires complete rest for healing to take place before a graduated running program can resume.
  • For pain that comes on during your run: If your pain comes on after 20 minutes of running, try cutting back your runs back to only 15 minutes for a week or so, and then slowly build back up to 20 minutes. If your pain returns as you increase your distance, repeat the above step. This rule can then be applied to any distance. For example, pain after 30 minutes? Cut it back 25 minutes. Pain after 40 minutes? Don’t run more than 35 minutes.


Remember… Training Load > Capacity = INJURY


Therefore, the other side of the equation involves increasing your tissue’s capacity for load. Things like strength training, getting enough sleep and eating a balanced diet will help to tip the scales in your favour. Your Physiotherapist can help guide you with appropriate strength, mobility and control exercises.

 In summary, remember these three things about running overuse injuries:

  1. Overuse injuries occur when your training load exceeds your body’s capacity for repair.
  2. Overuse injuries require a temporary reduction in training load before a graduated return to running can occur.
  3. Strength training can help reduce your risk of sustaining an overuse injury.



Saragiotto, B. T., Yamato, T. P., Junior, L. C. H., Rainbow, M. J., Davis, I. S., & Lopes, A. D. (2014). What are the main risk factors for running-related injuries?. Sports medicine44(8), 1153-1163

Van der Worp, M. P., Ten Haaf, D. S., van Cingel, R., de Wijer, A., Nijhuis-van der Sanden, M. W., & Staal, J. B. (2015). Injuries in runners; a systematic review on risk factors and sex differences. PloS one10(2), e0114937.

Van Gent, R. N., Siem, D., van Middelkoop, M., Van Os, A. G., Bierma-Zeinstra, S. M. A., & Koes, B. W. (2007). Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. British journal of sports medicine41(8), 469-480.


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