By Luther Chiew (Physiotherapist)
Premier Sports Medicine
Running pain usually comes from a mismatch between your training load and your current capacity, not just “bad form”. The most common running injuries affect the knee, lower leg, foot and hip, and what you do next depends on where it hurts, how it behaves during and after running, and what changed in your training. Many are overuse problems rather than one-off accidents, but sharp pain, major swelling, trauma, numbness, fever, or pain that changes the way you run needs prompt assessment.
Need help with recurring running pain? See our Running Injury Clinic assessment and treatment.
A useful starting point is simple: if pain is mild, stable, and settles quickly after a run, load modification often helps. If pain is worsening, localised to bone, associated with a limp, or keeps returning every time you build up, get it checked. General information can help you recognise patterns, but is not a substitute for an individual assessment.
1. Patellofemoral pain: pain around or behind the kneecap
Patellofemoral pain is one of the most common running injuries, and for good reason. The knee is consistently reported as the most frequently injured running region in the literature. Training demand, recovery and hip or knee capacity may contribute; the causes differ between runners.
What it usually feels like
You usually feel a dull ache around or behind the kneecap. It often flares during running, especially downhill, and with squats, stairs, lunges, or sitting for a long time with your knee bent. The pain builds with load and settles when you back off. Usually it isn’t caused by one specific event.
What often contributes
A recent jump in weekly kilometres is a common trigger. So is adding hills, intervals, or extra race pace work before your knee has adapted. Fatigue matters too, because tired legs absorb load less well late in a run or late in a training block.
Reduced strength or control through your hip and thigh often shows up in assessment. That does not mean your form is “wrong”. It means your current capacity is not matching your training demands.
What to do
Cut back the sessions that stir it up most, usually downhill running, hard efforts, and high-volume weeks. Keep moving if pain stays tolerable and settles within a day, because complete rest for too long often leaves your knee less prepared when you restart. If pain is worsening, causing a limp, or changing your stride, get it assessed.
2. Achilles tendinopathy: pain and stiffness in the back of the ankle
Achilles tendon pain often starts quietly. You notice stiffness with your first few morning steps, soreness at the start of a run, then some easing as you warm up. The Achilles tendon is the thick cord at the back of your ankle that joins your calf muscles to your heel. It is not the same as a calf strain, though the two can overlap.
Typical signs runners notice
Stiffness first thing in the morning is common. So is tenderness roughly 2 to 6 cm above the heel, or right where the tendon meets the heel bone. Faster running, hills, and repeated push-off usually aggravate it.
Some runners describe a “warm-up effect”, where it settles during the run then aches later that day or the next morning. That delayed pattern is a hallmark sign.
Why runners get it
Achilles problems usually follow a spike in tendon load. A block of hills, sudden speed work, more sprinting, more jumping, or simply too many hard sessions too close together can do it. Tendons adapt to load over time, but they hate abrupt change.
If your calf is already tired, your tendon carries more strain on the next session. That is why this issue often shows up after a few hard weeks rather than one run. For a deeper breakdown, see a clearer guide to Achilles tendon pain and recovery.
When it needs quicker assessment
A sudden sharp pain, a snapping sensation, marked weakness when pushing off, or major swelling needs urgent review. Those signs point away from a simple load irritation and need prompt assessment.
3. Medial tibial stress syndrome: shin splints along the inner shin
“Shin splints” is one of the most searched running terms, but it is not very precise. In runners, it usually refers to pain along the inner border of the shin bone from repeated loading. It is common, annoying, and easy to aggravate if you ignore it.
How to recognise it
You usually feel a broad, diffuse soreness along the lower inside part of the shin. It tends to come on during running and can linger after, especially if training stays heavy. Pressing along the area often feels tender over several centimetres rather than one exact spot.
Common training patterns behind it
Rapid increases in distance are a classic trigger. So is returning to running after a break and trying to pick up where you left off. Hard surfaces, lots of jumping or speed work, and back-to-back impact sessions can all add up.
This injury often reflects simple overload. Your shin tissues are being asked to absorb more impact than they are currently ready for. If that sounds familiar, it helps to understand what tends to drive inner shin pain in runners.
Shin splints vs stress injury
Broad shin soreness is different from a more focal bone stress pattern. A small tender spot, pain that is worsening, night pain, or pain with hopping needs individual assessment. Bone stress injuries need earlier action.
4. Iliotibial band pain: pain on the outside of the knee
Iliotibial band pain stands out because it often arrives at a very predictable point in the run. You feel fine, then the outer knee suddenly burns or sharpens and forces you to stop.
This is often blamed on a “tight IT band”, but that explanation is too simplistic. Load tolerance, hip and thigh capacity, running exposure, and the surfaces you train on usually are bigger contributors.
What makes it stand out
Pain sits on the outside of the knee and can feel sharp, hot, or stabbing. It often appears after a certain distance, especially on descents, and settles when you stop. Pressing the outer knee is often tender.
What tends to drive it
Sudden mileage changes are a common factor. Downhill running, cambered roads, and repeated runs on the same side of a sloped path can also load the area more. Reduced strength capacity around the hip and thigh often sits in the background.
Research on overuse injuries has long pointed toward hip muscle function as one factor worth paying attention to, especially in knee-related problems above and below the knee.
Early management
Complete rest is not always required. But repeated runs that trigger a hard flare are not productive either. The better approach is to modify load early, settle irritability, and rebuild strength and tolerance.
5. Plantar fascia pain: heel pain with first steps and after running
Plantar fascia pain is a major source of heel pain in runners. The plantar fascia is the strong band of tissue under your foot that helps support the arch and handle load during push-off.
Common symptoms
You usually feel sharp pain under the heel, sometimes spreading into the arch. First steps in the morning are often the worst. It can also hurt after sitting, after a run, or when you start walking again later in the day.
Running-related triggers
A sudden load change is common. More hills, more speed, more time on your feet, and abrupt footwear changes can all stir it up. Reduced calf capacity often matters because the calf and plantar tissues share the load during running.
Helpful next steps
Short-term settling often involves reducing aggravating load, especially high-volume or hill-heavy sessions. Longer-term progress usually depends on building calf and foot strength and exposing the area to load in a graded way.
Persistent heel pain deserves assessment because several heel conditions can look similar. Plantar fascia pain is common, but it is not the only explanation for sore heels.
6. Tibial bone stress injury: a more serious shin pain runners must not ignore
This sits in a different category from general shin soreness. A tibial bone stress injury means repeated loading has exceeded your shin bone’s ability to recover. At one end, that is a stress reaction. Further along, it becomes a stress fracture.
Warning signs
The classic pattern is localised shin pain in one spot. Hopping hurts. The pain starts earlier in the run than it used to, then starts showing up with walking as well. Pressing one exact area is often clearly tender.
Unlike broader shin splints, bone stress pain tends to become more focused and more predictable as it progresses.
Why it happens
Large training spikes are a major factor, but not the whole picture. High cumulative mileage, poor recovery, a previous bone stress injury, and low energy availability all matter. If you are under-fuelling, sleeping poorly, and stacking hard sessions, your bone is trying to adapt without enough support.
That bigger picture matters because bone stress is not just a footwear issue or a form issue. It is often a recovery and capacity issue too. If you are unsure, learn which stress-related shin signs deserve attention.
Why early action matters
Pushing through focal bone pain usually prolongs recovery. Bone stress injuries respond far better when picked up early, before walking becomes painful or the injury progresses further.
7. Calf strain and soleus overload: tightness, cramping or a sudden grab in the lower leg
Calf trouble is common in both recreational and competitive runners, especially with speed work, hills, and in older runners. The soleus is the deeper calf muscle, and it works hard during steady running as well as climbing.
How it presents
Sometimes it builds as tightness, heaviness, or cramping. Sometimes it feels like a sudden sharp grab in the lower leg. Push-off usually hurts, and faster running or hills make it clearer.
Pain can sit high in the calf, low near the Achilles, or deeper than expected. That location changes the management.
Common reasons it shows up
Underprepared speed work is a big one. So is jumping back into hills after time off. Fatigue, reduced calf strength, and not enough exposure to repeated loading all make the calf more vulnerable.
Trail running can add another layer, because uneven surfaces demand more from the calf and ankle every step.
Return-to-run basics
Get walking comfortable first. Rebuild calf strength and your tolerance to repeated raises, hops, and loaded push-off before chasing pace again. Then layer speed and hills back in gradually.
If your calf suddenly grabs mid-run and you are not sure if it is a strain or overload, it helps to read what that sudden calf pain pattern usually means.
8. Hamstring pain: upper hamstring or muscle strain in runners
Hamstring pain is not one single problem. It can be a lower muscle strain, a tendon issue high near the sitting bone, or a load-related irritation from faster work.
What location tells you
Broad pain in the middle or lower back of the thigh often behaves differently from pain high near the sitting bone. Upper hamstring pain often shows up with hills, faster running, or long periods sitting. Lower hamstring muscle pain often feels more obvious during faster efforts or sudden acceleration.
Location helps guide the next step, but it does not diagnose the problem on its own.
Triggers to mention
Sprinting, strides, hill repeats, long runs, and sudden increases in pace work are common triggers. Hamstrings also get irritated when you return to speed too soon after backing off training.
Practical management points
Rehab depends on the exact presentation, but load adjustment is nearly always part of the plan. Then comes progressive strength, followed by gradual return to faster running.
Trying to stretch aggressively and hope for the best usually backfires.
9. Gluteal tendinopathy and lateral hip pain
Many runners say “hip pain” when the pain is actually on the outer side of the hip. That pattern often fits gluteal tendon irritation or lateral hip pain.
What it feels like
You usually feel an ache or sharp pain over the outside of the hip. It often flares on stairs, during longer runs, or when lying on that side in bed. Sometimes the pain spreads down the outer thigh.
Why runners develop it
Training changes are often involved, especially when volume, hills, or side-sloped running increase quickly. Reduced hip strength capacity and repeated compressive load around the hip can also keep it simmering.
This is one reason hip strength shows up so often in running rehab. It is not a magic fix, but it often matters.
What helps
Avoid repeatedly provoking it with the exact run that flares it hard. Reduce aggravating load, then rebuild with progressive strength work that matches your symptoms and your running goals. If every build-up ends the same way, look harder at your overall training load and why it keeps tipping over.
10. Ankle sprains and trail running twists
Not every running injury is an overuse problem. If you run trails, footpaths with rough edges, or uneven park tracks around Melbourne, ankle sprains stay firmly on the list.
When it happens
The usual mechanism is simple: you roll the ankle on a trail, kerb, gravel path, or uneven surface. Uneven terrain can increase the demands on balance and ankle control.
What to watch for
Swelling and bruising are common. Weight-bearing hurts, your ankle feels unstable, and your confidence on uneven ground drops fast. Some sprains settle quickly, others linger because the joint stays sore and reactive.
When to get it checked
If you cannot take several steps, have marked swelling, bony tenderness, or ongoing instability, get it assessed. Repeated ankle rolls are not something to brush off.
11. Why these injuries happen: training load, recovery and capacity
Across the research, the strongest pattern is not one perfect form fault. It is the interaction between load, recovery, and tissue capacity. Running injuries are common, with overuse dominating the picture in both recreational and competitive runners across 12 months.
Training load errors runners make
The usual mistakes are predictable. Weekly distance jumps too quickly. Intervals and hills get added in the same week. Races stack up without enough recovery. You get sick, travel, take time off, then return at your old pace and volume.
That is how good intentions turn into overload.
Capacity factors that matter
Strength matters, but not in isolation. Tendon and bone tolerance matter. Sleep matters. Nutrition matters. Stress matters. Previous injury matters because tissues that have been irritated before often need a smarter build-up the next time.
Shoes and surface have a role too, just not the starring role many runners assume. If that is your main question, read what shoes can and cannot do for injury risk.
Recreational vs competitive runners
The patterns overlap more than most people think. Competitive runners usually accumulate more volume and speed, so the load challenge is obvious. Recreational runners often get hurt when training is inconsistent, then suddenly spikes because motivation outruns preparation.
12. What to do if you have running pain: keep running, cut back or stop?
This is the question most runners actually want answered. The short version is: base the decision on symptom behaviour, not panic.
Signs you can often modify and monitor
If pain stays mild, does not worsen during the run, settles within 24 hours, and does not change your stride, modified running is often reasonable. That usually means less distance, flatter routes, easier pace, or fewer weekly sessions.
That is very different from stubbornly doing the exact same run and hoping the pain gets bored.
Signs you should stop and get assessed
Sharp pain, limping, major swelling, focal bone pain, numbness, trauma, and symptoms that keep escalating despite cutting back all deserve assessment. The same applies if you are unsure whether the issue is muscle, tendon, joint, or bone. A practical guide to when pain has crossed the line helps if you tend to second-guess yourself.
Simple changes that buy time
Reduce one variable at a time. Cut distance, pace, hills, or frequency. Swap one run for cycling, pool running, or another low-impact session. Space hard sessions further apart.
Those changes do not solve everything, but they often stop a manageable issue becoming a long rehab process.
When to seek individual care
If pain persists, returns every time you build up, or you cannot work out whether it is tendon, muscle, joint, or bone-related, get assessed. That is especially true if symptoms are changing the way you run or stopping you from training consistently.
The goal is not just to settle pain. It is to understand what your current load, recovery, strength, and running demands are doing together so your next build-up is smarter than the last. For a running injury assessment focused on getting you back to training with a clear plan, use individual advice rather than guessing.
If running pain keeps returning or is stopping you from progressing, book a Running Injury Assessment with Premier Sports Medicine.
About the author
Luther Chiew is a physiotherapist at Premier Sports Medicine with an interest in running, sports and overuse injuries. His background includes strength and conditioning, and he holds a Bachelor of Applied Science and a Master of Physiotherapy Practice from La Trobe University.
Read Luther’s practitioner profile.
Clinical content reviewed and approved by Luther Chiew, Physiotherapist.
This article provides general education. An individual assessment may lead to different advice.
