Running Injuries

More than 40 million people in the United States run regularly. Although there are many health benefits from running regularly, there is also a risk of injury. Injuries from running usually involve the muscles, tendons, joints, and bones of the legs. Most are due to repetitive activity rather than a single traumatic event.


Knee pain is the most common symptom of injury in runners. The most common cause of knee pain in runners is patellofemoral pain syndrome. The hallmark of this syndrome is the gradual onset of pain in the front of the knee, near the kneecap. The pain is worse after sitting for a long time or when going up and down stairs or hills. Another cause of knee pain is iliotibial band syndrome, which affects the outside of the knee and can travel up the outer side of the thigh to the hip.

JAMA, Running Injuries

Other common injuries in runners include medial tibial stress syndrome, also known as “shin splints.” This causes pain over the shins and is more common in beginning runners. Long-distance runners can get stress fractures, small fractures of the bone that result from repeated “stress” on the bone, most often in the lower leg, hip, or foot. Other foot problems include Achilles tendinitis andplantar fasciitis. Achilles tendinitis causes pain along the heel cord (Achilles tendon) at the back of the ankle, whereas plantar fasciitis causes pain at the bottom of the foot or the heel itself. Plantar fasciitis usually feels worse after a period of rest, such as in the morning just after getting out of bed.


Certain groups of runners have a higher chance of becoming injured. These include beginning runners, runners with previous injuries, those who run more than 40 miles (65 km) a week, those who suddenly increase the speed or distance of their running, and women with low bone density (osteopenia or osteoporosis).


Every individual is different, but some general recommendations include

  • If you are a beginning runner, start slowly and increase running time and distance gradually.
  • Include 1 or 2 “rest days” or days spent doing other types of exercise (strength training or cross-training) each week.
  • Choose a shoe that is comfortable with a proper amount of support, and change shoes every 350 to 500 miles.
  • Soft surfaces (eg, treadmill, track) are better than hard surfaces (eg, concrete, asphalt).
  • Although many runners like to stretch before or after running, stretching has not been shown to reduce injuries.


The most important treatment for running injuries is rest, or changing activities, to allow for healing. Other treatments include ice, special devices such as splints or orthotics, and pain relievers such as nonsteroidal anti-inflammatory drugs. Physical therapy can also help for more serious injuries. Surgery is rarely needed.

If you have pain while running that lasts for more than a few days or is severe enough to make you stop running, see your doctor. Do not try to push through the pain.



Adaptado de la Hoja para el paciente de JAMA

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Fotografía —modificada— de François Abgraall, usada bajo licencia de Creative Commons


Selecting and Effectively Using Running Shoes


Running shoes should be selected after careful consideration. With so many brands and styles of shoes on the market today, it is important to find the best fit for your feet and your needs.

Consider the following when choosing a running shoes:

  • Shoe size: the most common mistake in shoe selection is picking the wrong size. Be sure the shoe fits after break-in.
  • Past experiences with shoes.
  • Problems with your current shoes.
  • Biomechanical needs (arch type, pronation, orthopedic injuries).
  • Environmental conditions.
  • Running and racing requirements.


Carefully select shoes that fit the length and width of your feet. Determine what shoe shape you require based on your foot type. The wet test can be used to determine your foot type. Moisten your foot with water, and stand on any surface that will leave an imprint of your foot.

Normal Arch: A normal foot has a normal-sized arch and leaves an imprint that has a flare but shows the forefoot and heel connected by a wide band. A normal foot lands on the outside of the heel then rolls inward (pronates) slightly to absorb shock. Runners with a normal foot and normal weight are usually considered biomechanically efficient. Stability shoes work best for a normal foot and normal arch.

Low Arch: Flat feet have a low arch and leave a nearly complete imprint of the sole of the foot, indicating an overpronated foot that strikes on the outside of the heel and rolls inward excessively. Motion-control shoes work best for a flat foot with a low arch.

High Arch: High-arched feet leave an imprint showing a very narrow band connecting the forefoot and heel. This type of foot is underpronated and is not an effective shock absorber. Cushioned shoes work for a rigid foot with a high arch. Old shoes also show a pattern of wear that helps determine running style. Examine the soles of your shoes for a pattern of wear. Next, put your shoes on a table and look from the back of the shoe to the heel. If your shoe tilts to the inside, you may have a low arch. If your shoe tilts to the outside, you may have a high arch.


Purchase running shoes from a good running shoe store or from someone knowledgeable about matching the correct type of shoe to your foot type and stride pattern. They can help you find the perfect fit that meets your needs.

Watch for shoes with excessive wear. Worn shoes often amplify a foot problem, and injuries can occur when a shoe is worn too long before it is replaced.

Analyze the need to purchase new shoes based on the number of miles on your old shoes, not by the amount of tread left on the outer soles. Most estimates place midsole breakdown, and increased potential for injury, between 400-500 miles. For some, this means replacing shoes before they show major wear.


Most people (85 percent) wear shoes that are too small. Shoe size varies among manufacturers. Have the shoe clerk help you select the correct shoe size. The shoe should have adequate room at the widest part of the foot. The shoe shouldn’t be tight, but it shouldn’t slide around either. Your heel should also fit snugly into the rear of the shoe.

Try shoes on later in the day, and bring the socks you normally run in. Try on several pairs of shoes in the category closest to your foot type. Make sure you try on both shoes since the sizes of your feet can be slightly different, and keep them on your feet for about ten minutes to make sure they are comfortable. Most good stores will allow you to run up and down the block to experience what running will feel like in the shoes.

Consider purchasing two pairs of running shoes. Alternating their use increases the life expectancy of each pair.

Once you’ve purchased new shoes, run easily in the shoes for a short distance. It is important to allow sufficient time, between 60-70 miles, to break in the new pair.

After you have wisely selected your new running shoes, take them home, put them on and enjoy the run!

Reprinted with permission of the American College of Sports Medicine. Copyright © 2011 American College of Sports Medicine. This brochure was created and updated by Shannon Crumpton and is a product of ACSM’s Consumer Information Committee. Visit ACSM online at

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