Symptoms, Causes, and Treatment of Running Injuries in the Middle Distance Athlete

Posted by Scott Christensen

Running injuries of the leg and lower back are the most common types of acute or chronic ailments found in distance runners. 

Aches and pains are common in runners training in excess of 15 miles per week, but these transition to injuries when the ailment is severe enough to reduce the number of miles run over the course of at least one week and/or cause the runner to take medication or see a health care professional.

Most running injuries are musculo-skeletal overuse syndromes related to cumulative stress and strain of the legs. 

All of the common injuries have noticeable symptoms, related causes, and training characteristics as to what to try/avoid and how to treat the injury from a training perspective. 

An observant coach will take heed of these and address the athlete’s potential for injury before they reach the acute level by which they will need to seek professional care.  Injury prevention is the key to athletic success.


Included below are several of the most common running injuries:


Patellofemoral Pain Syndrome


  • Generalized ache of the knee during or after running
  • Pain while sitting for a long period of time
  • Swelling and/or pain to the touch at the knee joint


  • Imbalance of forces at the hip, knee, and foot resulting in poor alignment of the leg
  • Overpronation of the foot
  • Weakness in the core
  • Too much hill running


  • Try to stretch quads, hip flexors, supine hamstring, calf muscles
  • Try to strengthen glutes and quads
  • Try to foam roll the glutes and IT band
  • Avoid hill training sessions
  • Avoid deep squats and lunges
  • Avoid speed work


Tibial Stress Syndrome (shin splints)


  • Pain before and after running in the shin area on either side
  • Pain along the shin bone, but not centered in one spot


  • Poor flexibility and/or weakness of the calf and soleus
  • Overstriding
  • Too rapid of an increase in training mileage
  • Worn out shoes
  • Running on the same type of surface every day


  • Try to stretch the calf and soleus several times each day
  • Try to foam roll the calf, soleus, and anterior tibialis each day for one minute each
  • Try to improve footwear
  • Avoid jumping, sprinting, and walking too long
  • Avoid running for a few days.  Try biking or pool running


* Coaching Resource: The Mile: Successful Coaching Strategies


Achilles Tendonitis


  • Pain may be at the top or bottom of the tendon where the calf and soleus connect to the heel
  • Pain first thing in the morning, at the beginning of a run, and after a run


  • Poor flexibility and/or strength of the calf and soleus
  • Worn out shoes
  • Too much hill running or sprinting
  • Too rapid of an increase in training mileage


  • Try to stretch calf and soleus first thing in morning
  • Try to stretch hip flexors and supine hamstring/calf stretch several times during the day
  • Try to do eccentric heel drops on the edge of a step or curb
  • Try to foam roll the calf for at least one minute each day
  • Try to improve footwear
  • Avoid jumping, lunges, and intense sprinting
  • Avoid increasing training mileage
  • Avoid running past the point of minimal pain


Stress fractures


  • Pain along a bone provoked by tapping directly on the bone
  • Pain that occurs sharply after a run
  • Sharp pain when weight bearing, but dull pain at rest


  • Overtraining
  • Poor nutrition, especially vitamin and mineral intake
  • Worn out shoes
  • Glut and core weakness


  • Try nothing if a stress fracture is suspected.  Seek medical advice.
  • Once cleared, try gentle mileage and strengthening
  • Avoid all impact activities


Plantar Fascitis


  • Pain on the bottom of the foot where the arch meets the heel
  • Pain is worse with the first step in the morning


  • Poor flexibility of the calf and soleus
  • Overpronation without correction
  • Rapid increase in sprinting activities
  • Worn out shoes high arched rigid feet


  • Try to roll a frozen water bottle or lacrosse ball under foot for five minutes each day
  • Try to stretch and strengthen calf and soleus with several activities each day
  • Try orthotics
  • Try to strengthen the hips and core
  • Try a plantar fascia self-mobilization stretch each day
  • Avoid unsupported footwear like sandals
  • Avoid hill training sessions

Illiotibial Band Syndrome (IT Band)


  • Pain on the outside of the knee joint
  • Pain is worse after running or while going down stairs


  • Weakness in the glutes
  • Poor flexibility of the hip flexor
  • Overpronation
  • Running downhill too much or on the same side of a crowned road


  • Try to foam roll the IT band for at least one minute several times per day
  • Try to strengthen the glutes and the core
  • Try to stretch the hip flexors
  • Try to correct pronation
  • Avoid running past point of pain
  • Avoid hill work and intense sprinting
  • Avoid too much running in spiked racing shoes


* Additional Resource: Every 800m – 1600m Workout For The Entire High School Season



Scott Christensen - Scott Christensen’s teams have been ranked in the national top 10 eight times. He won the 1997 High School National Championship and his squads have captured multiple Minnesota State Championships. Scott has coached 13 Minnesota State Championship-winning teams and 27 individual Minnesota State Champions. He was the USTFCCCA Endurance Specialist School junior team leader for the World Cross Country Team in 2003 and the senior team leader in 2008. Scott is a 14-year USATF Level II endurance lead instructor.

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