Foot and knee injuries are the most commonly seen running injuries. These overuse injuries can almost always be corrected with physical therapy. Many of these overuse injuries occur due to muscular imbalances and poor biomechanics that have developed due to repetitive incorrect motion.

Patellofemoral Pain Syndrome


This typically presents as anterior knee pain, around the patella. There can be tenderness of the underside of the patella due to possible swelling in the knee joint. Sometimes the knee can feel swollen or full without actual swelling present. Potential cracking or popping can occur anywhere during the knee range of motion. Usually pain occurs with activity and is at its worst with going down stairs or hills

Mechanism of Injury: 

Tight quads cause excessive pressure on the femur. This pressure increases with running as a result of increased ground reaction force. During quad contraction, the patella moves under the patellar tendon. Consequently, tightness in one location may lead to muscular imbalance. The patella then glides excessively to one side due to Imbalanced forces. Primarily, this muscular imbalance occurs in the VMO, hip abductors and hip external rotators. As a result of the excessive pressure and muscular imbalance, repetitive abrasion and irritation of the bone occur ultimately leading to tissue breakdown.

Abnormal biomechanics that lead to PFPS:

  • Excessive pronation
  • Femoral anteversion
  • Patella alta
  • Increased Q angle

Physical Therapy Interventions: 

  • Initial decrease in running mileage
  • Quad stretches
  • Exercises to increase glute strength

Patellar Tendonitis/Tendinopathy

running knee

Traditionally, patellar tendon pain is felt below patella. Pain felt at the beginning of activity or directly after is indicative of acute tendinitis. With chronic tendinitis, pain may lead to termination of sport and interference with ADLs such as rising from a chair or climbing stairs.

Mechanism of Injury: 

Due to repeated stress on the tendon, microtears occur contributing to the tendinitis. Tightness in the quads and/or muscular imbalance are causes of stress to the tendon. Patellar tendinitis is also commonly paired with PFPS.

Physical Therapy Interventions: 

  • Decrease running mileage
  • Exercises to strengthen glutes
  • Progressive loading of quads

Achilles Tendonitis

achilles running

Achilles tendonitis pain presents in the heel or higher up on the Achilles tendon. The main complaint is pain and stiffness with walking and pain at it’s worst during initial movement. Many complain of calf tightness when experiencing achilles pathology.

Mechanism of Injury 

Irritation occurs when demand placed on the tendon outweighs the tendon’s capacity. Irritation results in microtraumas to the tendon. During normal walking, the tibia must roll over the foot, lengthening the gastrocnemius complex. Increased length of the gastroc produces force in the tendon, which is transmitted during push off. Overuse of the calf muscles is another contributor to achilles pain. Calf overuse is commonly due to decreased hip extensor strength and hip flexor range of motion.

Physical Therapy Interventions: 

  • Initially decreasing running miles
  • Slow increase in load to the Achilles tendon
  • Increase glute strength
  • Stretch hip flexors to increase hip extension ROM

Plantar Fasciitis   

Primarily, plantar fasciitis presents as burning pain in the middle of the foot. Usually, pain is worse in the morning and after prolonged sitting or weight bearing. It is also increased during push off and toe walking.

Mechanism of Injury: 

This pathology occurs due to stress on the fascia during the windlass mechanism. To further explain, the windlass mechanism is essentially the shortening of the plantar fascia resulting from big toe extension. Stress on the fascia can be increased to due excess pronation resulting in decreased arch height. Flat feet further attribute as cause of plantar fasciitis in runners. Also, calf tightness can contribute to this condition. Plantar fasciitis also can be contributed to increased load or mileage of running.

Physical Therapy Interventions:

  • Mobility exercises for ankle and plantar fascia
  • Supportive footwear prescription
  • Arch exercises
  • Calf stretching
  • Proximal hip strengthening

Shin Splints

Medial tibial stress syndrome is another term used to name shin splints. Pain in the middle to bottom third of the inside of the shin is traditional to this pathology. Additionally, pain can be sharp to the touch or achey during or after exercise. If the condition progresses, pain might be present consistently.

Mechanism of Injury 

Shin splints typically develop when muscular stress overloads the tibia. Muscles contributing to stress include; posterior tibialis, soleus and flexor digitorum longus muscle. Primary impairments commonly contributing to shin splints include; repetitive running/jumping, hypermobility of the hip, and overpronation in weight bearing.

Physical Therapy Interventions: 

  • Arch exercises = preventing overpronation during stance
  • Glute strengthening
  • Footwear analysis
  • Gentle stretching

Check out this blog post about the reasons that strong glutes are important!

And as always, stay up to date with our instagram series of the week! We demonstrate common exercises we use in the clinic to address your impairments!

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🔹Calf Release 🔹 ▫️⠀⠀⠀⠀⠀⠀⠀⠀⠀ ▫️⠀⠀⠀⠀⠀⠀⠀⠀⠀ The calf muscle also known as the gastroc/soleus complex is responsible for ankle plantar flexion when it contracts. If this muscle gets tight, it restricts dorsiflexion. Adequate ankle dorsiflexion is necessary for normal walking and running as well as proper squat/lunge mechanics. Your calves become tight due to regular lack of motion throughout the full range. Sometimes shoe wear can contribute to tightness of this muscle ▫️⠀⠀⠀⠀⠀⠀⠀⠀⠀ ▫️⠀⠀⠀⠀⠀⠀⠀⠀⠀ If your calves are sore/tight or you think you are lacking mobility at the ankle, give this drill a try and let us know what you think! ▫️⠀⠀⠀⠀⠀⠀⠀⠀⠀ ▫️⠀⠀⠀⠀⠀⠀⠀⠀⠀ To perform this drill:  1. Sit on floor with the foam roller under the calf 2. Roll up and down to mobilize the calf muscle  3. When you find a tight/tender spot, pause here. 4. When you find a spot of tension, pause her 5. If you can tolerate more pressure, place the opposite leg on top of the leg you are foam rolling 6. For an added mobilization, point the toes up and down slowly to further stretch the tissue

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