As people across America heed orders to stay at home, more people have begun lacing up their sneakers and getting outside. Now, after weeks of rapidly increasing mileage, I’ve begun seeing the aftermath of the COVID running boom: people who haven’t run or exercised in years are experiencing sudden, unexpected aches, pains, and full-on injuries.
This isn’t surprising. Over my years of working with people with musculoskeletal injuries, I’ve heard the same complaints numerous times from patients who’ve ramped their mileage too quickly. Often, it sounds something like: “Everything was going so well – I could run eight miles! – then suddenly my knee hurt so much I could hardly take a step.”
I understand the enthusiasm. It’s fun to feel the endorphins and see yourself getting better at something. But despite our bodies’ ability to adapt to stress and become stronger, injuries can happen when there’s too much stress or there’s not enough recovery between loads.
While this can happen with experienced athletes, running-related injuries are particularly common among new runners. In the first year and half of running, more than 8 out of 10 novice runners will experience an injury that’s severe enough to take them out of running for at least a day.
Some of the most common running-related injuries are:
- “Runner’s knee” (patellofemoral pain syndrome). Runner’s knee is characterized by pain in the front of the knee, usually under the kneecap. Your knee might pop or grind, but you won’t feel clicking or catching, and it won’t buckle (if it does, see a physical therapist). It might feel sore when running, going up or down stairs, walking downhill, or after sitting for long periods of time.
- “Shin splints” (medial tibial stress syndrome). Shin splints are a term for pain, achiness or tenderness along the shinbone. Without adjustments, shin splints may progress into a stress fracture, an injury that requires weeks off running.
- Achilles tendinitis. Achilles tendinitis is characterized by achiness or pain along the tendon on the back of your ankle, tightness in the calf, and stiffness when you wake up in the morning. Going up on your tiptoes may feel especially painful.
- Iliotibial band syndrome (ITBS). ITBS typically presents as aching or sharp pain on the outside of your knee or on the outside of your hip, especially when bending or straightening the knee.
How do you prevent these injuries from happening?
While there’s no way to guarantee you avoid injury, there are general principles that will help reduce the risk:
- Build your volume (the amount you run) slowly. Increasing by 10% a week works for most people. Slow and steady increases in running volume will win the race.
- Don’t increase volume, intensity and frequency at the same time. If you’d like to run more miles per week, don’t start running faster and more often at the same time. Pick one thing to increase at a time.
- Warm up prior to exercise. While jumping out of bed or up from your desk and starting running may seem efficient, it’s also a recipe for injury.
- Incorporate a strength routine. Exercises with weights or bodyweight can greatly reduce injury risk. Not sure where to start? This routine is a great option of a no equipment-required program you can do in a small space.
What if it’s too late for prevention?
If you’re already hurt, take a three step approach:
- Modify the load. The first question most runners ask is whether they have to stop running. That depends on your pain. Skipping one to three days of running can sometimes completely resolve the issue. Here are some good rules:
- Don’t run if your pain:
- is present when you’re walking prior to running
- causes you to limp
- starts immediately and gets worse during your run
- starts after your run and lingers for hours.
- Reduce your volume and run with caution if the pain:
- goes away as you warm up
- goes away as you warm then returns at the end of the run
- Continuing running, but keep an eye on your symptoms if the pain:
- starts in the middle of a run
- feels better as you run,
- doesn’t bother you after the run
- Don’t run if your pain:
- Identify and treat your weaknesses. If you don’t have a strength routine, now is the time to start one. Here’s a simple at-home workout that doesn’t require equipment.
- Rebuild slowly. If you’ve taken a break or reduced your volume, or if you want to begin running more than before, take a long-term approach. Running a bit less today is better than not being able to run at all in a month.
With these tools in hand, you should be off and running in no time. Sometimes, though, despite our best efforts, we can’t solve our own pain. When that’s the case, a physical therapist will help get you back on track. Reach out to one if your pain doesn’t improve with rest, strengthening and changes in the amount you run, or if you feel severe pain, numbness or tingling, or a progressive loss of strength.
About the author: Megan Hill, PT, DPT
Megan Hill, Doctor of Physical Therapy, is a licensed physical therapist focused on musculoskeletal rehab and chronic pain management. She dropped her plans to go to law school for physical therapy after a knee injury from the Chicago Marathon left her in need of rehab, and she hasn’t looked back since. She’s on a mission to empower people to manage their health through exercise, education and coaching, rather than relying on passive approaches.
Megan earned a Doctor of Physical Therapy degree from the University of Illinois at Chicago (UIC). She also holds a Bachelor of Arts degree in psychology from Duke University and is a certified running coach.
Megan lives in Denver, Colorado, where she spends every spare second running, biking, hiking, sailing and stand up paddleboarding with her husband, Layton, and dog, Ollie.