A catalog of the pains that show up most
Running does you good, but it charges a toll. A systematic review by Kakouris, Yener and Fong (2021), gathering more than 9 thousand runners, showed that over a period the overall injury incidence sits around 40%. It is not the bad luck of a few, it is the average of the sport. The useful part is that these injuries are not random: a handful of diagnoses concentrates most of the cases.
A quick map of each one is worth it, without turning into self-diagnosis:
- Patellofemoral syndrome (runner's knee): diffuse pain in the front of the knee, around or behind the patella. It worsens going down stairs, squatting or after sitting for a long time.
- Iliotibial band syndrome: pinpoint pain on the side of the knee, which usually shows up at the same mileage point and eases when you stop.
- Plantar fasciitis: pain in the sole of the foot, near the heel, classic in the first steps after waking up.
- Shin splints (medial tibial stress): diffuse pain along the inner edge of the shin, at the start of the workout.
- Achilles tendinopathy: pain and stiffness in the tendon above the heel, worse in the morning and during the warm-up.
They all have one trait in common, and that is where prevention lives.
The real villain is not the shoe or the foot strike
The industry spent years selling the idea that injury comes from the wrong shoe or from a pronated foot strike. Research does not support that starring role. What shows up again, study after study, is load: how much you run, at what intensity and, above all, how fast you increased it.
The most quoted estimate, that 60% to 70% of running injuries come from training error, appears in the literature (Nielsen and colleagues, 2012), but the authors themselves classify it as anecdotal evidence, not as a number settled by controlled study. In other words: use it as a compass, not as a precision figure. The point that holds is the direction: most overuse injuries are avoidable because they are born from a training decision, not from an anatomical fate.
Where the signal becomes clear is in the abrupt jump. Nielsen and colleagues (2014), following 874 novice runners for a year, saw more distance-related injuries (including runner's knee, iliotibial band and shin splints) in those who increased weekly mileage above 30% in a short interval, compared with those who increased less than 10%. The lesson is not to memorize a percentage, it is to respect the principle: the body adapts to load with a delay, and one week's ambitious peak sends the bill in the next one.
What actually prevents it
Injury prevention in running is not a gadget, it is a handful of boring, effective habits.
- Gradual progression: increase volume or intensity, almost never both in the same week. Include lighter weeks from time to time so the body consolidates the adaptation. Avoid the isolated "heroic workout", much longer than everything you have done in the month.
- Strength: here the evidence is robust. A meta-analysis by Lauersen and colleagues (2014), with more than 26 thousand people, concluded that strength training cut overuse injuries by nearly half. Two or three short strength sessions per week for legs, hips and core do more for your shin than any insole.
- Sleep and recovery: adaptation happens during rest, not during the workout. Insufficient sleep is hidden load. You cannot separate "training more" from "sleeping well".
- Respect pain: pain that builds over the run, that changes the way you run, or that persists the next day is a signal to stop, not to negotiate. Pushing through acute pain is the most common recipe for turning a nuisance into a stress fracture.
Special care: stress fracture
The stress fracture deserves its own paragraph because it is the one that forgives the least. It is a microcrack in the bone from repeated overload, common in the tibia and in the bones of the foot. It usually starts as localized pain, at a specific point, that worsens with impact and does not go away with the warm-up (unlike shin splints, which sometimes ease). Pushing through turns it into a long injury, weeks to months out.
When to see a physical therapist or a doctor
The practical rule: pain that changes your mechanics, that lasts more than a week despite relative rest, or that appears at a specific bony point, calls for professional evaluation. A physical therapist for functional diagnosis and rehabilitation; a sports medicine physician or orthopedist when there is suspicion of a stress fracture, swelling, or pain that prevents walking. Nothing replaces the in-person evaluation of someone examining you. This text is information, not clinical management.
The elite trap
Eliud Kipchoge runs between 200 and 220 km per week and rarely gets injured. It is tempting to copy. Do not copy the dose. Kipchoge is a rare genetic outlier, trains in Kaptagat with coach Patrick Sang and the NN Running Team, has a massage therapist, a physical therapist and full-time recovery, and built that volume over more than a decade. His body takes a beating all day and is reassembled by a team. Yours trains before or after work hours, sleeps whatever is left and has no massage therapist waiting at home.
What works for us mortals is the principle, not the number: Kipchoge's base is made of easy running (about 80% of the volume at light intensity), consistency over the years and the discipline not to force it. That principle fits any schedule. Elite mileage does not. Take the logic of patient progression and leave the 220 km volume where it belongs: in the support ecosystem that only the elite has.
