Aches and Pains

Where injury is concerned, correct diagnosis is important to get the best resolution. This article is a guide only which might point you in the direction of a solution, or best of all, help you to avoid aches and pains in the first place.  If you are in any doubt, visit your GP or a physio.

We will start by looking at the the most common problems faced by endurance runners.

We have a list of local people and businesses who may be able to help you with both resolutions to your aches and pains (such as a physiotherapist) and others to help you avoid them in the first place (such as yoga, pilates, cross training and gyms). Please follow this link to find them.

Runner’s Kneea tender pain in front of or around and behind the kneecap (See also ITBS). Might be worse when going downstairs, kneeling or squatting. Lots of potential causes, including overuse, hard surfaces, weak muscles. Solutions are rest, ice packs and strengthening drills, particularly for the quadriceps. More details on resolutions suggested by Runners World are here. 

ITBS (Iliotibial band syndrome) – a pain around the outside of the knee and possibly behind the kneecap (See also Runners Knee). The cause is not as specific to the knee as the pain might suggest, but is because of an inflammation of the Iliotibial band which runs from the outside of the hip, down the side of the thigh and ends on the shin. This band works hard holding the kneecap in place. Solutions include massage of the IT band (a foam roller can work) and stretching/strengthening exercises. See suggestions by Runners World here

Plantar Fasciitispain or severe ache under the heel, often at its worst when getting up in the morning. The pain may clear while running but re-appear afterwards. It is usually possible to cure this problem without medication. Suggested treatments are to rest and raise the foot on a stool or similar, wear shoes with arch support,  don’t walk around in flip flops, barefoot or in high heels. Carry out specific stretches every day until the pain is gone, click here for a really clear set of suggested stretches.  

Achilles tendinitis – pain or severe ache at back of heel, or at back of lower leg close to heel along the achilles tendon. Can be hard to walk at normal pace.  The achilles tendon has been worked too hard and over time it has become inflamed or some scar tissue has built up on it. The cause might be tight calf muscles, sudden increased mileage, stiff shoes or overtraining. Also too much hill running or over-pronation. (Note – if you feel a lump on your tendon, see your GP as it may be the more serious Achilles tendinosis). To prevent tendonitis, the NHS recommends that a warm up is always carried out before a run, also you should buy your running shoes only after gait analysis to check your pronation (how your foot lands). To treat the problem, no running of course. Various stretching exercises and after recovery, calf strengthening drills. A visit to a sports physiotherapist can be a great help in both helping recovery and guiding you on how to avoid this problem in future.

Shin Splintsaching, stabbing sensation in the shins.  Common in those who do lots of exercise involving weight on the legs. Its important not to run through the pain. The NHS have a really god article about the symptoms, causes and treatment of shin splints here. The first part of the cure is to stop running for two or three weeks, carrying out cross training to keep fit. Gradually build up distance when running recommences.

Sprain, usually of the ankle – severe pain when it happens, usually caused by an unexpected hard landing of the foot on a rogue object ………………

Pulled muscle – (hamstring, calf) created by overstretch of a muscle which causes muscle fibre and or tendons to tear. ………………………

Blisters – a soreness or liquid filled sac that is painful when rubbed, caused by friction between the skin and another object and accelerated by heat. The way to avoid them is to wear properly fitting shoes and always use socks made of a synthetic material – cotton is your enemy here. Those with very sensitive feet might wear a double skin sock. In a very long race, you can change your socks for a dry pair.


Warm up – Don’t run quickly without a warm up. Either do some dynamic stretching (stretching while moving, such as high knees or gentle jog) or a slow run. Your lungs also need to be ready to run. It can take up to 7 minutes for your body to be in a ready state, so you might find that when starting a run you are more out of breathe for a little while from the start than you are after 15 minutes. If you are in a race you want those 7 minutes to be over before the race starts, so make sure your warm up is long enough. There are differing opinions about the benefits of warming up, but no-one thinks it will do you any harm so best to err on the safe side.

Warm down (cool down) – at the end of a hard run you should jog then walk while your heart rate and breathing become normal, then do some static stretching (standing still stretching) to avoid your muscles shrinking and maintain flexibility.  The NHS has a good guide to static stretching here.  

Shoes – When you run, your feet hit the ground with much more force and in a different position than when walking. Running shoes are therefore designed quite differently than walking shoes. They also need to be bigger than walking shoes, usually by one or one and a half sizes. So a runner who uses size 10.5 walking shoes might need 11.5 or size 12 running shoes. The way your foot hits the ground matters as it’s hitting the ground hard, so running shoes can have compensation built in for pronation. The best way to choose running shoes is to go to a specialist running shoe shop that has gait analysis, at the very least for your first pair of shoes. 

Weekly distance – Don’t increase your weekly volume by more than 10% from the previous week. Give your body a chance to become used to the change before increasing again. If you increase by 10% a week fior three weeks, wait another couple of weeks before the next increase. You can alter the distance of each run during the week if you want to increase the length of a run without increasing weekly volume. For example week one might have three runs of 5k, 5k and 10k. Week two might have three runs of 4k, 5k and 11k.

Runner’s lip – Its hard to take a drink from a bottle while running, particularly in a race. The bottle moves back and forward with each pace, bouncing off lips, teeth or gums. Usually leads to ineffective fluid intake. The solution is to stop for a few seconds and have a proper drink!

Graeme Loudain – September 2019

These notes are published as a general aid to all endurance runners. They are guidelines based on current best practice, intended to illustrate the points in the articles rather than provide a precise training schedule. They are written in a way to be of help to runners. Individuals will have their own requirements and the content of the notes will not suit all. Please use them in the spirit in which they are intended and modify them to suit your own needs. If you have suggestions for improvement, amendments or comment, please email