5 Common Injuries in Road Runners (And How Physiotherapy Can Help)

Ask any regular road runner, and they'll tell you: it's not a matter of if they'll get injured, but when. That instinct is backed by research — a widely cited clinical review published in Sports Health found that anywhere from 27% to 70% of recreational and competitive distance runners sustain an overuse injury in any given year, with most running injuries falling into this wear-and-tear category.

A big contributing factor is the pavement itself. Unlike trail surfaces, which constantly vary and force the body to adapt, roads are flat, hard, and repetitive — meaning the same joints and tendons can end up absorbing the same impact, in the same way, over and over.

Here are five common running injuries this can lead to, and how physiotherapy and prevention strategies can help you to keep running long-term.

1. Shin splints

Shin splints (or medial tibial stress syndrome) develop from repetitive impact on hard pavement, often triggered by a sudden increase in weekly mileage or running on unforgiving surfaces without adequate recovery.

Symptoms: Aching or sharp pain along the shin bone, which typically worsens during or after running.

Physiotherapy treatment:

• Soft tissue mobilisation to relieve tension in the lower leg muscles.
• Taping to offload stress from the shin.
• Dry needling to release tension in the tibialis posterior and surrounding muscles

Prevention tips: Physiotherapists can identify muscle imbalances or tightness early and prescribe strengthening exercises to reduce recurrence.

2. Runner's knee  

Runner's knee (or patellofemoral pain syndrome) results from the repetitive, high-volume impact of road running, and can be aggravated by cambered roads that place uneven load through the knee.

Symptoms: Pain and mild swelling around or behind the kneecap, often worsening with distance or after long runs.

Physiotherapy treatment:

• Strengthening exercises targeting the hip and quadriceps.
• Kinesio taping to reduce knee strain.

Prevention tips: Physiotherapists can prescribe a targeted hip and quad strengthening programme to improve knee tracking before symptoms develop.

3. Plantar fasciitis  

Inflammation of the plantar fascia, the thick band of tissue running across the bottom of the foot, often develops from the repetitive pounding of hard road surfaces or worn-out running shoes.

Symptoms: Sharp heel pain, especially with the first steps in the morning or after long periods of standing.

Physiotherapy treatment:

• Soft tissue mobilisation to release tension in the foot and calf.
• Shockwave therapy to improve blood flow and speed up healing.
• High-power laser therapy to reduce inflammation of the plantar fascia and promote tissue repair.

Prevention tips: A daily stretching routine for the calf and foot to maintain flexibility and reduce tension on the arch.

4. Achilles tendonitis  

An overuse injury of the Achilles tendon, which connects the calf muscles to the heel, often aggravated by consistent flat-surface running or a sudden increase in speedwork.

Symptoms: Pain and stiffness at the back of the heel, particularly in the morning or after physical activity.

Physiotherapy treatment:

• Eccentric exercises to strengthen the Achilles tendon.
• Shockwave therapy to stimulate healing.
• Range-of-motion work for the ankle to restore flexibility.

Prevention tips: Physiotherapists often recommend gradually increasing training intensity and pace, along with calf-strengthening exercises.

5. IT band syndrome  

Inflammation of the iliotibial (IT) band, a thick band of connective tissue that runs down the outside of the thigh, often develops from the repetitive knee-bending motion of road running, and can be worsened by consistently running the same direction on a cambered road or track.

Symptoms: Pain on the outside of the knee, which can worsen with increasing distance.

Physiotherapy treatment:

• Manual therapy for releasing tension along the IT band and hip muscles.
• Strength training focusing on hip stabilisers to reduce the strain on the knee.
• Stretching and flexibility work to improve muscle balance.

Prevention tips: A combination of strength and mobility training, along with varying routes and running direction where possible.

‍

At Hein Viljoen Physiotherapy, we're happy to help road runners keep logging the kilometres they love. Let's talk about how we can run alongside you on your journey to recovery.