Running Injuries: How Physiotherapy Can Help You Run Stronger and Stay Active
Running is one of the simplest ways to stay fit, improve cardiovascular health and get outside — but it is also an activity that places repeated loads on the muscles, tendons, bones and joints of the body.
Whether you are a beginner preparing for your first 5 km, a recreational runner training for a half marathon, or an experienced marathon runner, niggles and injuries can sometimes become part of the journey. The good news? A running injury does not always mean you need to stop running completely. Physiotherapy can help identify what is contributing to your symptoms, modify your training appropriately and build your capacity so that you can return to running safely and confidently.
What are the most common running injuries?
Running-related injuries can affect almost any part of the lower limb. Research suggests that the knee, foot and ankle, and lower leg are among the most frequently affected areas in runners.
Some common running injuries include:
Patellofemoral pain (pain around or behind the kneecap)
Achilles tendinopathy
Medial tibial stress syndrome, sometimes referred to as "shin splints"
Plantar heel pain
Iliotibial band-related pain
Calf and hamstring injuries
Stress reactions and stress fractures
Hip or gluteal pain
Ankle injuries
Running injuries are particularly common during periods of increased training, such as when preparing for a marathon or suddenly increasing running frequency. However, it is important to recognise that there is no single training-load threshold that guarantees an injury. Research examining the relationship between running distance, frequency, intensity and injury has produced mixed findings. This is one reason why an individualised approach is so important.
Why do running injuries happen?
It can be tempting to blame a running injury on one thing — increasing your kilometres, changing your shoes, running hills or having "weak glutes" — but injuries are rarely that simple. Running places repeated stress on the body. With appropriate training, your body adapts to this load and becomes stronger and more resilient. Problems can occur when the demands placed on the body exceed its current capacity to tolerate and recover from that load.
This may happen following:
A sudden increase in running volume
Adding speed work, hills or intervals
Increasing long-run distance
Returning to running after time off
Increasing both running and other exercise simultaneously
Insufficient recovery between sessions
Poor sleep, nutrition or hydration
Continuing to train through progressively worsening symptoms
Importantly, an increase in training load is not automatically "bad". Training is how runners become fitter and stronger. The goal is to find a level and progression that allows your body to adapt.
Should you stop running if you are injured?
Not necessarily. One of the most important parts of physiotherapy for runners is determining how much running your body can currently tolerate. Depending on the injury, your physiotherapist may recommend temporarily reducing your running volume, slowing your pace, avoiding hills or intervals, or spacing out your running sessions. In other situations, you may be able to continue running with some modifications. The goal is not simply to get your pain down. It is to gradually rebuild your capacity so that you can return to the type of running you actually want to do. For example, someone with knee pain who wants to complete a marathon will have very different rehabilitation goals from someone who wants to comfortably run 5 km once or twice a week.
How can physiotherapy help with running injuries?
A physiotherapy assessment looks beyond the location of your pain.
Your physiotherapist may assess:
1. Your running history
Understanding your recent training is often one of the most useful parts of an assessment.
We may discuss:
How many kilometres you are currently running
Your typical weekly schedule
Long-run distance
Running pace and intensity
Hills and speed sessions
Recent changes to your training
Other activities such as gym training or sport
Previous injuries
Recovery, sleep and general training demands
This helps provide context for your symptoms.
2. Strength and physical capacity
Running requires your body to repeatedly absorb and produce force. Your physiotherapist may assess the strength and capacity of your calves, quadriceps, hamstrings, glutes and other muscles, as well as your ability to control single-leg movements. This can help identify areas where building strength or endurance may be useful. Strength training is often an important part of rehabilitation for runners, although it should be individualised rather than treated as a universal injury-prevention formula. Recent research on exercise-based injury prevention in endurance runners has found mixed results overall, with some evidence suggesting benefits when programs are appropriately supervised.
3. Running technique
Your physiotherapist may also look at how you run, particularly if your symptoms are influenced by running mechanics. This does not mean there is one "perfect" running technique that every runner needs to adopt. Instead, in some circumstances, small changes to factors such as cadence, stride length, speed or foot strike may help alter the loads experienced by particular tissues. Technique changes should therefore be considered as one potential tool rather than a requirement for every runner.
4. Your training load
Rather than simply telling you to "rest", your physiotherapist can help you modify your training while maintaining as much fitness and activity as possible.
This might involve temporarily changing:
Distance
Pace
Frequency
Hills
Intervals
Long-run duration
Recovery days
The aim is to find a level of training that your body can tolerate while gradually increasing your capacity again.
What does running rehabilitation look like?
A good rehabilitation program should progress with you. Early rehabilitation may focus on reducing aggravating loads and settling symptoms while maintaining fitness through activities that your body can tolerate.
As symptoms improve, treatment may progress towards:
Build strength → increase tissue capacity → reintroduce running load → increase distance → introduce hills/speed → return to normal training
Your physiotherapist may prescribe exercises such as calf raises, squats, split squats, step-ups, hamstring exercises or hip strengthening, depending on your individual needs. The exercises themselves are only one part of rehabilitation. The bigger picture is gradually exposing your body to the demands it needs to handle. For a marathon runner, that ultimately means preparing the body to tolerate long periods of repetitive loading — not just getting through a few pain-free strength exercises in the clinic.
When should you see a physiotherapist?
It can be useful to see a physiotherapist when:
Pain is repeatedly occurring during or after running
Your symptoms are gradually getting worse
Pain is changing the way you run
You are reducing your running because of pain
You are repeatedly getting the same injury
You are struggling to return to running after an injury
You are training for a race and want help managing your training load
You are unsure whether you should continue running
Early assessment can be particularly helpful when symptoms are persistent or recurring, as it allows you to understand what your body is currently able to tolerate rather than waiting until the problem forces you to stop completely.
Running injuries don't have to mean giving up running
For many runners, the biggest concern when they develop an injury is: "Will I ever be able to run normally again?"
In many cases, rehabilitation is not about choosing between running and resting. It is about finding the right amount of running and strengthening at each stage of recovery. Your body is capable of adapting to running — and physiotherapy can help you understand how to progressively build that capacity. At Project Rehab, our physiotherapists can work with you to assess your injury, develop an individualised rehabilitation program and help you safely return to the running you enjoy. Whether your goal is to get back to your regular 5 km, complete your first half marathon or prepare for your next marathon, physiotherapy can help you understand your injury and develop a plan to keep moving forward.
References
Videbæk S, Bueno AM, Nielsen RO, Rasmussen S. Incidence of Running-Related Injuries Per 1000 h of running in Different Types of Runners: A Systematic Review and Meta-Analysis. Sports Medicine. 2015.
Nielsen RO, et al. Training errors and running related injuries: a systematic review. International Journal of Sports Physical Therapy.
Ceyssens L, et al. The Association Between Running Injuries and Training Parameters: A Systematic Review.Journal of Athletic Training. 2022.
Wu H, Brooke-Wavell K, Fong DTP, Paquette MX, Blagrove RC. Do Exercise-Based Prevention Programs Reduce Injury in Endurance Runners? A Systematic Review and Meta-Analysis. Sports Medicine. 2024.
Alexander JL, Culvenor AG, Johnston RRT, Ezzat AM, Barton CJ. Strategies to prevent and manage running-related knee injuries: a systematic review of randomised controlled trials. British Journal of Sports Medicine. 2022.
Linton L, Culpan J, Lane J. Running-Centred Injury Prevention Support: A Scoping Review on Current Injury Risk Reduction Practices for Runners. Translational Sports Medicine. 2025.
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At-home neurological physiotherapy brings physiotherapy to you, allowing for the highest level of comfort and convenience.
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Physiotherapy can benefit individuals with a wide range of needs. Some conditions include: Amputees. Acquired Brain Injury, Parkinson's Disease, Motor Neurone Disease, Multiple Sclerosis, Alzheimer’s Disease, as well as various intellectual disabilities, developmental delays, and chromosomal disorders, among others.
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Yes, Project Rehab is a registered NDIS provider, making it easy for clients on the NDIS program to receive neurological physiotherapy.
