Unraveling overuse injuries in runners: Identifying and responding to early warning signs

If you're in the middle of training and don't want an injury to set you back, this article will help you understand overuse injuries and how to know when you're at risk.

What is an overuse injury?

Overuse injuries happen when you place more load on your body than it can handle, and you become injured.

Research shows us that these types of sports injuries develop in two different ways:

• Suddenly: In one very hard exercise session, if the activity level is too high for your current tissue strength and endurance, or
• Gradually: Over time, if you do not allow enough recovery time between hard workouts

Overuse injuries develop when you don't allow your body enough time to adapt to new training loads.

Why do overuse injuries happen?

Most commonly, overuse injuries develop when you disrupt your body's natural growth and repair process in response to exercise.

Your body's natural growth and repair process

When you exercise, you stress your tissues (bones, ligaments, tendons, muscles, joints), and they develop tiny micro-injuries. In response, your body goes into repair mode and removes unwanted injured cells, repairs the remaining ones, and adds new, stronger ones. In this way, your tissues heal and are made more robust.

It's crucial to understand that this micro-injury-repair cycle is a normal stress reaction and response to exercise. It helps your body adapt to higher loads, which is why you get stronger and your activities get easier.

Problems only arise when you load your tissues again before your body completes the previous repair cycle.

For example, not allowing enough rest after workouts interrupts your healing and rebuilding process. It also results in more micro-injuries, which your body’s repair process may be unable to keep up with. Over time, the injured tissues become irritated and sore and lose some strength.

This is why overuse injuries develop.

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What parts of your body are more susceptible to overuse injuries?

Sports-related overuse injuries can occur in various structures and parts of your body, including your:

• Bones
• Muscles
• Tendons
• Fascia
• Bursae
• Nerves

Studies suggest that this is sport-specific, and certain sports may predispose you to particular types of overuse injuries.

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What are the most common overuse injuries in runners?

As a runner, you’re probably acutely aware that running causes a repetitive impact on your lower limbs. This means if you overdo it and develop an overuse injury, it will likely be in your lower limb tendons, joints, or surrounding structures.

The most common running injuries caused by overuse are:

Overuse injuries of the knee

• Patellar tendinopathy (jumper’s knee)
• Patellofemoral pain syndrome (Runner’s knee)
• IT band syndrome
• Generalized knee pain (whole knee joint soreness without specific injury)

Hip overuse injuries

• Hip flexor tendinopathy
• Gluteal tendinopathy
• Generalized hip pain (whole hip joint soreness without specific injury

Shin splints is an example of a running overuse injury in the lower leg.

Lower leg overuse injuries

• Achilles tendinopathy or tendonitis
• Tibialis posterior tendinopathy
• Peroneal tendinopathy
• Medial tibial stress syndrome (Shin splints)
• Plantar fasciitis

Other examples of overuse injuries in runners:

• Back pain
• Stress fractures

Next, learn what evidence-based strategies work best to prevent overuse injuries when running.

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