Written by the Phoenix Rehab physiotherapy team. Clinically reviewed by Louise Yow, Principal Physiotherapist & Director, AHPC A1300363H. Last reviewed 12 October 2026.
The running injuries we see most are shin pain, pain around the kneecap, pain on the outside of the knee, Achilles tendon pain and heel pain. Shin pain, Achilles tendon pain and heel pain were the most common running injuries in a 2012 review of the research.1 Most of them follow one pattern: weekly distance, speed or hills going up faster than tendon and bone can adapt. The table below lists every running injury we see, by body part.
The injury usually starts a month before it hurts, on the training plan.
You sign up for the Standard Chartered Singapore Marathon in December. Three runs a week become five. The long run moves from the park connector near home to East Coast Park on Sunday at 6am, when the air is already wet. You add an interval day because the plan says so, and a new pair of shoes because the old ones look tired.
For a few weeks nothing hurts. Then the shin aches for the first kilometer and warms up. The knee starts on the same bend of the same route every Sunday. The heel is worst on the first step onto the bathroom tiles.
Your heart and lungs adapt to training faster than your bone and tendon do. So the fitness arrives first and the tissue follows later, and the plan is written for the fitness. That gap is where most running injuries sit.
NS men training for the IPPT 2.4 km run meet the same problem in a shorter, sharper form: a few weeks of hard running on legs that sat behind a desk all year.
The running habits, and what they load
| Running habit | What it loads | What it most often irritates |
|---|---|---|
| A big jump in weekly distance, as in a marathon block | Shin bone and the long bones of the foot | Shin splints, stress fractures |
| The long run, late, tired and hot | Calf, Achilles, hips, lower back | Achilles tendon, outer knee, lower back |
| Downhill running and stairs | Front of the knee | Kneecap pain, patellar tendon |
| Hill repeats, intervals and sprint finishes | Hamstring, calf, Achilles, hip flexors | Hamstring strain, calf strain, hip flexor strain |
| Cambered roads and the edge of the path | Outer knee and ankle on one side | Outer knee (ITB), peroneal tendons |
| Trails and curb edges | Ankle ligaments and tendons | Ankle sprain, peroneal tendons |
| Thin shoes, narrow toe box, tight laces | Forefoot and the top of the foot | Metatarsalgia, Morton’s neuroma, top-of-foot tendons |
Every running injury, by body part
Start from where it hurts. Each linked row goes to the page that covers that injury in full.
| Where | Injury | How running usually causes it |
|---|---|---|
| Lower back | Low back pain after running (lumbar strain) | Long runs, with the trunk tiring in the last few kilometers |
| Lower back | SI joint pain, at the back of the pelvis | Uneven loading from one side, and returning to running after having a baby |
| Hip | Pain on the outside of the hip (gluteal tendinopathy) | Feet crossing the midline as you run, inclines, and more often in women over 40 |
| Hip and groin | Stress fracture of the hip (femoral neck) | Deep groin pain on running, in high-distance runners or runners who are not eating enough for their training |
| Hip and groin | Hip flexor strain or tendon pain (iliopsoas) | Speed work and uphill running |
| Hip and buttock | High hamstring tendon pain (proximal hamstring tendinopathy) | Hill repeats and speed work, with pain sitting on a hard chair |
| Buttock | Deep buttock pain (deep gluteal or piriformis syndrome) | Deep buttock pain that builds on long runs |
| Thigh | Hamstring strain | Sprint finishes and interval days |
| Knee | Kneecap pain (patellofemoral pain) | Downhill running and sudden jumps in weekly distance |
| Knee | Outer knee pain (ITB syndrome) | The knee bending and straightening under load thousands of times on a long run, worse on cambered roads |
| Knee | Patellar tendon pain (jumper’s knee) | Hill repeats, speed work and bounding drills |
| Knee | Meniscus tear | A twist on a trail, or a wear-related tear in older runners |
| Knee | Knee arthritis flare | A rise in weekly distance on a knee that already has arthritis |
| Shin | Shin splints (medial tibial stress syndrome) | A fast rise in distance on hard surfaces, mostly in newer runners |
| Shin | Stress fracture of the shin bone (tibia) | Bone load rising faster than the bone can remodel, more so when the runner is not eating enough |
| Calf | Calf strain (tennis leg) | Pushing off at speed, more often in runners over 40 |
| Calf | Achilles tendon pain (Achilles tendinopathy) | Hill work, a rise in distance, or a return after a break |
| Lower leg | Leg tightness that builds on every run (chronic exertional compartment syndrome) | Tightness that builds with each run and settles with rest |
| Ankle | Ankle sprain | A curb edge or a tree root rolling the ankle inwards |
| Ankle | Peroneal tendon pain, on the outside of the ankle | Cambered roads and trails |
| Ankle | Tibialis posterior tendon pain, on the inside of the ankle | The arch flattening under load on long runs |
| Foot | Plantar heel pain (plantar fasciitis) | A rise in distance with tight calves |
| Foot | Stress fracture of the foot (2nd or 3rd metatarsal) | Sudden jumps in weekly distance |
| Foot | Stress fracture of the midfoot (navicular) | High-distance training, with an ache on the top of the midfoot |
| Foot | Ball-of-foot pain (metatarsalgia) | Landing on the forefoot in thin shoes |
| Foot | Pain and tingling between the toes (Morton’s neuroma) | A narrow toe box on long runs |
| Foot | Pain on the top of the foot (extensor tendinopathy) | Laces tied tight, and hill running |
| Big toe | Stiff, painful big toe joint (hallux rigidus) | The big toe bending at every push-off |
Not on the list, or not sure which row is yours? That is what the first appointment is for.
The common ones, in more detail
Shin pain: shin splints, or a stress fracture
What it feels like. Shin splints ache along the inner edge of the shin bone over a length you can trace with your fingers. The ache is worst in the first kilometer, eases as you warm up, and comes back after the run. A stress fracture hurts at one spot you can cover with a fingertip. It hurts to press, it gets worse with every run instead of easing, and it may ache at night.
What is usually going on. Bone remodels to the load you give it. A marathon block that adds distance fast, on concrete park connectors, asks the shin to take more than it has had time to build for. Not eating enough for the training slows that rebuilding down. The shin splints page covers the irritation end of this, and the stress fracture page covers the point where the bone itself has started to crack.
What we measure. Where exactly it hurts to press, single-leg hopping on each side, calf endurance as single-leg heel raises counted against the other leg, and your weekly distance for the past six to eight weeks.
This week. Cut your distance back to a level that does not bring the ache on, and swap some runs for cycling or the pool. If one spot on the bone hurts to press, or hopping on that leg hurts, stop running and see a doctor. Whether you need a scan is the doctor’s decision.
Pain around the kneecap
What it feels like. An ache around or behind the kneecap. It hurts going down the stairs at the MRT station, after sitting through a film, and on the downhill stretch of your route.
What is usually going on. The joint behind the kneecap is carrying more load than it currently tolerates. The knee is the most commonly injured site in long-distance runners in a 2007 review of the research.2 Downhill running and a sudden rise in weekly distance are the usual triggers. See kneecap pain for the full picture.
What we measure. Single-leg squat control, thigh and hip strength on each side, and how far into a run the ache starts.
This week. Take the downhills and stairs out of your route, shorten the long run, and keep easy flat runs that stay at a mild ache or less. Start strength work for the thigh and hip. Rest alone settles the ache but does not build the strength the knee needs when you return.
Pain on the outside of the knee
What it feels like. A sharp pain on the outside of the knee that starts at the same point in every run, often the same kilometer, and gets bad enough to stop you. Walking down stairs afterwards hurts. Walking on the flat often does not.
What is usually going on. The knee bends and straightens under load many thousands of times on a long run, and the tissue on the outside of the knee gets irritated where it crosses the joint. Long runs, downhills and cambered roads, such as the slope at the edge of a coastal path, add to it. We go through it in detail on outer knee pain that starts at the same point every run.
What we measure. When in the run the pain starts, by time or distance, hip strength side to side, and how the knee tracks on a single-leg squat and step-down.
This week. Run shorter than the point where it starts, on flat routes. On a cambered road or a running track, change direction or side so the same leg is not always on the low side.
Achilles and calf
What it feels like. Achilles tendon pain is stiff for the first steps in the morning, eases as you warm up, and is sore again the next day. A calf strain is different: a sudden pull or stab in the muscle mid-run, often on a push-off or a hill. See Achilles tendinopathy and calf strain.
What is usually going on. Hills, a rise in distance or a return after a break load the tendon faster than it adapts. Runners over 40 see more of both.
What we measure. Single-leg heel raises to fatigue, counted against the other leg. The difference between sides is often larger than runners expect.
This week. Take hills and speed work out. Running can often continue if the pain stays mild during the run and is no worse the next morning. Start slow, heavy heel raises. A snap or a kick at the back of the ankle belongs in the doctor-first list below.
Heel pain
What it feels like. Pain under the heel on the first steps out of bed, and again when you stand up after sitting. It may ease once you are moving and come back later in the day.
What is usually going on. Load on the tissue under the heel and arch has gone up, often with a rise in distance and tight, under-strength calves. See plantar fasciitis and what causes heel pain.
What we measure. Calf strength and endurance on each side, how far the big toe bends back, and how long you can stand and walk before it starts.
This week. Cut distance and long periods of standing. Wear supportive shoes in the house instead of going barefoot on tiled floors. Start calf strengthening.
The ankle
What it feels like. Either a roll on a curb or a tree root on a trail, with swelling on the outside of the ankle, or an ache that builds over weeks with no single moment, on the outside or inside of the ankle.
What is usually going on. The roll is an ankle sprain. The slow ache is usually one of the tendons around the ankle, irritated by cambered roads, trails or long runs. We cover both in ankle pain from running.
What we measure. Single-leg balance with eyes open and closed, hopping, and heel raises on each side.
This week. After a roll, if you cannot take four steps on it, or the bone on either side of the ankle hurts to press, see a doctor first. Otherwise, start balance work early. An ankle that has been sprained before and not retrained rolls more easily.
Weekly distance, and the jump that causes most of it
Running injuries follow changes in load more closely than load itself. A runner who has done the same weekly distance for a year rarely gets hurt by it. A runner who adds a lot of distance over a couple of weeks often does.
In a Danish study of novice runners, those who increased their weekly distance by more than 30% over a two-week period had more of what the researchers called distance-related injuries, such as kneecap pain, outer knee pain and shin splints, than runners who increased by less than 10%.3 The famous “10% rule” is less tidy than it sounds, though. A Dutch trial that gave novice runners a slower, graded build-up found no drop in injuries compared with a standard plan.4 So treat the numbers as a guide. The rule underneath them is simpler: avoid big jumps, and change one thing at a time.
In a marathon block, several things often change in the same month: more distance, an interval day, hills, new shoes, an earlier start time. Each is reasonable. Together they are a large jump. Singapore heat adds to it, because the same pace on a humid morning costs more effort than it would in a cool one.
The same pattern shows up in the lower back, in the last few kilometers of a long run when the trunk tires. That is covered in back pain after running.
Marathon training, trail running and walking
The same legs meet a different load in a marathon block, on a trail descent, on a morning walk and in the weeks before an IPPT. Where an injury already has a row in the table above, we point you to it instead of repeating it.
Marathon and half-marathon training blocks
Most marathon runners we see are 10 to 16 weeks into a plan for a December race, with the Sunday long run longer than ever. Distance rises faster than bone and tendon adapt, so bone stress injuries of the shin and foot, Achilles tendon pain and outer knee pain (ITB syndrome) cluster here, each with its own row above.
The long run shows it first: the ache arrives at the same kilometer, once the calf has tired. We count heel raises and hops on each side against your last eight weeks of distance.
Heat exhaustion is heavy sweating, dizziness, headache, nausea or cramps in a runner still thinking clearly: stop, get into shade, cool down and drink. If it has not eased within 30 minutes, or is getting worse, go to the emergency department now. Call 995 if a runner is confused, slurring or collapsed in the heat, which can be heat stroke, and start cooling them while you wait.
Trail running and hiking descents
Downhill loads the front of the thigh and the knee, because the thigh muscles brake each step as they lengthen. After a first long descent at Bukit Timah or a holiday hike, both thighs are often sore for two to three days, which is usually expected. Pain at one spot on one knee that returns on the next descent is usually kneecap pain, covered above.
Roots and wet ground roll the ankle into an ankle sprain, also covered above. We test a slow single-leg step-down from a box, thigh strength and balance on each side.
A trip on a descent often ends on an outstretched hand. A wrist that swells and will not take weight through the palm after a fall needs a doctor the same day. If it is broken, see wrist fracture recovery. Pain at the base of the thumb after a fall can be a scaphoid fracture, even when the wrist still moves.
What our patients say
Google reviews from our clinics in Singapore.
Brisk walking for older adults
Many of the walkers we see are in their sixties and seventies, walking the estate or the park connector each morning, often after a doctor asked them to move more. Walking is a lighter load than running, but it is daily, and going from a short walk to an hour within a week is still a jump.
| Where | Injury | How walking usually causes it |
|---|---|---|
| Foot | Plantar heel pain | A jump in daily walking, then bare feet or flat slippers on tiled floors at home |
| Knee | Knee arthritis flare | Longer walks, with stairs or slopes added at the same time, on a knee that already has arthritis |
| Hip | Hip osteoarthritis | A groin ache and stiffness after a longer walk, worst getting out of the car |
| Calf | Achilles tendon pain | Hill routes, or a return after weeks of not walking |
| Wrist | Wrist fracture | A trip on a curb or an uneven drain cover, landing on an outstretched hand |
We measure walking speed over a set distance, sit-to-stands in 30 seconds, standing balance on one leg and heel raises on each side. Leg strength and balance are part of what decides whether a trip becomes a fall. Muscle loss with age is covered on sarcopenia.
NS IPPT 2.4 km run
The pattern we see is a few weeks of fast interval runs on a stadium track or hard road before the test window, on legs that did little running the rest of the year.
The injuries are already in the table: shin splints, a stress fracture of the shin or foot, and outer knee pain (ITB syndrome). Running laps in one direction adds load to the outer knee on one side.
We test where the shin hurts to press, hopping and heel raises on each side, and how your weekly running changed over the past six weeks. If one spot on the bone hurts to press, stop running and see a doctor, as the shin section above explains.
Your unit’s medical officer decides your medical status for the IPPT, including any change to your test. A physiotherapist does not. We can put what we found in writing for you to bring to the medical officer.
Back to full training on tests, not dates
A date tells you how long it has been. A test tells you what the leg can do. Before you go back to full training, these should be true on the injured side:
- Brisk walking for 30 minutes with no pain during or the next morning.
- Single-leg heel raises close to the count on the other leg (within about 10%).
- Single-leg hopping, 20 or more in a row, with no pain. For a stress fracture, your doctor clears this first.
- A single-leg squat and step-down that hold their line, matching the other side.
- Run-walk intervals with pain that stays mild during the run and is no worse the next morning.
In The Phoenix Recovery Protocol, this is the work of Return & Perform, the last of the four stages after Calm & Protect, Move & Mobilize, and Rebuild & Strengthen. Distance comes back first, then hills, then speed, one at a time.
Is this normal?
Usually expected: muscle soreness in both legs for one to two days after a long run, a race or a new hill route, which eases once you are moving.
Worth getting checked: pain on one side, at one spot, that is there at the start of the next run, that changes the way you run, or that is still there after a week of easier running.
When to see a doctor first
- Call 995 for chest pain, collapse or fainting, breathlessness out of proportion to the effort, or confusion, slurred speech or strange behavior during or after a run in the heat, which can be heat stroke.
- Go to the emergency department now if your urine turns dark brown or cola-colored with severe muscle pain after a long or hard run, which can be exertional rhabdomyolysis. Also for a fall on a trail with a knock to the head followed by vomiting, worsening headache or drowsiness, for a bone that looks out of place, for back pain with numbness between the legs or new problems passing urine or stool, and for a snap or kick at the back of the ankle that stops you pushing off, which can be an Achilles rupture.
- See a doctor the same day for deep groin pain that is worse with each step or makes you limp, which can be a stress fracture of the hip, for an ankle you cannot walk on after a roll, and for a calf that is swollen, hot and tender with no injury, especially after a long flight to an overseas race.
- See a doctor soon for pain at one spot on the shin or foot that hurts to press and gets worse with every run, a knee that swells within hours of a twist, locks or gives way, numbness or pins and needles down the leg, leg tightness on every run that comes with numbness in the foot, night pain that does not change with position, or missed periods while training hard.
Questions people ask
What are the most common running injuries?
The running injuries we see most are shin pain, pain around the kneecap, pain on the outside of the knee, Achilles tendon pain and heel pain. Most follow one pattern: weekly distance, speed or hills going up faster than tendon and bone can adapt. Physiotherapists assess, treat and refer when a doctor is needed.
How much can I increase my weekly running distance?
There is no exact safe percentage. In one Danish study, novice runners who raised weekly distance by more than 30% over two weeks had more knee and shin injuries than those who raised it by under 10%. A Dutch trial found a slower build alone did not lower injuries. Avoid big jumps and change one thing at a time.
How can I tell shin splints from a stress fracture?
Shin splints ache along a length of the inner shin, worst early in the run, easing as you warm up. A stress fracture hurts at one spot you can cover with a fingertip, hurts to press, worsens with every run and may ache at night. If one spot hurts to press or hopping hurts, stop running and see a doctor.
Why does the outside of my knee hurt at the same point every run?
Pain on the outside of the knee that starts at the same point in every run is often ITB syndrome. The knee bends and straightens under load thousands of times on a long run, and long runs, downhills and cambered roads add to it. Running shorter than that point, on flat routes, keeps you training while it is assessed.
When can I go back to full running after an injury?
Go back on tests, not dates. Brisk walking for 30 minutes without pain, single-leg heel raises close to the other side, hopping with no pain, a steady single-leg squat, then run-walk intervals with pain that stays mild and is no worse next morning. Distance returns first, then hills, then speed. For a stress fracture, your doctor clears hopping first.
Where are you with this right now?
1. It is settling on its own
If it eases week by week while you run shorter, flatter and slower, you are on the right road. Bring distance back first, then hills, then speed, one change at a time. You do not need us for this, and we would rather say so.
2. It has stopped improving
It settles when you rest and comes back on the first long run back. You have dropped the hill route, you stop at the same kilometer every Sunday, or you have deferred a race without saying why. That pattern is usually a strength and load problem, and rest alone rarely changes it. It is worth measuring. If it has been months, the Stalled Recovery Review is three appointments over three weeks with the same therapist, because what a leg does under load cannot be read in one visit.
3. You have had surgery, or you have a date
An ACL reconstruction, a meniscus repair, an Achilles repair or an ankle ligament reconstruction each has a shape, with protected weeks before running comes back. See physiotherapy after surgery and the recovery programs. All of it runs on the four stages of the Phoenix Recovery Protocol.
Next step
Find out which stage you are in
The same ache, at the same kilometer, every week. Pain is the first thing to leave. Movement and strength are the last things trained back, and most people stop before that part is done. One Assessment and Treatment is a single 45-minute appointment at $230, nett, no GST. Your therapist finds what is actually limiting you, treats it in the same appointment, and you leave with your current stage and a written plan.
Prefer to phone? Each of our five clinics has its own number on the clinics page. No referral needed to book.
Related reading
Sources
- Lopes AD, Hespanhol LC, Yeung SS, Costa LOP. What are the most common running-related musculoskeletal injuries? A systematic review. Sports Med. 2012;42(10):891-905.
- van Gent RN, Siem D, van Middelkoop M, van Os AG, Bierma-Zeinstra SMA, Koes BW. Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. Br J Sports Med. 2007;41(8):469-480.
- Nielsen RO, Parner ET, Nohr EA, Sørensen H, Lind M, Rasmussen S. Excessive progression in weekly running distance and risk of running-related injuries: an association which varies according to type of injury. J Orthop Sports Phys Ther. 2014;44(10):739-747.
- Buist I, Bredeweg SW, van Mechelen W, Lemmink KAPM, Pepping GJ, Diercks RL. No effect of a graded training program on the number of running-related injuries in novice runners: a randomized controlled trial. Am J Sports Med. 2008;36(1):33-39.
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