t2coaching: Running Injury

Given the high rate of running related injury in endurance running, I was always battling an injury the first 15 years of my triathlon journey, injury-preventing exercises should be included in athletes training plans. Movements include sport-specific strengthening exercises using functional movement patterns to reduce the likelihood of problems.

The more common running injury causes and methods of prevention are describe below. I never diagnosis and injury with and athlete. Though my shared experience with what the athlete may be dealing with, we communicate and then they seek treatment from a local qualified specialist.

Iliotibial Band (ITB) Syndrome

I tend to have a tight ITB band from cycling. I have a leg length discrepancy so that does not help and I struggle to get my Triathlon Bike fit dialed it.  ITB is  pain on the lateral side of the leg just below the knee and tight night along the Iliotibial band. The discomfort starts 10-15 minutes into a run and stops when finished.  Prevention includes strengthen the core and glute muscles (gluteus minimus, glute medius, gluteus maximus) and external hip rotators  plus improve stability during stance phase of running and reduce the stress on the ITB.

Plantar Fasciitis

I developed PF in 1999 while training for my 2nd Ironman in Florida. Still new to ironman training, I was also struggling with IT band syndrome before developing PF.  The plantar fascia is a band of connective tissue that runs along the bottom of the foot, from the heel bone to the metatarsals.  Pain along the bottom of the heel that feels worse in the morning upon waking. The pain is usually located on the inner or medial side of the heel, and some athletes may experience pain toward the center of the bottom of the heel. It is most painful when pushing off while running. Causes can be tight calf muscles that pull on the Achilles, which pulls on the calcaneus, which pulls on the plantar fascia. Like most injuries a strong core, posterier kinetic chain, helps prevent it. Prevention begins by strengthening the glute muscles, hip flexors, quadriceps and core. Barefoot walking, stride and cadence running drills  can help strengthen the muscles in the foot.  Still probably the most painful injury I have had to date.

Achilles and Tibialis Tendinitis

When I am training for an Ironman my Posterior Tibialis tendonitis along with Achilles flares up, my first injury since my first Ironman in 1997. The Achilles tendon is located at the back of the lower part of the leg, directly above the heel. Just like the tight calfs can cause Plantar Fasciitis, a  lack of calf-muscle strength and tightness, improper recovery between workouts, running on your toes, too much volume or intensity too soon. Besides a progressive training plan with slow increases in volume and intensity, prevention includes running form assessment, stride and cadence drills, strengthen and stretching the calves and use of a form roller. After Ironman Texas 2017, I went to an A.R.T Doctor, had a full strength and treadmill running form assessment. I understand my imbalances and found some treatment and relief

Runner’s Knee
I am fortunate to have never experience pain or aching beneath the kneecap. When the patella repeatedly moves out of alignment during running, the articular cartilage beneath it becomes irritated. Tightness or weakness in the quadriceps and knee extension weakness are associated with patello-femoral pain syndrome. Running gait, overpronation, has also been known to increase stress along the inside of the patella.Coaches can evaluate an athlete’s gait to check for overpronation or stride issues and integrate drills to address these issues during the athlete’s training sessions.Weak glute and core muscles can cause an athlete’s hip to drop while running, causing the patellae to fall out of alignment. The best way to prevent runner’s knee is with a strong and healthy kinetic chain. Athletes should work on strengthening the muscles in their quadriceps, hips, glutes, and core during training, use a foam roller to loosen tight quadriceps.

Shin Splints
I have not experience shin splits,  pain in the front of the lower part of the leg, since 1999
Both muscular and bone-related shin pain can cause “shin splints”. Approximately 90% of shin splints occur in the bone. If athletes feel pain when pressing on the inside of their shinbone after running, it may be a sign of posterior medial tibial stress syndrome. Prevention includes running form assessment, gait analysis and running shoes. Prevention involves
use of a foam roller on shins and calves daily. As with many injuries, a good strategy for prevention is to follow the 10% rule and adding hip and core strengthening exercises, decreasing stride length and increasing cadence.

Piriformis Syndrome

Since entering the 40-44 age group, I have noticed tight Piriformis. It is know at a “Pain in the Butt”, pain deep within their glutes on one side, mostly when seated. The piriformis is a small muscle that lies deep within the buttocks and right next to the sciatic nerve. Its role in running is to help stabilize the hip as the athlete lands during gait. When the piriformis becomes too tight, it squeezes the sciatic nerve, causing pain. Tightness in the piriformis is caused by weakness in one or more of the muscles in the kinetic chain.

Overpronation can also be an issue.
One of the jobs of the piriformis is to help prevent the knee from rotating too much. Too much pronation creates too much rotation and tension along the piriformis.There are a variety of exercises that athletes can perform to help prevent piriformis syndrome.

These include standing resistance-band hip abduction, lateral band walks, plyometric jump squats, planks and fire hydrant’s.
Athletes can also use a foam roller every day to keep muscles loose and work out any tight spots.

Strained/Pulled Hamstring

There are two common types of hamstring strains or pulls that can result from running. If the athlete experiences pain near the glutes that’s especially uncomfortable during the terminal stance phase of running, the injury may be a proximal hamstring strain. A sudden, sharp pain closer to the knee that occurs during a run and forces the athlete to stop is due to a pull or strain in the middle third of the hamstring. The pain athletes experience when loading their hamstrings may be mild or excruciating, depending on the severity of the strain.

This injury occurs when athletes stretch their hamstring muscles too far, when athletes put a sudden and heavy load on their hamstrings, or a combination of both.
If the loaded hamstring is weak or fatigued, or both, the result may be a strain or pull.


Coaches should prescribe exercises that strengthen the glutes, hip flexors, quads, core and hamstrings to prevent strains and tears.
Exercises to include in strength and conditioning sessions include the hip raise, the reverse hip raise, the walking lunge, planks and the dumbbell step-up.
Interval training, hill running, and stair climbing are other excellent activities for building hamstring strength.
As with other injuries, the use of a foam roller is recommended to prevent muscle tightness.


What injuries had you struggled with and how have you treated them?

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