Common overuse injuries
Evidence: moderate
The four injuries that fill running clinics share one story: load applied faster than the tissue tolerates. Progressive loading, relative rest and load management have reasonable support; several popular add-ons such as foam-rolling the iliotibial band and routine orthotics are oversold relative to their evidence.
Not medical advice
This is a general knowledge base, not medical or dietary advice. If you are injured, unwell or weighing up a supplement or a change to your diet, speak to a doctor, physiotherapist or registered dietitian who knows your situation.
Four overuse injuries account for a large share of the running caseload: iliotibial band syndrome, patellofemoral pain (runner’s knee), plantar fasciopathy and medial tibial stress syndrome (shin splints). Each is load-related, each responds to managing load and building tissue capacity, and each has a folk remedy that the evidence does not back. Achilles trouble belongs with the tendinopathy page.
Iliotibial band syndrome
This is lateral knee pain that builds during a run, common in higher-mileage runners. The old model blamed friction, picturing the iliotibial band sawing back and forth across the bony bump on the outside of the knee. Anatomical work showed the band does not actually slide that way; the pain is better explained by compression of a richly innervated fat layer between the band and the bone (Fairclough et al. 2006).
That correction matters because the friction model justified stretching and foam-rolling the band to ‘loosen’ it. You cannot meaningfully lengthen or ‘loosen’ the iliotibial band: anatomically it is a tough fascial sheet anchored along the length of the femur, not a free-sliding muscle that stretches (Fairclough et al. 2006). The better-supported approach is relative rest plus hip-abductor strengthening, which reduces pain and improves function across studies (Frontiers 2024). Foam rolling may give short-term symptom relief, but as a comfort measure rather than a cure.
Stretching the band is the wrong target
The iliotibial band is a tough fascial structure you cannot stretch like a muscle, and the friction it was blamed for is largely an illusion (Fairclough et al. 2006). Time spent rolling and stretching it is better spent strengthening the hip and managing load (Frontiers 2024).
Patellofemoral pain (runner’s knee)
See patellofemoral pain for the dedicated page. It is diffuse pain around or behind the kneecap, often worse on hills, stairs and after sitting. It is multifactorial; hip weakness is commonly associated, though prospective evidence that it causes the pain is mixed, and the load on the kneecap joint depends heavily on how the hip controls the leg during running (PFP reviews 2016-2018).
The best-supported treatment is exercise therapy, and combined hip and knee strengthening beats knee strengthening alone for both pain and function. The Manchester and Gold Coast consensus statements place this combination at the top of the evidence (PFP reviews 2016-2018). Alongside strengthening, the usual load-management principles apply: cut volume to a tolerable level, then rebuild gradually rather than resting completely.
Plantar fasciopathy
See plantar fasciopathy for the dedicated page. It is pain under the heel, classically sharp with the first steps of the morning. The familiar name ‘plantar fasciitis’ implies inflammation, but the tissue change is mainly degenerative, which is why ‘fasciopathy’ is the more accurate term (Rathleff et al. 2015).
Because the problem is load-related tissue change, progressive loading helps. An RCT found high-load strength training, slow heel raises with a towel bunched under the toes to load the fascia, gave lower pain and better function at three months than stretching, with outcomes converging by a year (Rathleff et al. 2015). The practical gain is faster early relief. Orthotics are frequently prescribed, but they earn a caveat: they give modest medium-term pain relief of uncertain clinical importance (Whittaker et al. 2018), and only weak evidence supports them for preventing running injuries (Bonanno et al. 2017). They are a reasonable comfort aid for some runners, not a routine fix.
Orthotics: a comfort aid, not a cure
Foot orthoses can ease heel-pain symptoms for some people, but the effect is modest (Whittaker et al. 2018) and the evidence for routine or preventive use is weak (Bonanno et al. 2017). Try the cheaper, better-evidenced loading and load-management route first. See insoles and orthotics, running shoes and barefoot running.
Medial tibial stress syndrome (shin splints)
This is diffuse pain along the inner edge of the shin, brought on by running and eased by rest. It sits on the same spectrum as bone stress injury, so a sudden rise in training load is a central trigger (MTSS reviews). Other risk factors include female sex, higher body mass, a previous episode and greater navicular drop (MTSS reviews).
Management rests on relative rest and graded load progression, the same load-first logic as the other overuse injuries (MTSS reviews). Various passive add-ons such as shockwave therapy, compression and shock-absorbing insoles are used, but their supporting evidence is thin, so they are adjuncts rather than the core treatment.
Shin pain that localises is a red flag
Diffuse shin pain along the inner border is typical of medial tibial stress syndrome, but pain that narrows to a single tender spot, especially on the front edge of the shin, can mark a tibial bone stress injury and needs assessment. See bone stress injuries.
The common thread
All four respond to the same core: reduce load to a tolerable level, build the capacity of the relevant tissue with progressive strengthening, then rebuild running load gradually (see running injuries and strength training for runners). The popular passive add-ons, from rolling the iliotibial band to routine orthotics, range from harmless comfort aids to wasted effort. None substitutes for managing load and strengthening the tissue.