Prevention and treatment of three common running injuries

The causes of ITBFS, shin splints and tendonitis relate to at least one of three problems: too much too soon, too much for too long and improper footwear.
Of the three events in triathlon, running is the sport that causes the most injuries. In fact, running-associated ailments affecting the back, hips, knees, ankles and feet are more commonly encountered than those injuries associated with both biking and swimming combined.

Three of the most common running injuries experienced by triathletes are iliotibial band friction syndrome (ITBFS), shin splints and tendonitis of the patellar and Achilles tendons. Knowing how to deal with these injuries once they occur is important, but preventing them altogether has the obvious advantages of allowing uninterrupted training and enhanced enjoyment of training and racing.

Battle of the band

The iliotibial band is a thick, fibrous tissue that originates above the hip and descends along the outside of the thigh to its termination point directly below the knee. It serves as an important attachment for many of the muscles of the hip and leg, but its primary function is to provide lateral stability to the knee when in a standing position.

When the knee is bent beyond approximately 30 degrees, the ITB slides backwards over the outer portion of the thigh bone. In some runners, as the ITB slides back and forth along the outside of the thigh during running there is repetitive friction that causes inflammation and pain that are the classic symptoms of the condition commonly referred to as runners knee.

In some cases, the point of friction, inflammation and pain is up close to the hip, but in the vast majority of cases its down at the knee. The pain is often stabbing or throbbing in nature and is not restricted to a specific point. It is almost always associated with weight-bearing exercise and can be alleviated by stiff-legged walking, which prevents the ITB from sliding backwards.

ITBFS is self-limited and does not lead to more severe injuries. However, ITBFS is often so painful that running becomes impossible.

Since ITBFS generally only causes pain while running, the application of ice or the use of pain medications is not usually necessary. Instead, treatment involves identifying and addressing any predisposing factors. These can include anatomic considerations, improper footwear or simply ITB tightness.

Changing your running shoes can be helpful in correcting the first two of these causes, while stretching exercises may help with the third. Useful stretches lengthen the ITB at the hip, decreasing friction at the knee.

Shin splints

Shin splints are another common injury seen in runners, especially in beginners. Each time a runner strikes the ground, the weight of the body impacts the ground with tremendous force. This force must be dissipated through the ligaments, tendons, muscles and the bones of the foot, leg and back.

If the surrounding tissues are weak, the bones bear the brunt of the force, and this can lead to micro trauma that causes inflammation in the outer layer of the shinbone, the periosteum. At first, the pain of shin splints is only associated with activity, but if the condition is allowed to progress the pain can become constant. If ignored, shin splints can lead to stress fractures of the tibia.


Tendonitis is inflammation of a tendon. The most common locations for tendonitis in runners are in the knee and the ankle. The patellar tendon attaches the large thigh muscles to the shin. The repeated forceful bending and straightening required for running subjects this tendon to enormous forces that can result in injury.

Similarly, the Achilles tendon, which attaches the calf muscle to the heel, is also prone to injury for the same reason. Like shin splints and ITBFS, tendonitis begins as localized pain associated with activity. If allowed to progress, however, swelling within the tendon can occur and a palpable nodule often arises. Pain eventually becomes persistent, even at rest. Left unchecked, tendonitis can progress to tendon rupture, a serious and debilitating injury.

Treatment and prevention

Treatment for shin splints and tendonitis is similar and includes icing the affected area, the judicious use of oral non-steroidal anti-inflammatory medications (NSAIDs) and rest.

With the onset of any of these three common injuries, a complete cessation of running is the best policy. Tough medicine in the short term, perhaps, but dealing with an injury early on leads to faster healing, a lower likelihood of injury recurrence and a speedier return to activity. Only after the pain and swelling have completely subsided should one consider returning to running.

The root causes of each of these injuries relate to at least one of three problems: too much too soon, too much for too long and the use of improper footwear. When starting a running program or returning to one after injury it is critical to address each of these.

A good program for beginners or those who are returning from injury incorporates a long build phase that allows for strengthening of supporting muscles and adaptation of the body to the rigors of running.

Long runs should be relatively short at first and lengthened gradually over a matter of weeks or even months. Overall running volume should also begin at a low level and increase in a measured fashion, and strength exercises combined with stretching can help prevent the recurrence of the injury.

Finally, buy your shoes from a running-specific store where the staff can analyze your gait and find a shoe that works best for your needs, and be sure to replace your shoes on a regular basis to ensure maximal cushioning and performance.

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