Running injuries – The basics

With grateful thanks to Bronwyn Cottrell – B.Sc. Physiotherapy (Wits) 

As a physiotherapist and a keen runner, I often get asked advice on what is the best way to avoid an injury. Unfortunately, injuries are largely multidimensional and seldom is it simply one factor which is the cause of injuries. A common mistake I see in many runners is herd diagnosis and treatment plan. Runners typically love to run in groups; stories and secrets are shared on the run, as are injuries, prevention and treatment too. There is a ‘running injury trend’ and often a common treatment works for most, however it is important to remember that no one is a textbook, and what works to John may not necessarily work for Jane.

In time I will unpack running injuries, what are the leading causes and through my experience what has worked best in treating or preventing such injuries. It is however vital that one remembers that its s advised that an injured runner should be assessed by a medical professional so that individual and focused treatment plans can be prescribed.

Extensive research has been done on sporting injuries and the prevention there of, and one cannot argue the fact that strength work and exercise prescription are key fundamentals in rehabilitation. Running is primarily a one-legged sport and thus most of my running rehab involves one legged exercise which naturally need to be done on both legs.

I was brought up in a running house, where both my parents would go out in the early hours of the morning Tuesday to Sunday to get their morning fix. I now find myself starting my day with a morning run before the day can start. Being surrounded by long distance runners my whole life and being one myself I understand the runner’s psyche. How many runners do you know do their rehab exercises? Very very few. As the trend to run with a coach is increasing, I am glad to say more and more runners are starting to include strength sessions into the week however this number is still pretty low. The thinking of a runner typically goes, ‘I have done my run, I have had my work out.” And so, most of us get home and get on with the day.

As a result of this I like to give my patients 4-5 key exercises to do as soon as they get home from the run. Many patients will argue they do not have the time, as they need to shower, get kids up and get to work. Thus, I encourage those that feel that to cut the run 5 minutes short. 5 minutes that is all. Get home and do these exercises while the kettle boils, make them part of the run. My exercises are always individual based exercises. Here however are five of my favourites:

1. One leg shoulder bridge.

One leg shoulder bridge

This exercise focuses largely on the hamstring and glutes and is a great way to load the hamstring tendon. This exercise can be played with I order to increase or decrease difficulty as needed. Try aiming to eventually do 3 sets of 10 one leg shoulder bridges using a Pilate’s ball.

2. Step-up.


A great exercise for quad activation and important one to do when trail running as this mimic the action needed to climb boulders and koppies. The quads are the powerhouse of the legs and strong quads have been shown to play a vital role in the rehab of knee injuries.

3. X- Band walks

X-Band Walk

No this is not a one leg exercise but must be my absolute favourite glute exercise. Strong glutes are important for any lower limb function as well as stability during one leg activities, sadly not many people know how to get them working. In my practice majority of patients with lower limb injuries have weak glutes. I have often heard people say you need to run with your glutes, and I am still trying to figure out how this is done. I do however know how to get the glutes working so that when you run your glutes will be strong and therefore will be activated.

4. 747.


Good proprioception is important when running. This is the position sense of your body, so that your brain subconsciously knows where your limbs are in space. Sadly, this is often forgotten or ignored. Good proprioception will make you a better more efficient runner. I am often surprised as to how many runners cannot balance on one leg. If you can’t balance on one leg how can you run without placing stress and strain through the body? One can play with exercise in order to make it more difficult and challenging as your proprioception improves.

5. 12 O’-clock

12 O’-clock

This must be my favourite exercise. It works everything while closely mimicking the running form. No, you do not touch the floor while running but if you can do this exercise with perfect form and control you can be sure that you can run with perfect form and control.

Exercise prescription is largely individually based that includes the prescription of repetitions of an exercise. There is little research out there that states what number of reps are best for exercise. Typically, your runner is not looking to build big muscles but wanting to improve strength and endurance of these muscles. As mentioned typically runners are also looking for a quick fix that can be done while the kettle boils. Therefore, I commonly prescribe these exercises 3 sets of 8-10 after every run. For long distance runners I try encouraging them to include them in after a long weekend run too as it is a great opportunity to build endurance strength of tired legs.

I have spent much time on the other side of the bed and know better than most how hard it can be to include strength work into a training programme. I have however experienced the value of it too, after a big hamstring injury and a broken foot without the focused rehab I would never have gotten back on the road to pre injury state as quickly and efficiently as I did.