Running is one of the most accessible and effective forms of exercise, but it comes with its share of injury risks. Research shows that up to 79% of runners experience an injury each year, with certain injuries recurring more than others. The “Big 5” injuries—knee pain, shin splints, stress fractures, plantar fasciitis, and IT band syndrome—can sideline even the most dedicated athletes. The good news is that with proper awareness, strength training, and recovery, many of these injuries are preventable.

Here’s a breakdown of each, along with exercises and strategies to help you stay on track.

1. Knee Pain (Patellofemoral Pain Syndrome)

❓What it is: Often called “runner’s knee,” this pain occurs around or behind the kneecap. Muscle imbalances, overuse, and poor mechanics are common contributors. There are several structures that could be contributing to pain and your physical therapist can identify WHICH structure it is and WHY its happening.

📚What does the research say?: Weak hip abductors and glute muscles have been linked to increased risk of patellofemoral pain in runners (Ferber et al., 2010).

🏋️Prevention Exercises:

• Wall assisted single leg squats– Strengthens gluteus medius to stabilize the hip and knee.
  
  
• Eccentric Step-downs – Improves quadriceps and hip control while simulating single-leg landing mechanics.
  
  

2. Shin Splints (Medial Tibial Stress Syndrome)

❓What it is: Pain along the inner shin, usually caused by repetitive stress on the tibia and     surrounding muscles. Your physical therapist should be able to rule out stress fracture and  identify what structure is the source of your pain (soleus, posterior tibialis, toe flexors)

📚Research-based fact: A 2025 meta-analysis found that age (older runners), low foot arch height, high training volume, and prior injury significantly increase risk of MTSS (Pillai et al, 2025)

🏋️Prevention Exercises:

• Posterior tibialis strengthening– Strengthen posterior tibialis to better absorb impact and improve push off mechanics
  
  
• Solues Stretch on Slant Board – Improves calf flexibility, reducing strain on the shin.
  
  

3. Stress Fractures

❓What it is: Small cracks in the bones of the lower leg or foot, often due to repetitive stress without adequate recovery. The most common place for these to occur in the runner is the tibia, and the metatarsal bones in the foot, but they can also pop up in other areas of the foot and lower leg (navicular bone, fibula) as well as the femur. 

📚Research-based facts: A newer modeling study (“grounded running”) suggests that reducing flight time (i.e., minimizing the airborne phase) during running significantly reduces bone strain (in the tibia-fibula complex), which could lower stress fracture (Khassetarash et al, 2024)

Key Points from Recent Literature

• Lower extremity predominates: tibia > metatarsals > navicular > fibula > calcaneus > femur.
  
  
• Female runners have higher incidence, especially tibial, metatarsal, and pelvic/femoral sites.
  
  
• Distance runners: tibia and metatarsals most common.
  
  
• Sprinters / explosive athletes: metatarsals, femur, and calcaneus more frequent.
  
  
• High-risk areas are weight-bearing, high-load bones that undergo repetitive bending or axial load.
  
  

🏋️Prevention Exercises:

• Single-leg Calf Raises – Strengthen the lower leg muscles to absorb impact.
  
  
• Foot intrinsic strengthening – Strengthen legs and improve bone-loading safely.

4. Plantar Fasciitis

❓What it is: Inflammation of the thick band of tissue on the bottom of the foot, causing heel pain. Pain is usually on the inside of the heel and worst in the morning and with impact

📚Research-based fact: A recent 2025 study showed that manual physical therapy is effective in treatment of plantar fascia thickening, pain intensity and activity limitations, particularly in patients associated with acute plantar fasciitis.(Khammas et al, 2025).

🏋️Prevention Exercises:

• Foot Intrinsics Strengthening (Short foot) – Improves arch support and foot stability.
  
  
• Calf Stretch and Rolling the Foot – Reduces tension on the plantar fascia.
  
  

5. IT Band Syndrome



❓What it is: Pain along the outside of the thigh and knee caused by friction of the iliotibial band over the lateral femoral epicondyle.

📚Research-based fact: A 2023 study found that as runners get more fatigued, activation (via EMG) of several muscles that feed into the IT band — including the glutes (maximus and medius), tensor fascia lata (TFL), and biceps femoris — decreases significantly (Chen et al, 2023)

🏋️Prevention Exercises:

• Side-lying Leg Lifts – Strengthen glute medius to reduce IT band stress.
  
  
• Foam Rolling the IT Band – Helps reduce tissue tightness, though should be combined with strengthening for long-term prevention.
  
  

💥 The Bottom Line

Preventing running injuries isn’t just about logging miles—it’s about strengthening, stretching, and respecting recovery. Incorporating exercises targeting the hips, calves, shins, and feet can significantly reduce your risk of the Big 5 injuries.

Pro tip: Gradually increase mileage, maintain proper running mechanics, and prioritize cross-training and mobility work. Small, consistent steps go a long way toward keeping you running pain-free for years.

📌 Book a consultation today with  Move with Meg to get a tailored plan and hands-on guidance for optimal results.

📩Email Meg at Meg@movewithmegpt.com to schedule your appointment now. 

Read more: https://www.movewithmegpt.com/blog
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Meg Pezzino, PT, DPT, SCS, is a board-certified sports specialist and running-focused physical therapist based in the DMV. Through her practice, Move With Meg Physical Therapy, she helps runners prevent injuries, improve strength, and move with confidence.

Disclaimer: The exercises and recommendations provided are general guidelines for injury prevention and may not be appropriate for everyone. Stop any exercise that causes pain and consult a qualified medical or rehabilitation professional to determine what is safe and appropriate for your individual needs.