As a workout, running has much to offer. Runners don’t need classes, physical facilities or equipment, other than a pair of shoes, so it’s inexpensive. It’s an easy and accessible sport that can be done nearly anywhere, so it is not difficult to fit a run into a busy schedule. But there is one disadvantage to running as a workout: People who do a lot of it tend to get hurt.

In fact, at least 50 percent of regular runners get hurt each year—some estimates put the percentage even higher—sometimes from trauma, such as a fall, but more often from overuse.

“People who run, love it. But you need the right preparation to be a safe runner and avoid injuries,” says Elizabeth Gardner, MD, a Yale Medicine orthopedic surgeon who specializes in sports medicine. She recommends getting fitted for sneakers at a store that specializes in running shoes, and balancing running with other workouts like swimming or yoga that don’t involve pounding the pavement. “Cross-training and stretching go a long way toward avoiding running injuries."

Yale Medicine Orthopedics & Rehabilitation offers expert diagnosis and treatment for all types of running injuries.

Though there is a near endless list of ways people can hurt themselves while running, the vast majority of running injuries fall into one of the three following categories.

Iliotibial (IT) band friction syndrome. The IT band is made of fibrous tissue that connects the buttocks muscles to the upper portion of the tibia (shin). A root cause of this injury is weak gluteus (buttock) muscles. IT band injuries are particularly common in women, because their wider hips stress the IT band, which irritates the bursa of inflamed tissue.

• What it feels like. An IT band injury is particularly painful when a person with one tries to run downhill or walk down stairs. The pain can be located either on the side of the hip or on the outer side of the knee.
• How it is diagnosed. IT band injuries can often be diagnosed based on the patient’s description of symptoms and a physical exam that identifies tightness in the affected body part. The doctor may not need to do an X-ray or other imaging, unless there is concern about a related problem.
• How it is treated. IT band syndrome can almost always be resolved without surgery, but it takes consistent effort. Treatment strategies involve stretching and/or foam rolling the IT band; patients learn different exercises they can do at home to lengthen and strengthen gluteal muscles, along with the IT band and hamstrings. If that fails to work, very rarely surgery may be required to release the IT band.

Stress fracture. Small breaks that result from overuse, stress fractures can happen in the tibia (shin bone) or metatarsal bones of the feet, as a result of repetitive pounding on surfaces. Dietary factors (such as an eating disorder or lack of dairy) can predispose a person to stress fracture.

• What it feels like. Unlike many running injuries that don’t actually hurt until later, some people describe the pain of a stress fracture as feeling like “a knife is jabbing into the bone with every step you take.” A stress fracture requires immediate attention, because if it progresses, the person can end up fracturing the whole bone, all the way through.
• How it is diagnosed. Symptoms (such as the inability to bear weight or walk) and a clinical exam can suggest the possibility of stress fracture, but the diagnosis is always confirmed by an imaging study. Most can be identified by X-ray; a small percentage require magnetic resonance imagery (MRI) to determine the extent of the break.
• How it is treated. A person with a stress fracture needs to wear a cast and use crutches to allow the bone to heal, which can take as long as 12 weeks. A significant break may need surgery for fixation. A permanent pin may be placed at the site of the break to provide extra support and a foundation for healing. 

Runner’s knee. This injury has multiple sources. It can be caused by weakness or imbalance of the quadriceps (thigh) muscles or problems with your feet (such as flat feet). Abnormal alignment of your leg bones, which ends up putting additional pressure on the kneecap, can also contribute as it can wear down the cartilage under the kneecap.

• What it feels like. People with runner’s knee experience tenderness around the patella or just under the kneecaps. The pain is often worse when walking up or down stairs or while squatting, kneeling or sitting cross-legged.
• How it’s diagnosed. Though an experienced orthopedic doctor is often able to make a diagnosis based on the patient’s description of symptoms and a physical exam, imaging tests—including an X-ray or MRI—are often used for confirmation.
• How it’s treated. Rest, anti-inflammatory pain medications and physical therapy (including stretching and strengthening exercises) are the mainstay of treatment. It is also important to make sure the patient is wearing appropriate footwear.  Some patients benefit from steroid or hyaluronic acid injections or injections of platelet-rich plasma to stimulate healing.

Yale Medicine is known for being among the first to offer innovative treatments for all types of orthopedic injuries, including those affecting runners. We are on the forefront of developing and utilizing effective new treatments, such as platelet-rich plasma, to stimulate healing factors.

 Another advantage of seeking treatment at Yale Medicine is that athletes work with like-minded physicians who understand that the last thing a patient wants to hear is the advice to stop taking part in activities the patient finds rewarding.

“Many of our doctors are athletes themselves—or they have had athletic careers in the past,” says Dr. Gardner, who played field hockey and captained the women’s lacrosse team while she was an undergraduate at Yale. “We want to take care of your injuries and get you back to your sport as quickly as possible. But most of all, we want to help you avoid getting injured in the first place!”