Keeping injury-free while training or increasing mileage can seem like an impossible task, but through proper conditioning and knowledge, runners can stay healthy while tacking on additional mileage and shedding minutes off their pace. This is the second half of a two-part article on preventing injuries and knowing the telltale symptoms of common running pains; for a thorough analysis of injuries from the head to the waist, see Part I.

Legs and Ankles

A thorough, detailed analysis of leg and ankle injuries could last a lifetime. Certain leg cramps and common injuries, however, can be averted through conditioning, stretching, and strength training. A combination of static and dynamic stretching, along with muscle massages post-run, can alleviate cramping, keep legs limber, and even lengthen some muscles and ligaments for improved performance.

Upper-Leg Pain

When pain from the top of the kneecap to the bottom of the groin is severe enough that walking is made difficult, it is important to seek the consult of an orthopedist. Lesser-symptoms in the region (those which do not prevent movement, but make legs feel “stiff”) can include cramping in the quadriceps (front of thigh) or hamstring (tendon which runs on either side of the back of the knee), or tightness in the Iliotibial band (a thickening of tissue on the outside of the thigh, running perpendicular to the ground when standing) to name but a few common symptoms.

To prevent muscle cramping in the upper leg, runners should:

• Stretch thoroughly. By performing a combination of static (sitting) and dynamic (moving) stretches, runners can improve blood flow to key muscle groups and experience an increased range of motion.
• Build distance slowly. Adding more than a 10% increase in mileage per week can cause muscle strain and cause serious injury. Be sure to only add 10% extra on top of the week’s longest accomplished distance.
• Perform strength training exercises. When executed properly, weightlifting exercises such as squatting and deadlifting can work under-used running muscles, boosting overall leg strength and stability.

Knee Pain

Knee pain can result from myriad causes, though the most common knee injuries are the result of overuse, over-burdening, or improper running form. Many novice runners experience Chondromalacia, a pain along the ridges of the kneecap that is caused by the rubbing of the patella against the cartilage-laced edges of the femur and tibia within the knee joint. Other common knee injuries include patellofemoral pain (also known as Jumper’s Knee—a pain which is felt underneath the bottom of the knee cap), and Baker’s cysts (the sensation of pain and a lump behind the knee, resulting from a non-malignant growth which may need to be removed by an orthopaedic surgeon). When knee pain is sharp, prevents flexibility, and happens at random, this may be the sign of a meniscal tear and should be treated by a doctor before resuming athletic activity.

To prevent knee pain, runners should:

• Strengthen supporting muscle groups around the painful joints. By increasing strength in these areas, less strain is put on joints and allows them to move more freely.
• Cross-train as often as possible. By alternating forms of exercise, overall leg strength improves.
• Improve their running stride. Focusing on the way in which a runner’s foot hits the ground can have a profound impact on the amount of stress placed on the knee. An average runner’s knee absorbs three times his or her body weight on every footfall, so maintaining proper form (legs kept limber, feet landing as close to the center of the body as possible, maintaining short strides) can alleviate the amount of force placed on delicate joints.
• Find a proper pair of shoes. Selecting a shoe which provides the proper level of cushioning and support can help alleviate knee pain. While some runners praise the barefoot experience over bulkier, corrective shoe models, it is important to pick a pair which works best for a runner’s body no matter the make or model.

Shin Pain/Shin Splints

Shin splints, known formally as medial tibial stress syndrome, are caused by excess forces pushing against the connective tissues surrounding the shin bone. In many cases, shin splints are the result of muscles being over-taxed—leaving them unable to bear the weight and shock forces of running. Increasing mileage and/or speed too quickly does not allow muscles enough time to strengthen, causing pain as they struggle to keep up with the extra work. Additionally, shin splints can occur when runners incorporate uneven terrain, hard surfaces, or hills into their workouts without gradual incorporation into a workout routine.

To prevent shin splints, runners should:

• Add distance slowly. Most runners should abide by the “Ten-percent rule,” which states that runners should only add ten percent of their previous week’s workout to an upcoming week’s schedule. For example, a person who runs 20 miles in one week should only add two miles to his or her workout the next week.
• Incorporate uneven surfaces into a workout gradually. If a runner is looking to incorporate trail or hill workouts, he or she should do so gradually over time.
• Ensure that all footwear is in good condition. Old and worn-out shoes may not cushion the foot properly, leading to increased forces being placed on the shin.
• Improve form. Leaning forward or backward, along with inefficient foot striking, can place unnecessary pressure on key muscle groups around the shin.

Achilles Tendonitis

Achilles tendonitis, one of the most common and vexing of all running injuries, can cause immense pain and derail even the strongest athlete. This injury has many causes, but among the most common are a lack of flexibility, overpronation, over-training, and a change in shoe style (transitioning from a stability model to a minimalist shoe, for example). Typically, Achilles tendonitis sufferers will experience pain anywhere from the heel of the foot to the bottom of the calf muscle, with pain setting in after physical activity has stopped.

To prevent Achilles tendonitis, runners should:

• Stretch thoroughly. Static stretching can allow many runners to improve flexibility in the muscles surrounding the Achilles, which will allow the tendon to become more elastic over time. Walking and light jogging can also help stretch tight muscles in this area.
• Use RICE (Rest, Ice, Compression, and Elevation). Runners who have a track record of Achilles tendonitis should consider preventative measures by applying RICE after runs—even when symptoms are not severe.
• Pay attention to running form. As mentioned throughout the article, improving running form can help prevent many common injuries as the body moves more efficiently.

Ankle Pain

A full examination of the differing symptoms and injuries a runner can experience in the ankle would could call for an article devoted solely to the topic. Many of the most common injuries, including sprains and twists, can be avoided by using the same techniques to improve muscle strength in the area along with flexibility. In addition to strengthening and stretching, ankle injuries can be prevented through experience and conditioning.

To prevent common ankle pains, runners should:

• Stretch frequently. Rotating the foot in a circular motion can help stretch vital ankle muscles, promoting flexibility in the region.
• Build strength. Building ankle strength can make the joint more capable of withstanding potential twists and sprains from uneven surfaces. Ankle plantarflexion (raising one’s body onto the tips of one’s toes) and ankle dorsiflexion (rocking one’s body weight onto one’s heels) are two exercises which can build muscle surrounding the joint.
• Wear proper shoes. Runners experiencing chronic ankle pain should consider wearing running shoes which provide additional ankle stability. See our shoe review section for examples.

Feet and Toes

As with ankle pain, there are myriad foot injuries experienced by runners, but a few common injuries stand out among the rest. Plantar fasciitis, extensor tendonitis, blisters, and toenail injuries are among the most commonly-experienced ailments. Plantar fasciitis is inflammation of the tendons in the bottom of the foot, extensor tendonitis is inflammation of tendons running along the top of the foot to the toes, blisters are painful fluid buildups on the skin, and toenail injuries can include blisters on the nail bed—or as many distance runners will attest to—black or otherwise-discolored toenails due to acute injury.

To prevent plantar fasciitis, runners should:

• Use the RICE method to alleviate painful symptoms as they arise.
• Consider changing running shoes. As discussed in Christopher McDougall’s Born to Run, some runners have benefitted from transitioning to minimalist shoes, barefoot-simulating shoes, or barefoot running in its entirety.
• Alternatively, consider custom orthotics. Orthotics can help runners land on their feet differently, reducing the amount of stress placed on the heel.

To prevent extensor tendonitis, runners should:

• Ease into new shoes slowly. Extensor tendon pain is a common result of runners logging too many miles in minimalist-style shoes too quickly.
• Consider using foam tape to cushion the painful region of the foot. Foam tape can help buffer the tendon from hitting the top of the foot—a common cause of this form of tendonitis.
• As with most inflammatory injuries, use the RICE method when experiencing symptoms.

To prevent skin, blistering, and toenail injuries, runners should:

• Wear properly-fitting shoes. Ill-fitting footwear may not allow feet to dissipate moisture, leading to blisters. Additionally, shoes which do not fit properly in the toe box can cause toenail injuries due to impact stress—the toenail hits the top of the shoe, causing blistering and bruising.
• Use non-cotton socks for long-distance runs. Cotton socks retain moisture, forcing skin to become chafed and irritated. Consider wearing moisture-wicking running socks made of non-cotton materials.
• Use foam tape at the onset of toe pain. Foam tape can create a cushioned buffer between a potentially-injured nail bed and the shoe, mitigating symptoms before they get worse.