Physical Therapy for Runners: The Ultimate Guide to Preventing Injuries

If you’re a runner, you know the importance of staying healthy and injury-free. But even the most experienced runners can find themselves on the sidelines with an injury from time to time. That’s where physical therapy for runners comes in.

Physical therapists are experts in helping runners recover from injuries and preventing them from happening in the first place. In this guide, we’ll discuss how physical therapists work with runners, the most common running injuries, and tips for preventing them. We’ll also give you a sneak peek at some of the top exercises that physical therapists recommend for runners!

Disclaimer: This post was written by JayDee Vykoukal, Doctor of Physical Therapy. It has been reviewed by Chrissy Carroll, MPH, RRCA Running Coach, ACSM cPT. This post is for informational purposes only and does not constitute medical advice. Please consult a physician for any medical concerns.

How Physical Therapists Work with Runners

Physical therapists (PTs) are highly trained experts in the field of sports medicine. They focus on movement disorders and injury rehabilitation, as well as taking a proactive approach to prevent injuries from occurring in the first place.

Whether you’re concerned about a potential injury, dealing with chronic issues, or recovering from a recent injury, a physical therapist can be your best friend for reaching your running goals free of pain (relatively speaking!) and injury- seriously! There are even PTs out there specialized in orthopedics and running to help maximize your performance.

Common Running Injuries

Runners put repetitive stress on their bodies that can lead to injury over time if they aren’t careful. Plus, they can also sustain a sudden injury (like a sprain). According to Healthline, some common running injuries that PTs can help you address include the following:

1. Knee pain

The knee is one of the most vulnerable joints for runners because it bears a lot of weight with each stride you take. Knee pain can be caused by an imbalance between your quadriceps and hamstrings muscles or weakness in your hips, glutes, adductors (inner thigh), and/or abductor (outer thigh) muscles (yes- professional athletes suffer from these issues too!).

More specifically, many runners suffer from patellofemoral syndrome, pain under the kneecap. This can be caused due to structural issues or imbalances listed above that cause tracking issues.

2. Achilles tendonitis

The Achilles tendon is the large tendon that attaches your calf muscle to your heel. Thus, this type of tendonitis is a result of inflammation in this tendon. It’s typically caused by overuse – whether that’s too many total miles in your training program, too much of a steep increase in mileage, or too much speed work.

3. Shin splints

Shin splints can be caused by a number of things, but overuse or a sudden increase in mileage is one of the most common causes. Other causes include weak ankle muscles, poor foot alignment, or incorrect running form.

Shin splints are also known as “medial tibial stress syndrome” and they can come in two forms: anterior shin splints, which affect the muscles on the front of your shin, and posterior shin splints, which affects the muscles on the back of your shin.

4. Plantar Fasciitis

This is caused by inflammation of the plantar fascia, the connective tissue that runs along the bottom of your foot. It’s often caused by overuse, weak ankles, or insufficient arch support. Many times, plantar fasciitis presents with heel pain during or after running, or first thing in the morning.

5. ITB syndrome

This syndrome is characterized by inflammation of the iliotibial band (ITB), a dense band of connective tissue that runs from your upper hip to your knee. It’s often caused by overuse, poor running form, and/or weak hips and glutes.

6. Stress Fractures

These fractures can occur in any bone but are common in the lower leg, foot, and even spine. They’re often caused by overtraining, running on hard surfaces, or running too many miles too quickly.

Athletes with RED-S (relative energy deficiency in sport, aka those not eating enough to fuel their training) may be at increased risk of shin splints as well.

7. Muscles Strains

These strains occur when a muscle or tendon is stretched or torn. They’re often caused by overtraining, poor form, and/or weak muscles that can’t keep up with your training. One of the most common muscles to sustain a strain are the hamstrings.

8. Joint Sprains

These occur when you stretch or tear a ligament, the tissue that connects two bones. They’re most often caused by a sudden, traumatic event (like stepping in a hole or on a rock). Ankle sprains are the most common in runners.

9. Others Potential Injuries

Of course, there are other potential injuries that a runner can sustain. These include hip pain (such as bursitis), low back pain, and upper back pain.

Preventing Injuries with Physical Therapy

As you read through the potential running injuries above, you may have taken note of a few common issues that were leading to problems. Muscle weakness, muscle imbalances, poor form, and overtraining are all common denominators when it comes to running injuries.

The body is intricately connected, making it crucial to recognize connections between all the parts of our body we use to run (which is practically everything). This makes it easy to understand that injuries do not happen in isolation, but rather at a runner’s “weakest point.” For example, a runner may be experiencing foot pain and not realize that it is caused by weakness in the core or glutes (or vice versa). Having an expert that understands these complex relationships is crucial!

Injury Prevention Tips

The best way to avoid injuries as a runner is to take a preventative approach. Here are some tips that can help you stay healthy and running injury-free:

1. See a Physical Therapist

Physical therapists are experts in movement disorders and injury rehabilitation, so they can help you identify any imbalances or weaknesses that may be putting you at risk for an injury. They can also prescribe specific exercises to help address these issues.

These days, you can find a local or virtual PT depending on your needs and preferences. If you don’t have insurance coverage for PT, telehealth has made seeking care reasonably priced and while still remaining high quality (if not more so!).

2. Make Sure Your Shoes Fit Properly

A good pair of running shoes should provide adequate cushioning, support, and stability. If your shoes are old or don’t fit well, it’s time for a new pair! What type of terrain you are running on regularly will also determine what shoes are appropriate for you. Not sure what you need? Talk to a PT or shoe specialist for specific tips.

3. Strength Training

Strengthening your muscles with a consistent routine will help them better absorb the impact of running and reduce your risk of injuries. As a runner, there are specific movements and muscles to focus on, which we’ll discuss below!

4. Stretch Regularly

Stretching after each run will help keep your muscles limber and reduce the risk of strains or tears. This is particularly important for anyone suffering from chronic stiffness (which is a lot of runners!).

5. Cross-Train

Running is a high-impact activity, so it’s important to incorporate other low-impact activities like biking or swimming into your routine. This allows you to give certain muscle groups a break while still getting in some exercise time!

6. Don’t Overdo It

It can be tempting to run as far and fast as possible every day, but this puts you at higher risk for injury. Instead, try adding mileage slowly each week so that your body has time to adapt (and get stronger!). Also, consider taking one (or more) rest day per week where you don’t do any running at all – just relax!

[Related: Need help creating a running plan that fits your goals and fitness level? Here are over 15 running training plan options to try.]

7. Pay Attention to Form

How you run is arguably most important for preventing injury. While there are some general rules to follow, it will also depend on your body’s unique structure, strengths, weaknesses, and even past injuries. You can use a mirror or record a video with your phone to get a general idea of how you’re moving (maybe you’ll notice your upper body is slouched or your stride looks off). If you need more personalized advice, talk to your local PT!

8. Don’t Forget Your Overall Health

One of the best things you can do for your tissue health is to take excellent care of your body. This includes proper nutrition, hydration, sleep, stress management, and more. Be kind to your body!

Physical Therapy Exercises for Runners

Here are some of the top recommended exercises for runners. We’ve broken them up into strength and stretching to make it easy for you.

Strengthening Exercises

These exercises all address common problem areas in the lower legs and core. What’s most important with these is to be able to appropriately activate and coordinate the muscles you are trying to target. This will help ensure that the work you do on these exercises actually carries over to your running form! Try getting these exercises in at least 2 times per week.

Lunges

A great exercise for strengthening your glutes and hamstrings is lunges. Start by standing with your feet hip-width apart, then step forward with one foot so that you’re bending at the knee. Lunge and bend the front knee as far before pushing off backward to return to the starting position. Alternate between sides for 10 to 15 repetitions and 2 to 3 sets total.

Since you are essentially doing a mini-lunge every time you take a stride while running, this is a great move to practice with control. Factors to keep in mind are to keep the hips square, knees, hips, and feet aligned, and to stay light on your feet as you move in and out of the position.

Jump Squats

Start by standing with the feet hip-width apart, then squat down as if you’re sitting in a chair – keep your weight on your heels, not your toes. Squat down as low as possible before springing back up to lift the feet 1 to 3 inches off the ground. Then land gently back in the starting position and repeat 10 times for 3 sets.

Once again, the key is to focus on form and land lightly. Keep the knees behind the toes and aligned with the outside edge of the foot and your core tight. Choose a speed you can do with good form with the goal of increasing your power and speed as tolerated.

Singe Leg Deadlift

Start by standing on one leg and lifting the other off of the ground, then bend forward at your waist to touch your toes while keeping the balancing leg and back in a straight line. Keep your weight balanced through your foot planted on the ground (and core tight) as you return to the starting position. Repeat 10 times on one leg before switching to the other side.

Focus on keeping your hips square (not rotating) and back flat. When comfortable, you can add weight to your hands.

Resistance Band Monster Walks

This exercise will strengthen your glutes and hips, which are key for running endurance and form. Wrap a loop resistance band around both ankles, then walk forward with the right foot, followed by the left. Keep the legs hip-width apart (or even wider) with each step. Take about 20 steps for each set, repeating 2 to 3 times. Additionally, you can try side-stepping in each direction as well.

Most importantly, focus on keeping good form throughout the body to maximize your efforts and boost your running stamina.

Stretching Exercises

Below are a few stretches to address areas that are often tight and sore in runners.

Runner’s Stretch

This is a runner’s favorite because it addresses the commonly tight hip flexors (front of the thigh). Start by stepping into a wide lunge stance with the leg/hip you want to stretch in the back. The amount of stretch correlates to the placement of your feet (how far apart they are). Once you’ve found a comfortable position that keeps the front knee safe (not in front of the toes or collapsing inward), hold the position for 30+ seconds for 2-3 sets.

If you’re having trouble holding this position or want a deeper stretch, try dropping your back knee to the ground.

Calf Stretch

This is an easy exercise to do before or after running that will help loosen tight calf muscles. Place one foot behind you on a raised surface such as a step or curb, with the ball of your foot pressed firmly against it. Let the heel fall down toward the ground so that you feel a stretch in the back of your leg – hold for 30 seconds (or more) before switching legs.

Hamstring Stretch

This final classic stretch is used to prevent injury by stretching the muscles in the back of your thighs (which get tight during running). Sit on the ground with one leg extended out in front of you while resting the opposite leg on the ground. Use your hands to pull your straight leg up toward the ceiling until a stretch is felt. Use a belt or strap as needed if you are having trouble reaching and relaxing at the same time Hold for 30+ seconds for 2-3 sets.

Child’s Pose

This is a basic yoga pose that helps to stretch out your lower back and hips. Plus, you can add your upper back and arms into the mix by keeping your arms outstretched in front of you. Start by kneeling on the ground with the tops of your feet flat on the floor, then bending forward until the chest is resting on thighs and forehead touches the floor. At the same time, your butt will move as close to your heels as possible. Hold for 30 seconds before releasing. Repeat for 2 to 3 sets as needed.

Many yoga poses are a great way for runners to get in some functional stretching. Other options include pigeon, cat/cow, butterfly, downward dog, and more.

Foam Rolling

This is a great way to loosen up tight muscles and help prevent injury. Place a foam roller underneath the muscle you want to stretch and massage, then slowly roll back and forth over it. You can also use your own bodyweight to apply pressure by leaning on the roller. Do this for each of the following muscles: hamstrings, quadriceps, IT band, and calves.

For a full explanation and demo, see the ultimate guide to foam rolling.

The Bottom Line

A well-balanced home exercise program is crucial for preventing and managing runner injuries. The exercises listed above are a great place to start. Additionally, regular physical therapy can help prevent common running injuries. A PT will work with you to improve your strength, flexibility, and mobility with personalized recommendations- which are all key for runners. Having a PT on speed dial is one of the best tools you can utilize to keep reaching your running goals injury-free!

Feel free to pin this post to share with others!