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The Most Common Running Injuries

In view of the upcoming Hong Kong Marathon, our sports osteopath at The Round Clinic, Arthur Codsi, was invited by ESCAPADE Sports to write an article about the causes and treatment of the most common running injuries.

Shin Splints

Best described as "pain along the inner edge of the shinbone (tibia). Runners are the first ones to be affected because of the repetitive weight-bearing on the shinbone.


  • Pain lower region of leg, between knee and ankle, on the outer side.

  • On the lateral part of the tibia you’ll find the Tibialis Anterior which gets affected primarily.

  • can be confused with “tibial stress fracture”, which is a similar pain, but feels more internal than outer side.

  • Usually one side only.


Biomechanically, over-pronation is the common cause for this injury. This happens when the foot inside arch collapses. Shocks from running will be absorbed less effectively and the arch-collaps puts the tibialis muscle in over-drive, causing the inflammation.A previous ankle sprain, tight calf muscles and old shoes all contribute to the process.


Manual osteopathic treatment and temporary refrain from running are your best bet.

The over-pronation necessitates custom-made orthotics to correct the faulty ankle mechanics. Stretching main calf muscles are also necessary as they lower pressure at the front on the tibia.

Chondromalacia patellae

Also known as “runners knee” - it is an inflammation on the patella as well as softening of the cartilage underneath. Cartilages absorb and smoothen the movements of joints. The patella moves up and down when bending/extending the knee which allows more levers to be put on the knee joints. If that movement is being impaired, inflammation and local pain sensation develops.


Generally felt around the patella plus front and inner side of the knee.

The main muscle controlling the patella is located on the inner part of your leg (Vastus Medialis - part of the Quadriceps) so watching out for tenderness around there is usually a good indicator.


Poor kneecap alignment due to unilateral traction on the kneecap from the Quadriceps muscle. Underlying is a pelvic misalignment.


If not too much cartilage damage, usual inflammation treatment will be effective - RICE (Rest, Icing, Compression, Elevation). This may be coupled with anti-inflammatory medicines and manual therapy such as osteopathy to accelerate the healing process. A rotation of the pelvic alignment needs to be assessed and corrected in order to normalise the traction path of the leg muscle.

Plantar Fasciitis

The base of the foot is being helped by a thin layer of muscle called the Plantar Fascia. This fibrous band of connective tissue starts at the heel and goes all the way to the toes. The primary function is to support the arches as well as absorb shocks during walking, running and jumping.


50% of the cases, pain will mainly affect the point on insertion on the heel, the other 50% on the whole sole of the foot. It will be most severe in the morning when muscles are cold and after periods of rest with pressure on the foot. Any pressure through the arches (jumping, running, standing on tip-toes) will likely cause pain.

Risk Factors:

  • Tight calf (due to common insertion with achilles tendon)

  • High arches

  • Leg length difference

  • Running on hard surfaces


First-line conservative approaches include rest, heat, ice, and calf-strengthening exercises as it is closely related to the fascia through the heel. Stretching those areas will be necessary to lower inflammation in the fibres. You may also use a soft ball to roll on the sole and look for tender points. Acupuncture has also shown to give great results for this particular pathology.

Good Luck!

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