More people than ever are turning to outdoor running as a safe option for exercise during the pandemic. Whether you’re new to running or a regular runner, it’s likely that you’ve experienced pain associated with running at some point. This is extremely common. We tend to believe that running is something everyone can and should be able to enjoy since it’s one of the most natural forms of exercise. Unfortunately, the reality is that running without pain is not always the norm. Regular running takes a toll on the body and requires proactive measures for it to remain pain free. 

Below are eight commons reasons that running might cause pain, along with exercises, stretches and actions you can take to keep yourself healthy and ready to hit the pavement.

Please note: I will be posting videos on my IGTV over the next few weeks to help people better understand the exercises and stretches under “actions to take” for each issue. Join me on Instagram for the latest updates.

1. IT Band Syndrome

Pain Location: Lateral aspect of knee, top of hip or both

What it is: Overuse of the connective band of tissue that runs from the hip to the knee on the outside of the thigh. Although most commonly associated with overuse from running, the IT band can also get excessively tight from weak muscles in the glutes, hips, legs and low back. If you feel pain or tightness on the outside of your knee when your heel hits the ground during running then your IT band is in need of stretching and/or cross-training for injury prevention.

Actions to Take: A balance of flexibility and strength training is usually key for preventing IT band syndrome. Foam rolling is a great first action to take even though it may feel uncomfortable on the outer thigh if your IT band is especially tight. It will get easier the more you do it. (I recommend a high-density roller by SPRI.) Stretching the IT band can also be done by crossing the tight leg behind the other and leaning the torso away from the affected side. Lastly, strengthen weak muscles and replace a couple days of running with strength training for a while. Two great exercises to start with are clam shells and hip bridges while squeezing a medicine ball, pilates ring or yoga block between the thighs. 

2. Weak Transverse Abdominus

Pain Location: Low back, hip flexor tightness, sometimes achilles pain too

What it is: The transverse abdominus (TA) is a muscle that wraps around the core and stabilizes it. Subsequently, it also helps stabilize the pelvis and the spine. When the TA is strong, it helps prevent low back pain and keeps the pelvis in the correct position. When it’s weak, the pelvis drifts into an anterior tilt and places strain on the lumbar spine. The TA can become weak from lack of use, incorrect use or improper pelvic and spinal posture. 

Actions to Take: Physical therapy and Pilates training are both great options for learning how to properly engage the TA. If these options are inaccessible then simply start with supine pelvic tilts, dead bugs, and planks drawing the belly button to spine so that the stomach flattens.  

3. Large Q-angle

Pain Location: Medial aspect of knee; can result in patellofemoral pain syndrome, chrondromalacia or ACL injuries

What it is: The q-angle is a measurement from the patella (knee cap) to a point on the pelvis. This measurement tends to be larger for women due to greater pelvic width (“them birthing hips!”). The larger the q-angle, the greater the stress on the knee due to the patella tracking more laterally instead of smoothly up and down.

Actions to Take: Although structural width of the pelvis is obviously out of our individual control, women can take proactive measures to strengthen the medial aspect of the knee and to keep the lateral aspect from being too tight. This might include wall squats and glute strengthening for enhanced stability as well as isolated quadricep extension with rotation to target the vastus medialis obliqus (VMO) – i.e. the most medial muscle fiber in the quadriceps group. Stretching tight muscles such as hamstrings, calves and the lateral aspect of the quadricep can also prove helpful.

4. Unstable Ankles

Pain Location: Ankle pain or weakness and/or plantar fascia pain. Can also impact higher joints resulting in knee, hip and/or low back pain. 

What it is: Unstable ankles result from weak muscles in the feet and/or lower legs. Core stabilization also impacts how stable the ankles are. If you notice discomfort in the ankles or feet when running then you might need to improve stability, especially if you are prone to ankle sprains.   

Actions to Take: Balancing exercises can be useful for improving ankle stability. It’s easy to get creative with how these are done too (single leg reach, balancing side leg lifts, dancer’s pose, warrior III, and more). Towel grabs and other foot strengthening exercises can also prove useful. Rolling out the plantar fascia with a pin roller or on a lacrosse ball can help release tight areas that compensate for weakness. 

5. Improper Footwear

Pain Location: Pain usually begins in the foot but higher joints can eventually become painful if footwear is not corrected

What it is: Improper footwear can be the result of shoes that are worn out, tied too tight or loose, or are not correctly fitted to your foot shape, length and/or width. Running shoes that fit properly should have approximately 1/2-inch room after the toe before the end of the shoe. They should not cut off circulation when laced up and also should not slip down the heel. A proper fit for your arch is extremely important too. Whether you have a neutral, high or low arch matters a lot for running comfort and shoes should be fitted according to your individual needs. You know you’re ready for a new pair of shoes when you’ve run between 300-500 miles and the tread of the shoe is worn down. If you’re not sure how many miles you’ve run then a good rule is to replace shoes every six months.  

Actions to Take: I like to tell people to visit smaller, local running stores to get fitted. Most have die-hard, passionate runners working in them and they are often trained in basic gait analysis so they can get you the right shoe.

6. Weak Abductors

Pain Location: Weak abductor muscles (think the lateral part of your glutes that stabilize your hips, low back and outer thighs) can result in IT band syndrome, patellofemoral pain syndrome and/or abductor tears. Most of these injuries are from overuse of the muscles while running and/or jumping during sports. Overuse doesn’t always mean that a muscle is strong. As is usually the case with abductors, these injuries stem from weak muscles.   

What it is: Weak abductor muscles can be identified in one of several ways: 1) Perform a squat and note if your knees drift inward. This is a telltale sign that the abductors are weaker than the opposing muscle group (the adductors). 2) Make note of your foot’s arch. Many people who are flat-footed and excessively pronate tend to have weak abductors. 3) Perform a clamshell or side lying leg lift with the leg that is lying on top. If this feels difficult right away or quickly after starting, your muscles may need strengthening.

Actions to Take: Clamshells and side-lying leg lifts are two of the first exercisees I recommend to clients, as well as supervised side lunges with correct form. Once a baseline of strength is established therabands are a great way to ramp up resistance and build on progress. 

7. Poor Running Gait

Pain Location: Poor running gait can impact any joint or muscle in your body from head to toe depending on what the issue is. 

What it is: Normal running is smooth and not “jumpy” looking. When there is excessive up/down movement that places extra stress on the joints. There should be a brief “flight phase” when both feet are off the ground but it shouldn’t look like a person is jumping rope or doing jumping jacks. Posture should be upright, not slumped, and arms should be bent at roughly 90 degrees at the elbows, staying relatively close to the body and swinging gently forward and back with slight rotational movement. If you notice that you’re bending forward in your torso while running or that your arms swing really low, high or wide then you may experience some upper body discomfort as well as lose energy efficiency in the exercise. Feet should be landing and rolling from mid-foot to forefoot smoothly, not striking hard with the heel first. Lastly, stride length should be appropriate for your size and athleticism. For most people, a large stride length reduces hip extension and causes issues. If you feel that you’re a “heel striker” then correcting your stride length might be the place to start. 

Actions to Take: It’s extremely hard to analyze your own gait. As you may be able to tell, gait analysis is complicated and takes an expert’s experienced eyes and feedback. You can start by filming yourself running outdoors or on a treadmill and seeing if anything stands out as appearing unusual – sometimes you might surprise yourself! But your best bet is to get with a running coach or personal trainer who specializes in running. You could even test your luck at a local running store when you get fitted for your next pair of shoes. Sometimes these stores have treadmills set up so that experts can help offer feedback on your shoe and running gait needs. 

8. Poor Running Posture & Thoracic Weakness

Pain Location: To be fair, I already mentioned poor running posture in the last section about running gait, but it warrants more attention. Nearly every week I see a handful of runners in my neighborhood alone who are in dire need of postural help. You may consider improving your posture while running if you feel pain in your upper back, neck and/or shoulders afterwards. Poor posture can translate down your body and result in weak glutes, tight hip flexors and improper foot strike. 

What it is: When thoracic and spinal extension muscles such as traps, rhomboids, lats, rear delts, erector spinae, multifidus and more are weak then it becomes difficult for the torso to maintain an upright position during running. As the body slumps forward the lungs close off, making breathing more labored, and the hip flexors take over work that hip extensors should be driving. 

Actions to Take: Strength training several times a week is critical to correct posture so that you can run pain free and so that you can *live* pain free. Posture impacts quite a lot. One of the most important places to start is with thoracic extensions. In other words, teaching your body to isolate and lift tall from the upper back. Trunks lifts from a mat or prone on a bosu ball are great options. Also, it will be important to do full spine extensions from a mat. Quadruped exercises and supermans are great beginner exercises. Dumbbells and weight machines might also come in handy to target the rotator cuff, traps, rhomboids, rear delts, lats, etc. To sum, kick-start a strength training program focused on the back and/or find one to follow along with.

Run and be happy (& pain free)!

Yours in health and wellness,

Maggie