Common Running Injuries in Trail Runners (And How Physiotherapy Can Help)

Trail running is exhilarating, offering runners the chance to experience fresh air, spectacular mountains, and breathtaking views. However, the varied terrain, steep inclines, and technical obstacles increase the risk of injury and many a trail ends in a trial for the runner. In endurance trail running, where trail runners are sometimes running over the span of more than one day, athletes often push their bodies to the limit, which increases the risk of injury.

Let us look at some of the most common injuries among trail runners and explore how physiotherapy can help recovery and prevent re-injury.

1. Ankle sprains   

Ankle sprains occur when the ligaments supporting the ankle are overstretched, often from uneven surfaces or sudden changes in direction.

- Symptoms: Pain, swelling, bruising, and limited movement.

- Physiotherapy treatment:

• ‍Strapping to provide support and avoid further injury.
• ‍Manual therapy to improve joint mobility.
• ‍Strength exercises for the ankle, focusing on surrounding muscles for better support.

- Prevention tips: Physiotherapists can advise strength work to lower the risk of re-injury.

2. Runner’s knee

Runner's knee (or patellofemoral pain syndrome) is the result of repetitive stress on the knee joint, often aggravated by downhill running.

- Symptoms: Pain around or behind the kneecap, especially when going downhill or after long periods of trail running.

- Physiotherapy treatment:

• Strengthening exercises targeting the hip and quadriceps.
• Kinesio taping to reduce knee strain.

- Prevention tips: Physiotherapists can help with form correction, focusing on avoiding knee collapse during steps, and advise footwear changes if necessary.

3. Plantar fasciitis  

Inflammation of the plantar fascia, the thick band of tissue running across the bottom of the foot, often from high-impact landings or poor footwear support.

- Symptoms: Sharp pain in the heel, particularly in the morning or after long periods of standing.

- Physiotherapy treatment:

• Soft tissue mobilisation to release tension in the foot and calf.
• Shockwave therapy to improve blood flow and speed up healing.
• High-power laser therapy to reduce inflammation of the plantar fascia and promote tissue repair. 

- Prevention tips: Physiotherapists can strengthen foot and calf muscles and select trail-appropriate footwear.

4. Achilles tendonitis 

An overuse injury of the Achilles tendon, which connects the calf muscles to the heel, often aggravated by sudden increases in training intensity or incline.

- Symptoms: Pain and stiffness at the back of the heel, particularly in the morning or after physical activity.

- Physiotherapy treatment:

• Eccentric exercises to strengthen the Achilles tendon.
• Shockwave therapy to stimulate healing.
• Range-of-motion work for the ankle to restore flexibility.

- Prevention tips: Physiotherapists often recommend a gradual build-up in training intensity, combined with calf-strengthening exercises.

5. IT band syndrome   

Inflammation of the iliotibial (IT) band, a thick band of connective tissue that runs down the outside of the thigh, often due to repetitive bending and straightening of the knee on uneven ground.

- Symptoms: Pain on the outside of the knee, which can worsen with prolonged downhill running.

- Physiotherapy treatment:

• Manual therapy for releasing tension along the IT band and hip muscles.
• Strength training focusing on hip stabilisers to reduce the strain on the knee.
• Stretching and flexibility work to improve muscle balance.

- Prevention tips: Physiotherapists advise a combination of strength and mobility training for a balanced approach.

6. Hamstring strains   

Overstretching or tearing of the hamstring muscles, often occurring during fast descents or when tackling steep terrain.

- Symptoms: Sharp pain in the back of the thigh, bruising, and difficulty moving the leg.

- Physiotherapy treatment:

• Rehabilitation exercises to gradually restore hamstring strength.
• Dry needling to release muscle tension.
• Kinesio taping to provide support and ensure a safe return to running.

- Prevention tips: Physiotherapists advise a well-rounded strengthening routine that includes the glutes and core to prevent future strains.

While trail running provides a unique adventure, it also presents distinct challenges for the body. If you are dealing with any of these injuries, a physiotherapist can help you not only recover but also provide advice on how to prevent future issues.  

At Hein Viljoen Physiotherapy, we feel happy when we get to help trail runners keep on running those trails they love. Whether through manual therapy, strengthening programmes, or advanced treatments like shockwave or high-power laser therapy, we can assist you in healing from and prevent injuries. Let's talk about how we can run alongside you on your journey to recovery and enjoyment.