Common Injuries and Illnesses in Running

  1. Ankle Sprains
  2. Stress Fractures (e.g., tibia, metatarsals)
  3. Plantar Fasciitis
  4. Achilles Tendinopathy
  5. Shin Splints (Medial Tibial Stress Syndrome)
  6. IT Band Syndrome
  7. Runner’s Knee (Patellofemoral Pain Syndrome)
  8. Hamstring Strains
  9. Heat Exhaustion / Heat Stroke
  10. Hypoglycaemia
  11. Dehydration
  12. Muscle Cramps

Injury Management Framework

1. Ankle Sprain

  • Causes: Poor footing, uneven ground, rapid changes in direction.
  • Signs/Symptoms: Swelling, pain, bruising, difficulty weight bearing.
  • First Aid: RICE, elevate, do not continue running.
  • Paramedic: Check for fracture (Ottawa rules), neurovascular status, analgesia per JRCALC.
  • First Aid Level: Compress with bandage, monitor swelling, refer to GP or physio.

2. Stress Fractures

  • Causes: Overuse, poor shoes, increase in training.
  • Signs/Symptoms: Localised pain, worse with weight-bearing.
  • First Aid: Cease activity, immobilise if needed.
  • Paramedic: Immobilise, analgesia, advise imaging.
  • First Aid Level: Support with splint or padding, refer to A&E or GP.

3. Plantar Fasciitis

  • Causes: Poor arch support, overtraining.
  • Signs/Symptoms: Heel pain, worse in morning or with initial steps.
  • First Aid: Rest, ice, stretch calf/foot.
  • Paramedic: Rule out Achilles rupture, advise onward referral.
  • First Aid Level: Recommend supportive footwear, refer to physio.

4. Achilles Tendinopathy

  • Causes: Excessive hill running, poor warm-up.
  • Signs/Symptoms: Heel/ankle pain, swelling.
  • First Aid: Ice, rest, avoid running.
  • Paramedic: Consider rupture if sudden onset, immobilise.
  • First Aid Level: Advise GP follow-up, heel supports.

5. Shin Splints

  • Causes: Overtraining, improper shoes.
  • Signs/Symptoms: Diffuse shin pain.
  • First Aid: Ice, rest.
  • Paramedic: Differentiate from stress fracture.
  • First Aid Level: Refer to GP or physio.

6. IT Band Syndrome

  • Causes: Downhill running, tight IT band.
  • Signs/Symptoms: Outer knee pain, worse on flexion.
  • First Aid: Stretching, rest.
  • Paramedic: Rule out knee pathology.
  • First Aid Level: Recommend foam rolling, physio.

7. Runner’s Knee

  • Causes: Overuse, misalignment, weak quads.
  • Signs/Symptoms: Anterior knee pain, crepitus.
  • First Aid: Rest, ice.
  • Paramedic: Exclude dislocation, refer to GP.
  • First Aid Level: Strength exercises, tape support.

8. Hamstring Strain

  • Causes: Sprinting, overstriding.
  • Signs/Symptoms: Sudden pain, bruising, weakness.
  • First Aid: RICE.
  • Paramedic: Assess for rupture, provide analgesia.
  • First Aid Level: Advise rest, avoid stretching acutely.

9. Heat Exhaustion / Heat Stroke

  • Causes: Overexertion in heat.
  • Signs/Symptoms: Dizziness, nausea, cramps, confusion.
  • First Aid: Remove from heat, cool rapidly.
  • Paramedic: ABCs, IV fluids, active cooling per JRCALC.
  • First Aid Level: Cool packs, shade, fluids orally if alert.

10. Hypoglycaemia

  • Causes: Inadequate food intake, diabetic medication.
  • Signs/Symptoms: Sweating, confusion, tremors, unconsciousness.
  • First Aid: Oral glucose if conscious.
  • Paramedic: Confirm with BM test, administer glucose IV or IM as per JRCALC.
  • First Aid Level: Sugary drink or gel, monitor.

11. Dehydration

  • Causes: Fluid loss > fluid intake.
  • Signs/Symptoms: Dry mouth, dizziness, cramps.
  • First Aid: Encourage oral fluids.
  • Paramedic: Assess severity, IV fluids if needed.
  • First Aid Level: Rest, encourage sips of water.

12. Muscle Cramps

  • Causes: Electrolyte imbalance, dehydration.
  • Signs/Symptoms: Sudden tightness or pain.
  • First Aid: Stretching, massage.
  • Paramedic: Electrolyte assessment if needed.
  • First Aid Level: Rest, hydrate, stretch.

 

Return-to-Play/Work Criteria

Condition Minimum Time Off Clearance By Criteria for Return
Ankle Sprain 3–7 days GP/Physio Full ROM, no pain
Stress Fracture 4–8 weeks Hospital X-ray confirms healing
Plantar Fasciitis 1–4 weeks GP Pain-free, normal gait
Achilles Tendinopathy 2–6 weeks GP/Physio No swelling, full ROM
Shin Splints 2–4 weeks GP/Physio Pain-free running
IT Band Syndrome 1–3 weeks Physio No pain, full range
Runner’s Knee 2–4 weeks GP Quadriceps strength normal
Hamstring Strain 2–6 weeks Physio Full strength, no pain
Heat Stroke 1–2 weeks GP Normal vitals and hydration
Hypoglycaemia Case-by-case GP Cause identified and managed
Dehydration 1–3 days Self/GP Normal fluid balance
Muscle Cramps 1–2 days Self/Physio Adequate hydration, normal electrolytes

Performer/Participant Injury Info Sheet

What to Do if Injured:

  • Stop running immediately
  • Notify nearest medic or event official
  • Do not continue without assessment

Who to Report To:

  • Event medic, team leader, or supervisor

Why You Cannot Return Without Clearance:

  • Continuing could worsen the injury
  • Medical personnel need to verify you’re safe to participate

What ‘Clearance’ Means:

  • Evaluation from a GP, physio, or emergency department
  • Written confirmation or discharge
  • Demonstrated pain-free, safe movement

 

Quick Reference Guide for Medics/First Aiders

Immediate Steps:

  1. Assess scene safety
  2. Determine level of consciousness
  3. Control any bleeding or deformity
  4. Apply RICE where indicated
  5. Administer glucose if needed and safe
  6. Call 999 for collapse, cardiac arrest, or unresponsive casualties

Return to Participation:

  • Mild injuries may return once pain-free and stable
  • Medical clearance needed for significant injuries

Red Flags for Escalation:

  • Unconsciousness or confusion
  • Inability to weight bear
  • Obvious deformity
  • Chest pain or cardiac symptoms
  • Severe swelling or neurovascular compromise

 

Injury Summary Table

Injury First Aid Red Flags Clearance
Ankle Sprain RICE Inability to walk, deformity GP/Physio
Heat Stroke Cool, fluids Confusion, collapse GP/Hospital
Hypoglycaemia Glucose Seizure, coma GP/Paramedic
Cardiac Arrest CPR, AED Unresponsive Hospital/Cardiology

 

Sample/Examples of how you could document for CPD

What?
I reviewed a detailed guide on common injuries and medical emergencies in runners. It covered presentations such as ankle sprains, stress fractures, shin splints, plantar fasciitis, heat stroke, hypoglycaemia, and dehydration. The document provided symptom breakdowns, red flags requiring escalation, and return-to-play guidance, along with clear first aid and paramedic-level responses.

So What?
I regularly attend 999 calls to collapsed or injured runners in parks, streets, and public footpaths. This article helped refresh my differential diagnosis when assessing lower limb pain, such as distinguishing shin splints from stress fractures or Achilles tendinopathy from plantar fasciitis. It reinforced key red flags like neurovascular compromise, inability to weight bear, and altered conscious states. The sections on heat-related illness and hypoglycaemia were particularly useful for real-time street-level triage, especially with minimal history. It reminded me of the importance of applying structured assessment frameworks such the Ottawa Ankle Rules and considering safeguarding when someone is found collapsed alone in training gear.

Now What?
I’ll incorporate this into my quick-reference notes for use during summer shift cycles when exercise-related incidents are more common. I plan to revisit JRCALC guidance on heat stroke and prehospital glucose protocols to ensure alignment. I’ll also share this with newer colleagues or students during shift debriefs to discuss decision-making around conveyance, escalation, and the importance of documenting safe return-to-activity advice, even when patients decline transport.

Estimate Time: to read, digest and read any links that are referred to: 45 minutes