Preventing Running Injuries: From Shin Splints to Runner's Knee

Amsterdam is a running city. From loops around Vondelpark to the Amstel and the bridges of the canal belt, it is one of the reasons so many people have taken up running here or built up their weekly kilometres. With more kilometres comes a higher risk of a running injury. Most running injuries do not come from a single wrong step, but from a build-up of load that increases just a bit faster than your body can adapt to. That also means there is a lot you can do, with a few targeted choices, to help prevent running injuries.

In this article we walk through the most common running injuries, explain why training build-up usually matters more than your shoes, and offer practical building blocks: warning signs to recognise, strength exercises, and guidance on when to keep running and when it is worth seeing a physiotherapist.

The 5 most common running injuries

Research into running injuries consistently shows similar patterns: most complaints sit in the knee, lower leg or Achilles tendon, and develop gradually through overuse rather than a single acute event. The five complaints we see most often in runners at Physical Studio are:

• Runner's knee (ITBS), pain on the outside of the knee that increases during running
• Shin splints, a dull or burning pain along the front or inside of the shin bone
• Achilles tendon complaints, stiffness or pain in the Achilles tendon, often most noticeable during the first steps in the morning
• Heel spur and plantar fasciitis, pain under the heel or sole of the foot, typically worst during the first steps after rest
• Proximal hamstring tendinopathy, overuse of the hamstring attachment under the sit bone, often seen in runners who have quickly increased their mileage

What these complaints have in common is that they rarely occur in isolation. Training build-up, strength and running technique often all play a role. That is why at Physical Studio we look beyond just the spot where the pain is.

Why training build-up matters more than shoes

New running shoes are often the first thing people blame when something starts to hurt, but the biggest risk factor for a running injury is usually how quickly your training load increases. Connective tissue such as tendons and the iliotibial band adapts more slowly than muscle and fitness do. Jumping from 20 to 35 kilometres a week within two weeks, or adding interval training without building up to it, asks for an adaptation that tissue simply hasn't had time to make yet.

A commonly used principle is to increase your weekly mileage gradually rather than sharply, and to build in a lighter week after a build-up week so tissue can recover. This is a general guideline, not a guarantee against injury, but it does give direction. Other factors that matter at least as much as footwear: enough sleep and recovery time, variation in running surface, and sufficient strength in hip, knee and ankle to absorb the repeated load of running.

That does not mean shoes are irrelevant. Very worn-out footwear or a shoe that does not suit your running pattern can play a role. But if running injuries keep recurring despite new shoes, the cause more often lies in training build-up, strength or running technique.

Shin splints: recognising and addressing them

Shin splints, also known as medial tibial stress syndrome, feel like a dull or burning pain along the inside or front of the shin bone. The pain usually develops gradually, gets worse during running, and can linger for a while after exercise. This complaint is often seen with a rapid increase in training volume, running on hard surfaces, or insufficient strength in the calf and shin muscles.

In the early phase it often helps to temporarily adjust your training load and switch to a softer surface, such as grass or woodland trails instead of asphalt. Research shows that targeted strength and stability exercises for the lower leg and ankle can help with recovery and with reducing the chance of recurrence. If the pain persists despite adjusting your training, an assessment by a physiotherapist is worthwhile to rule out other causes, such as a stress fracture.

Runner's knee and ITBS: pain on the outside of the knee

Runner's knee, or iliotibial band syndrome (ITBS), causes a sharp or burning pain on the outside of the knee that increases during running and eases again once you stop. The iliotibial band runs from the hip along the outside of the thigh to just below the knee, and with repeated bending and straightening it can rub against a bony point on the outside of the thigh bone.

Runner's knee is often connected to hip stability: weak hip abductors can cause the knee to drop slightly inward during running, increasing the friction. Running on slopes or a cambered surface, and a rapid increase in training volume, often play a role too. Targeted hip stability and strength exercises usually form the core of an approach, combined with temporarily adjusting your training load. Read more about the approach to runner's knee on our conditions page.

Achilles tendon complaints in runners

Achilles tendon complaints often show up as stiffness or pain that is most noticeable during the first steps in the morning or after a period of rest, and that can actually ease off once you warm up. Achilles complaints usually develop gradually, through a combination of training build-up that goes too fast, a jump in hill training or sprint work, and insufficient calf strength to absorb the repeated load of running.

Research shows that exercise therapy, particularly eccentric calf exercises, can be effective in reducing Achilles tendon complaints. It is important to build up the load gradually and not return too quickly to full training intensity. Persistent pain, a sudden snap, or the feeling that the tendon has 'given way', are signals to have this assessed right away, for example by your GP or physiotherapist.

Strength training for runners: 5 key exercises

Runners sometimes skip strength training because it doesn't add kilometres, but sufficient strength in the hip, knee and ankle helps your body absorb the repeated load of running. The exercises below are a general guideline. Build up gradually, pay attention to your form, and stop if you feel pain. If you are unsure which exercises suit your situation, an assessment by a physiotherapist or personal trainer is recommended.

1. Single leg squat

Stand on one leg, slowly bend through the knee and hip as if sitting back into a chair, then rise back up. Make sure your knee stays in line with your second and third toe rather than dropping inward. This exercise trains the hip stability that matters for helping to prevent runner's knee. Start with a small number of repetitions and build up gradually. Stop if you feel pain in the knee.

2. Lateral band walk

Place a resistance band around your lower legs, stand upright and step sideways while keeping tension on the band. Keep your hips facing forward. This exercise targets the hip abductors directly, a muscle group that is often weak in runners dealing with runner's knee or shin splints.

3. Eccentric calf raise

Rise up onto your toes with both legs, shift your weight onto one leg, then slowly lower your heel over a few seconds. This slow, controlled lowering is where most of the training stimulus for the Achilles tendon comes from. Perform the exercise with both a straight and a slightly bent knee, to target different parts of the calf muscle and tendon.

4. Plank with leg lift

Get into a forearm plank position, keep your pelvis stable and alternately lift one leg a few centimetres off the ground. This trains the core stability you need to keep your pelvis and hips stable while running, which in turn affects the knee and shin.

5. Nordic hamstring curl (build-up variant)

Kneel with your ankles secured, for example under a bench or by a partner, and slowly lower your upper body forward from the knees in a controlled way. Catch yourself with your hands as soon as you lose control. This is a demanding exercise that can contribute to general hamstring strength, which is also useful for helping to prevent proximal hamstring tendinopathy. Build up to it gradually, for example starting with support from a partner or a resistance band.

When to keep running and when to see a physiotherapist

A mild, dull muscle soreness after a hard training session is normal and usually not a reason to stop. Sharp, burning or stabbing pain that gets worse while running is a different matter. A useful rule of thumb: if a complaint changes your running pattern, such as limping or clearly slowing down to avoid the pain, that is a signal to stop and adjust your load.

Get in touch with a physiotherapist if a complaint persists for more than one to two weeks despite adjusting your training, if the pain returns as soon as you build back up, or if you're not sure what is causing it. At Physical Studio our physiotherapists are also qualified personal trainers, and where useful we use ultrasound and VALD Force Decks to objectively measure where strength or stability is falling short. You do not need a referral to book an appointment.

Seek medical help right away, for example from your GP or an out-of-hours GP service, if you experience sudden, severe pain after a snap in the calf or Achilles tendon, a strongly swollen or deformed joint, pain that is also present at complete rest, or fever combined with a painful, swollen leg. These are signals that do not fit a typical overuse injury and deserve immediate assessment.

Running in Amsterdam: build-up schedules from Vondelpark to marathon

Amsterdam offers plenty of variation to mix up your training build-up. A loop around Vondelpark is roughly 4.5 kilometres on a relatively soft surface, which makes it well suited to easy endurance runs or recovery jogs. For longer runs, many runners head to the Amstel or the Amsterdamse Bos, where the surface and quieter traffic give room for a longer, steady effort. If you're training towards a running event, such as the Amsterdam half marathon or marathon, it's worth building up your weekly mileage gradually and scheduling a lighter week periodically.

Bridges and quays along the canal belt naturally add some interval and hill-style stimulus to a run, which can be useful as long as you dose it deliberately. For runners training towards a first 10K, half marathon or marathon, it's worthwhile to discuss a training build-up beforehand that suits your current capacity. Our physiotherapists and personal trainers are happy to help, with a running technique analysis and a strength programme matched to your goal and starting level.

Not sure about a recurring complaint, or want your running pattern and strength assessed ahead of a running goal? Book an appointment at Physical Studio, direct access, no referral needed.