12.AUG.2016 6 MIN READ | 6 MIN READ

A survey conducted by the Australian Sports Commission found that 70% of recreational and competitive runners sustain injuries over any 12-month period.

Last updated on 28 January 2021

Singaporeans are increasingly health conscious and choosing to adopt healthier lifestyles that consist of more and more exercise. However, this supposedly healthy approach also increases the risk of injury. Running, one of the most common and popular forms of exercise, contains significant risk.

A common injury is known as runner’s knee. This is a collective term to describe several conditions that lead to pain around the kneecap or patella, such as anterior knee pain syndrome, patellofemoral malalignment, chondromalacia patella and iliotibial band syndrome.

The risk for injury is higher for middle-aged weekend warriors – working professionals above the age of 45 who adopt a semi-regular exercise regime in a bid to keep themselves healthy as they get older. A study published in the Orthopaedic Journal of Sports Medicine found that novice runners between the ages of 45 – 65 are at the highest risk of getting injured during running, with those between the ages of 30 – 45 coming in second.

The risk of runner's knee develops from overuse or traumatic injuries

Runner injury risk
“Injuries sustained from running are often overuse injuries,” says Dr Kevin Lee, an orthopaedic surgeon practicing in Mount Elizabeth Hospital, Singapore. These injuries can occur in any age group but the middle-aged weekend warriors do tend to get more of it.”

Causes of running injury

Based on the study, these are the 2 main reasons why this occurs:

  • General fitness: as people grow older, their muscles, ligaments and joints tend to get weaker, which means that they are more susceptible to injury.
  • Body weight: as people who are not active tend to get heavier as they grow older.

“The common musculoskeletal injuries sustained during running are mostly lower limbs, like knee or ankle injuries and they are either overuse injuries or traumatic injuries (from falls or accidents),” Dr Lee says.

“Overuse injuries are more common and, as the term implies, arise from over-training and are not uncommon in novice runners who amp up their running volume or intensity in a sudden, non-progressive manner. This does not allow the body (in particular the bones, tendons, ligaments and muscles) to adapt to the increased workload and they thus sustain stress-related injuries such as ligament tears, ACL injury or sprained ankles.”

What are the most common injuries caused by running?

According to Dr Lee, the 5 most common injuries caused by running are:

Shin splint and stress fracture

Shin splints present as pain on the inner side of the lower leg and is a type of overuse injury. This is due to inflammation of the lining on the inner side of the shinbone. Treatment includes rest, ice, stretches and anti-inflammatory medications. With the above measures, most shin splints resolve in about 2 weeks. If runners persist in running despite the pain, then shin splints can progress to stress fractures of the shin, heel and foot.

Quadriceps or patella tendonitis refers to the inflammation of the quadriceps tendons which lie below and above the patella (knee cap) respectively. This is a common overuse injury caused by repeated high intensity workouts.

Iliotibial band syndrome (ITBS)

The ITB is a thick band of tendon-like tissue that starts from the outside of the hip and pelvis, and runs down the side of the thigh and inserts into the outside and front of the knee. This is an overuse injury that presents as pain on the outside of the knee or outside of the hip.

Ankle sprain

This is a traumatic injury and usually caused by running on uneven terrain. Ankle ligaments on the outside of the ankle are usually partially torn and this causes bruising and swelling.

Meniscus tear

Meniscus tear is a traumatic injury of the knee that usually involves a twisting motion around the knee. There are 2 menisci in the knee and they are rubber-like structures that act as shock absorbers. When the meniscus is torn, there will be pain in the knee when running, bending and squatting. It can also feel unstable and locked (a feeling of the knee getting stuck at a certain position).

When to receive specialist treatment for running injuries?

When to seek specialist treatment
When it comes to overuse injuries, it can be difficult to know whether you are suffering from a serious injury or just a slight muscle pull. Unless there is severe pain that affects mobility, Dr Lee recommends the RICE (Rest, Ice, Compress, Elevation) method as the initial treatment. This is a common self-treatment where you should apply a cold compress to the affected area and rest the affected limb, preferably on a slightly elevated surface.

Proper adherence to the RICE method can usually alleviate minor running injuries over a period of time. “However, if pain and swelling in the particular joint or limb persists 2 weeks after the injury despite rest, icing the injured part and taking painkillers, then you should seek specialist medical attention,” Dr Lee says.

How to treat running injuries?

Depending on the severity of your condition, treatment can range from surgery to anti-inflammation medication. For those whose conditions are between the extremes of this range, there are a few specialised treatments that can help, says Dr Lee.

Radial shockwave therapy

Radial shockwave therapy is the application of pressure waves to the injured area. The shockwave is absorbed by the tissue, creating reactions that can help improve recovery. This treatment can be used for tendonitis, ITBS and heel pain.

Platelet-rich plasma (PRP) treatment

Platelet-rich plasma (PRP) treatment is another new procedure that can be used to treat conditions such as tendon injuries, muscle tears and joint sprains. Platelets are the component in blood that is responsible for clotting and the healing of injuries. Blood is drawn from the patient, and the concentration of the platelets is increased through a process known as centrifugation. The now platelet-rich blood can then be injected into the affected area to speed up recovery. This treatment can be used on an assortment of sports injuries and help with recovery after an operation.

Keyhole surgery or minimally invasive surgery

Keyhole surgery, or minimally invasive surgery, can be an option for those who require minor surgery. Unlike traditional open surgery, keyhole surgery involves only 2 or more small incisions near the affected area. A small pinhole camera is inserted into an incision to provide the surgeon with vision of the affected area. Surgical tools are inserted through other incisions to allow the surgeon to repair ligament and tendon tears. Multiple studies have shown that keyhole surgery performed by an experienced surgeon is just as effective as traditional open surgery over the long-term, while having a shorter recovery time and less pain.

What are the risks of delayed treatment?

Risks of delayed treatment
It’s not uncommon for people to dismiss injuries sustained from running and other sports as minor inconveniences that will go away with time. Many also attribute such problems to getting old.

However, lack of treatment can have grave consequences in the long run. “When treatment is delayed for overuse injuries such as patella tendonitis or ITB syndrome, these conditions will become chronic and less receptive to conservative treatment,” Dr Lee says. “Early treatment is essential so that recovery is quicker and patients can return to running much earlier.”

Knee meniscus tear

In the case of traumatic injuries such as meniscus tears, delays in treatment might result in the tear becoming larger or the patient sustaining further injuries, such as ligament tears. This will result in a more complicated surgery and more pain for the patient. A knee with a meniscus or ligament (usually the anterior cruciate ligament) tear that is left untreated is also unstable.

Knee osteoarthritis

“Over time, there is accelerated wearing out of the knee cartilage,” Dr Lee explains. “Widespread loss of knee cartilage is known as osteoarthritis in the knee and in severe cases, the only solution might be a knee replacement procedure.”


Article contributed by Dr Kevin Lee, orthopaedic surgeon at Mount Elizabeth Hospital


Nielsen, R O, et al. (2013, May 2) Predictors of Running-Related Injuries Among 930 Novice Runners: A 1-Year Prospective Follow-up Study. Orthopaedic Journal of Sports Medicine, 1(1). DOI: https://doi.org/10.1177/2325967113487316

Running. (n.d.) Retrieved from http://sma.org.au/resources-advice/sports-fact-sheets/running/

Lee Boon Leng Kevin
Orthopaedic Surgeon
Mount Elizabeth Hospital

Dr Kevin Lee is an orthopaedic surgeon practising at Mount Elizabeth Hospital and Parkway East Hospital.