Trail and Ultra Running Injuries and How to Heal Up!

Injuries in trail and ultramarathon running can put a damper on the stoke, and unfortunately are common to find. Most runners suffer some kind of injury every year. With every mile, our muscles are breaking down while hopefully on their way to getting stronger. Sometimes, they break down too much though, and lead to one of the injuries discussed below.

In this article we will cover the causes, symptoms, and common fixes to the following:

Runners Knee
Illiotibial Band Syndrome
Achille’s Tendinitis
Plantar’s Fasciitis
Shin Splints
Avulsion Fractures
Stress Fractures
Patellar Tendinitis
Overtraining Syndrome

Runner’s Knee

This injury is so common that it was named after us. In more scientific terms, patellofemoral pain syndrome (PFPS) is an overuse injury that is a result of repeated impact on the knee joint that comes from hard surfaces like asphalt (especially “crowned” roads), long downhills, or having a major muscle group in your legs stronger than its opposite group, such as quadriceps vs hamstrings. A common symptom is pain on the front of the knee, especially under or behind the kneecap (whereas pain to the side of the kneecap may be ITBS, listed below).

PFPS may be a “slow burn”, meaning you have experienced pain getting worse over time. A reason for this may be the gradual breakdown of the cartilage in your joints, specifically in the knee. The pain may feel like it radiates from an epicenter, vs. having a specific sharp pain point. Often, an uphill grade tends to cause more irritation with this injury than would a downhill grade, but either may induce pain.

Cutting back on milage, or switching to a low impact activity like cycling, mountain biking, or swimming for a couple of weeks is a pretty common fix. A light dosage of anti-inflammatory medicine and gently stretching your major leg muscle groups is a good addition as well. 

Illiotibial Band Syndrome (ITBS)

The Illiotibial Band is a huge tendon that wraps from your outer glutes/hips to the knee. When you touch your outer thigh, you are touching the IT band. Though it is a tendon, it can still become inflamed or irritated, as can the muscle structures beneath it. This happens as a result of the band moving back and forth across muscles and the bone structures beneath. Irritation is increased if you are running on a sloped road, or a surface the repeatedly causes one footstep or hip to be higher than the other.

ITBS is typically felt on the outside lower area of the knee. It is common to care for by resting, alternating low-impact activities, icing. Also, stretching and strengthening the legs, hips, and lower back can help with prevention.

Achilles Tendonitis

The Achilles Tendon in the grouping of tissues that connects your heel to your gastrocnemius – or calf – muscles. A common cause for inflammation is a rapid increase in hills, rapid increase in volume, or an increase in speed work. Switching shoes could also lead to inflammation, especially if the heel-to-toe drop of your shoes changed since the last model that you wore. 

Symptoms are stiffness or a pulling feeling on the back of your ankle or in your calves.

Though this is felt primarily in the Achilles Tendon and calves, it can be a result of stiffness in many muscle groups. Rolling and stretching across all the major leg muscles groups can help to loosen your muscles all round. Otherwise, gently stretch the calves, ice the affected area, and reduce volume or rest completely. 

Plantar Fasciitis

The plantar fascia is commonly referred to as the arch – that tissue across the bottom of your foot. Flex that muscle too much (or not enough) and you can wind up with overused (or too weak) of plantar fascia. If you wake up and the first steps out of bed feel like your muscles are tearing away from themselves, but then the pain eases as you get moving, that is a pretty good indicator that you’ve got PF going on. 

This can be a tricky one to get rid of, but it can be done!

First, get your feet checked out at a running specialty store. They’ll be able to see how much support and/or cushion you’ll need. More does not always equal better. 

Second, roll a golf ball or Rubz ball against the floor with your foot. This will help break apart any dead muscle tissue. There are also special socks made that keep your toes flexed at night so that the muscles heal while they are most extended, therefore not breaking down with each footstep. A quick search for Plantar Fasciitis Sock should get you some results.

Third, heat the area to keep those muscles loose. 

Fourth, consider a low impact sport while healing.

Finally, consider talking to a doctor about orthotics if the pain continues long term. There are arguments for and against orthotics. For, being that it offers “support” and relief where you need it. If you always support a muscle though, it doesn’t have to be used and gets weaker. This could cause reliance on the orthotic, potentially leading to a vicious cycle of always needing more and more support. 

Shin Splints

If your shins feel like they are on fire when you walk to the coffee pot, or run to the end of the driveway, there’s a chance you’ve got shin splints. 

When your muscles and tissues get overused, they become inflamed and irritated. This inflammation can come from an increase in volume, improper fitting or worn out shoes (lack of or too much support), and weak or imbalanced muscles. This is also common in track athletes due to the repetitive directional pull of the same muscles.

Rest up. Gently massage your shins and apply ice for 10-15 minutes a few times per day to ease the inflammation. Stretch your ankles and shins by rotating your foot in circles while pressing your toes into the ground with your shoes on before and after activity.

Avulsion Fracture

If you rotate a joint hard enough, your tendon may pull a piece of the bone away from itself either completely, or partially, almost like a zipper pulling your bone apart. This may happen with a severe ankle roll. 

Symptoms will be immediate pain and swelling in the location of the fracture. You may even hear the bone break, much like a tree branch. Pain upon pressure application or loss of movement of the area is common. Try to get ice on the area as soon as possible to keep the swelling down, and elevate the affected area.

You should seek professional medical attention if you believe you have an avulsion fracture. A doctor will likely X-ray the area and propose soft wrap, a boot, a cast, or surgery based on severity. A doctor may prescribe an anti-inflammatory to keep pain and swelling at bay. A minimum of 6-14 weeks of complete rest or alternate activity should be expected, with potentially longer times.

(Run Infinite’s Coach Brandon had a 5th metatarsal fracture in 2017. The bone was “partially zipped down”. He spent 11 weeks in a boot, and it was 13 weeks before being able to run again, if you’re curious. Not rad, but you’ll make it through!)

Stress Fracture

This is yet another overuse injury caused by repetitive stress on a bone that supports weight. Most stress fractures from running occur in the shins, but the pelvis and femur are also subject to potential fracturing. 

A stress fracture is likely to feel like an isolated, hot, sharp pain. They often come on without warning. If applying pressure to the area makes it hurt more, this could indicate a stress fracture.

Taking time off is critical with this injury in order to prevent a full blown break. Ice can help ease the pain and swelling. A physician may suggest some kind of support like crutches depending on severity.

Patellar Tendinitis

If you press just beneath the knee and bend your leg in and out, you’ll feel the patellar tendon activating. If this area is painful  or swollen, you might have patellar tendinitis. This injury is often referred to as “jumper’s knee”. This injury originates from overuse resulting in actions like kicking, climbing, and jumping, which put stress on the tendon. 

There are many muscle groups that connect in near the knee. Therefore, maintaining flexibility by stretching can help relieve tightness and muscles pulling against each other in this area. As usual, rest and ice are typically the fix. A physical therapist may suggest an exercise regimen to strengthen the area around the tendon if need


This one is as simple as it sounds- too much exposure to sun! For you mountain runners, is important to note that with elevation gain, UV rays are harsher. The American Academy of Dermatology has found that there is an 8-10% increase in UV harshness per 1,000ft of elevation gain [1]. This means that somebody in Breckenridge, CO may burn twice as fast as somebody at sea level.

This tends to be a factor on race day and on those weekend long runs. Remember that even in the winter, the sun shines and protection is important. It is possible to have rays reflect off snow and burn your eyes! 

High SPF sunscreen, UPF clothing, and UV protective sunglasses are your best bet against the sun rays. If you find yourself getting burned, make sure to stay hydrated and apply aloe vera to the affected area. In more extreme cases, such as peeling, consider seeing a physician.

Overtraining Syndrome (OTS)

Overtraining Syndrome is a mixture of  just about everything. Mental burnout, calorie defict, low energy, continual soreness or lethargy, declining performance, increased resting heart rate. mood swings, amenorrhea, and lack of enthusiasm are all potential symptoms. Essentially, you’re training so much that your body can’t catch up through recovery or adaptation and the body starts to holistically show the wear and tear. 

Overtraining is real and serious. If you feel that you are overtraining, you need to take some time to rest, sleep, and eat nutrient packed foods to let your body catch up to you! 

We’ve got an entire article dedicated to this topic. Check it out!


A common cause is an improperly fitting shoe. A rule of thumb (literally) is to leave one thumbnail length between your big toe and the end of the shoe. Experiment with different socks to find what works best. Most people find success with wool or synthetic material instead of cotton. Toe socks may also help prevent the skin-on-skin contact between your toes. Yup, they feel funky, but more comfy that a blister if you are prone to them in that area. Applying an anti-chafe before activity may also help.

If you get blisters, try to resist popping them and let them disappear on their own. If they cause discomfort or force you to alter your form, disinfect the skin and use a sterile needle to drain them. Cover with a band aid and antiseptic. Do not pull the skin off! Allow the skin to dry and fall off on its own in order to form callous that will toughen the skin and make you less prone to blisters in the future.


Whenever something touches your skin, you lose skin cells. Magnify that by thousands of steps, salty sweat, some dirt, and fabric, and you’ve got a situation that is ready for some chafing. Repetitive contact with anything else can leave your skin raw or even bloody. It happens to almost everybody, whether on thighs, armpits, or unspeakables. 

Preventative action is best with products like Gold Bond or Body Glide. Band Aids on the nipples are an honest way to prevent chafe on race day. Similarly, for those long ultra days wearing a pack, duct tape on your shoulders/side of neck can minimize skin contact too. 

In conclusion:

With most injuries, take a RICE approach. Rest, ice, compress, and elevate. Success and recovery happens over time; you can’t eat the fruit the same day you plant the seed.


Other sources used intermittently:

Four Pass Loop

Just outside the mountain town of Aspen, Colorado lies one of the pinnacle trail running experiences in Colorado: The Four Pass Loop. Enveloped by flowered tundra, alpine lakes, jagged peaks, lush grasses, streams, and every color in the spectrum, this giant loop takes you for a ride, as its name claims, over four separate mountain passes.

Leadville 100 Mile

Rich with mining history, the Race Across the Sky is one of America’s original 100 milers and one of the most competitive. Bring your high-altitude lungs!

Notify of
Inline Feedbacks
View all comments
Trail running ultrarunning training plans 100 mile 50 marathon 14ers mountain

30 DAY




Let's Run Together. Follow Along.

Send Stoke. Support the Site.