By Dr. Marc Gregory Guillen, PT, DPT, OCS, FAAOMPT
Free Body Physical Therapy · Chicago, IL
Last updated: March 6, 2026 · Reading time: ~11 minutes
If your shins are aching, your knee is grumbling, or your Achilles is barking after your first real outdoor runs of the season — you are not unlucky. You are statistically average. Roughly half of recreational runners pick up an injury every year, and the majority cluster in the few weeks when training volume jumps. After more than a decade treating runners in Wicker Park and Humboldt Park, we see the same wave from March through May. The good news: most spring running injuries are predictable, preventable, and highly treatable — if you understand what is actually going wrong inside the tissue, not just where it hurts.
The short answer. Spring running injuries are caused by a load-capacity gap — your training volume rises faster than your tissues can adapt. The six conditions that account for the majority of cases are runner’s knee, shin splints, Achilles tendinopathy, IT band syndrome, plantar fasciopathy, and hamstring strains. The fastest fixes are not rest and stretching. They are progressive loading, targeted strengthening up and down the kinetic chain, and treating the root biomechanical cause — not just the site of pain.
In this guide
- Why spring is the riskiest season for runners
- The 6 running injuries we treat most every spring
- Push through, or get evaluated? How to tell the difference
- How physical therapy actually treats running injuries
- What injury prevention actually looks like (and what doesn’t work)
- Frequently asked questions
- Ready to run pain-free? Book your evaluation
Why spring is the riskiest season for runners
The core problem isn’t running. It’s the mismatch between what your body is conditioned to handle and what you’re suddenly asking it to do. A Chicago winter spent on a treadmill — or off your feet entirely — leaves your tendons, bones, and connective tissue adapted to lower loads. When the temperature climbs into the 50s and you jump from 10 miles a week to 25, those tissues simply cannot remodel fast enough.
In our clinic, we call this the load-capacity gap. Your training load surges, but your tissue capacity stayed at winter levels. A 12-month prospective study published in Sports Medicine — Open found that previous injury is the single strongest predictor of future running injuries, and that about 51% of runners in their cohort sustained at least one injury during the surveillance period. Spring is when that gap is widest — and when the injury clock starts ticking fastest.
Chicago-specific factors make this worse. The Lakefront Trail’s concrete is far less forgiving than a treadmill belt. Wind off Lake Michigan changes your stride mechanics. And the packed spring race calendar — the Shamrock Shuffle in March, Chi Town Half in April, Chicago Spring Half Marathon in May — creates pressure to ramp up before your body is ready for it.
The 6 running injuries we treat most every spring
Across the running injury literature, the knee, ankle/foot, and lower leg consistently account for more than 80% of all running-related injuries. Here are the six conditions we see most between March and June at Free Body Physical Therapy — and what’s actually happening underneath each one.
1. Runner’s Knee (Patellofemoral Pain Syndrome)
Runner’s knee is the single most common running injury, responsible for up to 16% of all running-related diagnoses according to a systematic review published in the Journal of Sport & Health Science. It shows up as a diffuse ache around or behind the kneecap that worsens with stairs, squatting, or longer runs.
What’s actually happening: Weakness in the hip abductors and quadriceps allows the kneecap to track poorly in its groove, creating friction and irritation. After a winter of reduced running, these stabilizing muscles are often the first to lose their conditioning. However, the knee doesn’t work in isolation — the hamstrings play a critical role in controlling knee flexion load and deceleration forces during each stride, while the adductors help govern lower limb alignment from the hip down. Further down the chain, calf weakness (particularly the soleus) reduces the ankle’s ability to absorb impact, pushing excessive load up into the knee with every footfall.
What we do in clinic: We assess hip and ankle mechanics first — not just the knee. Treatment typically involves targeted hip strengthening (especially the glutes and adductors), quadriceps and hamstring retraining, calf and soleus loading work, manual therapy to address any joint restrictions, and a gradual return-to-run protocol.
2. Shin Splints (Medial Tibial Stress Syndrome)
That burning ache along the inner edge of your shinbone is the hallmark of medial tibial stress syndrome — and it’s worth understanding what’s actually going on, because not all shin pain is the same.
What’s actually happening: MTSS is a bone stress injury driven by repetitive loading that outpaces the tibia’s ability to remodel. A weakened soleus that fails to control tibial load during push-off, weak intrinsic foot muscles shifting demand onto the flexor digitorum longus, and restricted ankle dorsiflexion all consistently show up as contributing factors. It’s also worth distinguishing MTSS from a tibial stress fracture — they share similar mechanisms but are distinct injuries. A stress fracture presents with pinpoint tenderness at one spot; MTSS produces a more diffuse band of soreness running 4–6 cm along the posteromedial shin.
What we do in clinic: We differentiate MTSS from stress fractures through a thorough clinical exam — and refer for imaging when suspicion is high. Treatment targets the underlying movement faults: soleus and calf loading work, intrinsic foot strengthening, ankle mobility, and restoring hindfoot control in weight-bearing. We also address training load directly, because no amount of rehab overrides a mileage spike. Most patients feel significant relief within the first few weeks once the load imbalance and the mechanics driving it are corrected.
3. Achilles Tendinopathy
That stiffness in your heel on the first few steps out of bed, or the ache that builds during a run and lingers after — that’s the hallmark of Achilles tendinopathy, and one of the most stubborn injuries a runner can face.
What’s actually happening: The Achilles doesn’t fail from a single event — it fails when load repeatedly exceeds the tendon’s capacity to adapt. The tendon cells become reactive, producing substances that disrupt the matrix and drive pain. Weakness in the calf, particularly the soleus, is almost universally present, meaning the tendon is constantly being asked to absorb more than it can handle.
What we do in clinic: The goal is matching load to the tendon’s current capacity — not rest, but the right kind of loading. Isometric calf holds are often the entry point, loading the tendon without the high-energy demands that aggravate a reactive tendon, and they have a well-documented pain-relieving effect. From there we build progressively through strength work and endurance before reintroducing the elastic demands of running. Timelines vary, but the structured progression is what separates a full return to running from a cycle of flare-ups. The APTA Clinical Practice Guideline for midportion Achilles tendinopathy supports this multimodal, loading-based approach.
4. IT Band Syndrome (Lateral Knee Pain)
That sharp or burning pain on the outer side of your knee, often appearing at a predictable point in your run, is typically labeled IT band syndrome — and it’s one of the most misunderstood injuries in running.
What’s actually happening: The traditional explanation — that the IT band is tight and rubs back and forth over the lateral femoral epicondyle — has been largely debunked. MRI and cadaver research shows it’s a fixed, dense structure that doesn’t actually move over the bone. You couldn’t stretch it if you tried; you could tow a car with it. The current evidence points to fat pad compression beneath the band as the likely pain source. It’s also worth knowing that “IT band syndrome” is one of the most overdiagnosed labels in running — lateral knee pain can come from the lateral meniscus, proximal tibiofibular joint, gluteus medius trigger points, lumbar referral, and more. Getting the right diagnosis matters because the treatment for each is different.
What we do in clinic: We don’t reach for the foam roller — it achieves nothing on a structure that doesn’t lengthen. We assess the full chain: foot and ankle mechanics, hip strength, lumbar involvement, and neural tension. The imbalances driving lateral knee stress are rarely local — hip weakness, restricted ankle mobility, a stiff proximal tibiofibular joint and other factors can all accumulate over miles. Treatment targets whatever combination we find, alongside gait retraining where indicated.
5. Plantar Fasciitis (Plantar Fasciopathy)
That sharp heel pain on your first steps out of bed is one of the most recognizable feelings in running — and one of the most mismanaged.
What’s actually happening: “Plantar fasciitis” is a misnomer — current evidence points to collagen breakdown and tissue degeneration, not inflammation. The plantar fascia sits on the same load-continuum as tendon injuries: reactive overload, disrepair, and degeneration. The primary driver is a biomechanical fault that turns the fascia into a stress riser — most commonly restricted hindfoot mobility combined with weak intrinsic foot muscles. It’s also worth noting that not all heel pain is plantar fasciopathy: lateral plantar nerve involvement, fat pad pathology, and calcaneal bone stress reactions can all present similarly and need to be ruled out.
What we do in clinic: We identify the biomechanical fault first — without addressing that, the tissue never gets a chance to heal. Treatment combines hindfoot joint mobilization, intrinsic foot strengthening, and progressive loading of the fascia itself. Trigger points in the gastrocnemius, soleus, tibialis posterior, long toe flexors, and abductor hallucis are frequently overlooked contributors — we address these directly with dry needling, which can make a significant difference to symptoms. Low-load isometrics are the entry point, with good evidence for immediate pain relief, before building through higher load work and back to the demands of running. Most patients see significant improvement within 12 weeks with the right program.
6. Hamstring Strains
Hamstring injuries spike in spring when runners add speed work or hill repeats before their posterior chain is ready. The APTA Clinical Practice Guidelines for hamstring strain injuries emphasize that a history of previous hamstring injury is the strongest risk factor for reinjury — making proper rehabilitation critical.
What’s actually happening: A hamstring strain occurs when the muscle or the muscle-tendon unit is loaded beyond its capacity, most commonly during high-speed running or forceful hip flexion under load. Where the pain sits tells us a lot about what we’re dealing with. Mid-belly pain raises the question of whether the hamstring — and the surrounding posterior chain — was strong enough to handle the demand. The adductors, gluteus medius and maximus, external rotators, and gastrocnemius/soleus all play a role in sharing that load, and weakness anywhere in that chain can leave the hamstring exposed. Pain at the proximal insertion — deep in the sit bone — points more toward hamstring tendinopathy or neural tension stemming from the lumbar spine. Both can be present simultaneously, and treating one while missing the other is one of the most common reasons this injury drags on.
What we do in clinic: We assess lumbar and neural involvement first to confirm the source of the pain. Treatment then progresses through phases: isometric loading and dry needling in the early stage to manage pain and begin tissue loading, progressive eccentric strengthening as capacity builds, sport-specific agility training, and a supervised return to full-speed running. We don’t clear runners to return until they’ve met objective strength and functional benchmarks — because the strongest predictor of a hamstring strain is having had one before.
Push through, or get evaluated? How to tell the difference
Not every ache requires a clinic visit. But some warning signs should never be brushed off. Here’s how we coach our runners:
Get evaluated if any of these are true:
- Pain alters your running form or causes a visible limp
- Symptoms have lasted more than 7–10 days without improvement
- Pain worsens during a run rather than warming up and fading
- You feel sharp, localized bone pain (potential stress fracture — this needs imaging)
- You notice swelling, joint giving way, or locking
The biggest mistake we see runners make? Waiting until an injury has become chronic before seeking help. Early intervention almost always means a shorter recovery and fewer missed training days. Runners who address problems in the acute stage routinely return to full training in 4–6 weeks. Those who push through for months can face 3–4 months of rehab. The math on that trade-off is brutal — and avoidable.
How physical therapy actually treats running injuries
At Free Body Physical Therapy, every running injury evaluation begins with the whole picture: training history, race goals, biomechanics, and the demands of life outside running. This is exactly why we hold the line on true one-on-one, 45-minute sessions. No assistants. No juggling patients. No generic exercise printouts.
A typical running-injury treatment plan at our clinic includes:
- Comprehensive movement assessment — running gait, single-leg strength, hip stability, ankle mobility, foot mechanics, and lumbar/neural screening. We’re looking for the root cause, not just the site of pain.
- Manual therapy — joint mobilization, soft tissue mobilization, and dry needling delivered by a fellowship-trained manual therapist (FAAOMPT — a credential held by less than 1% of physical therapists nationwide).
- Individualized loading programs — no two runners get the same program. Loading protocols are built around your specific deficits, your tissue’s current capacity, and your race calendar.
- Running mechanics coaching — research shows real-time gait feedback can meaningfully reduce injury-related forces at the knee and ankle.
- Return-to-run programming — structured, criteria-based progressions, not arbitrary calendar timelines. You don’t go back to full mileage because four weeks passed. You go back because your body has earned it.
What injury prevention actually looks like (and what doesn’t work)
After treating hundreds of runners across Wicker Park, Humboldt Park, Logan Square, and Bucktown, here are the prevention strategies that actually move the needle — and a few popular ones that don’t.
Follow the 10% rule — but understand its limits
Increasing weekly mileage by no more than 10% is a reasonable starting guideline. But the research suggests injury risk is more accurately predicted by the ratio of your acute training load to your chronic training load over the prior 4 weeks. A sudden spike — even one that technically obeys the 10% rule — can be risky if your chronic baseline was very low. Translation: jumping from 5 miles a week to 5.5 is fine. Jumping from 0 miles for two months to 5.5 is not.
Strength train — yes, even as a runner
Running is a single-leg sport. If you can’t control your pelvis on one leg, your knees and ankles pay the price. We recommend strength training at least twice per week, focused on hip abductors, glutes, adductors, quadriceps, hamstrings, calf complex (especially soleus), and intrinsic foot muscles. Heavy, slow resistance work is more protective than high-rep, low-load exercises — a counterintuitive truth most runners resist until they’ve been injured once or twice.
Don’t skip the transition period
If you’ve been running indoors all winter, give yourself 2–3 weeks of reduced volume when you move outside. The Lakefront Trail’s hard surface, Chicago wind, and variable terrain are completely different stressors than a climate-controlled treadmill. Your body needs time to adapt.
Rotate your shoes
Evidence consistently shows runners who rotate between two or more pairs of running shoes have lower injury risk than those who use a single pair. Different shoes shift the distribution of forces across your tissues — reducing repetitive loading on any single structure.
Get a preventative assessment
You don’t have to be injured to benefit from PT. A preventative movement assessment at Free Body PT identifies strength deficits, mobility limitations, and biomechanical patterns that put you at risk — before they become injuries. Think of it as a pre-season tune-up. Most of the runners we see for one return every spring.
Frequently asked questions
How long does it take to recover from a running injury with physical therapy?
Recovery time depends on the injury, its severity, and how long you waited before seeking treatment. Most acute running injuries we treat at Free Body PT respond well within 4–8 weeks of consistent care. Chronic conditions like Achilles tendinopathy, plantar fasciopathy, or recurring IT band pain may take 8–12 weeks. The advantage of early intervention is significant — runners who come in within the first 1–2 weeks of symptoms almost always recover faster than those who push through for months.
Should I stop running completely if something hurts?
Not necessarily. Many running injuries actually respond better to modified activity than to complete rest, because tendons and bones need progressive loading to heal. That said, you should stop running if pain alters your gait, worsens during a run, or involves sharp localized bone pain. A physical therapist can help you determine the right level of activity modification for your specific situation — usually within the first session.
What makes Free Body PT different for treating runners?
Every session at Free Body PT is a full 45 minutes of one-on-one time with a licensed physical therapist — no assistants, no technicians, no split attention. Our founder, Dr. Marc Guillen, is a fellowship-trained manual therapist (FAAOMPT) with over a decade of experience treating Chicago runners. Treatment plans are truly individual, and assessments look at the whole kinetic chain — not just the site of pain. That level of care simply doesn’t exist at a high-volume PT chain.
Does insurance cover physical therapy for running injuries?
Yes. Most insurance plans cover physical therapy for running-related injuries, and Free Body PT is in-network with multiple major providers. Call us at (773) 599-3393 or email admin@freebodypt.com to verify your specific coverage before your first visit.
Can physical therapy actually prevent running injuries, or is it only for treatment?
PT is one of the most effective tools for prevention. A preventative assessment identifies strength deficits, mobility restrictions, and movement patterns that increase injury risk — and we then build a targeted program around them before pain ever shows up. Many of our Chicago runners come in for a pre-season evaluation every spring, especially those training for the Chicago Marathon or spring half marathons.
I’ve been to PT before and it didn’t help. Why would this be different?
We hear this constantly, and it almost always comes down to the care model. At many high-volume clinics, therapists see 2–4 patients simultaneously, sessions run short, and treatment plans are essentially generic. At Free Body PT, you get one therapist, fully focused on you, for 45 minutes. Fellowship-level training in manual therapy means we can identify and treat issues a generalist approach often misses. If past PT felt like going through the motions, we are the opposite of that experience.
Do I need a referral from my doctor to start physical therapy?
In most cases, no. Illinois allows direct access to physical therapy without a physician referral. A PT can evaluate your injury, begin treatment immediately, and refer you for imaging or to a physician if needed. This often saves weeks of waiting for appointments.
What should I expect at my first appointment?
Your initial evaluation is a thorough 45-minute one-on-one session. We’ll discuss your injury history, training details, and goals — then run a comprehensive physical assessment including strength testing, range of motion, joint mobility, and functional movement analysis. You’ll leave with a clear understanding of what’s causing your symptoms, a treatment plan, and usually a few targeted exercises to start that day.
Ready to run pain-free this spring?
Chicago’s spring running calendar — the Shamrock Shuffle, Chi Town Half, Lakefront 10 Miler, Chicago Spring Half Marathon — is already here. Whether you’re managing a nagging injury or want to get ahead of one before it starts, we’ll help you put together a real plan.
Schedule your one-on-one evaluation today.
📞 Call: (773) 599-3393
✉ Email: admin@freebodypt.com
🌐 Book online: freebodypt.com
2618 W Division Street, Suite B, Chicago, IL 60622 — serving runners across Wicker Park, Humboldt Park, Ukrainian Village, Logan Square, Bucktown, West Town and Bridgeport.
About the author
Dr. Marc Gregory Guillen, PT, DPT, OCS, FAAOMPT is the founder of Free Body Physical Therapy in Chicago. He is a board-certified Orthopaedic Clinical Specialist and a Fellow of the American Academy of Orthopaedic Manual Physical Therapists — a credential held by less than 1% of physical therapists nationwide. With over a decade of clinical experience treating musculoskeletal conditions in Chicago’s Wicker Park and Humboldt Park neighborhoods, Dr. Guillen is committed to one-on-one, evidence-based care that empowers patients to understand their bodies and achieve lasting results. He is bilingual in English and Spanish and proudly serves Chicago’s diverse communities. Dr. Guillen also serves as a fellowship mentor through the Manual Therapy Institute, training the next generation of advanced manual therapists.
Medical disclaimer: This article is for educational purposes only and does not constitute individual medical advice. If you are experiencing pain or injury, please consult a licensed physical therapist or physician for evaluation tailored to your specific situation.