If your young runner shows up with shin pain, knee pain, or a nagging ache that “just started,” the natural question is: what did she do wrong? Usually, the answer isn’t a single bad step. Distance running injuries in young athletes are overwhelmingly overuse injuries — the product of high-repetition, low-variability loading over the course of a season, not one dramatic moment. Understanding that distinction changes how you treat it, and more importantly, how you prevent the next one.
Overuse, Not Accident
A soccer player might roll an ankle on one bad cut. A distance runner’s body absorbs the same impact, in nearly the same pattern, over and over throughout the week. There’s very little variability in the motion — same joints, same angles, same surfaces, mile after mile. That’s exactly why running injuries build gradually instead of happening all at once, and why they often go unnoticed until they’re already significant.
The Injuries We See Most
- Shin splints (medial tibial stress syndrome). This is the most common complaint we see in runners who’ve ramped up mileage too quickly. Pain runs along the inner shin and tends to worsen with continued training rather than improve on its own.
- IT band syndrome. Pain on the outside of the knee from repetitive friction of the iliotibial band, often aggravated by sudden mileage increases or unaccustomed hill work.
- Patellofemoral pain (“runner’s knee”). A dull ache around or behind the kneecap, usually tied to how the kneecap is tracking under repetitive load.
- Stress fractures. The more serious end of the overuse spectrum — a sign that bone has been asked to absorb more cumulative load than it could adapt to in time.
- Sever’s disease. In younger runners whose growth plates are still open, repetitive heel impact can irritate the growth plate at the back of the heel. We’ve covered growth plate injuries in more depth previously, but it’s worth flagging here as one more pattern tied specifically to distance running in still-growing athletes.
The Classic Mistake
Almost every overuse injury we treat in young runners traces back to the same root cause: too much, too soon. A jump in weekly mileage at the start of a season, a sudden increase in intensity, or adding speed work before the base is built — all of these ask tissue to adapt faster than it physically can. Tendons, bones, and connective tissue need time to remodel and strengthen under new demands. When training load outpaces that adaptation window, something eventually gives.
Why Form Usually Isn’t the Real Problem
Parents and coaches often want to fix running form first, and form does matter at the margins. But for most young runners, form isn’t the primary driver of injury — training load progression and recovery are. An athlete with imperfect form who builds mileage sensibly and sleeps enough will usually outlast an athlete with textbook form who doubles her weekly mileage in three weeks. We look at form as one piece of the picture, not the whole picture.
What About Shoes and Surfaces?
Footwear and running surface can play a role — a brand-new pair of shoes, a sudden shift from grass to asphalt, or an unfamiliar hilly course can all act as contributing factors. But it’s rare that shoes or surface alone cause an injury. More often, they’re the tipping point layered on top of a training load that was already pushing the limits of what the body could handle.
How DSM Approaches Treatment
Instead of prescribing blanket rest and hoping the pain resolves, we start by understanding the training load history — what the mileage progression looked like leading up to the injury. We assess gait and biomechanics to understand how the specific tissue involved is being loaded. From there, treatment might include manual therapy and dry needling to address the affected tissue directly, paired with a structured return-to-running progression that rebuilds mileage in a way tissue can keep up with. The goal isn’t just resolving today’s pain — it’s making sure the same pattern doesn’t repeat next season.
If your runner is dealing with shin pain, knee pain, or an ache that won’t go away with a few days off, don’t…
