Wear and Tear or An Actual Trauma? A Runner’s Cheat Sheet to Pain



Minnesota summers may be short, but they’re oh-so-sweet—especially if you’re a runner who loves to take advantage of quiet mornings or cool evenings while logging miles around the lakes. Maybe you’re training for the Twin Cities Marathon in early October, or perhaps you find peace and purpose on an occasional jog. Regardless of your running style, pay attention to any out-of-the-ordinary snaps or clicks as you train—they could be your body’s way of telling you something is off and it’s time to slow your pace or re-adjust your running style.

“Each step taken while running can generate two to five times your body weight in forces through the lower extremities, including the hips—specifically through the femur and acetabulum, or the ball-and-socket joint of the hip,” says Dr. Gregory DeNunzio, DC, MS, BSME and clinical lead at ​​Sweere Center for Clinical Biomechanics and Applied Ergonomics at Northwestern Health Sciences University. “This alone can cause wear and tear damage to the hip joint, including muscles, tendons, and the labrum [the hip’s ring of cartilage].”

This can be particularly problematic for female runners, who have smaller bone dimensions and decreased bone density compared to male runners. The menstrual cycle and potential vitamin deficiencies can have an impact, too. “Any type of iron or vitamin D deficiency can lead to weakened bones, so the menstrual cycle can also have an effect due to blood loss and low iron,” Dr. DeNunzio shares. “The hormonal changes through the cycle, like the increase in estrogen, can cause an increase in ligament and tendon laxity, which may lead to a lack of stability at the joint.”

Sweat and (Labral) Tears

What should you watch for before, during, and after your run? “In an era where more is better (supposedly!), overuse injuries can occur,” says Dr. DeNunzio. Pain in the front of the lower leg could be a sign of shin splints, which happen when tissue pulls away from the shin bone. An aching sensation on the outside of the hip is a telltale signal of bursitis in the hip joint.

If you’re noticing sharp pains, watch out for labral tears. “Labral tears … can come and go depending on the movement. The pain will be more towards the front of the hip and into the groin but may also be at the side of the hip joint depending on the location of the tear,” says Dr. DeNunzio. “The cartridge that lines the acetabulum (hip socket) may tear and become pinched in the hip joint causing the pain.”

Plantar fasciitis is another common issue for runners; pain at the heel or underneath can be because of tight calf or soleus muscles. While you may not instantly connect plantar fasciitis with a hip issue, Dr. DeNunzio says they can be connected. “I mention plantar fasciitis and shin splints because at times trying to run with these conditions, especially if they are mild, may cause a compensation which can lead to hip and low back injuries,” he explains.

Getting a Doctor’s Note

To help prevent unnecessary wear and tear and keep your body in optimal shape for logging those miles and keeping your pace, Dr. DeNunzio recommends a combination of strength training and diet, including an emphasis on one key vitamin to help support bone health: Vitamin D. “Studies show that the vast majority of athletes are vitamin D deficient,” he explains. Our bodies absorb vitamin D from the sun, but if you’re wearing sunscreen (and you should be!), you may not be getting an adequate amount by spending time outdoors. It can be difficult to get adequate vitamin D from food alone, but you can find it via fortified foods and juices or consider supplementation. Just be sure to check in with your healthcare provider before starting.

Changing up your workouts regularly can be helpful to strengthen your body for your run; try mixing up your daily jogs with regular strength training. “Train in different planes of motion so that you can strengthen around the entire joint,” says Dr. DeNunzio. “Strength training should include the upper body, as it goes to running economy. The more lean muscle mass that we have overall leads to a more efficient utilization of oxygen.” [Editor’s note: More on multiple plane training can be found here.]

When the weather changes and your workouts move indoors, reduce potential injury by adjusting the treadmill while you’re running. “The one trend that I have seen through my 27+ years in practice and in working with runners occurs through the winter months when running on a treadmill,” shares Dr. DeNunzio. “The incline should be changed frequently throughout your run. By keeping the treadmill flat, the forces are reoccurring at the same points through the joints, effectively causing a repetitive motion injury of the lower extremities.”

Dr. DeNunzio also encourages runners to be more mindful of their footfall as they run. “Tell yourself to land softly,” he says. “It is a great way to absorb the forces more efficiently. I’ve received great feedback from runners by using that cue alone.”

The final tip for prevention is the most important: rest! According to Dr. DeNunzio, a rest and recovery day does wonders to help your body bounce back from tough workouts and long distances. If you skip your rest day, your muscles and joints don’t have the chance to repair themselves and you could risk overdoing it or injuring yourself. Says Dr. DeNunzio, “The body needs time to recover so that you are strong again for your next run.”


Located in Bloomington, Northwestern Health Sciences University is a premier integrative health institution that prepares the next generation of healthcare professionals deliver and advance healthcare, offering 11 areas of study. Its clinics and TruNorth Wellness Hub are open to the public to support healthier, better lives for all. Bloomington Clinic specializes in whole-family care, providing chiropractic treatment, acupuncture, Chinese medicine, massage therapy, naturopathic medicine, nutrition, and cupping. Sweere Clinic offers comprehensive care for complex pain conditions and trauma. The Biomechanics Lab and Human Performance Center support proper movement and recovery through gait analysis, rehabilitation, and strength and conditioning.





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