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Typical runner's injuries
Runner's knee (ITB syndrome)
Iliotibial band syndrome — pain on the lateral aspect of the knee. Worsens on downhill and long distances. Linked to weak gluteals and excessive pronation.
Patellofemoral pain syndrome
Pain under the kneecap, worse on stair descent and prolonged sitting. Linked to patellar tracking issues and quadriceps weakness.
Achilles tendinopathy
Tendinopathy of the Achilles tendon. Pain and thickening 2–6 cm from the heel. Morning stiffness. Whether regenerative treatment is an option in this condition is assessed by the clinic doctor.
Plantar fasciitis
Pain under the heel with the first morning steps. A typical companion of marathoners and amateur runners with excess pronation. → More
Stress fractures
Tibia, metatarsals, femur. A fatigue injury from excessive load. Diagnosis only by MRI; X-ray is normal in the first 2–3 weeks.
Patellar tendinopathy
"Jumper's knee." Pain below the kneecap. Typical for runners doing downhill and intervals.
Runner's knee
ITB syndrome
Pain on the lateral knee. Provoked by long runs and downhill. Regenerative treatment — ultrasound-guided CGF/PRP into the point of maximum tenderness + run-form correction (cadence, gluteal strength).
Patellofemoral syndrome
Pain under the kneecap. Chondromalacia. Intra-articular PRP + Hoffa block under ultrasound. Rehab — VMO training, foot-pronation correction.
Patellar tendinopathy
Pain below the kneecap. CGF into the tendon degeneration zone + Alfredson eccentric protocol. Return to running — 4–8 weeks.
Achilles and foot
Achilles tendinopathy
CGF or PRP under ultrasound into the degeneration zone. 2–3 sessions. Combined with eccentric exercises. Return to running — 6–8 weeks.
Plantar fasciitis
Ultrasound-guided injection into the maximum thickening zone of the aponeurosis. 2–3 sessions. Important — orthotic insoles, calf stretching, gradual return to load.
Peroneal / posterior tibial tendinitis
Common cause of lateral / medial leg pain in runners with pronation/supination issues. Ultrasound-guided CGF + footwear and form correction.
Stress fractures — a special case
When to suspect
Pinpoint bone pain, worse at night and rest. Lasting more than 2 weeks. Often after sudden volume increase, surface or shoe change. Risk factors — low energy availability (RED-S), vitamin D deficiency, menstrual disorders in women.
Diagnosis
MRI — method of choice. X-ray often normal in the first 2–3 weeks. CT — to clarify fracture line. Mandatory — exclusion of systemic causes (hormones, vitamin D, calcium).
Treatment
Key — offload for 4–8 weeks (cross-training: swimming, cycling). Regenerative treatment (BMAC or PRP) speeds bone regeneration. Return to running only after MRI follow-up.
Return to running — protocol
Simply "no longer hurts" is not yet a reason to return to full load. The right return is staged with verification at each step.
Stage 1 — pain control
Regenerative procedure, orthopedic offload (if needed), NO NSAIDs. Paracetamol, ice, compression.
Stage 2 — cross-training
Swimming, cycling, elliptical — maintain cardio base without impact. 2–4 weeks.
Stage 3 — walking and trial running
Brisk pain-free walking for 30 minutes — signal to try 1–2 minutes of running. Walk/run protocol for 1–2 weeks.
Stage 4 — volume restoration
Increase weekly mileage by no more than 10% per week (the 10% rule). No intervals for the first 2–4 weeks.
Stage 5 — intervals and racing
Gradual addition of tempo and interval work. First race — 6–12 weeks from return start, depending on distance.
Stage 6 — prevention
Strength & Conditioning twice a week. Regular shoe inspection (replace every 600–800 km). Listen to body signals — "a little tweak" often heralds a major injury.
Clinic and method matching — free of charge
Describe your case and attach your MRI report. We will identify clinics that use the relevant methods and forward your request to them. No obligation; we reply within 24 hours.
Send a requestWhen surgery is needed
Surgery is discussed if conservative and injection treatment has not helped for 3–6 months, with advanced joint destruction, a complete tendon or ligament tear with loss of function, or neurological problems such as increasing weakness, numbness or bladder and bowel dysfunction. The clinic physician decides based on the images and examination; we can arrange a surgeon’s consultation.
Who it is not suitable for and possible risks
Contraindications
- Active infection — at the injection site or systemic, with fever.
- Active cancer or ongoing chemotherapy.
- Blood clotting disorders or a low platelet count. Anticoagulants are discussed with the physician.
- Pregnancy and breastfeeding — the procedure is usually postponed.
- A corticosteroid injection into the same area in recent weeks.
- A complete tendon or ligament rupture with loss of function — surgical repair is usually needed.
Possible risks
- Pain and swelling at the injection site for 1–3 days.
- Bruising where blood or fat tissue is taken.
- Rarely, infection. The procedure is therefore performed under sterile conditions with ultrasound or X-ray guidance.
- The effect may be absent or smaller than expected.
If any of these apply to you, mention it in your request. The coordinator will check with the clinic physician whether treatment is possible. Contact a coordinator.
Scientific evidence
Studies of regenerative methods show mixed results. Clinic physicians rely on research including the following:
- Andia I et al. Platelet-rich plasma for muscle injury and tendinopathy. Sports Med Arthrosc Rev, 2013.
- Sheth U et al. Efficacy of autologous platelet-rich plasma use for orthopaedic indications: a meta-analysis. J Bone Joint Surg Am, 2012.
Next steps: Treatment methods · Treatment cost · How treatment in Germany is organised · Outer knee pain
Frequently asked questions
This term describes knee pain in runners: on the outside — iliotibial band syndrome; at the front under the kneecap — patellofemoral pain syndrome. The basis of treatment is temporarily reducing running volume, strengthening the hip and thigh muscles and correcting technique.
It depends on the diagnosis and recovery. After tendinopathy or patellofemoral pain, many runners return to long distances after several months of gradual training. Timelines are individual; volume is built up gradually, guided by the absence of pain.
The basis of treating a stress fracture is offloading for 6–8 weeks or longer, sometimes with a brace or crutches, and finding the cause: training errors, low energy availability, vitamin D deficiency, osteoporosis. Injection methods for stress fractures are poorly studied and do not replace offloading.
In tendinopathy the pain is in the tendon and eases after warming up; in a stress fracture there is pinpoint bone pain that worsens with every step and persists at rest. MRI helps tell them apart definitively, showing bone marrow oedema in a fracture.
Usually not. Most often a temporary reduction in load for 2–6 weeks, treating the cause — muscle strengthening, correcting technique and footwear, a sensible training plan — and a gradual return to previous volume help.
RegenPAS is a patient service centre in Munich, not a clinic. We review your images and symptoms and send a request to several partner clinics at once. Clinics that can accept you send their own conditions and price; prices differ between clinics, and you choose the option that suits you. The coordinator replies within 24 hours, and a clinic physician’s preliminary opinion follows in 1–3 business days. We then arrange the appointment, visa invitation, interpreter, transfers and accommodation. Treatment decisions are made by the clinic physician. Contact a coordinator.
Your MRI (or CT, X-ray) report and the images if you have them, plus a short description of your symptoms and previous treatment. Send them via the form on the website — the assessment is free and without obligation: the coordinator replies within 24 hours, and the clinic physician’s preliminary opinion follows in 1–3 business days.
The cost depends on the method, the diagnostics needed and the clinic itself: prices differ between clinics. We request offers from several clinics and send you their conditions and quotes so you can compare. Price guidance is on the treatment cost page. For an outpatient procedure, 2–3 days in Munich are usually enough: examination, procedure and follow-up visit.