The Runner’s Pain Map: What the Location of Your Pain Can—and Can’t—Tell You
When a runner comes into my clinic, one of the first questions I ask is pretty obvious:
“Where does it hurt?”
Where you feel pain gives me a place to start. Anterior knee pain makes me think about different structures than pain behind the ankle. Groin pain creates a different list than lateral hip pain.
But after years of evaluating and treating runners, I can tell you that where you hurt is only the beginning of the story.
Running injuries commonly involve the knee, ankle/foot and lower leg, but there are numerous possible diagnoses within each of those regions.¹ Two runners can point to exactly the same spot and have completely different problems.
Your Hip Hurts—But Where?
Take hip pain.
If you point to the front of your hip or groin, I may consider the hip joint, labrum, femoroacetabular impingement (FAI), hip flexors or adductors. But I also need to consider the lumbar spine, femoral nerve and—particularly in runners—a femoral neck bone stress injury. This broad differential for anterior hip pain is something I emphasize in my running medicine course.
Posterior hip pain creates another list entirely, including the lumbar spine, sciatic nerve and other hip-related conditions.
Pointing to a body part isn't a diagnosis.
Your Knee Is Another Great Example
Pain in the front of the knee, particularly with activities such as squatting, stairs or prolonged sitting, can fit a patellofemoral pain pattern.
Move that pain to the outside of the knee and iliotibial band-related pain becomes one consideration. But lateral knee pain isn't automatically an ITB problem. A good evaluation still needs to consider other potential sources of symptoms.²
This is why I'm cautious when a runner tells me, “I Googled it, and I have _____.”
Maybe.
But let's ask some more questions first.
The Behavior of Your Pain Tells Me a Lot
I don't just want to know where it hurts. I want to hear the story.
Does it hurt when you first wake up? Does it improve after you warm up? Does it come back later in the run? What happens with hills or speed? How does it feel afterward? What changed in your training?
Tendon problems, for example, can have a recognizable pattern. A runner may experience morning or after-sitting stiffness, feel better once they warm up and then have symptoms return as load accumulates. Hills and faster running may also increase symptoms. These patterns are part of the tendon assessment framework I teach in my running course.
That information tells me much more than simply hearing, “My Achilles hurts.”
I Built This Process Into the RUNsource App
This clinical reasoning process—figuring out where something hurts, when it hurts and how it behaves—is something I also built into the RUNsource app.
If you're injured and wondering, “What is this?” you can ask Katherine, my AI running-injury agent.
Katherine walks you through many of the questions I would ask in the clinic: Where exactly is the pain? When did it start? What makes it worse? Does it warm up during a run? Is there morning stiffness? Does walking or hopping hurt? Did you recently change mileage, speed or hills?
Based on your answers, Katherine can help identify types of running injuries that may fit your symptoms and direct you to an injury plan within the app.
Katherine isn't replacing a PT or physician and isn't making a medical diagnosis. There are times when an in-person evaluation or medical workup is absolutely necessary.
Bone pain is a good example.
Bone Pain Gets My Attention
Bone stress injuries occur when repetitive loading exceeds the bone's ability to adequately recover and adapt. In runners, common locations include the tibia, metatarsals and femur.³
Symptoms can progress from pain associated with running to pain with everyday activities. Focal bony tenderness or pain with hopping increases my concern. My course specifically emphasizes identifying these findings and referring runners for appropriate medical evaluation when a bone stress injury is suspected.
As a PT, part of my job is knowing when something shouldn't simply be treated with exercises.
Location Is a Clue, Not a Diagnosis
Your body doesn't come with perfectly labeled compartments.
Pain around the medial ankle, for example, can potentially involve a tendon, nerve, bone, lumbar involvement or referred pain.
So yes, tell me where it hurts.
But then tell me when it hurts, what makes it better or worse, what changed in your training and what happens as the run progresses.
Whether I'm evaluating you at Precision Performance or Katherine is helping you work through those questions in RUNsource, we're trying to put the pieces together.
Because the location gives us a map.
The story helps us figure out where we're actually going.
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References
Francis P, Whatman C, Sheerin K, Hume P, Johnson MI. The proportion of lower limb running injuries by gender, anatomical location and specific pathology: a systematic review. J Sports Sci Med. 2019;18(1):21–31.
Geisler PR. Current clinical concepts: synthesizing the available evidence for improved clinical outcomes in iliotibial band impingement syndrome. J Athl Train. 2021;56(8):805–815.
Warden SJ, Davis IS, Fredericson M. Management and prevention of bone stress injuries in long-distance runners. J Orthop Sports Phys Ther. 2014;44(10):749–765.
Mihevc Edwards K. Precision Performance Running Medicine Course. 2025. Clinical course materials.
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