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Injury prevention

Running injuries and prevention

Running injuries are unfortunately common, with studies showing an overall incidence of lower extremity injuries ranging from 19.4% to 79.3%. As such, the summary here endeavours to make the most of evidence that varies from strong to weak. Make of it what you want, work out your own ideas & programme, and good luck for more injury-free running!

The most-reported sites of injury in decreasing order of frequency are the knee, lower leg, foot, and upper leg. Running related injuries seem to be multifactorial in origin. Several risk and protective factors for lower extremity injuries have been identified among longer distance runners in larger observational studies and interventional trials, although overall the quality of evidence is limited. For example, there is high quality evidence for increased injury risk in those with prior running injuries or running more than 60 km/week, while a weekly graduated increase in running distance is protective against knee injury.

Evidence for other risks and preventative approaches is based on moderate or low-quality evidence or from fewer studies, studies with conflicting results, or inferred from biomechanical observations. There are likely differences according to the distance or type of running. This section focuses on running distances of 5km or more, rather than shorter track running.

A. Running Smarter

i. Gradually Increase Your Training Load. A common reason behind running injuries is when runners increase their training load too fast and too soon. The 10% rule can be a good guide for avoiding training load-related injuries: every week you should only increase your training by 10% compared
to the week before.

Some of the best evidence for prevention is for a gradual increase in running distance in prevention of knee injuries (which are also the most common site of injury). Novice runners are sometimes at increased risk of injury. This may partly be due to building up training too quickly, resulting in a lack of time for tissues to adapt to training loads.

ii. Avoid Overtraining. Overtraining is a common cause of running injuries. Exposure to a high training load (duration, frequency, or running distance) increases the risk of injury. Overtraining is when your body can’t keep up with the physical demands that you are placing on it. Running beyond
your current level of fitness can put muscles, tendons and ligaments under strain.

iii. Listen to your body. Do not ignore pain during and after running. If moderate or persistent, reduce or modify your running programme.

iv. Warm Up Before You Train. Warming up properly before training is probably a good way to prevent muscle-related injuries. If you’re going on a long, slow run, you can warm up by starting off slowly.

v. Correct Your Running Form. Having proper running form can reduce your risk of running injuries as is thought to allow you to reduce the impact caused by each step by working with the body’s innate suspension systems to absorb running impact correctly. For example, knee stiffness has been
observed to be a predictor or injury, possibly with less ability of the knee to act like a spring and to dissipate energy. This could be mitigated by either shortening step length or running on a stable but softer surface. Novice runners also tend to increase a trunk-flexed posture during fatigued running.

vi. Terrain. Run on a clear, smooth, even and reasonably soft surface, at least until stronger.

vii. Maintain hydration. Drink plenty of water before, during and after your run. It’s surprising how much fluid you lose, especially on a hot day.

viii. Learn from Other Runners. A good reason to join a running club! Identify previous injuries and consider how to prevent them recurring.

B. Getting Better Prepared

i. Get Your Shoes Fitted Professionally. There is relatively limited evidence for specific running shoes preventing injury, and common advice is to ensure footwear comfort. Running orthotics may protect against some injuries such as shin splints. It’s a good idea to be fitted in a shoe running shop, to break in new shoes, and to replace shoes after 500km or more as the foam cushioning often compresses down.

ii. Previous running injuries. A history of previous injuries was found to be a significant risk factor for further injuries in multiple high-quality studies. Runners with prior injuries should pay extra attention to signs of injuries, avoid other determinants of injuries, and take time to recover fully. If you injure yourself, it may be prudent to ask your doctor, physiotherapist or other health professional for medical advice before returning to running.

iii. Strength & Mobility Training. Strength training has some better evidence for injury prevention relating to exercise more generally. Strengthening of lower limb and core muscles probably is a good approach, even though there is a lack of high-quality evidence specifically for running injuries. Some also advocate for so-called mobility training exercises.

iv. Flexibility. It appears intuitive that greater lower extremity flexibility would lower joint stress and diminish the risk of overuse running injuries; however, little supportive scientific evidence exists.

v. Age. There is conflicting evidence over whether greater age is a risk factor for overall lower extremity running injuries, with increased injuries in some and decreased injuries in other studies.

C. General Health

i. Eat Plenty of Healthy Food. A good general principle. Running also may increase your appetite.

ii. Sufficient sleep. As a rule of thumb, you should be sleeping between 7 and 9 hours per night. Often some more if you’ve been exercising.

iii. Health benefits of running. There is good evidence for improved mood (less anxiety-depression) and reduced cardiovascular disease from running. Good news is that much of the health benefits occurs with relatively brief & non-intense running – within 1 to 2.5 hours per week.

Injury ExamplesDescription
Runner’s Knee (Patellofemoral Syndrome)A very common overuse injury and is a general term for knee pain located in the front of the knee or around the kneecap.
Achilles TendinitisMay occur from a runner stepping up their training load (mileage or intensity) too fast and too soon.
Iliotibial Band SyndromeThe iliotibial (IT) band of muscle and tissues runs along the outside of your upper leg, connecting your hip to your knee
Shin SplintsAn injury of the front or inner part of your calves- or your shins. Also called medial tibial stress syndrome (MTSS)
Hamstring InjuriesInjury often with tears of the muscles of the posterior thigh.
Ankle StrainCommonly occurs if a runner twists or rolls their ankle whilst running.
Plantar FasciitisIrritation of the fascia, or the thick layer of tissue, on the sole of your foot
Stress FracturesHairline crack forms in the bone commonly of the upper foot bones, heels, and lower leg bones. Serious impact-related running injury.

Useful websites


Review: Incidence and determinants of lower extremity running injuries in
long distance runners: a systematic review. Br J Sports Med 2007;41:469–480.
doi: 10.1016/j.jshs.2020.06.006

Risk factors for overuse injuries in short- and long-distance running: a
systematic review. J Sport Health Sci 2021;10:1428.
doi: 10.1136/bjsm.2006.033548

Strength training as superior, dose-dependent and safe prevention of acute
and overuse sports injuries: a systematic review, qualitative analysis and
meta-analysis. Br J Sports Med 2018;52:1557–1563.
doi: 10.1136/bjsports-2018-099078

A 2-Year prospective cohort study of overuse running injuries. The Runners
and Injury Longitudinal Study (TRAILS). Amer J Sports Med
2018;46(9):2211–2221. doi: 10.1177/0363546518773755

What are the differences in injury proportions between different populations
of runners? A systematic review and meta-analysis. Sports Med (2015)
45:1143–1161. doi:10.1007/s40279-015-0331-x

Prevention of running-related injuries in novice runners: are we running on
empty? Br J Sports Med 2012;46:836–837. doi:10.1136/bjsports-2012-091505

Running shoes and running injuries: myth busting and a proposal for two new
paradigms: ‘preferred movement path’ and ‘comfort filter’. Br J Sports Med
2015;49:1290–1294. doi:10.1136/bjsports-2015-095054

Effectiveness of foot orthoses and shock-absorbing insoles for the prevention
of injury: a systematic review and meta-analysis. Br J Sports Med
2017;51:86–96. doi:10.1136/bjsports-2016-096671