Injury Prevention For Runners

4–6 minutes

I. Introduction

Running is one of the most popular and accessible forms of exercise, requiring only shoes and a sidewalk to get started. However, injuries are very common, with 37% of runners dealing with an injury each year. Over the years, factors such as flat feet, weak hips, and shoes have been blamed for running injuries. While these factors may play a role, injuries ultimately come down to two major factors: training errors and reduced tissue capacity. This article will explore these factors and provide practical methods to modify your training and improve your tissue resilience to stay injury-free.

II. Risk factors

The main risk factors for running injuries are:

Being previously injured in the last 12 months. This is the biggest risk factor for almost all conditions, not just running injuries. Reasons for this may include not fully restoring the capacity of the injured tissue, persistent compensations developed while attempting to offload the injured structure, and not easing back into running once you return.
- Solution: Make sure you fully rehab your injury with a sports or running focused physical therapist-make sure your recovery includes a progressive strengthening and plyometrics program. When you do resume running, make sure to ease into it rather than resuming at your pre-injury running volume.
<5 years running experience. With more running experience, the body gradually develops tissue tolerance and improved running mechanics, and runners tend to make better programming decisions the longer they have been running.
- Solution: If you are a new runner, gradually increase your running volume. Consider starting with walk-run intervals as you get started. The 10% rule may be used as a new runner, but this rule may not be as effective for more experienced runners. If you recently increased your mileage and start to develop pain, it may be a sign you are progressing too quickly.
Running >3 times per week. This may reflect bigger training errors, or the lack of rest may not allow recovery time for lower body tissues between runs.
- Solution: Consider cross-training with cycling, rowing, elliptical, or other modalities to improve cardiovascular fitness rather than running 4-7 days per week. You can also utilize off-days to perform a strengthening program or mobility routine.

III. Training Errors

Training errors are one of the key factors leading to running injuries. The most common errors include:

Rapid mileage progression (>30% increase/week)
Multiple variable changes (shoes + terrain + speed) all at once
Insufficient recovery days
Overuse of hills or speed workouts without prior exposure
Lack of individualized programming or cross-training

Having more gradual and intentional training can greatly mitigate running injuries, and don’t forget that rest/recovery days are just as important as your running days. Other running strategies, such as increasing your cadence by 10%, can reduce repetitive loading on your lower body and keep you running more often.

IV. Building Tissue Capacity

Our natural asymmetries and anatomical variations alone are not enough to cause injury: they need to be coupled with training errors to lead to pain and injury. This is because most injuries occur when training load exceeds tissue tolerance. Our anatomy is one piece of our tissue tolerance, but there are several other factors we can influence to work within our window of tolerance:

Strength training: Aim for at least 2x/week focusing on key muscle groups (quads, hips, calves). This can improve overall tissue resiliency and increase how much load your body can handle. In addition, your overall running performance will improve from consistent strengthening.
Sleep and nutrition: These are “boring” but absolutely critical recovery fundamentals for musculoskeletal health. Although the principles seem straightforward, having adequate sleep and nutrition can be very difficult. If you are struggling, reach out to a sports nutritionist or your primary care doctor. Strategies like sleep hygiene (e.g. avoiding screens 1 hour before bedtime) can help improve poor sleepers.
Variation: Based on the injured areas, you can use a different shoe type or utilize alternative running surfaces to distribute load to uninjured areas. For example, running uphill, using minimalist shoes and a forefoot strike puts more load on the achilles and less on the knee. If you have an achilles injury, switching to a more cushioned shoe or changing to a heel strike can allow you to run without flaring up your symptoms while you rehab your achilles.
Wearable data: tracking step count, heart rate, and recovery trends allow you to prevent training spikes and ensure you are truly recovering on off days.

V. Interpreting Pain and When to Modify

As you are increasing your running mileage or returning to the pavement after an injury, following these pain rules can help to guide your progression:

Pain Level	What It Means	Recommended Action
≤2/10, resolves same day	Normal adaptation	Continue, monitor, maintain current level until pain-free
3–6/10, next-day soreness	Early irritation	Rest/reduce load
Limp, swelling >24 hrs, night pain	Likely injury	Seek evaluation

VI. Key Takeaways / Summary

Running injuries are very common, especially in novice runners, those who run more than 3 days a week, and those who have been previously injured
Most running injuries stem from a mismatch between training load and tissue capacity.
Prevention = gradual progression + adequate recovery + consistent strength work.
Listen to early warning signs and adjust before pain becomes injury.

If you are still unable to return to running after an injury despite following these guidelines, then reach out and schedule an appointment

This content is intended for educational purposes only and does not constitute medical advice. Injury risk and training needs vary between individuals. The information provided should not replace a comprehensive evaluation by a qualified healthcare professional. If you are experiencing pain, injury, or have a medical condition, consult a licensed medical provider before making changes to your training.