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URLhttps://marathonhandbook.com/guide-to-injury-prevention/
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Meta TitleRunning Injury Prevention: 15 Ways To Stay Injury-Free
Meta DescriptionRunning injuries are common, but many can be prevented with the right approach. Learn 15 expert-backed tips to stay injury-free, improve performance, and keep logging miles without setbacks.
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Getting injured from running is no fun. While injuries are common among runners, the good news is that, with the right approach, injury prevention is possible for many. As a certified running coach, I am typically approached by recreational runners for one of two reasons. Either the runner is looking for a training plan that will help them improve performance and run faster—or is looking for individualized coaching that will help prevent running injuries or at least reduce the risk of injury. Distance runners seemingly have a fairly high injury risk, as running is a high-impact activity involving a repetitive motion. Most surveys and estimates in research literature 1 DAOUD, A. I., GEISSLER, G. J., WANG, F., SARETSKY, J., DAOUD, Y. A., & LIEBERMAN, D. E. (2012). Foot Strike and Injury Rates in Endurance Runners.  Medicine & Science in Sports & Exercise ,  44 (7), 1325–1334. https://doi.org/10.1249/mss.0b013e3182465115 note that about 30-75% of runners experience an injury over the course of a year of training. However, with the right training program for your ability level, a good balance between hard training sessions and recovery, and supplementary injury-prevention techniques, it is possible to significantly reduce your risk of common running injuries. We’ll take a look at the most common running injuries and share practical, effective tips to help you prevent them while continuing to log your miles. What Causes Injuries In Runners? What Are the Most Common Injuries From Running? What Are the Best Ways to Prevent Running Injuries? What Causes Injuries In Runners? Recreational and competitive runners are especially prone to  overuse  injuries due to the repetitive nature of running and the high-impact stress it places  on the lower body.  In fact, the feet, shins, knees, hips, and spine are subject to 2-3 times your body weight 2 NILSSON, J., & THORSTENSSON, A. (1989). Ground reaction forces at different speeds of human walking and running.  Acta Physiologica Scandinavica ,  136 (2), 217–227. https://doi.org/10.1111/j.1748-1716.1989.tb08655.x when you run, and research indicates runners take approximately 1,400 steps per mile at an 8-minute-per-mile pace. Therefore, it’s not surprising that many runners deal with overuse injuries from running. That said, it is also possible for distance runners to experience acute running injuries, which have a sudden onset, but the most common running injuries are typically categorized as overuse injuries. Risk factors for running injuries can be divided into three different categories: Personal factors such as sex, age, body weight, and foot arch type. Training factors such as training volume, the variety of workouts you do, how aggressively you increase your mileage, strength training (or lack thereof), and running shoes. Health and lifestyle factors such as a history of previous injuries, sleep quality and quantity, smoking, etc. What Are the Most Common Injuries From Running? Most running-related injuries occur in the lower limbs: Foot Ankle Lower leg: Shin and calf muscles Thigh: Quads, hamstrings, femur Pelvis, Hips, groin, glutes Aside from lower limb injuries, distance runners can also be at risk for back injuries. Here are some of the most common running injuries: Most Common Running Injuries Plantar fasciitis Posterior tibial tendon dysfunction (PTTD) Achilles tendinitis Stress fractures Medial tibial stress syndrome (shin splints) Compartment syndrome  Patellofemoral pain syndrome (runner’s knee) Patellar tendinitis  IT band syndrome  Piriformis syndrome  High hamstring tendonitis What Are the Best Ways to Prevent Running Injuries? #1: Get Proper Running Shoes As a coach and personal trainer, I have consistently found that most runners assume they are experiencing running-related injuries due to improper running shoes. Ultimately, there isn’t a magic pair of running shoes that will keep you running injury-free, and research hasn’t found a strong association between a certain type of running shoes and injury prevention. Generally, you should pick the running shoes that feel most comfortable to you. In fact, a systematic review 4 Van Alsenoy, K., van der Linden, M. L., Girard, O., & Santos, D. (2021). Increased footwear comfort is associated with improved running economy – a systematic review and meta-analysis.  European Journal of Sport Science , 1–13. https://doi.org/10.1080/17461391.2021.1998642 published in the European Journal of Sport Science, found that the incidence of running injuries decreases when runners choose running shoes that feel most comfortable. Plus, the rate of perceived exertion and running economy improved. In other words, there isn’t a specific running shoe brand or type (stability running shoes, neutral running shoes, maximalist running shoes, zero drop running shoes, motion control running shoes, etc.) that is inherently better than the other types of running shoes. Rather, the winning combination tends to be finding a running shoe that fits your foot shape and feels comfortable right out of the box. If it is the right running shoe for your needs, it should feel comfortable right away, with no break-in period needed. The most important step in running injury prevention and running shoes is replacing them as soon as they are worn out.  This is generally every 300-500 miles, depending on your body weight, the type of running shoes you wear, training frequency, whether you wear orthotics, etc. Finally, it is valuable to rotate your running shoes by wearing multiple pairs on different training runs throughout the week. Rotating running shoes has been found 5 Malisoux, L., Ramesh, J., Mann, R., Seil, R., Urhausen, A., & Theisen, D. (2013). Can parallel use of different running shoes decrease running-related injury risk?  Scandinavian Journal of Medicine & Science in Sports ,  25 (1), 110–115. https://doi.org/10.1111/sms.12154 to decrease the risk of injuries by allowing the cushioning materials to fully rebound in between workouts and provide different levels of cushioning or stress application to your feet and legs. For example, you might wear a maximalist running shoe for longer runs to provide excellent cushioning, while wearing a firmer, lightweight shoe for speed work or tempo runs . #2: Follow a Good Training Plan There isn’t a single best training plan for all runners. You need a training plan appropriate to your fitness level and running goals. Following an expertly designed training plan , rather than flying by the seat of your pants and doing runs willy-nilly, will help ensure that you are progressing at an appropriate rate, getting enough rest and recovery, and balancing easy runs with quality speed work.  Check out our training plan database here! #3: Don’t Overdo It One of the most common training errors that increases the risk of injury for runners is either doing too much too soon or doing too many hard workouts without enough recovery or rest days in between. Most running coaches follow the principle of the 10% rule , which means that you should not increase your mileage from one week to the next by more than 10%. For example, if you are running 30 miles per week, you should not run more than 33 miles the following week. However, the 10% rule doesn’t have clear guidelines for how to increase training intensity. It is also important not to jump into speed work suddenly or increase the volume of high-intensity running each week. #4: Use the 80/20 Rule The 80/20 rule of running states that 80% of your training volume should be easy runs at a comfortable pace, and only 20% should be high-intensity speed work , such as interval workouts, threshold runs, and racing. #5: Vary Your Training Incorporating different types of runs and paces will help vary the impact stresses on your body relative to plodding along at the same pace every day. You should also vary your routes, especially if you run on sloped or cambered roads. Softer surfaces like grass and trails may be easier on joints and bones than concrete and asphalt. #6: Work On Your Running Form Issues with your running form can be a key risk factor for running injuries. As such, correcting issues in running form  and technique  is essential for running injury prevention programs. For beginners and experienced runners with a history of injuries, it is important to get a professional running gait analysis from an experienced running coach, running shoe fit professional, or physical therapist who specializes in distance running. Overstriding is the most common running form mistake that can increase the risk of injuries, but it is not the only one that may be causing them. #7: Always Warm Up and Cool Down Although studies haven’t demonstrated a statistically significant benefit of stretching , 6 Lauersen, J. B., Bertelsen, D. M., & Andersen, L. B. (2013). The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials.  British Journal of Sports Medicine ,  48 (11), 871–877. https://doi.org/10.1136/bjsports-2013-092538 doing a warm-up and cool-down can help prepare your body for your workout, facilitate recovery, and reduce muscle soreness. #8: Incorporate Strength Training Studies suggest that incorporating strength training into your overall training program is one of the most effective ways to reduce the risk of running injuries. A 2013 systematic review and meta-analysis 7 Lauersen, J. B., Bertelsen, D. M., & Andersen, L. B. (2013). The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials.  British Journal of Sports Medicine ,  48 (11), 871–877. https://doi.org/10.1136/bjsports-2013-092538 of randomized control trials conducted at the Institute of Sports Medicine Copenhagen evaluated the results of 25 studies encompassing 26,000 runners who had encountered a total of over 3,500 injuries from running.  Results revealed that strength training was runners’ most effective injury-prevention strategy, with a relative reduction in injury risk of about 68.5%.  Strength training exercises such as squats, lunges, split squats, deadlifts, single-leg balance, planks, single-leg glute bridges, and plyometrics can make runners more injury-resilient. Strength training strengthens the muscles, bones, joints, and connective tissues so that your own body weight is less of a “stress“ or load. Strength training workouts can also improve your neuromuscular coordination, identify and correct muscle imbalances, improve core strength, increase your ability to have good posture and running form, and improve your running economy. 8 Šuc, A., Šarko, P., Pleša, J., & Kozinc, Ž. (2022). Resistance Exercise for Improving Running Economy and Running Biomechanics and Decreasing Running-Related Injury Risk: A Narrative Review.  Sports ,  10 (7), 98. https://doi.org/10.3390/sports10070098 Proprioceptive training, such as single-leg balance with closed eyes, has also been shown to be an effective running-injury-prevention technique, reducing relative injury risk in runners by over 50%. All these benefits of strength training for runners can set you up for a greater chance of injury-free running. #9: Correct Muscle Imbalances  Muscle imbalances certainly increase the risk of common running injuries.  For example, weaknesses in the vastus medialis, one of the quadriceps muscles, can increase the risk of runner’s knee. 9 Kunene, S. H., Ramklass, S., & Taukobong, N. P. (2018). Anterior knee pain and its intrinsic risk factors among runners in under-resourced communities in Ekurhuleni, Gauteng.  South African Journal of Physiotherapy ,  74 (1). https://doi.org/10.4102/sajp.v74i1.452 ‌I highly recommend a few physical therapy sessions to  identify muscle imbalances and develop a strength-training program to help you correct these issues and prevent injuries. #10: Address Issues Studies suggest 10 van Poppel, D., van der Worp, M., Slabbekoorn, A., van den Heuvel, S. S. P., van Middelkoop, M., Koes, B. W., Verhagen, A. P., & Scholten-Peeters, G. G. M. (2020). Risk factors for overuse injuries in short- and long-distance running: A systematic review.  Journal of Sport and Health Science ,  10 (1). https://doi.org/10.1016/j.jshs.2020.06.006 that a history of a previous running injury is one of the most significant risk factors for running injuries. Instead of passively giving your body time to heal while you cross-train, you should try to identify and address the underlying causes . Physical therapy, correcting your running form, changing running shoes, tweaking your training plan, etc., as needed, will help address the root cause and, therefore, be among the most important steps for preventing future running injuries. #11: Fuel Your Body Underfueling by being in a caloric deficit or following a weight loss diet or other restrictive diet that eliminates certain food groups and nutrients sets your body up for compromised recovery. This can increase your risk of injury. Relative Energy Deficiency In Sport (RED-S) 11 Statuta, S. M., Asif, I. M., & Drezner, J. A. (2017). Relative energy deficiency in sport (RED-S).  British Journal of Sports Medicine ,  51 (21), 1570–1571. https://doi.org/10.1136/bjsports-2017-097700 is a common problem with recreational runners and competitive runners trying to get leaner or lose body fat for running.  It can also happen unintentionally if you run high mileage and aren’t conscious of how many calories you need to eat. RED-S increases the risk of stress fractures 12 Rachel. (2021, July 13).  Relative Energy Deficiency in Sports syndrome (RED-S) and stress fractures . QSP Physiotherapy & Massage. https://qsp.physio/red-s-and-stress-fracture/?v=6cc98ba2045f and can compromise hormonal balance and muscle recovery. It is important to fuel your body before and after training sessions by getting enough calories, complex carbohydrates, and protein to replenish glycogen stores and repair muscle damage. Additionally, fasted running can increase muscle protein breakdown. On the other hand, there’s some evidence to suggest 13 Winter, S. C., Gordon, S., Brice, S. M., Lindsay, D., & Barrs, S. (2020). A Multifactorial Approach to Overuse Running Injuries: A 1-Year Prospective Study.  Sports Health: A Multidisciplinary Approach , 194173811988850. https://doi.org/10.1177/1941738119888504 being overweight can increase the risk of some common running injuries. Therefore, working with a registered dietitian or sports nutritionist can be a cornerstone of your running injury-prevention program. #12: Don’t Neglect Cross-Training Workouts Low-impact cross-training workouts reduce the impact stress of running and utilize different muscle groups. This can help reduce the risk of overuse injuries while still giving you a great aerobic workout. Running high mileage may increase the risk of injury , 14 van der Worp, M. P., ten Haaf, D. S. M., van Cingel, R., de Wijer, A., Nijhuis-van der Sanden, M. W. G., & Staal, J. B. (2015). Injuries in Runners; A Systematic Review on Risk Factors and Sex Differences.  PLOS ONE ,  10 (2), e0114937. https://doi.org/10.1371/journal.pone.0114937 so scaling back easy runs in favor of cross training may possibly help you reach your running goals while decreasing the risk of overuse injuries. #13: Get Enough Sleep Sleep is essential for overall health, wellness, and recovery from training. According to the National Sleep Foundation, adults should be getting 7 to 9 hours of sleep per night , 15 Hirshkowitz, M., Whiton, K., Albert, S. M., Alessi, C., Bruni, O., DonCarlos, L., Hazen, N., Herman, J., Adams Hillard, P. J., Katz, E. S., Kheirandish-Gozal, L., Neubauer, D. N., O’Donnell, A. E., Ohayon, M., Peever, J., Rawding, R., Sachdeva, R. C., Setters, B., Vitiello, M. V., & Ware, J. C. (2015). National Sleep Foundation’s updated sleep duration recommendations: final report.  Sleep Health ,  1 (4), 233–243. https://doi.org/10.1016/j.sleh.2015.10.004 but distance runners following a running plan may need additional sleep to support recovery. Studies 16 Milewski, M. D., Skaggs, D. L., Bishop, G. A., Pace, J. L., Ibrahim, D. A., Wren, T. A. L., & Barzdukas, A. (2014). Chronic lack of sleep is associated with increased sports injuries in adolescent athletes.  Journal of Pediatric Orthopedics ,  34 (2), 129–133. https://doi.org/10.1097/BPO.0000000000000151 have found that sleep-deprived workouts increase the risk of injury. #14: Manage Stress Levels The body responds to all forms of stress the same way, whether it is the positive stress of your training sessions or the negative stress of losing a job, struggling financially, or not getting enough sleep.  Stress increases cortisol levels 17 Mayo Clinic . (2021, July 8).  Chronic stress puts your health at risk . Mayo Clinic; Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress/art-20046037 and stimulates the sympathetic nervous system (the fight-or-flight response). This increases heart and respiratory rates and compromises health and healing when it becomes chronic. Stress management techniques , such as  mindfulness meditation and breathwork exercises,  can help prevent injuries if you notice  stress is an issue in your life.  #15: Listen to Your Body One of the most important steps in any running injury prevention plan is to  listen to your body. Even if your training plan tells you to go for a 6-mile run or a 20-minute tempo run, if you feel like you are tired, experiencing excessive muscle soreness, have aches and pains, or are teetering on the edge of overtraining, it is way more important to swap the work out for a rest day or cross training workout as needed than to follow your running plan to a T. What are your secrets to injury-free running? For more injury-related content, check out our database for running injuries, where we have in-depth articles on a whole host of running injuries, from running cramps to running earaches: References 1 DAOUD, A. I., GEISSLER, G. J., WANG, F., SARETSKY, J., DAOUD, Y. A., & LIEBERMAN, D. E. (2012). Foot Strike and Injury Rates in Endurance Runners.  Medicine & Science in Sports & Exercise ,  44 (7), 1325–1334. https://doi.org/10.1249/mss.0b013e3182465115 2 NILSSON, J., & THORSTENSSON, A. (1989). Ground reaction forces at different speeds of human walking and running.  Acta Physiologica Scandinavica ,  136 (2), 217–227. https://doi.org/10.1111/j.1748-1716.1989.tb08655.x 3 4 Van Alsenoy, K., van der Linden, M. L., Girard, O., & Santos, D. (2021). Increased footwear comfort is associated with improved running economy – a systematic review and meta-analysis.  European Journal of Sport Science , 1–13. https://doi.org/10.1080/17461391.2021.1998642 5 Malisoux, L., Ramesh, J., Mann, R., Seil, R., Urhausen, A., & Theisen, D. (2013). Can parallel use of different running shoes decrease running-related injury risk?  Scandinavian Journal of Medicine & Science in Sports ,  25 (1), 110–115. https://doi.org/10.1111/sms.12154 6 Lauersen, J. B., Bertelsen, D. M., & Andersen, L. B. (2013). The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials.  British Journal of Sports Medicine ,  48 (11), 871–877. https://doi.org/10.1136/bjsports-2013-092538 7 Lauersen, J. B., Bertelsen, D. M., & Andersen, L. B. (2013). The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials.  British Journal of Sports Medicine ,  48 (11), 871–877. https://doi.org/10.1136/bjsports-2013-092538 8 Šuc, A., Šarko, P., Pleša, J., & Kozinc, Ž. (2022). Resistance Exercise for Improving Running Economy and Running Biomechanics and Decreasing Running-Related Injury Risk: A Narrative Review.  Sports ,  10 (7), 98. https://doi.org/10.3390/sports10070098 9 Kunene, S. H., Ramklass, S., & Taukobong, N. P. (2018). Anterior knee pain and its intrinsic risk factors among runners in under-resourced communities in Ekurhuleni, Gauteng.  South African Journal of Physiotherapy ,  74 (1). https://doi.org/10.4102/sajp.v74i1.452 10 van Poppel, D., van der Worp, M., Slabbekoorn, A., van den Heuvel, S. S. P., van Middelkoop, M., Koes, B. W., Verhagen, A. P., & Scholten-Peeters, G. G. M. (2020). Risk factors for overuse injuries in short- and long-distance running: A systematic review.  Journal of Sport and Health Science ,  10 (1). https://doi.org/10.1016/j.jshs.2020.06.006 11 Statuta, S. M., Asif, I. M., & Drezner, J. A. (2017). Relative energy deficiency in sport (RED-S).  British Journal of Sports Medicine ,  51 (21), 1570–1571. https://doi.org/10.1136/bjsports-2017-097700 12 13 Winter, S. C., Gordon, S., Brice, S. M., Lindsay, D., & Barrs, S. (2020). A Multifactorial Approach to Overuse Running Injuries: A 1-Year Prospective Study.  Sports Health: A Multidisciplinary Approach , 194173811988850. https://doi.org/10.1177/1941738119888504 14 van der Worp, M. P., ten Haaf, D. S. M., van Cingel, R., de Wijer, A., Nijhuis-van der Sanden, M. W. G., & Staal, J. B. (2015). Injuries in Runners; A Systematic Review on Risk Factors and Sex Differences.  PLOS ONE ,  10 (2), e0114937. https://doi.org/10.1371/journal.pone.0114937 15 Hirshkowitz, M., Whiton, K., Albert, S. M., Alessi, C., Bruni, O., DonCarlos, L., Hazen, N., Herman, J., Adams Hillard, P. J., Katz, E. S., Kheirandish-Gozal, L., Neubauer, D. N., O’Donnell, A. E., Ohayon, M., Peever, J., Rawding, R., Sachdeva, R. C., Setters, B., Vitiello, M. V., & Ware, J. C. (2015). National Sleep Foundation’s updated sleep duration recommendations: final report.  Sleep Health ,  1 (4), 233–243. https://doi.org/10.1016/j.sleh.2015.10.004 16 Milewski, M. D., Skaggs, D. L., Bishop, G. A., Pace, J. L., Ibrahim, D. A., Wren, T. A. L., & Barzdukas, A. (2014). Chronic lack of sleep is associated with increased sports injuries in adolescent athletes.  Journal of Pediatric Orthopedics ,  34 (2), 129–133. https://doi.org/10.1097/BPO.0000000000000151 17
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[Run Training](https://marathonhandbook.com/running/) - [News](https://marathonhandbook.com/news) - [Shoes & Gear](https://marathonhandbook.com/running-gear-and-shoes/) - [Coaching](https://marathonhandbook.com/online-coaching/) [Podcast](https://marathonhandbook.com/podcast/) Newsletter Menu [Run](https://marathonhandbook.com/run/) \> [Injury](https://marathonhandbook.com/run/injury/) \> [Recovery and Treatment](https://marathonhandbook.com/run/injury/recovery-and-treatment/) # Running Injury Prevention: 15 Ways To Stay Injury-Free Smart strategies to keep you running strong and injury-free ###### Last Updated: Apr 1, 2026 2:47 pm [![sayer headshot](https://marathonhandbook.com/wp-content/uploads/2022/02/sayer-headshot-80x80.jpg)](https://marathonhandbook.com/author/ambersayer/) ###### [Amber Sayer, MS, CPT, CNC](https://marathonhandbook.com/author/ambersayer/) ![sayer headshot](https://marathonhandbook.com/wp-content/uploads/2022/02/sayer-headshot-128x128.jpg) [Amber Sayer, MS, CPT, CNC](https://marathonhandbook.com/author/ambersayer/) Amber Sayer is our Senior Running Editor, and a NASM-Certified Nutrition Coach and UESCA-certified running, endurance nutrition, and triathlon coach. She holds two Masters Degrees—one in Exercise Science and one in Prosthetics and Orthotics, as well as a Certified Personal Trainer and running coach for 12 years. [Here's My Full Profile](https://marathonhandbook.com/author/ambersayer/) [learn about our editorial process](https://marathonhandbook.com/editorial-process/) Senior Running Editor Updated by [Katelyn Tocci](https://marathonhandbook.com/author/katelyn-tocci/) ![a smiling marathon runner](https://marathonhandbook.com/wp-content/uploads/2021/08/cropped-Profile-2-128x128.jpeg) [Katelyn Tocci](https://marathonhandbook.com/author/katelyn-tocci/) Katelyn Tocci is our Head Coach and Training Editor; 100-mile ultrarunner, RRCA + UESCA Certified Running Coach [Here's My Full Profile](https://marathonhandbook.com/author/katelyn-tocci/) *** [learn about our editorial process](https://marathonhandbook.com/editorial-process/) Save this Article Getting injured from running is ***no fun.*** While injuries *are* common among runners, the good news is that, with the right approach, injury prevention is possible for many. As a certified running coach, I am typically approached by recreational runners for one of two reasons. Either the runner is looking for a training plan that will help them improve performance and run faster—or is looking for individualized coaching that will help prevent running injuries or at least reduce the risk of injury. Distance runners seemingly have a fairly high injury risk, as running is a high-impact activity involving a repetitive motion. Most [surveys and estimates in research literature](https://scholar.harvard.edu/files/dlieberman/files/2012b.pdf)[1]()DAOUD, A. I., GEISSLER, G. J., WANG, F., SARETSKY, J., DAOUD, Y. A., & LIEBERMAN, D. E. (2012). Foot Strike and Injury Rates in Endurance Runners. *Medicine & Science in Sports & Exercise*, *44*(7), 1325–1334. <https://doi.org/10.1249/mss.0b013e3182465115> note that **about 30-75% of runners experience an injury over the course of a year of training.** However, with the right training program for your ability level, a good balance between hard training sessions and recovery, and supplementary injury-prevention techniques, it is possible to significantly reduce your risk of common running injuries. We’ll take a look at the most common running injuries and share practical, effective tips to help you prevent them while continuing to log your miles. Jump to: 1. [What Causes Injuries In Runners?](https://marathonhandbook.com/guide-to-injury-prevention/#what-causes-injuries-in-runners "What Causes Injuries In Runners?") 2. [What Are the Most Common Injuries From Running?](https://marathonhandbook.com/guide-to-injury-prevention/#what-are-the-most-common-injuries-from-running "What Are the Most Common Injuries From Running?") 3. [What Are the Best Ways to Prevent Running Injuries?](https://marathonhandbook.com/guide-to-injury-prevention/#what-are-the-best-ways-to-prevent-running-injuries "What Are the Best Ways to Prevent Running Injuries?") ![A runner holding their knee.](https://marathonhandbook.com/wp-content/uploads/Running-Injury-Prevention.jpg) ## What Causes Injuries In Runners? Recreational and competitive runners are especially prone to *overuse* injuries due to the repetitive nature of running and the high-impact stress it places on the lower body. In fact, the feet, shins, knees, hips, and spine are subject to [2-3 times your body weight](https://onlinelibrary.wiley.com/doi/10.1111/j.1748-1716.1989.tb08655.x)[2]()NILSSON, J., & THORSTENSSON, A. (1989). Ground reaction forces at different speeds of human walking and running. *Acta Physiologica Scandinavica*, *136*(2), 217–227. <https://doi.org/10.1111/j.1748-1716.1989.tb08655.x> when you run, and research indicates runners take approximately 1,400 steps per mile at an 8-minute-per-mile pace. Therefore, it’s not surprising that many runners deal with overuse injuries from running. Indeed, [studies suggest](https://pubmed.ncbi.nlm.nih.gov/1439399/)[3]()van Mechelen, W. (1992). Running Injuries. *Sports Medicine*, *14*(5), 320–335. <https://doi.org/10.2165/00007256-199214050-00004>[:](https://doi.org/10.2165/00007256-199214050-00004) **about 50-75% of all running-related injuries result from** **overuse.** That said, it is also possible for distance runners to experience acute running injuries, which have a sudden onset, but the most common running injuries are typically categorized as overuse injuries. Risk factors for running injuries can be divided into three different categories: 1. **Personal factors such as sex, age, body weight, and foot arch type.** 2. **Training factors such as training volume, the variety of workouts you do, how aggressively you increase your mileage, strength training (or lack thereof), and running shoes.** 3. **Health and lifestyle factors such as a history of previous injuries, sleep quality and quantity, smoking, etc.** ![A man sits on the ground holding his ankle.](https://marathonhandbook.com/wp-content/uploads/2022/01/How-Not-To-Get-Injured-A-Runners-9-Step-Guide-To-Injury-Prevention-6.jpg) ## What Are the Most Common Injuries From Running? Most running-related injuries occur in the lower limbs: - **Foot** - **Ankle** - **Lower leg: Shin and calf muscles** - **Thigh: Quads, hamstrings, femur** - **Pelvis, Hips, groin, glutes** Aside from lower limb injuries, distance runners can also be at risk for back injuries. Here are some of the most common running injuries: ### Most Common Running Injuries - **Plantar fasciitis** - **Posterior tibial tendon dysfunction (PTTD)** - **Achilles tendinitis** - **Stress fractures** - **Medial tibial stress syndrome (shin splints)** - **Compartment syndrome** - **Patellofemoral pain syndrome (runner’s knee)** - **Patellar tendinitis** - **IT band syndrome** - **Piriformis syndrome** - **High hamstring tendonitis** ![A runner stands on the road with their hands on their knee.](https://marathonhandbook.com/wp-content/uploads/2022/01/How-Not-To-Get-Injured-A-Runners-9-Step-Guide-To-Injury-Prevention-7.jpg) ## What Are the Best Ways to Prevent Running Injuries? ### \#1: Get Proper Running Shoes As a coach and personal trainer, I have consistently found that most runners assume they are experiencing running-related injuries due to improper running shoes. Ultimately, there isn’t a magic pair of running shoes that will keep you running injury-free, and research hasn’t found a strong association between a certain type of running shoes and injury prevention. **Generally, you should pick the running shoes that feel most comfortable to you.** In fact, a [systematic review](https://www.tandfonline.com/doi/full/10.1080/17461391.2021.1998642)[4]()Van Alsenoy, K., van der Linden, M. L., Girard, O., & Santos, D. (2021). Increased footwear comfort is associated with improved running economy – a systematic review and meta-analysis. *European Journal of Sport Science*, 1–13. <https://doi.org/10.1080/17461391.2021.1998642> published in the *European Journal of Sport Science,* found that the incidence of running injuries decreases when runners choose running shoes that feel most comfortable. Plus, the [rate of perceived exertion](https://marathonhandbook.com/rate-of-perceived-exertion/) and [running economy](https://marathonhandbook.com/comfortable-running-shoes/) improved. In other words, there isn’t a specific running shoe brand or type (stability running shoes, neutral running shoes, maximalist running shoes, zero drop running shoes, motion control running shoes, etc.) that is inherently better than the other types of running shoes. Rather, the winning combination tends to be finding a running shoe that fits your foot shape and feels comfortable right out of the box. If it is the right running shoe for your needs, it should feel comfortable right away, with no break-in period needed. The most important step in running injury prevention and running shoes is replacing them as soon as they are worn out. **This is generally every 300-500 miles, depending on your body weight, the type of running shoes you wear, training frequency, whether you wear orthotics, etc.** Finally, it is valuable to rotate your running shoes by wearing multiple pairs on different training runs throughout the week. Rotating running shoes [has been found](https://pubmed.ncbi.nlm.nih.gov/24286345/)[5]()Malisoux, L., Ramesh, J., Mann, R., Seil, R., Urhausen, A., & Theisen, D. (2013). Can parallel use of different running shoes decrease running-related injury risk? *Scandinavian Journal of Medicine & Science in Sports*, *25*(1), 110–115. <https://doi.org/10.1111/sms.12154> to decrease the risk of injuries by allowing the cushioning materials to fully rebound in between workouts and provide different levels of cushioning or stress application to your feet and legs. For example, you might wear a maximalist running shoe for longer runs to provide excellent cushioning, while wearing a firmer, lightweight shoe for speed work or [tempo runs](https://marathonhandbook.com/what-is-a-tempo-run/). ![A person sits on the road barefoot holding their ankle.](https://marathonhandbook.com/wp-content/uploads/2022/01/How-Not-To-Get-Injured-A-Runners-9-Step-Guide-To-Injury-Prevention-13.jpg) ### \#2: Follow a Good Training Plan There isn’t a single best training plan for *all* runners. You need a training plan appropriate to your fitness level and running goals. **Following an expertly designed training plan**, rather than flying by the seat of your pants and doing runs willy-nilly, will help ensure that you are progressing at an appropriate rate, getting enough rest and recovery, and balancing easy runs with quality speed work. Check out our training plan database [here\!](https://marathonhandbook.com/running/) ### \#3: Don’t Overdo It One of the most common training errors that increases the risk of injury for runners is either **doing too much too soon or doing too many hard workouts** without enough recovery or rest days in between. Most running coaches follow the principle of the [10% rule](https://marathonhandbook.com/the-10-percent-rule/), which means that you should not increase your mileage from one week to the next by more than 10%. For example, if you are running 30 miles per week, you should not run more than 33 miles the following week. However, the 10% rule doesn’t have clear guidelines for how to increase training intensity. It is also important not to jump into speed work suddenly or increase the volume of high-intensity running each week. ![A person wearing yellow running shoes holds their ankle.](https://marathonhandbook.com/wp-content/uploads/2022/01/How-Not-To-Get-Injured-A-Runners-9-Step-Guide-To-Injury-Prevention-8.jpg) ### \#4: Use the 80/20 Rule The 80/20 rule of running states that **80% of your training volume should be easy runs at a comfortable pace, and only 20% should be high-intensity speed work**, such as interval workouts, threshold runs, and racing. ### \#5: Vary Your Training **Incorporating different types of runs and paces** will help vary the impact stresses on your body relative to plodding along at the same pace every day. You should also vary your routes, especially if you run on sloped or cambered roads. Softer surfaces like grass and trails may be easier on joints and bones than concrete and asphalt. ### \#6: Work On Your Running Form Issues with your [running form](https://marathonhandbook.com/proper-running-form/) can be a key risk factor for running injuries. As such, **correcting** **issues in running form** and technique is essential for running injury prevention programs. For beginners and experienced runners with a history of injuries, it is important to get a professional running [gait analysis](https://marathonhandbook.com/running-gait-analysis/) from an experienced running coach, running shoe fit professional, or physical therapist who specializes in distance running. Overstriding is the most common running form mistake that can increase the risk of injuries, but it is not the only one that may be causing them. ![Bare feet next to blue running shoes on a wooden floor.](https://marathonhandbook.com/wp-content/uploads/2022/01/How-Not-To-Get-Injured-A-Runners-9-Step-Guide-To-Injury-Prevention-11.jpg) ### \#7: Always Warm Up and Cool Down Although studies haven’t demonstrated a statistically significant benefit of *stretching*,[6]()Lauersen, J. B., Bertelsen, D. M., & Andersen, L. B. (2013). The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. *British Journal of Sports Medicine*, *48*(11), 871–877. <https://doi.org/10.1136/bjsports-2013-092538> **doing a warm-up and cool-down** can help prepare your body for your workout, facilitate recovery, and reduce muscle soreness. ### \#8: Incorporate Strength Training **Studies suggest that incorporating strength training into your overall training program is one of the most effective ways to reduce the risk of running injuries.** A 2013 systematic review and meta-analysis[7]()Lauersen, J. B., Bertelsen, D. M., & Andersen, L. B. (2013). The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. *British Journal of Sports Medicine*, *48*(11), 871–877. <https://doi.org/10.1136/bjsports-2013-092538> of randomized control trials conducted at the Institute of Sports Medicine Copenhagen evaluated the results of 25 studies encompassing 26,000 runners who had encountered a total of over 3,500 injuries from running. Results revealed that strength training was runners’ most effective injury-prevention strategy, with a relative reduction in injury risk of about 68.5%. Strength training exercises such as squats, lunges, split squats, deadlifts, single-leg balance, planks, single-leg glute bridges, and plyometrics can make runners more injury-resilient. Strength training strengthens the muscles, bones, joints, and connective tissues so that your own body weight is less of a “stress“ or load. Strength training workouts can also improve your neuromuscular coordination, identify and correct muscle imbalances, improve core strength, increase your ability to have good posture and running form, and [improve your running economy.](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9319953/)[8]()Šuc, A., Šarko, P., Pleša, J., & Kozinc, Ž. (2022). Resistance Exercise for Improving Running Economy and Running Biomechanics and Decreasing Running-Related Injury Risk: A Narrative Review. *Sports*, *10*(7), 98. <https://doi.org/10.3390/sports10070098> Proprioceptive training, such as single-leg balance with closed eyes, has also been shown to be an effective running-injury-prevention technique, reducing relative injury risk in runners by over 50%. All these benefits of strength training for runners can set you up for a greater chance of injury-free running. ![A therapist extends a clients leg and holds their knee.](https://marathonhandbook.com/wp-content/uploads/2022/01/How-Not-To-Get-Injured-A-Runners-9-Step-Guide-To-Injury-Prevention-10.jpg) ### \#9: Correct Muscle Imbalances Muscle imbalances certainly increase the risk of common running injuries. For example, weaknesses in the vastus medialis, one of the quadriceps muscles, can [increase the risk of runner’s knee.](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6191677/)[9]()Kunene, S. H., Ramklass, S., & Taukobong, N. P. (2018). Anterior knee pain and its intrinsic risk factors among runners in under-resourced communities in Ekurhuleni, Gauteng. *South African Journal of Physiotherapy*, *74*(1). <https://doi.org/10.4102/sajp.v74i1.452> ‌I highly recommend a few physical therapy sessions to **identify muscle imbalances and develop a strength-training** **program** to help you correct these issues and prevent injuries. ### \#10: Address Issues [Studies suggest](https://pubmed.ncbi.nlm.nih.gov/32535271/)[10]()van Poppel, D., van der Worp, M., Slabbekoorn, A., van den Heuvel, S. S. P., van Middelkoop, M., Koes, B. W., Verhagen, A. P., & Scholten-Peeters, G. G. M. (2020). Risk factors for overuse injuries in short- and long-distance running: A systematic review. *Journal of Sport and Health Science*, *10*(1). <https://doi.org/10.1016/j.jshs.2020.06.006> that a history of a previous running injury is one of the most significant risk factors for running injuries. Instead of passively giving your body time to heal while you cross-train, you should try to **identify and address the underlying causes**. Physical therapy, correcting your running form, changing running shoes, tweaking your training plan, etc., as needed, will help address the root cause and, therefore, be among the most important steps for preventing future running injuries. ![A runner stopped in the road holding their heel.](https://marathonhandbook.com/wp-content/uploads/2022/01/How-Not-To-Get-Injured-A-Runners-9-Step-Guide-To-Injury-Prevention-3.jpg) ### \#11: Fuel Your Body Underfueling by being in a caloric deficit or following a weight loss diet or other restrictive diet that eliminates certain food groups and nutrients sets your body up for compromised recovery. This can increase your risk of injury. Relative Energy Deficiency In Sport (RED-S)[11]()Statuta, S. M., Asif, I. M., & Drezner, J. A. (2017). Relative energy deficiency in sport (RED-S). *British Journal of Sports Medicine*, *51*(21), 1570–1571. <https://doi.org/10.1136/bjsports-2017-097700> is a common problem with recreational runners and competitive runners trying to get leaner or lose body fat for running. It can also happen unintentionally if you run high mileage and aren’t conscious of how many calories you need to eat. [RED-S increases the risk of stress fractures](https://qsp.physio/red-s-and-stress-fracture/)[12]()Rachel. (2021, July 13). *Relative Energy Deficiency in Sports syndrome (RED-S) and stress fractures*. QSP Physiotherapy & Massage. <https://qsp.physio/red-s-and-stress-fracture/?v=6cc98ba2045f> and can compromise hormonal balance and muscle recovery. It is important to **fuel your body before and after training sessions** by getting enough calories, complex carbohydrates, and protein to replenish glycogen stores and repair muscle damage. Additionally, fasted running can increase muscle protein breakdown. On the other hand, [there’s some evidence to suggest](https://pubmed.ncbi.nlm.nih.gov/31994970/)[13]()Winter, S. C., Gordon, S., Brice, S. M., Lindsay, D., & Barrs, S. (2020). A Multifactorial Approach to Overuse Running Injuries: A 1-Year Prospective Study. *Sports Health: A Multidisciplinary Approach*, 194173811988850. <https://doi.org/10.1177/1941738119888504> being overweight can increase the risk of some common running injuries. Therefore, working with a registered dietitian or sports nutritionist can be a cornerstone of your running injury-prevention program. ![A runner sitting on a rocky trail holding their ankle.](https://marathonhandbook.com/wp-content/uploads/2022/01/How-Not-To-Get-Injured-A-Runners-9-Step-Guide-To-Injury-Prevention-4.jpg) ### \#12: Don’t Neglect Cross-Training Workouts Low-impact cross-training workouts reduce the impact stress of running and utilize different muscle groups. This can help reduce the risk of overuse injuries while still giving you a great aerobic workout. Running high mileage [may increase the risk of injury](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4338213/),[14]()van der Worp, M. P., ten Haaf, D. S. M., van Cingel, R., de Wijer, A., Nijhuis-van der Sanden, M. W. G., & Staal, J. B. (2015). Injuries in Runners; A Systematic Review on Risk Factors and Sex Differences. *PLOS ONE*, *10*(2), e0114937. <https://doi.org/10.1371/journal.pone.0114937> so **scaling back easy runs in favor of cross training** may possibly help you reach your running goals while decreasing the risk of overuse injuries. ### \#13: Get Enough Sleep Sleep is essential for overall health, wellness, and recovery from training. According to the [National Sleep Foundation, **adults should be getting 7 to 9 hours** of sleep per night](https://pubmed.ncbi.nlm.nih.gov/29073398/),[15]()Hirshkowitz, M., Whiton, K., Albert, S. M., Alessi, C., Bruni, O., DonCarlos, L., Hazen, N., Herman, J., Adams Hillard, P. J., Katz, E. S., Kheirandish-Gozal, L., Neubauer, D. N., O’Donnell, A. E., Ohayon, M., Peever, J., Rawding, R., Sachdeva, R. C., Setters, B., Vitiello, M. V., & Ware, J. C. (2015). National Sleep Foundation’s updated sleep duration recommendations: final report. *Sleep Health*, *1*(4), 233–243. <https://doi.org/10.1016/j.sleh.2015.10.004> but distance runners following a running plan may need additional sleep to support recovery. [Studies](https://pubmed.ncbi.nlm.nih.gov/25028798/)[16]()Milewski, M. D., Skaggs, D. L., Bishop, G. A., Pace, J. L., Ibrahim, D. A., Wren, T. A. L., & Barzdukas, A. (2014). Chronic lack of sleep is associated with increased sports injuries in adolescent athletes. *Journal of Pediatric Orthopedics*, *34*(2), 129–133. <https://doi.org/10.1097/BPO.0000000000000151> have found that sleep-deprived workouts increase the risk of injury. ![A black and white image with the foot in red.](https://marathonhandbook.com/wp-content/uploads/2022/01/How-Not-To-Get-Injured-A-Runners-9-Step-Guide-To-Injury-Prevention-5.jpg) ### \#14: Manage Stress Levels The body responds to all forms of stress the same way, whether it is the positive stress of your training sessions or the negative stress of losing a job, struggling financially, or not getting enough sleep. [Stress increases cortisol levels](https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress/art-20046037)[17]()Mayo Clinic . (2021, July 8). *Chronic stress puts your health at risk*. Mayo Clinic; Mayo Foundation for Medical Education and Research. <https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress/art-20046037> and stimulates the sympathetic nervous system (the fight-or-flight response). This increases heart and respiratory rates and compromises health and healing when it becomes chronic. Stress management techniques, such as **mindfulness meditation and breathwork exercises,** can help prevent injuries if you notice stress is an issue in your life. ### \#15: Listen to Your Body One of the most important steps in any running injury prevention plan is to **listen** **to your body.** Even if your training plan tells you to go for a 6-mile run or a 20-minute tempo run, if you feel like you are tired, experiencing excessive muscle soreness, have aches and pains, or are teetering on the edge of overtraining, it is *way* more important to swap the work out for a rest day or cross training workout as needed than to follow your running plan to a T. *What are your secrets to injury-free running?* For more injury-related content, check out our database for running injuries, where we have in-depth articles on a whole host of running injuries, from running cramps to running earaches: > [Running Injuries](https://marathonhandbook.com/running-injuries/) ### References - 1 DAOUD, A. I., GEISSLER, G. J., WANG, F., SARETSKY, J., DAOUD, Y. A., & LIEBERMAN, D. E. (2012). Foot Strike and Injury Rates in Endurance Runners. *Medicine & Science in Sports & Exercise*, *44*(7), 1325–1334. <https://doi.org/10.1249/mss.0b013e3182465115> - 2 NILSSON, J., & THORSTENSSON, A. (1989). Ground reaction forces at different speeds of human walking and running. *Acta Physiologica Scandinavica*, *136*(2), 217–227. <https://doi.org/10.1111/j.1748-1716.1989.tb08655.x> - 3 van Mechelen, W. (1992). Running Injuries. *Sports Medicine*, *14*(5), 320–335. <https://doi.org/10.2165/00007256-199214050-00004> - 4 Van Alsenoy, K., van der Linden, M. L., Girard, O., & Santos, D. (2021). Increased footwear comfort is associated with improved running economy – a systematic review and meta-analysis. *European Journal of Sport Science*, 1–13. <https://doi.org/10.1080/17461391.2021.1998642> - 5 Malisoux, L., Ramesh, J., Mann, R., Seil, R., Urhausen, A., & Theisen, D. (2013). Can parallel use of different running shoes decrease running-related injury risk? *Scandinavian Journal of Medicine & Science in Sports*, *25*(1), 110–115. <https://doi.org/10.1111/sms.12154> - 6 Lauersen, J. B., Bertelsen, D. M., & Andersen, L. B. (2013). The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. *British Journal of Sports Medicine*, *48*(11), 871–877. <https://doi.org/10.1136/bjsports-2013-092538> - 7 Lauersen, J. B., Bertelsen, D. M., & Andersen, L. B. (2013). The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. *British Journal of Sports Medicine*, *48*(11), 871–877. <https://doi.org/10.1136/bjsports-2013-092538> - 8 Šuc, A., Šarko, P., Pleša, J., & Kozinc, Ž. (2022). Resistance Exercise for Improving Running Economy and Running Biomechanics and Decreasing Running-Related Injury Risk: A Narrative Review. *Sports*, *10*(7), 98. <https://doi.org/10.3390/sports10070098> - 9 Kunene, S. H., Ramklass, S., & Taukobong, N. P. (2018). Anterior knee pain and its intrinsic risk factors among runners in under-resourced communities in Ekurhuleni, Gauteng. *South African Journal of Physiotherapy*, *74*(1). <https://doi.org/10.4102/sajp.v74i1.452> - 10 van Poppel, D., van der Worp, M., Slabbekoorn, A., van den Heuvel, S. S. P., van Middelkoop, M., Koes, B. W., Verhagen, A. P., & Scholten-Peeters, G. G. M. (2020). Risk factors for overuse injuries in short- and long-distance running: A systematic review. *Journal of Sport and Health Science*, *10*(1). <https://doi.org/10.1016/j.jshs.2020.06.006> - 11 Statuta, S. M., Asif, I. M., & Drezner, J. A. (2017). Relative energy deficiency in sport (RED-S). *British Journal of Sports Medicine*, *51*(21), 1570–1571. <https://doi.org/10.1136/bjsports-2017-097700> - 12 Rachel. (2021, July 13). *Relative Energy Deficiency in Sports syndrome (RED-S) and stress fractures*. QSP Physiotherapy & Massage. <https://qsp.physio/red-s-and-stress-fracture/?v=6cc98ba2045f> - 13 Winter, S. C., Gordon, S., Brice, S. M., Lindsay, D., & Barrs, S. (2020). A Multifactorial Approach to Overuse Running Injuries: A 1-Year Prospective Study. *Sports Health: A Multidisciplinary Approach*, 194173811988850. <https://doi.org/10.1177/1941738119888504> - 14 van der Worp, M. P., ten Haaf, D. S. M., van Cingel, R., de Wijer, A., Nijhuis-van der Sanden, M. W. G., & Staal, J. B. (2015). Injuries in Runners; A Systematic Review on Risk Factors and Sex Differences. *PLOS ONE*, *10*(2), e0114937. <https://doi.org/10.1371/journal.pone.0114937> - 15 Hirshkowitz, M., Whiton, K., Albert, S. M., Alessi, C., Bruni, O., DonCarlos, L., Hazen, N., Herman, J., Adams Hillard, P. J., Katz, E. S., Kheirandish-Gozal, L., Neubauer, D. N., O’Donnell, A. E., Ohayon, M., Peever, J., Rawding, R., Sachdeva, R. C., Setters, B., Vitiello, M. V., & Ware, J. C. (2015). National Sleep Foundation’s updated sleep duration recommendations: final report. *Sleep Health*, *1*(4), 233–243. <https://doi.org/10.1016/j.sleh.2015.10.004> - 16 Milewski, M. D., Skaggs, D. L., Bishop, G. A., Pace, J. L., Ibrahim, D. A., Wren, T. A. L., & Barzdukas, A. (2014). Chronic lack of sleep is associated with increased sports injuries in adolescent athletes. *Journal of Pediatric Orthopedics*, *34*(2), 129–133. <https://doi.org/10.1097/BPO.0000000000000151> - 17 Mayo Clinic . (2021, July 8). *Chronic stress puts your health at risk*. Mayo Clinic; Mayo Foundation for Medical Education and Research. <https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress/art-20046037> ### **Running. 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Getting injured from running is ***no fun.*** While injuries *are* common among runners, the good news is that, with the right approach, injury prevention is possible for many. As a certified running coach, I am typically approached by recreational runners for one of two reasons. Either the runner is looking for a training plan that will help them improve performance and run faster—or is looking for individualized coaching that will help prevent running injuries or at least reduce the risk of injury. Distance runners seemingly have a fairly high injury risk, as running is a high-impact activity involving a repetitive motion. Most [surveys and estimates in research literature](https://scholar.harvard.edu/files/dlieberman/files/2012b.pdf)1DAOUD, A. I., GEISSLER, G. J., WANG, F., SARETSKY, J., DAOUD, Y. A., & LIEBERMAN, D. E. (2012). Foot Strike and Injury Rates in Endurance Runners. *Medicine & Science in Sports & Exercise*, *44*(7), 1325–1334. <https://doi.org/10.1249/mss.0b013e3182465115> note that **about 30-75% of runners experience an injury over the course of a year of training.** However, with the right training program for your ability level, a good balance between hard training sessions and recovery, and supplementary injury-prevention techniques, it is possible to significantly reduce your risk of common running injuries. We’ll take a look at the most common running injuries and share practical, effective tips to help you prevent them while continuing to log your miles. 1. [What Causes Injuries In Runners?](https://marathonhandbook.com/guide-to-injury-prevention/#what-causes-injuries-in-runners "What Causes Injuries In Runners?") 2. [What Are the Most Common Injuries From Running?](https://marathonhandbook.com/guide-to-injury-prevention/#what-are-the-most-common-injuries-from-running "What Are the Most Common Injuries From Running?") 3. [What Are the Best Ways to Prevent Running Injuries?](https://marathonhandbook.com/guide-to-injury-prevention/#what-are-the-best-ways-to-prevent-running-injuries "What Are the Best Ways to Prevent Running Injuries?") ![A runner holding their knee.](https://marathonhandbook.com/wp-content/uploads/Running-Injury-Prevention.jpg) ## What Causes Injuries In Runners? Recreational and competitive runners are especially prone to *overuse* injuries due to the repetitive nature of running and the high-impact stress it places on the lower body. In fact, the feet, shins, knees, hips, and spine are subject to [2-3 times your body weight](https://onlinelibrary.wiley.com/doi/10.1111/j.1748-1716.1989.tb08655.x)2NILSSON, J., & THORSTENSSON, A. (1989). Ground reaction forces at different speeds of human walking and running. *Acta Physiologica Scandinavica*, *136*(2), 217–227. <https://doi.org/10.1111/j.1748-1716.1989.tb08655.x> when you run, and research indicates runners take approximately 1,400 steps per mile at an 8-minute-per-mile pace. Therefore, it’s not surprising that many runners deal with overuse injuries from running. That said, it is also possible for distance runners to experience acute running injuries, which have a sudden onset, but the most common running injuries are typically categorized as overuse injuries. Risk factors for running injuries can be divided into three different categories: 1. **Personal factors such as sex, age, body weight, and foot arch type.** 2. **Training factors such as training volume, the variety of workouts you do, how aggressively you increase your mileage, strength training (or lack thereof), and running shoes.** 3. **Health and lifestyle factors such as a history of previous injuries, sleep quality and quantity, smoking, etc.** ![A man sits on the ground holding his ankle.](https://marathonhandbook.com/wp-content/uploads/2022/01/How-Not-To-Get-Injured-A-Runners-9-Step-Guide-To-Injury-Prevention-6.jpg) ## What Are the Most Common Injuries From Running? Most running-related injuries occur in the lower limbs: - **Foot** - **Ankle** - **Lower leg: Shin and calf muscles** - **Thigh: Quads, hamstrings, femur** - **Pelvis, Hips, groin, glutes** Aside from lower limb injuries, distance runners can also be at risk for back injuries. Here are some of the most common running injuries: ### Most Common Running Injuries - **Plantar fasciitis** - **Posterior tibial tendon dysfunction (PTTD)** - **Achilles tendinitis** - **Stress fractures** - **Medial tibial stress syndrome (shin splints)** - **Compartment syndrome** - **Patellofemoral pain syndrome (runner’s knee)** - **Patellar tendinitis** - **IT band syndrome** - **Piriformis syndrome** - **High hamstring tendonitis** ![A runner stands on the road with their hands on their knee.](https://marathonhandbook.com/wp-content/uploads/2022/01/How-Not-To-Get-Injured-A-Runners-9-Step-Guide-To-Injury-Prevention-7.jpg) ## What Are the Best Ways to Prevent Running Injuries? ### \#1: Get Proper Running Shoes As a coach and personal trainer, I have consistently found that most runners assume they are experiencing running-related injuries due to improper running shoes. Ultimately, there isn’t a magic pair of running shoes that will keep you running injury-free, and research hasn’t found a strong association between a certain type of running shoes and injury prevention. **Generally, you should pick the running shoes that feel most comfortable to you.** In fact, a [systematic review](https://www.tandfonline.com/doi/full/10.1080/17461391.2021.1998642)4Van Alsenoy, K., van der Linden, M. L., Girard, O., & Santos, D. (2021). Increased footwear comfort is associated with improved running economy – a systematic review and meta-analysis. *European Journal of Sport Science*, 1–13. <https://doi.org/10.1080/17461391.2021.1998642> published in the *European Journal of Sport Science,* found that the incidence of running injuries decreases when runners choose running shoes that feel most comfortable. Plus, the [rate of perceived exertion](https://marathonhandbook.com/rate-of-perceived-exertion/) and [running economy](https://marathonhandbook.com/comfortable-running-shoes/) improved. In other words, there isn’t a specific running shoe brand or type (stability running shoes, neutral running shoes, maximalist running shoes, zero drop running shoes, motion control running shoes, etc.) that is inherently better than the other types of running shoes. Rather, the winning combination tends to be finding a running shoe that fits your foot shape and feels comfortable right out of the box. If it is the right running shoe for your needs, it should feel comfortable right away, with no break-in period needed. The most important step in running injury prevention and running shoes is replacing them as soon as they are worn out. **This is generally every 300-500 miles, depending on your body weight, the type of running shoes you wear, training frequency, whether you wear orthotics, etc.** Finally, it is valuable to rotate your running shoes by wearing multiple pairs on different training runs throughout the week. Rotating running shoes [has been found](https://pubmed.ncbi.nlm.nih.gov/24286345/)5Malisoux, L., Ramesh, J., Mann, R., Seil, R., Urhausen, A., & Theisen, D. (2013). Can parallel use of different running shoes decrease running-related injury risk? *Scandinavian Journal of Medicine & Science in Sports*, *25*(1), 110–115. <https://doi.org/10.1111/sms.12154> to decrease the risk of injuries by allowing the cushioning materials to fully rebound in between workouts and provide different levels of cushioning or stress application to your feet and legs. For example, you might wear a maximalist running shoe for longer runs to provide excellent cushioning, while wearing a firmer, lightweight shoe for speed work or [tempo runs](https://marathonhandbook.com/what-is-a-tempo-run/). ![A person sits on the road barefoot holding their ankle.](https://marathonhandbook.com/wp-content/uploads/2022/01/How-Not-To-Get-Injured-A-Runners-9-Step-Guide-To-Injury-Prevention-13.jpg) ### \#2: Follow a Good Training Plan There isn’t a single best training plan for *all* runners. You need a training plan appropriate to your fitness level and running goals. **Following an expertly designed training plan**, rather than flying by the seat of your pants and doing runs willy-nilly, will help ensure that you are progressing at an appropriate rate, getting enough rest and recovery, and balancing easy runs with quality speed work. Check out our training plan database [here\!](https://marathonhandbook.com/running/) ### \#3: Don’t Overdo It One of the most common training errors that increases the risk of injury for runners is either **doing too much too soon or doing too many hard workouts** without enough recovery or rest days in between. Most running coaches follow the principle of the [10% rule](https://marathonhandbook.com/the-10-percent-rule/), which means that you should not increase your mileage from one week to the next by more than 10%. For example, if you are running 30 miles per week, you should not run more than 33 miles the following week. However, the 10% rule doesn’t have clear guidelines for how to increase training intensity. It is also important not to jump into speed work suddenly or increase the volume of high-intensity running each week. ![A person wearing yellow running shoes holds their ankle.](https://marathonhandbook.com/wp-content/uploads/2022/01/How-Not-To-Get-Injured-A-Runners-9-Step-Guide-To-Injury-Prevention-8.jpg) ### \#4: Use the 80/20 Rule The 80/20 rule of running states that **80% of your training volume should be easy runs at a comfortable pace, and only 20% should be high-intensity speed work**, such as interval workouts, threshold runs, and racing. ### \#5: Vary Your Training **Incorporating different types of runs and paces** will help vary the impact stresses on your body relative to plodding along at the same pace every day. You should also vary your routes, especially if you run on sloped or cambered roads. Softer surfaces like grass and trails may be easier on joints and bones than concrete and asphalt. ### \#6: Work On Your Running Form Issues with your [running form](https://marathonhandbook.com/proper-running-form/) can be a key risk factor for running injuries. As such, **correcting** **issues in running form** and technique is essential for running injury prevention programs. For beginners and experienced runners with a history of injuries, it is important to get a professional running [gait analysis](https://marathonhandbook.com/running-gait-analysis/) from an experienced running coach, running shoe fit professional, or physical therapist who specializes in distance running. Overstriding is the most common running form mistake that can increase the risk of injuries, but it is not the only one that may be causing them. ![Bare feet next to blue running shoes on a wooden floor.](https://marathonhandbook.com/wp-content/uploads/2022/01/How-Not-To-Get-Injured-A-Runners-9-Step-Guide-To-Injury-Prevention-11.jpg) ### \#7: Always Warm Up and Cool Down Although studies haven’t demonstrated a statistically significant benefit of *stretching*,6Lauersen, J. B., Bertelsen, D. M., & Andersen, L. B. (2013). The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. *British Journal of Sports Medicine*, *48*(11), 871–877. <https://doi.org/10.1136/bjsports-2013-092538> **doing a warm-up and cool-down** can help prepare your body for your workout, facilitate recovery, and reduce muscle soreness. ### \#8: Incorporate Strength Training **Studies suggest that incorporating strength training into your overall training program is one of the most effective ways to reduce the risk of running injuries.** A 2013 systematic review and meta-analysis7Lauersen, J. B., Bertelsen, D. M., & Andersen, L. B. (2013). The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. *British Journal of Sports Medicine*, *48*(11), 871–877. <https://doi.org/10.1136/bjsports-2013-092538> of randomized control trials conducted at the Institute of Sports Medicine Copenhagen evaluated the results of 25 studies encompassing 26,000 runners who had encountered a total of over 3,500 injuries from running. Results revealed that strength training was runners’ most effective injury-prevention strategy, with a relative reduction in injury risk of about 68.5%. Strength training exercises such as squats, lunges, split squats, deadlifts, single-leg balance, planks, single-leg glute bridges, and plyometrics can make runners more injury-resilient. Strength training strengthens the muscles, bones, joints, and connective tissues so that your own body weight is less of a “stress“ or load. Strength training workouts can also improve your neuromuscular coordination, identify and correct muscle imbalances, improve core strength, increase your ability to have good posture and running form, and [improve your running economy.](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9319953/)8Šuc, A., Šarko, P., Pleša, J., & Kozinc, Ž. (2022). Resistance Exercise for Improving Running Economy and Running Biomechanics and Decreasing Running-Related Injury Risk: A Narrative Review. *Sports*, *10*(7), 98. <https://doi.org/10.3390/sports10070098> Proprioceptive training, such as single-leg balance with closed eyes, has also been shown to be an effective running-injury-prevention technique, reducing relative injury risk in runners by over 50%. All these benefits of strength training for runners can set you up for a greater chance of injury-free running. ![A therapist extends a clients leg and holds their knee.](https://marathonhandbook.com/wp-content/uploads/2022/01/How-Not-To-Get-Injured-A-Runners-9-Step-Guide-To-Injury-Prevention-10.jpg) ### \#9: Correct Muscle Imbalances Muscle imbalances certainly increase the risk of common running injuries. For example, weaknesses in the vastus medialis, one of the quadriceps muscles, can [increase the risk of runner’s knee.](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6191677/)9Kunene, S. H., Ramklass, S., & Taukobong, N. P. (2018). Anterior knee pain and its intrinsic risk factors among runners in under-resourced communities in Ekurhuleni, Gauteng. *South African Journal of Physiotherapy*, *74*(1). <https://doi.org/10.4102/sajp.v74i1.452> ‌I highly recommend a few physical therapy sessions to **identify muscle imbalances and develop a strength-training** **program** to help you correct these issues and prevent injuries. ### \#10: Address Issues [Studies suggest](https://pubmed.ncbi.nlm.nih.gov/32535271/)10van Poppel, D., van der Worp, M., Slabbekoorn, A., van den Heuvel, S. S. P., van Middelkoop, M., Koes, B. W., Verhagen, A. P., & Scholten-Peeters, G. G. M. (2020). Risk factors for overuse injuries in short- and long-distance running: A systematic review. *Journal of Sport and Health Science*, *10*(1). <https://doi.org/10.1016/j.jshs.2020.06.006> that a history of a previous running injury is one of the most significant risk factors for running injuries. Instead of passively giving your body time to heal while you cross-train, you should try to **identify and address the underlying causes**. Physical therapy, correcting your running form, changing running shoes, tweaking your training plan, etc., as needed, will help address the root cause and, therefore, be among the most important steps for preventing future running injuries. ![A runner stopped in the road holding their heel.](https://marathonhandbook.com/wp-content/uploads/2022/01/How-Not-To-Get-Injured-A-Runners-9-Step-Guide-To-Injury-Prevention-3.jpg) ### \#11: Fuel Your Body Underfueling by being in a caloric deficit or following a weight loss diet or other restrictive diet that eliminates certain food groups and nutrients sets your body up for compromised recovery. This can increase your risk of injury. Relative Energy Deficiency In Sport (RED-S)11Statuta, S. M., Asif, I. M., & Drezner, J. A. (2017). Relative energy deficiency in sport (RED-S). *British Journal of Sports Medicine*, *51*(21), 1570–1571. <https://doi.org/10.1136/bjsports-2017-097700> is a common problem with recreational runners and competitive runners trying to get leaner or lose body fat for running. It can also happen unintentionally if you run high mileage and aren’t conscious of how many calories you need to eat. [RED-S increases the risk of stress fractures](https://qsp.physio/red-s-and-stress-fracture/)12Rachel. (2021, July 13). *Relative Energy Deficiency in Sports syndrome (RED-S) and stress fractures*. QSP Physiotherapy & Massage. <https://qsp.physio/red-s-and-stress-fracture/?v=6cc98ba2045f> and can compromise hormonal balance and muscle recovery. It is important to **fuel your body before and after training sessions** by getting enough calories, complex carbohydrates, and protein to replenish glycogen stores and repair muscle damage. Additionally, fasted running can increase muscle protein breakdown. On the other hand, [there’s some evidence to suggest](https://pubmed.ncbi.nlm.nih.gov/31994970/)13Winter, S. C., Gordon, S., Brice, S. M., Lindsay, D., & Barrs, S. (2020). A Multifactorial Approach to Overuse Running Injuries: A 1-Year Prospective Study. *Sports Health: A Multidisciplinary Approach*, 194173811988850. <https://doi.org/10.1177/1941738119888504> being overweight can increase the risk of some common running injuries. Therefore, working with a registered dietitian or sports nutritionist can be a cornerstone of your running injury-prevention program. ![A runner sitting on a rocky trail holding their ankle.](https://marathonhandbook.com/wp-content/uploads/2022/01/How-Not-To-Get-Injured-A-Runners-9-Step-Guide-To-Injury-Prevention-4.jpg) ### \#12: Don’t Neglect Cross-Training Workouts Low-impact cross-training workouts reduce the impact stress of running and utilize different muscle groups. This can help reduce the risk of overuse injuries while still giving you a great aerobic workout. Running high mileage [may increase the risk of injury](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4338213/),14van der Worp, M. P., ten Haaf, D. S. M., van Cingel, R., de Wijer, A., Nijhuis-van der Sanden, M. W. G., & Staal, J. B. (2015). Injuries in Runners; A Systematic Review on Risk Factors and Sex Differences. *PLOS ONE*, *10*(2), e0114937. <https://doi.org/10.1371/journal.pone.0114937> so **scaling back easy runs in favor of cross training** may possibly help you reach your running goals while decreasing the risk of overuse injuries. ### \#13: Get Enough Sleep Sleep is essential for overall health, wellness, and recovery from training. According to the [National Sleep Foundation, **adults should be getting 7 to 9 hours** of sleep per night](https://pubmed.ncbi.nlm.nih.gov/29073398/),15Hirshkowitz, M., Whiton, K., Albert, S. M., Alessi, C., Bruni, O., DonCarlos, L., Hazen, N., Herman, J., Adams Hillard, P. J., Katz, E. S., Kheirandish-Gozal, L., Neubauer, D. N., O’Donnell, A. E., Ohayon, M., Peever, J., Rawding, R., Sachdeva, R. C., Setters, B., Vitiello, M. V., & Ware, J. C. (2015). National Sleep Foundation’s updated sleep duration recommendations: final report. *Sleep Health*, *1*(4), 233–243. <https://doi.org/10.1016/j.sleh.2015.10.004> but distance runners following a running plan may need additional sleep to support recovery. [Studies](https://pubmed.ncbi.nlm.nih.gov/25028798/)16Milewski, M. D., Skaggs, D. L., Bishop, G. A., Pace, J. L., Ibrahim, D. A., Wren, T. A. L., & Barzdukas, A. (2014). Chronic lack of sleep is associated with increased sports injuries in adolescent athletes. *Journal of Pediatric Orthopedics*, *34*(2), 129–133. <https://doi.org/10.1097/BPO.0000000000000151> have found that sleep-deprived workouts increase the risk of injury. ![A black and white image with the foot in red.](https://marathonhandbook.com/wp-content/uploads/2022/01/How-Not-To-Get-Injured-A-Runners-9-Step-Guide-To-Injury-Prevention-5.jpg) ### \#14: Manage Stress Levels The body responds to all forms of stress the same way, whether it is the positive stress of your training sessions or the negative stress of losing a job, struggling financially, or not getting enough sleep. [Stress increases cortisol levels](https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress/art-20046037)17Mayo Clinic . (2021, July 8). *Chronic stress puts your health at risk*. Mayo Clinic; Mayo Foundation for Medical Education and Research. <https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress/art-20046037> and stimulates the sympathetic nervous system (the fight-or-flight response). This increases heart and respiratory rates and compromises health and healing when it becomes chronic. Stress management techniques, such as **mindfulness meditation and breathwork exercises,** can help prevent injuries if you notice stress is an issue in your life. ### \#15: Listen to Your Body One of the most important steps in any running injury prevention plan is to **listen** **to your body.** Even if your training plan tells you to go for a 6-mile run or a 20-minute tempo run, if you feel like you are tired, experiencing excessive muscle soreness, have aches and pains, or are teetering on the edge of overtraining, it is *way* more important to swap the work out for a rest day or cross training workout as needed than to follow your running plan to a T. *What are your secrets to injury-free running?* For more injury-related content, check out our database for running injuries, where we have in-depth articles on a whole host of running injuries, from running cramps to running earaches: ### References - 1 DAOUD, A. I., GEISSLER, G. J., WANG, F., SARETSKY, J., DAOUD, Y. A., & LIEBERMAN, D. E. (2012). Foot Strike and Injury Rates in Endurance Runners. *Medicine & Science in Sports & Exercise*, *44*(7), 1325–1334. <https://doi.org/10.1249/mss.0b013e3182465115> - 2 NILSSON, J., & THORSTENSSON, A. (1989). Ground reaction forces at different speeds of human walking and running. *Acta Physiologica Scandinavica*, *136*(2), 217–227. <https://doi.org/10.1111/j.1748-1716.1989.tb08655.x> - 3 - 4 Van Alsenoy, K., van der Linden, M. L., Girard, O., & Santos, D. (2021). Increased footwear comfort is associated with improved running economy – a systematic review and meta-analysis. *European Journal of Sport Science*, 1–13. <https://doi.org/10.1080/17461391.2021.1998642> - 5 Malisoux, L., Ramesh, J., Mann, R., Seil, R., Urhausen, A., & Theisen, D. (2013). Can parallel use of different running shoes decrease running-related injury risk? *Scandinavian Journal of Medicine & Science in Sports*, *25*(1), 110–115. <https://doi.org/10.1111/sms.12154> - 6 Lauersen, J. B., Bertelsen, D. M., & Andersen, L. B. (2013). The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. *British Journal of Sports Medicine*, *48*(11), 871–877. <https://doi.org/10.1136/bjsports-2013-092538> - 7 Lauersen, J. B., Bertelsen, D. M., & Andersen, L. B. (2013). The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. *British Journal of Sports Medicine*, *48*(11), 871–877. <https://doi.org/10.1136/bjsports-2013-092538> - 8 Šuc, A., Šarko, P., Pleša, J., & Kozinc, Ž. (2022). Resistance Exercise for Improving Running Economy and Running Biomechanics and Decreasing Running-Related Injury Risk: A Narrative Review. *Sports*, *10*(7), 98. <https://doi.org/10.3390/sports10070098> - 9 Kunene, S. H., Ramklass, S., & Taukobong, N. P. (2018). Anterior knee pain and its intrinsic risk factors among runners in under-resourced communities in Ekurhuleni, Gauteng. *South African Journal of Physiotherapy*, *74*(1). <https://doi.org/10.4102/sajp.v74i1.452> - 10 van Poppel, D., van der Worp, M., Slabbekoorn, A., van den Heuvel, S. S. P., van Middelkoop, M., Koes, B. W., Verhagen, A. P., & Scholten-Peeters, G. G. M. (2020). Risk factors for overuse injuries in short- and long-distance running: A systematic review. *Journal of Sport and Health Science*, *10*(1). <https://doi.org/10.1016/j.jshs.2020.06.006> - 11 Statuta, S. M., Asif, I. M., & Drezner, J. A. (2017). Relative energy deficiency in sport (RED-S). *British Journal of Sports Medicine*, *51*(21), 1570–1571. <https://doi.org/10.1136/bjsports-2017-097700> - 12 - 13 Winter, S. C., Gordon, S., Brice, S. M., Lindsay, D., & Barrs, S. (2020). A Multifactorial Approach to Overuse Running Injuries: A 1-Year Prospective Study. *Sports Health: A Multidisciplinary Approach*, 194173811988850. <https://doi.org/10.1177/1941738119888504> - 14 van der Worp, M. P., ten Haaf, D. S. M., van Cingel, R., de Wijer, A., Nijhuis-van der Sanden, M. W. G., & Staal, J. B. (2015). Injuries in Runners; A Systematic Review on Risk Factors and Sex Differences. *PLOS ONE*, *10*(2), e0114937. <https://doi.org/10.1371/journal.pone.0114937> - 15 Hirshkowitz, M., Whiton, K., Albert, S. M., Alessi, C., Bruni, O., DonCarlos, L., Hazen, N., Herman, J., Adams Hillard, P. J., Katz, E. S., Kheirandish-Gozal, L., Neubauer, D. N., O’Donnell, A. E., Ohayon, M., Peever, J., Rawding, R., Sachdeva, R. C., Setters, B., Vitiello, M. V., & Ware, J. C. (2015). National Sleep Foundation’s updated sleep duration recommendations: final report. *Sleep Health*, *1*(4), 233–243. <https://doi.org/10.1016/j.sleh.2015.10.004> - 16 Milewski, M. D., Skaggs, D. L., Bishop, G. A., Pace, J. L., Ibrahim, D. A., Wren, T. A. L., & Barzdukas, A. (2014). Chronic lack of sleep is associated with increased sports injuries in adolescent athletes. *Journal of Pediatric Orthopedics*, *34*(2), 129–133. <https://doi.org/10.1097/BPO.0000000000000151> - 17
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