How to Prevent Running Related Injuries

Running injuries are frustrating.

You build fitness, find some momentum, start enjoying your training and then suddenly a sore knee, Achilles tendon, shin, foot or hip starts dictating how much you can do.

The obvious question is:

Can running injuries be prevented?

Not completely.

There is no exercise, shoe, running technique or training formula that makes a runner injury-proof.

What we can do is improve the way you prepare for running, build your physical capacity, manage changes in training and respond to early symptoms.

That is a more useful way to think about injury prevention: reducing risk while preparing the body to tolerate more running.

Our Running Physiotherapy approach looks at the runner as a whole rather than searching for one biomechanical fault or one weak muscle to blame.

Why Do Running Injuries Happen?

Running injuries are usually multifactorial.

Research has identified many possible associations, but no single factor explains why one runner develops pain while another does not.

Potential contributors can include:

• Previous injury.
• Changes in running volume.
• Changes in intensity or speed.
• Introducing hills or intervals.
• Returning after time away from running.
• Strength and physical capacity.
• Sleep and recovery.
• Overall health and nutrition.
• Running experience.
• Other sport or gym training completed at the same time.

A 2024 umbrella review of running-injury risk factors again highlighted just how varied these contributors can be, with training characteristics, lifestyle, health, morphology and biomechanics all potentially playing a role.

The important message is that injuries rarely come down to one thing.

Previous Injury Is One of the Strongest Clues

If you have injured an area before, it deserves attention.

Previous running-related injury is one of the more consistently identified risk factors for sustaining another running injury.

This may partly reflect:

• Incomplete rehabilitation.
• Persistent strength deficits.
• Returning to full running before capacity has been restored.
• Underlying training factors that were never addressed.
• Simply having a region that has previously been exposed to injury.

A runner whose Achilles pain has settled is not necessarily ready for the same hills, speed and mileage they were completing before the injury.

Being pain-free is one milestone.

Restoring physical capacity is another.

This is why our Return to Sport approach focuses on rebuilding what the athlete actually needs to do, rather than stopping rehabilitation when symptoms disappear.

Training Progression Matters, But Forget the Magic 10% Rule

One of the most common pieces of running advice is:

“Never increase your mileage by more than 10% per week.”

It sounds sensible.

Unfortunately, research has not established 10% as a universal safe threshold.

Studies looking at running volume, frequency, duration and intensity have produced inconsistent results.

What does make sense is avoiding large, unnecessary jumps in training demand, particularly when several things change at once.

For example, a runner might simultaneously:

• Increase weekly kilometres.
• Add interval training.
• Start hill repetitions.
• Add another running day.
• Begin strength training.

Each change may be reasonable individually.

Together, they can create a very different training week from what the body has recently been accustomed to.

Your Aerobic Fitness Can Improve Faster Than Your Tissues

This is particularly relevant to new runners and people returning after time away.

Your cardiovascular system can improve surprisingly quickly.

You start running regularly and within a few weeks breathing feels easier, your pace improves and your motivation increases.

The problem is that feeling fitter can encourage you to increase running faster than some tissues are ready for.

Muscles, tendons and bones all adapt to repeated mechanical loading, but they do not necessarily adapt at exactly the same rate.

A useful analogy is:

Don't let your engine outpace your chassis.

Your aerobic fitness may tell you that you can run further.

Your musculoskeletal system still needs enough exposure and recovery to become comfortable doing it repeatedly.

You can read more about this adaptation process in our article on mechanotherapy and physical loading.

Strength Training Can Support Running

Strength training should not replace running if your goal is to become a better runner.

But it can complement it.

Appropriate strength training can improve:

• Lower-limb strength.
• Force production.
• Running economy.
• Muscular capacity.
• Rehabilitation after many running injuries.

Recent systematic reviews support high-load and combined strength-training approaches for improving running economy and performance.

Interestingly, the evidence that strength programs prevent running injuries is less straightforward.

A 2024 meta-analysis found that exercise-based prevention programs did not significantly reduce running injuries overall, although supervised interventions performed better in subgroup analysis.

Another 2024 randomised trial found that a supervised hip and core program reduced lower-limb overuse injuries in novice runners.

So strength work makes sense for runners, but we should avoid selling it as a guaranteed injury-prevention formula.

What Should Runners Strengthen?

Running is not powered by one muscle.

Useful strength programs generally involve the whole lower limb.

Calf Strength

The calf complex is heavily involved in running.

The gastrocnemius and soleus help absorb and generate substantial forces during every stride.

Both straight-knee and bent-knee calf exercises can be useful depending on the runner.

Calf capacity is particularly relevant when managing Achilles tendon symptoms and many foot and ankle injuries.

Quadriceps Strength

The quadriceps help manage force around the knee during stance.

Strengthening may involve squats, split squats, leg press, step-ups and knee-extension exercises.

Quadriceps capacity is often particularly relevant in runners with knee pain, including patellofemoral pain.

Hamstring Strength

The hamstrings contribute throughout running and experience greater demands as speed increases.

Exercises can include Romanian deadlifts, hamstring curls, bridges and Nordic hamstring variations.

Hip Strength

Hip strength can form part of a well-rounded running program, but not because every running injury is caused by weak glutes.

The hips contribute to force production and control of the lower limb during running.

Exercises such as split squats, step-ups, deadlifts and other single-leg tasks can build hip capacity alongside the rest of the leg.

If hip or groin symptoms are limiting your running, our Hip & Groin Physiotherapy page provides more information about how we assess these problems.

Running Is Still the Most Specific Training for Running

No gym program completely replicates running.

Running repeatedly loads the body in a very specific way.

This means one of the best ways to become more tolerant of running is still appropriately dosed running.

A runner recovering from injury may therefore need a combination of:

• Strength training.
• Reduced running initially.
• Progressively increasing running exposure.
• Gradual return to hills or speed.
• Eventually restoring normal training.

Rest alone may settle symptoms, but it does not necessarily prepare the body for the load that originally caused the problem.

Do Ground-Reaction Forces Mean You Need to Squat Three Times Your Bodyweight?

No.

You may hear that running produces ground-reaction forces of several times body weight, followed by the conclusion that a runner therefore needs to lift an equivalent amount in the gym.

That comparison is too simplistic.

Running forces occur very quickly and are distributed across multiple tissues and joints.

A barbell squat produces force in a completely different way.

Both are useful loading environments, but a force recorded during running does not translate directly into a minimum gym-strength number.

Strength testing can still be extremely useful for runners.

The important part is interpreting the result in context rather than turning ground-reaction force into a simplistic lifting target.

Sleep and Recovery Matter

Training creates the stimulus.

Recovery allows adaptation to occur.

For runners balancing work, family, gym training and running, recovery can easily become the forgotten part of the program.

Poor sleep, high overall stress and inadequate recovery can affect training quality and potentially injury risk, although runner-specific evidence is still developing.

Sometimes the best adjustment is not another rehabilitation exercise.

It may be creating a week in which the hard sessions are actually separated by enough recovery.

Eating Enough Is Part of Injury Prevention

This is especially important for runners completing high training volumes.

Running requires energy.

If an athlete repeatedly consumes too little energy to support training and basic physiological function, this can contribute to a state of low energy availability and increase the risk of health and performance problems.

Bone health is particularly important.

Bone stress injuries may develop when repetitive mechanical loading exceeds the bone's current ability to remodel and recover.

Training volume matters, but so do nutrition, energy availability and bone health.

A runner with persistent focal shin or foot pain should therefore not automatically assume they simply have “tight calves”.

Do Running Shoes Prevent Injuries?

There is no universally injury-proof running shoe.

Research comparing different shoe types has generally provided low-certainty or inconsistent evidence for injury prevention.

The best shoe for an individual runner will depend on factors such as:

• Comfort.
• Previous experience.
• The type of running being completed.
• Current symptoms.
• Personal preference.

A shoe should generally feel comfortable and appropriate for what you are asking it to do.

But simply buying a more expensive shoe does not replace sensible training progression or rehabilitation.

Does Running Technique Cause Injuries?

There is no single perfect running style.

Healthy runners use a wide variety of:

• Cadences.
• Stride lengths.
• Foot-strike patterns.
• Trunk positions.
• Hip and knee movements.

That does not mean technique never matters.

For a runner with a particular injury, changing one aspect of running can sometimes alter load enough to reduce symptoms.

For example, a modest increase in cadence can reduce some measures of knee and hip loading and may help selected runners with patellofemoral pain.

But cadence does not need to be changed in every runner.

Our Running Physiotherapy assessments use gait analysis where it is clinically relevant rather than trying to make everybody run the same way.

Should You Change Your Foot Strike?

Not simply for injury prevention.

Rearfoot, midfoot and forefoot running styles all exist in healthy runners.

Changing foot strike changes where load is distributed rather than making the load disappear.

A more anterior foot strike can, for example, increase demand through the calf and Achilles region.

So deliberately changing foot strike should usually have a clear reason rather than being based on the assumption that one pattern is universally safer.

Listen to Niggles Without Panicking About Them

Not every ache after a run represents an injury.

Muscle soreness and transient discomfort can be normal parts of training.

But recurring or progressively worsening pain deserves attention.

Useful questions include:

• Is the pain appearing earlier in each run?
• Is it becoming more intense?
• Is it changing how I run?
• Is it worse the following morning?
• Has my training recently changed?
• Is the pain very focal over a bone?
• Am I starting to avoid normal activities because of it?

The earlier stages of an injury may allow relatively small training modifications.

Waiting until you cannot run at all can make the problem more disruptive.

Common Running Injuries

Running-related injuries commonly involve the knee, foot and ankle and lower leg.

At RHP, we regularly assess runners with:

• Patellofemoral or anterior knee pain.
• Achilles tendon pain.
• Calf injuries.
• Plantar heel and foot pain.
• Bone stress injuries.
• Shin pain.
• Hip and groin pain.
• Hamstring injuries.
• Lower back pain associated with running.

You can find more information through our Knee Physiotherapy, Foot & Ankle Physiotherapy, Hip & Groin Physiotherapy and Lower Back Pain Physiotherapy pages.

How to Reduce Your Risk of Running Injury

If we bring all of this together, the practical advice is fairly simple.

You Cannot Make a Runner Injury-Proof

That is probably the most important message.

We cannot guarantee that a runner will never get injured.

Running injuries are influenced by too many interacting factors for that.

What we can do is create a runner who is better prepared.

A runner who:

• Builds training progressively.
• Has adequate lower-limb strength.
• Maintains enough energy and recovery to adapt.
• Rehabilitates previous injuries properly.
• Understands how to modify training when symptoms appear.

That is a much more realistic version of an “injury-resistant” runner.

If pain is starting to interfere with your running, or you want help planning training around a previous injury, our Running Physiotherapy and Sports Physiotherapy teams can assess the problem and help you build towards your running goals.

Author in the know

Sam Donaldson

Director, APA titled Sports and Exercise Physiotherapist. Sam loves to treat athletes with lower limb injuries and has a special interest in knees of all ages; adolescent knee pain, athlete with knee pain, ACL injuries, ACL rehabilitation, Knee Osteoarthritis and Knee Replacement recovery. He is a Dad, Football enthusiast and loves to move. BAppSci (HMS), MPhtyStudies, MPHTY (Sports)