Injury Prevention for Runners

by Samantha Eakes, DPT

Whether or not you are an avid runner, you probably know running is a great form of exercise that is both easy and accessible. Some delve deep into the competitive/training aspect of running while for others running simply offers a way to relieve stress and enjoy the outdoors while staying active. Nothing is more frustrating than enjoying a fun, stress-relieving activity like running and then having to stop due to pain or injury.

Because running is such an accessible and popular exercise, it’s not surprising that injuries are pretty common. Usually, these injuries are seen in the lower extremity (LE) with the knee, lower leg, and foot being most common followed by the ankle and hip/pelvis. Research shows that risk factors for injuries include greater training distances per week and a history of previous injury. Increased mileage tends to incur more injuries when associated with a sudden increase as opposed to a gradual increase.  Anatomical risk factors may include pes cavus (a high arch) with moderate evidence to support this. With a higher arch we often have a stiffer foot that does not allow for the absorption of forces from the ground.  Muscle weakness is another anatomical factor found to be related to injury. Hip weakness has a known link to LE injuries, including injuries in runners, so incorporating hip and glute strengthening exercises can be helpful. Lower extremity and core strengthening in general is found to be beneficial for runners, including foot, ankle, and proprioceptive exercises (such as balance training). Additionally, muscles can be strengthened both concentrically (shortening the muscles) and eccentrically (lengthening the muscles. Running, like many activities and sports, requires both concentric and eccentric muscle contraction; therefore, strengthening both kinds of contractions can be beneficial.

What about stretching? Stretching is great; however, there is not sufficient evidence that stretching decreases running injuries. In general, normal ranges of motion with sufficient strength in those ranges helps reduce injuries. Stretching can still be beneficial to improve symptoms and maintain mobility. Overall, resistance training has been found to be more important forinjury prevention when compared to stretching. Runners may also seek out orthotics as another option to help with pain and injury prevention. While there is not strong evidence to claim orthotics will prevent injuries, many individuals who use them have high satisfaction and custom orthotics may be effective to help treat many running related injuries such as patellofemoral pain and pes cavus-related pain. When it comes to the correct running shoe, follow the generally accepted rule: motion control shoes are best for over-pronators (flat feet) while a shoe with more cushion is good for the pes cavus/supinator individuals.

Part of running’s broad appeal owes to being a simple activity we can keep enjoying as we age.  Those who continue regular running see benefits in their cardiovascular health and slower age-related declines in VO2 max (maximal oxygen consumption) and muscle strength. However, declines in leg tendon stiffness and declines in muscular power, especially of the achilles tendon, can increase injuries to this area. Injuries in younger runners versus aging runners can present differently due to normal age-related changes in our body and changes in running mechanics. Younger runners experience more knee and lower leg pain, including IT band syndrome and shin splints. Master runners tend to experience more muscular and tendinous injuries to the hamstrings, calf muscles, and achilles tendon (achilles tendinopathy is most common).  Additional strengthening of the calf muscles may be beneficial for the aging runner. Also, you may be interested to know that regular participation in running has NOT been linked with increased hip and knee osteoarthritis unless there is a prior hip or knee surgery.

Ultimately, if you enjoy running, go for it! It can be a great activity. Just remember, ramp up your speed and mileage gradually to decrease your chance of injury and add some additional strength training to be sure your body can take the impact associated with running. If you begin to experience pain or injury, adjust your mileage and intensity and don’t wait to see your local physical therapist for individualized advice and treatment to keep you on the roads, treadmills, and trails.


  1. van Gent R N et al. Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. Br J Sports Med.2007;41:469-480.
  2. Fields K B et al. Prevention of running injuries. Curr Sports Med Rep. 2010;9:3:176-182.
  3. Willy R W, Paquette M R. The Physiology and Biomechanics of the Master Runner. Sports Med Arthrosc Rev.2019;27:15-21.

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