Running injuries: what causes them and what can be done
How many injuries there really are, why load explains more than technique, what the studies say about prevention programs, and how to manage a niggle without stopping running.
Running injuries are nearly always overuse: there is no impact and no single moment, there is a tissue that was asked for more than it had learned to tolerate. That is good news, because the main variable — load — is the one you control.
Risk depends heavily on previous experience
A systematic review with meta-analysis measured incidence per hour of running: 17.8 injuries per 1,000 hours in novices versus 7.7 in recreational runners. The most frequent sites are the knee, foot/ankle and lower leg.
Load, not posture
Sudden jumps in mileage are linked to more injuries; the exact 10% is folklore
The systematic review on load changes concludes the overall evidence is conflicting and that the 10% rule was never validated. What has been observed in runner cohorts is that raising weekly distance by more than 30% over two weeks is linked to more injuries than staying below 10%.
- Change one variable at a time: distance, or intensity, or elevation.
- Watch the odd weeks: a holiday, an unplanned local race or a change of surface all count as a load increase.
- Sleep. It is the recovery factor with the biggest impact and the most ignored.
- Pain that appears cold and improves as you warm up is usually tendinous and tolerates controlled work; pain that gets worse as you run does not.
What the studies say about prevention
Generic prevention programs do not clearly reduce injuries; supervised ones do show an effect
A 2024 meta-analysis of preventive exercise programs in distance runners found no overall difference in injury risk or rate versus controls. In the subgroup of supervised interventions, risk was lower. The honest reading: there is no magic prevention routine, and adherence and supervision matter as much as the exercises.
So strength training is useless?
It is very useful — for performing better: it improves running economy and time-trial performance (strength for runners). Selling it as injury insurance promises more than the evidence supports.
The five most common niggles
| Problem | Where it hurts | First reasonable adjustment |
|---|---|---|
| Patellofemoral pain | In front of and around the kneecap | Raise cadence 5–10%, cut descents, quad and hip strength |
| Iliotibial band syndrome | Outer side of the knee | Avoid slopes and cambered roads, glute medius strength |
| Achilles tendinopathy | The tendon, stiff in the morning | Progressive calf loading, cut interval volume |
| Plantar fasciitis | Heel, on the first step of the day | Progressive foot loading, cut hills |
| Shin pain / medial tibial stress | Inner edge of the shin | Cut volume, review recent increases, consider seeing someone |
How to manage a niggle
- 1
Score the pain from 0 to 10
Up to 3, and not worsening during the run or the next day, you can keep running with reduced load. Above that, you stop or switch activity.
- 2
Cut load instead of stopping entirely
Trimming volume by 30–50% and removing intensity is usually enough. Stopping dead deconditions the tissue and makes the return more fragile.
- 3
Keep the engine going with something else
Bike, elliptical or pool running preserve aerobic fitness while the tissue recovers.
- 4
Come back gradually
Reintroduce volume before intensity; intervals are the last thing to come back.
When this stops being a job for a guide
Pain lasting more than two weeks despite reducing load, limping, swelling, night pain or pinpoint bone pain: see a healthcare professional. This is education, not diagnosis.
Takeaways
- The first year of running is the highest-risk one: progress slowly.
- Big jumps in mileage are the most flagged modifiable factor.
- There is no magic prevention routine; supervision and adherence matter.
- Mild niggle: cut load, do not stop completely.
- Persistent pain or bone pain: healthcare professional.
Sources for this chapter
- [1]Videbæk S, Bueno AM, Nielsen RO, Rasmussen S (2015). Incidence of Running-Related Injuries Per 1000 h of running in Different Types of Runners: A Systematic Review and Meta-Analysis. Sports Medicine. meta-analysis
- [2]Damsted C, Glad S, Nielsen RO, Sørensen H, Malisoux L (2018). Is there evidence for an association between changes in training load and running-related injuries? A systematic review. International Journal of Sports Physical Therapy. review
- [3]Nielsen RO, Parner ET, Nohr EA, Sørensen H, Lind M, Rasmussen S (2014). Excessive progression in weekly running distance and risk of running-related injuries: an association which varies according to type of injury. Journal of Orthopaedic & Sports Physical Therapy. trial
- [4]Wu H, Brooke-Wavell K, Fong DTP, et al. (2024). Do Exercise-Based Prevention Programs Reduce Injury in Endurance Runners? A Systematic Review and Meta-Analysis. Sports Medicine. meta-analysis