Knee injuries are the most common running-related injury among recreational runners. This includes overuse injuries such as patellofemoral (knee cap) pain and iliotibial band pain on the side of the knee.
Running is easily accessible and one of the most common types of physical activity in Canada. Running participation may be recreational or competitive, over a variety of distances from sprints to ultra marathons, and done on numerous surfaces – including indoors, roads, and trails. Unfortunately, running related injuries are common, including those to the hip, pelvis, knee, lower leg, ankle, and foot.
(see Section 04 - Prevention)
Knee injuries are the most common running-related injury among recreational runners. This includes overuse injuries such as patellofemoral (knee cap) pain and iliotibial band pain on the side of the knee.
Although not as common as other injuries, some runners may experience lower back pain.
The hip and pelvis are common sites for running-related injuries.
Lower leg injuries are the third most common running-related injury, including shin splints or medial tibial stress pain, which is inflammation around the front of the tibia.
Injuries at the Achilles tendon (Achilles tendonitis or rupture) and calf (calf strains) are common injuries in running.
Injuries of the foot and ankle are the second most common type of running-related injury, including pain and inflammation across the bottom of the foot, also known as plantar fasciitis.
The knee accounts for 42% of all running injuries, followed by the foot/ankle (17%), lower leg (13%), hip/pelvis (11%), Achilles/calf (6%), upper leg (5%), and lower back (3%). Lower extremity injuries accounts for 20 to 80% of all injuries among runners.
It is estimated that...
Injury risk factors include personal factors (unmodifiable) and training errors (modifiable).
Older age and abnormal anatomical alignment have been found to be risk factors for increased risk of running related injury.
There is increased risk of injury in more competitive runners compared to less competitive runners. One review reported the incidence of injury was 15% in novice runners, 26% in recreational runners, and 63% in competitive runners.
Increasing your weekly running distance by more than 10% or running 6 or more times per week can increase your risk of injury. A sudden change in running surface or running intensity will also increase your risk of injury.
BMI is a measure of body composition based on your weight and height. There is conflicting evidence related to BMI; there is some evidence that having more body fat increases your risk of running-related injuries, especially those of the lower leg and foot. However, there is other evidence that having low BMI associated with low energy availability may increase risk of bone stress injuries among runners.
Your risk of new injury is influenced by previous injury, as well as possibly previous incomplete rehabilitation.
The way you run has a direct impact on how forces are applied to different segments and joints in your lower limbs. There is some evidence that rear foot (heel strikers) have increased risk of injury than forefoot strikers.
Training and regular practice are expected of athletes, but how much is too much? Your risk of injury can increase if you train too much or improperly. Learn more about how to find your training load “sweet spot.”
Use the onset of pain or symptoms as a guide for participating in, or refraining from, running. Muscle soreness is expected with a change in running duration or intensity; however, any joint pain should not last or get worse 24 hours after exercise, as it indicates that the body is not properly prepared for the chosen speed and distance.
Talk to your coach or organization, if applicable, about the prevention strategies below and how they might be incorporated into training and policies.
Addressing overstriding and working on landing softly are considered some of the most beneficial strategies for improving running technique. Overstriding occurs when the distance between where your foot hits the ground and your centre of mass is considered to be too long. Reduce overstriding by taking shorter and quicker steps. A 5% to 10% gradual increase in running cadence (number of steps per minute) is an appropriate way to reduce overstriding and decrease vertical loading on joints.
Improve running by:
There is some evidence that regularly performing a multi-component strength training program that includes lower extremity and core strengthening two or more times per week can reduce your risk of injury.
The use of foot orthoses may help reduce the incidence of lower limb injuries and pain in runners.
The risk of all lower body injuries may be reduced by up to 50% by regular participation in a balance training exercise program with a resistance training component, such as a neuromuscular training warm-up program. Strength and flexibility hip and knee exercises can reduce your risk of injury.
Sport Injury Prevention Research Centre Neuromuscular Training
The Sport Injury Prevention Research Centre has developed a neuromuscular training warm-up program that can be adapted to many sports. Incorporating a warm-up program like this one into your training program at least two times per week has been associated with a significant reduction in lower body injuries.
Click here to view poster.
Oslo Sport Trauma Research Centre Neuromuscular Training
Adopt strength training exercises designed to prevent injuries to the hip, knee, and back. The Oslo Sport Trauma Research Centre has developed specific exercises in video and PDF form to help prevent injuries.
Learn more about exercises to help prevent hip/groin injuries.
Learn more about exercises to help prevent knee injuries.
Learn more about exercises to help prevent back injuries.
For more exercises, visit http://fittoplay.org/.
Get Set Neuromuscular Training
The Get Set app contains exercises that can be done at home. Created by the Oslo Sports Trauma Center, Norwegian School of Sport Sciences, and Making Waves AS in 2014 for the International Olympic Committee, the app allows you to search by body part to view exercises that work to strengthen each area of the body, or search by sport to view a library of exercises that are specific to running.
Download Get Set for Android.
Download Get Set for iOS.
Load management and progression
As a newer runner, gradually transitioning into running from low-impact activities can minimize your risk for injury. This includes moving from incline walking to a slow jog, gradually increasing speed (on a treadmill or outdoors) until running becomes comfortable.
Taking a break between training days gives your body time to recover and helps you to assess your current training load. Increasing your running distance or speed by 5-10% each week allows the body to rest while still increasing mileage and intensity.
Equipment
Rotate your footwear. It is important to alternate between two or more different pairs of running shoes during your training to reduce your risk of injury. This better disperses the physical load on the muscles, joints, and bones and reduces excessive force to one area of the body.
Sleep, Vigilance and Sport Injury Prevention
Being successful in physical activity requires a high degree of alertness, also known as vigilance. Sufficient sleep helps your body to recover, allows you to achieve your goals, and reduces your risk of injury. Getting less than 8 hours of sleep can increase your rate of injury by up to 70%! Watch this video to learn more about how sleep and vigilance are connected.
Sport-related Physicals
Running can be a physically demanding sport and some pre-existing conditions may increase the risk of injury. An annual sport-related physical evaluation ensuring fitness to participate can help to reduce risk of injury. KidsHealth provides information about what sports physicals are, why they may be appropriate and where you may go to get them.
Learn more about Kids Health Sports Physicals.
Talk to your organization or school about the prevention strategies below and how they might be incorporated into training and policies.
Addressing overstriding and working on landing softly are considered some of the most beneficial strategies for improving running technique. Overstriding occurs when the distance between where your foot hits the ground and your centre of mass is considered to be too long. Reduce overstriding by taking shorter and quicker steps. A 5% to 10% gradual increase in running cadence (number of steps per minute) is an appropriate way to reduce overstriding and decrease vertical loading on joints.
Improve running by:
There is some evidence that regularly performing a multi-component strength training program that includes lower extremity and core strengthening two or more times per week can reduce your risk of injury.
The use of foot orthoses may help reduce the incidence of lower limb injuries and pain in runners.
The risk of all lower body injuries may be reduced by up to 50% by regular participation in a balance training exercise program with a resistance training component, such as a neuromuscular training warm-up program. Strength and flexibility hip and knee exercises can reduce the risk of running-related injuries.
Sport Injury Prevention Research Centre Neuromuscular Training
The Sport Injury Prevention Research Centre has developed a neuromuscular training warm-up program that can be adapted to many sports. Incorporating a warm-up program like this one into your training program at least two times per week has been associated with a significant reduction in lower body injuries.
Click here to view poster.
Oslo Sport Trauma Research Centre Neuromuscular Training
Adopt strength training exercises designed to prevent injuries to the hip, knee, and back. The Oslo Sport Trauma Research Centre has developed specific exercises in video and PDF form to help prevent injuries.
Learn more about exercises to help prevent hip/groin injuries.
Learn more about exercises to help prevent knee injuries.
Learn more about exercises to help prevent back injuries.
For more exercises, visit http://fittoplay.org/.
Get Set Neuromuscular Training
The Get Set app contains exercises that can be done at home. Created by the Oslo Sports Trauma Center, Norwegian School of Sport Sciences, and Making Waves AS in 2014 for the International Olympic Committee, the app allows you to search by body part to view exercises that work to strengthen each area of the body, or search by sport to view a library of exercises that are specific to running.
Download Get Set for Android.
Download Get Set for iOS.
Load management and progression
As a newer runner, gradually transitioning into running from low-impact activities can minimize your risk for injury. This includes moving from incline walking to a slow jog, gradually increasing speed (on a treadmill or outdoors) until running becomes comfortable.
Taking a break between training days gives the body time to recover and helps your runners to assess their current training load. Increasing running distance or speed by 5-10% each week allows the body to rest while still increasing mileage and intensity.
As a coach, talking with your runner about “listening to their body” is important so that they understand their body’s reaction to training and use the onset of pain or symptoms as a guide for participating in, or refraining from, activity.
Equipment
Recommend that your runners rotate their footwear. It is important to alternate between two or more different pairs of running shoes during training to reduce the risk of injury. This better disperses the physical load on the muscles, joints, and bones and reduces excessive force to one area of the body.
Sport-related Physicals
Running can be a physically demanding sport and some pre-existing conditions may increase the risk of injury. An annual sport-related physical evaluation ensuring fitness to participate can help to reduce risk of injury. KidsHealth provides information about what sports physicals are, why they may be appropriate and where you may go to get them.
Learn more about Kids Health Sports Physicals.
Talk to your coaches, teachers, organization, or school about the prevention strategies below and how they might be incorporated into training and policies.
Addressing overstriding and working on landing softly are considered some of the most beneficial strategies for improving running technique. Overstriding occurs when the distance between where your foot hits the ground and your centre of mass is considered to be too long. Reduce overstriding by taking shorter and quicker steps. A 5% to 10% gradual increase in running cadence (number of steps per minute) is an appropriate way to reduce overstriding and decrease vertical loading on joints.
Improve running by:
There is some evidence that regularly performing a multi-component strength training program that includes lower extremity and core strengthening two or more times per week can reduce your risk of injury.
The use of foot orthoses may help reduce the incidence of lower limb injuries and pain in runners.
The risk of all lower body injuries may be reduced by up to 50% by regular participation in a balance training exercise program with a resistance training component, such as a neuromuscular training warm-up program. Strength and flexibility hip and knee exercises can reduce the risk of running-related injuries.
Sport Injury Prevention Research Centre Neuromuscular Training
The Sport Injury Prevention Research Centre has developed a neuromuscular training warm-up program that can be adapted to many sports. Incorporating a warm-up program like this one into the training program at least two times per week has been associated with a significant reduction in lower body injuries.
Click here to view poster.
Oslo Sport Trauma Research Centre Neuromuscular Training
The Oslo Sport Trauma Research Centre has developed specific exercises in video and PDF form to help prevent injuries.
Learn more about exercises to help prevent hip/groin injuries.
Learn more about exercises to help prevent knee injuries,
Learn more about exercises to help prevent back injuries.
For more exercises, visit http://fittoplay.org/.
Get Set Neuromuscular Training
Created by the Oslo Sports Trauma Center, Norwegian School of Sport Sciences, and Making Waves AS in 2014 for the International Olympic Committee, the app allows you to search by body part to view exercises that work to strengthen each area of the body, or search by sport to view a library of exercises that are specific to running.
Download Get Set for Android.
Download Get Set for iOS.
Load management and progression
As a newer runner, gradually transitioning into running from low-impact activities can minimize your risk for injury. This includes moving from incline walking to a slow jog, gradually increasing speed (on a treadmill or outdoors) until running becomes comfortable.
Taking a break between training days gives your body time to recover and helps you to assess your current training load. Increasing your running distance or speed by 5-10% each week allows the body to rest while still increasing mileage and intensity.
Encourage coaches and teachers to talk with their runners about “listening to their body” to understand the body’s reaction to training, and to use the onset of pain or symptoms as a guide for participating in, or refraining from, activity.
Sport-related Physicals
Running can be a physically demanding sport and some pre-existing conditions may increase the risk of injury. An annual sport-related physical evaluation ensuring fitness to participate can help to reduce risk of injury. KidsHealth provides information about what sports physicals are, why they may be appropriate and where you may go to get them.
Learn more about Kids Health Sports Physicals.
The role of health professionals in preventing running injuries has two main components:
Addressing overstriding and working on landing softly are considered some of the most beneficial strategies for improving running technique. Overstriding occurs when the distance between where your foot hits the ground and your centre of mass is considered to be too long. Reduce overstriding by taking shorter and quicker steps. A 5% to 10% gradual increase in running cadence (number of steps per minute) is an appropriate way to reduce overstriding and decrease vertical loading on joints.
Improve running by:
There is some evidence that regularly performing a multi-component strength training program that includes lower extremity and core strengthening two or more times per week can reduce your risk of injury.
The use of foot orthoses may help reduce the incidence of lower limb injuries and pain in runners.
The risk of all lower body injuries may be reduced by up to 50% by regular participation in a balance training exercise program with a resistance training component, such as a neuromuscular training warm-up program. These programs have exercises that cover aerobic capacity, agility, strength, and balance that athletes can incorporate into their training/practice routines on a regular basis. Strength and flexibility hip and knee exercises can reduce the risk of running-related injuries.
Sport Injury Prevention Research Centre Neuromuscular Training
The Sport Injury Prevention Research Centre has developed a neuromuscular training warm-up program that can be adapted to many sports. Encouraging runners, their parents, and coaches to include a well-rounded training program into their warm-up at least two times per week has been associated with a significant reduction in lower body injuries.
Click here to view poster.
Oslo Sport Trauma Research Centre Neuromuscular Training
Adopt strength training exercises designed to prevent injuries to the hip, knee, and back. The Oslo Sport Trauma Research Centre has developed specific exercises in video and PDF form to help prevent injuries.
Learn more about exercises to help prevent hip/groin injuries.
Learn more about exercises to help prevent knee injuries.
Learn more about exercises to help prevent back injuries.
For more exercises, visit http://fittoplay.org/.
Get Set Neuromuscular Training
The Get Set app contains exercises that can be done at home. Created by the Oslo Sports Trauma Center, Norwegian School of Sport Sciences, and Making Waves AS in 2014 for the International Olympic Committee, the app allows you to search by body part to view exercises that work to strengthen each area of the body, or search by sport to view a library of exercises that are specific to running.
Download Get Set for Android.
Download Get Set for iOS.
Education
Encouraging runners to “listen to their body” is important so that they understand their body’s reaction to training and use the onset of pain or symptoms as a guide for participating in, or refraining from, activity.
Load management and progression
As a newer runner, gradually transitioning into running from low-impact activities can minimize your risk for injury. This includes moving from incline walking to a slow jog, gradually increasing speed (on a treadmill or outdoors) until running becomes comfortable.
Taking a break between training days gives your body time to recover and helps you to assess your current training load. Increasing your running distance or speed by 5-10% each week allows the body to rest while still increasing mileage and intensity.
Gait Training
Gait training may be a positive intervention for injury prevention. This can be accomplished by having the athlete watch him or herself run in a mirror, on video footage, or using 3D motion-capture while feedback on their running form is provided by a physiotherapist, coach, or trainer. A metronome or similar device can be used to improve running cadence.
Effective strategies for visual and audio feedback for improving running mechanics to reduce running-related injuries are available in this 2015 publication of the Journal of Orthopaedic & Sports Physical Therapy.
Increased hip adduction, due to weak hip abductors, is a common risk factor for multiple running-related injuries.
Sport-related Physicals
Running can be a physically demanding sport and some pre-existing conditions may increase the risk of injury. An annual sport-related physical ensuring fitness to participate can help to reduce risk of injury. The American Academy of Pediatrics provides information about preparticipation physical evaluation.
Learn more about Preparticipation Physical Evaluation.
