Running

01 Overview

Running is one of the most common activities in Canada. It can be competitive, up to the marathon and Olympic level, or done recreationally indoors or outdoors on a variety of terrains. Injuries related to running are common, including those to the hip, pelvis, knee, lower leg, Achilles tendon, ankle, and foot.

(see Section 04 - Prevention)
Athlete silhouette
View Common Injuries by clicking the blue dots on the silhouette

Knee injuries are the most common running-related injury among recreational runners. These injuries can result in runner's knee (patellofemoral pain syndrome) and inflammation of the lateral side of the knee (iliotibial band syndrome).

Although not common, a weak lower back can result in poor running posture, affecting lower limb biomechanics and increasing the likelihood of injury to the hip, knee, ankle, and foot.

The hip and pelvis are common sites for running-related injuries, often due to improper running biomechanics, weak muscles, and poor flexibility.

Lower leg injuries are the third most common running-related injury, including shin splints, an inflammation around the tibia (medial tibial stress syndrome).

Injuries at the Achilles tendon (Achilles tendonitis) and calf (calf strains) are common injuries in running. These injuries are often due to poor training habits, running environments, running biomechanics, weak muscles, and decreased flexibility.

Injuries of the foot and ankle are the second most common type of running-related injury. Inflammation from the heel to the toe (plantar fasciitis) is the most common type of foot injury.

02 Injury Statistics

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%). The top five most common overuse injuries are runner’s knee (patellofemoral pain syndrome), inflammation of the lateral side of the knee (iliotibial band syndrome), inflammation from the heel to the toe (plantar fasciitis), knee meniscal injuries, and shin splints, an inflammation around the tibia (medial tibial stress syndrome). Lower extremity injuries accounts for 20 to 80% of all injuries among runners.

Curious about the research on injuries?

It is estimated that...

View Summary of Incidence Rates

03 Risk Factors

  • Body Type

    Personal risk factors include: age, leg length difference, male height greater than 1.70m, and bow-leggedness (genu varum).

  • Poor Strength and Flexibility

    Weakness or limited flexibility in your legs, core, or lower back can increase your risk of injury. A good neuromuscular training program, such as strength and flexibility hip and knee exercises, can help decrease your risk of injury.

  • Training

    Increasing your weekly running distance by more than 10% or running 6 or more times per week can increase your risk of injury. Consistently running on a hard surface, experiencing high levels of muscle soreness, and poor recovery strategies may also increase your risk of injury.

  • Higher Body Mass Index (BMI)

    BMI is a measure of body composition based on your weight and height. Having more body fat increases your risk of running-related injuries, especially those of the lower leg and foot. A good exercise and running program can help improve your fitness level and reduce your risk of injuries.

  • Previous History of Injury

    Your risk of injury is influenced by previous injury and previous incomplete rehabilitation. Half of all runners who have reported an injury had previously sustained an injury to the same body part, and nearly all declared themselves as not 100% rehabilitated.

  • Running Biomechanics

    The way you run has a direct impact on how forces are applied to different segments and joints in your lower limbs. This includes too much or too little motion in your foot, ankle, lower leg, knee, thigh, hip, and pelvis.

View Summary of Risk Factors

04 How can I prevent injury?

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.

  • Participant & Parent

    Talk to your coach or organization, if applicable, about the prevention strategies below and how they might be incorporated into training and policies.

    Strength Training and Neuromuscular Training Program

    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.

    Other Considerations (about this section)

    Gradual Transition
    As a new 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.

    Running Form
    Addressing overstriding is considered one of the most beneficial biomechanical 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 short, quick steps, which will increase knee flexing to move the foot strike closer to your centre of mass. A 5% to 10% gradual increase in running cadence (number of steps per minute) is an appropriate way to reduce overstriding, improving biomechanics and leading to a smoother and safer running style.

    Improve running biomechanics by:

    • Obtaining feedback on your running form from a coach or trainer, if applicable, or by watching yourself run in a mirror or on recorded footage.
    • Using a metronome or similar device to improve running cadence.

    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.

    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.

  • Coach & Teacher

    Talk to your organization or school about the prevention strategies below and how they might be incorporated into training and policies.

    Strength Training and Neuromuscular Training Programs

    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.

    Other Considerations (about this section)

    Gradual Transition
    Gradually transitioning into running from low-impact activities can minimize the 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.

    Running Form
    Addressing overstriding is considered one of the most beneficial biomechanical strategies for improving running technique. Overstriding occurs when the distance between where the foot hitting the ground and the runner’s centre of mass is considered to be too long. Encourage your athletes to reduce overstriding by taking short, quick steps, which will increase knee flexing to move the foot strike closer to your centre of mass. A 5% to 10% gradual increase in running cadence (number of steps per minute) is an appropriate way to reduce overstriding, improving biomechanics and leading to a smoother and safer running style. An increased step rate can also decrease ground contact time, leg length compression, braking impulse, and vertical centre of mass excursion, or vertical oscillation, which can lead to a smoother and safer running style during prolonged running.

    Improve running biomechanics by:

    • Having runners watch themselves run in a mirror or on video footage while you provide feedback on their running form.
    • Using a metronome or similar device to improve running cadence.

    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.

  • Official & Administrator

    Talk to your coaches, teachers, organization, or school about the prevention strategies below and how they might be incorporated into training and policies.

    Strength Training and Neuromuscular Training Programs

    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.

    Other Considerations (about this section)

    Gradual Transition
    Gradually transitioning into running from low-impact activities can minimize the 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 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.

    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.

    Running Form
    Addressing overstriding is considered one of the most beneficial biomechanical strategies for improving running technique. Overstriding occurs when the distance between where the foot hitting the ground and the runner’s centre of mass is considered to be too long. Encourage your coaches and teachers to work with their athletes to reduce overstriding by taking short, quick steps, which will increase knee flexing to move the foot strike closer to your centre of mass. A 5% to 10% gradual increase in running cadence (number of steps per minute) is an appropriate way to reduce overstriding, improving biomechanics and leading to a smoother and safer running style. An increased step rate can also decrease ground contact time, leg length compression, braking impulse, and vertical centre of mass excursion, or vertical oscillation, which can lead to a smoother and safer running style during prolonged running.

    Improve running biomechanics by:

    • Having runners watch themselves run in a mirror or on video footage while the coach or teacher provides feedback on their running form.
    • Using a metronome or similar device to improve running cadence.

    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.

  • Health Professional

    The role of health professionals in preventing running injuries has two main components:

    1. Providing ongoing education to players, parents, and coaches on effective injury prevention programs such as balance and resistance training; and
    1. Ensuring that injured players are completely healed and fit-to-perform before returning to running to prevent re-injury or chronic injury.

    Running-related injuries include patellofemoral pain syndrome, iliotibial band syndrome, plantar fasciitis, meniscal injuries, and medial tibial stress syndrome.

    Strength Training and Neuromuscular Training Program

    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.

    Other Considerations (about this section)

    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.

    Gradual Transition
    Gradually transitioning into running from low-impact activities can minimize the 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.

    In the beginning stages of a running program, running on non-consecutive days gives the musculoskeletal system time to recover and helps the runner complete a self-assessment of his or her exercise response to the current training load. Increasing running distance or speed by 5-10% each week will allow the body to rest while still increasing mileage and intensity.

    Gait Training
    Gait training and retraining is 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 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 is a common risk factor for multiple running-related injuries. Direct manipulation of the hip adduction angle or an increase in step width with augmented feedback is an effective intervention to re-position the thigh and hip angle during running.

    Barriers that may limit the runner’s investment in gait retraining include pain and resistance to change. Muscle function capacity, joint flexibility, and skeletal structure may limit the amount of change he or she can accommodate. Applying new gait strategies to outdoor running surfaces may be an additional barrier if all the training was on a treadmill.

    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.