Six Ways to Prevent Running Injuries

Runners must be proactive in maintaining their physical health by building habits that help prevent running injuries.

Why?

Running is an inherently risky sport.

This is not a hot take — it’s fact. Two recent meta-analysis reviews in the Journal of Sports Medicine and Journal of Sport and Health Science quantified that risk. The average rate of injury for a recreational runner is somewhere between 50-80% per year depending on various factors. Approximately 25% of all runners are currently injured.

Why you need to proactively manage your running health

Two of the most important factors in running injuries are experience and mileage. It makes sense that novice runners with higher mileage are more likely to get injured than experienced runners with lower mileage.

Any experienced runner will tell you that dealing with injuries is just part of the game. The vast majority of running injuries — 80 to 90% — are overuse injuries from repetitive strain.

The most common injuries in recreational runners are patellofemoral pain syndrome (kneecap joint inflammation) and medial tibial stress syndrome (also known as shin splints). According to the above-mentioned studies, these two injuries were even more likely for 13 to18-year-old females.

The next most common injuries are iliotibial band (ITB) syndrome (the tendon that runs along the outside of your thigh and knee), Achilles tendinopathy, and plantar fasciitis.

These findings mirrored my real-life clinical experience as a physical therapist. These injuries are spread out pretty evenly from lower back pain to plantar fasciitis and everywhere in between.

Running injuries can occur anywhere and at any time in your running career, so it’s important to be vigilant — and proactive.

So, how do you avoid running injuries?

Don’t run.

It’s kind of like the advice they give in high school health class, “abstinence is the only 100% effective form of birth control.” It may be the most effective strategy, but it is by far the lamest. I’m still running.

I’m not saying running injuries are inevitable.

But, I am saying that injuries are very, very likely to occur, and the sooner you understand this likelihood and take the risks seriously, the less likely it is that you will be one of the 25% of runners who are injured at any given time.

It’s important that you understand that mitigating injuries is part of the sport, especially when you are pushing your body to its limit.

The question isn’t, “who can train the hardest?” The question you need to be asking yourself is, “who can recover from the hardest training?”

You’ve read this far, so I can tell I haven’t scared you away from running. I’m impressed. I will reward you with six bullet points that get to the point and teach you exactly what to do.

 

How to mitigate running related injuries, in chronological order, opposed to order of importance.

1. Don’t run too much, too fast, too soon.

2. Warm up and roll your problem areas before.

3. Running form matters, but don’t change your form all at once.

4. Roll for 90-120 seconds per muscle group within 30 minutes.

5. Take in 30 grams of protein within 30 minutes.

6. Practice an anti-inflammatory lifestyle.

Six ways to prevent running injuries

1. Don’t run too much, too fast, too soon

The research is clear: the number one factor contributing to running injuries is overuse or repetitive strain. Basically running too much, too soon, too fast.

There’s a generally accepted 10% rule, that says not to add more than 10% mileage per week. There is no research that supports this specifically and it doesn’t take into account the health and experience of the runner, speed, hills, etc. It also doesn’t explain how to start from scratch.

If you’re starting from no running, or from limited or infrequent running, the best rule of thumb is to start with run/walks. Run for a minute or two, and then walk for the same period of time. Gradually, you’ll be able to increase the time that you’re running and decrease the time that you’re walking.

Listen to your body – No pain, no gain, right? You need to learn to differentiate between “good, exertional, productive” pain and “bad, injurious, destructive” pain. In order to listen to your body effectively, you need to know what’s going on.

When you exercise you are stressing the body. Given the proper time to rest and recover, your body will adapt. Inflammation following exercise is a normal part of the recovery process. Soft tissue repetitive stress injuries occur when you stress, stress, and stress again without the necessary time to recover. Everyone’s inflammatory response is different, meaning they recover at faster or slower rates. Healthier experienced runners recover faster than unhealthy novice runners. This is why you have to learn to listen to your body, even if you don’t like what it’s saying.

Build calluses, but don’t push through blister-level pain. Blisters are the skin’s acute inflammatory response from doing too much, too fast, too soon. All these soft tissue running injuries behave very similarly, only it’s tendons, bursas, muscles, or cartilage that’s inflamed. If you have a blister, you can usually tell when you’re making it worse and need to stop, right? Sometimes you don’t realize you overdid things until that night or the next day. The same rules generally apply to your tendons, muscles, and cartilage when you are running, so be careful. My rule of thumb is, don’t push past 3-4/10 “discomfort”. Think about building an acclimation to forces as you train to train. The goal is to be able to do more next time.

2. Warm up and roll your problem areas before

A 2020 Journal of Bodywork and Movement Therapies article included 49 peer reviewed articles to determine the efficacy of static stretches, dynamic warmups, and foam rolling prior to running. They concluded that those traditional static stretches many of us were taught back in the day (hold the stretch for thirty seconds and repeat), don’t do much. Researchers found a small to no effect on performance or injury rate for foam rolling prior to running. That being said, my experience would say, rolling your “problem areas” prior to running is a very good idea.

3. Running form matters, but don’t change your form all at once

There are numerous studies that show changing to a more efficient running gait improves performance and injury resistance. I firmly believe that a more efficient running gait will lead to faster times, more mileage tolerated, and fewer injuries. That being said, there are some studies that literally conclude the opposite, that changing your gait can lead to new injuries. I’ve seen both happen. Working on a new gait is similar to changing shoe brands. Even if they are a perfect fit, they’re still new, and your body needs time to get acclimated.

The complexity of the run gait reminds me of a golf swing. There are so many individual things to think about that it’s impossible to address them all at once. Look forward, chest up, shoulders back, lean forward slightly, relax your shoulders, keep your shoulders out of your ears, relax your hands and swing them forward, not side to side, don’t overstride in front or behind, pull your knees through, keep your legs under you, bend your knees more, don’t cross your feet over, quick light quiet feet, don’t heel strike, breath, and try to have fun! Just like the golf swing, there’s going to be a learning curve before things become natural and fluid.

Don’t actively try to make any changes in your gait. Just be aware of them as you scan your body during your runs. As soon as you actively try to make any of these changes, you introduce the prefrontal cortex to the party. This bypasses the cerebellum, the “muscle memory” portion of our brain, and makes things a little clunky and mechanical. Just “be aware” of these changes so as not to lose the fluidity of your body’s natural movement pattern as you gradually run more efficiently over the weeks and months. Keep your run thoughts simple as you scan each body part during your runs. “Quick, light, and quiet feet, with all my energy moving forward, not side to side, or up and down”.

Aim for 180 steps per minute. Cadence, or steps per minute, is the one objective measure that you can safely work on at home to improve gait efficiency. What’s great is that it’s easy to calculate manually by counting your steps during a set time, or automatically through various smartwatch apps.

A cadence of 180 steps/min has been proven categorically time and time again to be the most efficient, regardless of your height. A cadence of 160 steps/min or less results in a higher ground contact time. The longer your foot is on the ground, the more time there is for things to go wrong. A quicker cadence gives you less time to pronate or overstride. Research has shown that even subtle increases in cadence can substantially reduce the forces going through the hips, knees, and ankles, resulting in fewer injuries.

4. Slow your roll after running

Stop making excuses for not making time to recover properly. You don’t half ass your workout, so don’t half ass your recovery. If you’re healthy and just finished an easy workout, you can probably wait until you get home to roll. But if you’re nursing a hip flexor strain, I wouldn’t jump in your car for a long drive immediately following a tough run or hike. Instead, schedule ten minutes of down time to roll, protein intake, and just be present as you roll.

Rolling your muscles after running leads to improved performance sooner, with fewer injuries. The idea is to mechanically flush out some of the post workout inflammation as well as to elongate your tight muscles like a rolling pin does with dough. Our muscles are most in need and most receptive to rolling immediately following your workout.

As an aging athlete and physical therapist who specializes in running injuries, I cannot overstate the importance of slow, deep, foam rolling as soon as possible following your runs. The research confirms my experience and education. That same journal article looked at the effects of post activity foam rolling on performance and recovery. They concluded that rolling 90-120 seconds per muscle group within 30 minutes of exercise improved recovery time.

5. Take in 30 grams of protein within 30 minutes

I’ve been in the health and fitness field a long time. Back in the early 90s the experts gave us a two hour window to eat our protein following a workout. Newer research suggests, the sooner the better, particularly for women over 40. Thirty grams within minutes is a good general rule. Skipping meals, particularly breakfast, and low protein diets have all been associated with higher injury rates.

6. The road to an anti-inflammatory lifestyle travels through the gut

There are a handful of variables that are under our control that impact our level of inflammation and our body’s ability to recover. Stress, sugar, alcohol, processed foods, and poor sleep can all increase cortisol levels and inflammation and slow down the body’s ability to heal and recover. More fruits, veggies, plant-based proteins, and sleep can all help speed the body’s ability to recover.

Turn these recovery practices into a routine. Think RPM after your workouts: Roll, Protein, Meditate.

When it comes to rolling and protein intake, research suggests “the sooner the better”. Stress increases cortisol levels, which impedes your body’s ability to recover. Put down your phone, turn off your brain, take a deep breath, and slowly roll… with your protein shake within reach.

 Who am I?

I’m Ben Biskovich, PT, the founder of Heal Strong for Life, one-on-one physical therapist training in Nashua, New Hampshire. I’m an orthopedic physical therapist with more than 20 years of experience. I’ve run 15 marathons in 15 states and have performed hundreds of run gait analyses on recreational to elite runners of all ages over those years. I’m here to tease out all the conflicting noise you get from social media and your running buddies, and teach you how to apply the latest research and my experience to your warmup and recovery routine. My goal is for you to learn how to mitigate running injuries while training, not treat them once they occur.

 

(1) “Incidence of Running-Related Injuries Per 1000 h of Running in Different Types of Runners: A Systematic Review and Meta-Analysis.” Journal of Sports Medicine. May 2015. Videbaek.

(2) “A systematic review of running-related musculoskeletal injuries in runners.” Journal of Sport and Health Science, September 2021. Kakouris.

(3) “Effects of foam rolling on performance and recovery.” Journal of Bodywork and Movement Therapy, 2020.