Avoid Running Injuries: 22 PTs, Coaches and Experts Weigh In

How to avoid running injuries

As with any sport or physical activity, injuries can happen when you run. Some are unavoidable, but many injuries can be avoided with proper precautions.

Below are 22 tips from a variety of experts on how to avoid injuries while running. We rounded up advice from everyone from marathoners and distance runners to orthopedic specialists and sports medicine doctors to put together the most comprehensive resource we could.

Whether you are totally new to running or you have been running for decades, you can use this post as a checklist to make sure you are taking the right measures to ensure and maintain your body’s health while you run.


The Basics of Running Injuries

First, understand that most runners suffer injuries of some kind.
Laura Schwecherl, a writer at Greatist, noted in 2012 that about 4 in 5 runners suffered some kind of injury every year. “Most injuries are caused by overuse—applying repeated force over a prolonged period of time,” she wrote. “Sudden changes in training volume, whether a newbie or a vet, can also do some damage.”

That means you need to pay attention to what your body is telling you.
Knowing that the odds are in the favor of injury, you should be vigilant and listen to the feedback from your own body, podiatrist Dr. Stephen M. Pribut writes on his site.

“If something is hurting pay attention to it, find out why, and change what is making it hurt. Rest if necessary, but if the pain doesn’t fade, don’t forget a visit to the doctor’s office if necessary.”

Inconsistency in your running is a big source of trouble.
Marathon trainer Art Liberman writes on his site, MarathonTraining.com, that inconsistency can lead to a host of problems. “It is vital that you do not miss several days in a row of running and then jump right back into your training program. Doing so greatly increases your risk of injury, as you must build your mileage gradually.”

Runners need strength.
Strength running coach Jason Fitzgerald writes in the Art of Manliness that, contrary to what many runners believe, strength plays an important role in preventing injuries.

“If you don’t complete regular strength work, you’re on the fast track to injury. While the entire topic of ‘injury prevention’ includes much more than just strength exercises, it’s a big part of the puzzle. Most runners that can’t string together a few months of consistent training because of chronic injuries don’t do any strength work.”

These are the five most commonly injured areas.
Dr. Owen Anderson, director of the Lansing Marathon, writes at SportsInjuryBulletin.com that there are five injury “hotspots” among runners:

  • Knee injuries (about 25–30% of injuries)
  • Calf and shin injuries (20% of all injuries)
  • Iliotibial band injuries (this is the “ long sheath of connective tissue which runs from the outside of the hip down to the lateral edge of the knee, he writes, and it accounts for 10% of all injuries)
  • Achilles tendon injuries (about 8% of all injuries)
  • Foot injuries, particularly a hobbling injury such as plantar fasciitis (10% of all injuries)


General Injury Prevention

Find the right shoes.
Dr. David Price, at Carolinas HealthCare Systems sports medicine & injury care clinic, writes on the organization’s website that any runner needs to get fitted with a proper pair of shoes. “Don’t just use an off-the-shelf shoe,” he writes. “Find a store that will properly fit you based on your running form and foot type.”
Warm up properly.
Dr. Nicole Arcand of the Norwich Orthopedic Group has put together a handy PDF about preventing lower-extremity injuries, and she puts early emphasis on the importance of warming up.

“The Achilles tendon is the biggest, strongest tendon in the body. The muscles in the back of the calf (including those that attach to the Achilles tendon) are more developed and stronger than the muscles in the front of the lower leg. This can be very pronounced in runners. Unless the muscles in the back of the calf are isolated and stretched, they can become very tight and cause significant unbalance in the foot and ankle. This tightness is responsible for many foot and ankle problems: from stress fractures, to plantar fasciitis, to Achilles tendonitis. Taking time to stretch before and after your run will help to significantly reduce your risk of these overuse injuries.”

Mark Sisson, who we hear from below, says warming up should be taken literally: You need to get your body temperature up before doing any kind of training. He goes so far as to suggest a warm bath right before stretches and warm-ups.
This includes dynamic stretches.
Understand that there are a couple of types of stretches, static and dynamic. Static stretches loosen up the muscles, but dynamic stretches actually improve their elasticity, CoachUp writes. Here are the two dynamic stretches CoachUp suggests:

“Knee grabs — Standing upright, bring one knee to 90 degrees. Hold on to the knee and bring towards opposite shoulder to produce a light stretch in the buttocks. Hold for a few seconds, release, and do the same on the opposite side as you proceed into the next step. Keep moving through each stretch.

“Toe Reachers — Standing upright place one foot in front of you a couple inches. Reach toes up towards the sky and push your butt back as you reach towards your toe. The active foot flexion coupled with pushing the sits bones behind you produces the stretch, not you bending down. Hold for a few seconds, release, then take a small step before doing the same on the opposite leg.”
Run on surfaces that absorb shock.
As Dr. Arcand above points out, a runner takes about 800 steps per mile, putting a force of more than 5x their body weight on each foot in each of those steps. Something needs to absorb that impact. Shoes help, but a shock-absorbing surface is a big help, too.

Minimalist runner Kevin Beck shares the following advice from distance runner Pete Pfitzinger on his site:
“Search for natural surfaces-dirt paths, grass fields, golf courses, trails-anywhere that will allow you to run with less shock and less chance of injury. The higher the percentage of your training that you do off-road, the lower your likelihood of developing overuse injuries.”

Pfitzinger also points out that downhill running can be harmful, especially for those on the precipice of aggravating or re-aggravating an injury.
Remember to hydrate.
Degree Men, the deodorant company, has a quality fitness and sports bog called The Adrenalist, and Adrenalist writer Trevor Rapp has some important advice regarding hydration, which he says is a little more nuanced than simply “drink water.”

“The real key to hydration … is to make sure you’re drinking well before the time to run arrives, not just right when you’re about to take off,” he writes. “In fact, you really shouldn’t drink much within an hour of heading out, although you can have a bit right before you start. It’s important, interestingly enough, not to over hydrate, which can be tempting if you’re running a really long race like a marathon.”
Science doesn’t support the claims that compression clothing helps prevent injury.
Calgary’s Running Injury Clinic issued a report in 2012 that said any claims about the benefits of compression gear are simply marketing and not backed by scientific research.

“[B]ased on these few studies [cited in the report] that have investigated the effect of compression clothing on sprinting and endurance running, they have reported modest-to-no effect in terms of physiological measures and overall performance times.”
Sprinters, don’t overexert yourself.
This sounds like common sense advice, but primal living advocate Mark Sisson gets right to the heart of how sprinters frequently fail to heed this advice:

“Think you’ve got ‘one more in ya?’” he writes on his blog. “Stop. End your workout. That’s exactly when you need to quit. Sprinting should not be done to failure, because failure means fatigue and fatigue is when systems fail, technique breaks down, and injuries occur. Stopping just short of that point is ideal for injury prevention. I always stop my workout right when I figure I have another one or two in me. It’s just not worth it.”
Training extends beyond your workouts.
Women’s Health associate editor Alison Goldman writes that various other lifestyle choices will have an effect on your endurance workouts, and how your body will respond to them.

“Make sure you consider hydration and nutrition part of your training, too,” Goldman writes, citing Ironman Women athlete Paula Newby-Fraser. “If you feel awful a couple of hours after a workout or you’re totally drained the next day, it could be a sign that you need to up your electrolyte, fluid, and protein intake directly following your workout.”


Preventing Knee Injuries

avoid running injuries
Build up speed steadily.
UK health-insurance provider Bupa has a nice collection of fitness information resources on its site, and one of those is a page about preventing runner’s knee.

“Don’t suddenly increase how far or how fast you run. Steadily building up your training is the best way to develop your running and fitness without risking injury. If you notice a small niggle that isn’t getting better, listen to your body. Stop training, rest and get advice from a physiotherapist.”
Strengthen your muscles.
Central Florida podiatrists Dr. Gary Goodman and Dr. Elizabeth Annis write that strong muscles in your hips, legs and core go a long way in preventing knee issues.

“When your hips are weak or tight, the movements of your knees become limited. Running without this knee mobility forces your body out of alignment and strains the ligaments surrounding your knees. Incorporate light strength training in your workout regimen of these areas.”


Preventing Hamstring Injuries

Strengthen your hamstrings with squats, kicks and lunges.
Andy Mitchell, head physiotherapist for English soccer team Wigan Athletic writing for FourFourTwo, suggests the above exercises for strength. Then, do something to improve the flexibility of your hamstrings — he recommends yoga.
Do exercises that replicate the movements of running.
James Marshall, a strength and conditioning coach in England, writes that hamstring exercises need to be a little bit eccentric, but they also need to approximate the motions you make when running. He recommends good mornings lifts, or stiff leg deadlifts, instead of something like machine curls.
Have an expert analyze your stride.
If your gait features some unhealthy mechanics, that could lead to trouble. Oregon physical therapist Joe Uhan explains one example of what an unhealthy stride could do to a hamstring over at irunfar.com.

“[Over-lengthening the hamstring] is arguably a more common cause of chronic tightness and pain in distance runners. The hamstring plays a substantial role in ‘slowing down’ the foot at the end of the swing phase, as it readies to contact the ground. If the stride is, for some reason, too long, or if the stride has inadequate hip flexion and the hamstring is ‘stuck’ in a constantly lengthened state, the hamstring gets over-stretched and over-worked with each stride.”


Preventing Shin Splints

Respond to any pain in the shin area quickly.
Mount Merrion Physical Therapy, in Ireland, writes that shin splints occur when the muscles and tendons covering the shin bones get inflamed and begin to hurt. This is something most runners deal with at some point.

The good news? Prevention is easy, the doctors there say. “[I]t’s best to reduce your running distances. You would be wise to ice the area every day if you can. Avoid stretching an inflamed muscle. Remember, if the pain is not settling within 3-5 days, best to get the injury assessed by a chartered physiotherapist, which would include a full foot and lower limb assessment to establish whether foot orthotics may help with recovery and reduce your risk of suffering shin splints in the future.”


Preventing Foot and Ankle Injuries

Do balance training, especially if you have had an ankle injury in the past.

Longtime runner John Davis offers the following exercise on Runners Connect to improve your balance and your ankles’ stability:

  1. Balance on one leg on flat ground.
  2. Progress to doing squats and leg-swings first with your eyes open.
  3. Do the previous exercise with your eyes closed.
  4. Move to an unstable  surface like a wobble board to increase the difficulty as you improve.

Research suggests taping and bracing ankles is effective.
Physical therapy company Athletico wrote a piece in 2011 that argued taping and bracing your ankles improves their stability with no negative effects. “Some athletes feel that taping and bracing slows them down, which makes for a difficult cost/benefit analysis,” Athletico’s Dave Heidloff wrote.

“If taping or bracing is something you feel may be good for you, I’d encourage you to check out some braces at a sporting goods store or talk to an athletic trainer about getting taped up to see how it feels.”


Preventing Lower Back Injuries

New York orthopedic spine surgeon Dr. Sean McCance writes at Spine-Health.com that running puts stress on the lower back area, and he suggests the following preventative measures to ensure that stress doesn’t lead to pain or other problems:

  • Warm up properly
  • Stretch the hamstrings twice a day
  • Keep muscles strong and toned, particularly your back muscles
  • Cross-training helps avoid overuse syndrome
  • Wear the right shoes
  • Run on a “forgiving surface” such as a rubber track


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