Preventing future running injuries is a top priority for me now that I am almost recovered from surgery. I took some time to read up on the topic and discovered that some of the things I had been concentrating on were not going to be quite as helpful. There are other things I can do that would be more effective. With that in mind, let’s take a look at what I found.
How to reduce the risk of injuries from running
Are there things you can do to prevent injuries from running? The incidence of running injuries is high. As much as 40%-50% of runners experience a running injury each year. According to one study, 85% of runners had at least one injury that required them to take a day off from running (Fields et al., 2010).
Among the recommended prevention measures I’ve heard are strengthening the muscles used in running, stretching, using a training plan, and gradually increasing mileage. Does any of this really work?
To determine which injury prevention strategies are supported by science, and which are ineffective, I investigated research studies. You might be surprised to find out that what you’ve been taught might not work. Finally, let me share with you the best strategies to keep you injury-free while running!
A previous injury was consistently reported as the greatest risk factor. Other risk factors include being overweight, being an inexperienced runner, having high weekly mileage, a low running cadence, and running in worn-out shoes.
Training mistakes including excessive mileage and sudden changes in training were the cause of many running injuries. However, terrain type and running at night were not found to increase the risk of injury (Fields, et al., 2010).
Injury prevention strategies
I will discuss whether proper warm-ups and cool-downs, stretching, strength training, cross-training, training methods, shoes/orthotics, or coaching are useful in preventing running injuries.
Other sports have been shown to benefit from warm-ups, but there is not a ton of info on the benefits in running. It was difficult to find studies looking at warm-ups and cool-downs alone.
I believe the benefits shown from warming up in other sports is enough of a reason to add it to your running routine. It may be beneficial.
Although stretching is probably the most frequent recommendation for preventing injuries, there isn’t much evidence supporting its helpfulness in injury prevention. In fact, I found multiple comprehensive studies that reported stretching did not reduce the risk of injuries (Fields et al, 2010; Kozinc & Šarabon, 2017). I am reluctant to list stretching as not working, but I could not find any studies showing that runners who stretched had a lower injury rate.
That is not to say stretching is not worthwhile and should not be done. Stretching does improve flexibility and has health benefits. I would still include stretching as part of your exercise routine, just not for the reasons of injury prevention.
A strength training program may also help prevent injuries. A strength training program not only increases muscle strength, but also ligaments, tendons, and connective tissue strength.
It is also possible to reduce injuries by screening for muscle imbalances and correcting them (Fleck & Falkel, 2012). Running specific strength training may improve athletic performance as well.
Here is the best advice for adding strength workouts to your running plans.
The best time to strength train is on the opposite day of running or at least eight hours apart if done on the same day. For runners, your running workout should be first. For example, if you run in the morning and want to strength train the same day, you should perform your strength training workout in the evening (Jones & Bampouras, 2007).
I found a couple of studies on cross-training. Both support the idea that cross-training can be used as a way to reduce injuries. A military study showed that adding more weighted marching instead of running reduced injuries (Kozinc & Šarabon, 2017). In a second study, cross-training was used to prevent injuries in high school runners. Students who added in cross-training achieved improvements in their running goals. It is reasonable to substitute two runs per week with cross-training (Paquatte et al., 2018).
Triathletes provide a final example of the usefulness of cross-training. Triathletes maintain similar running paces to those who run exclusively. The use of different muscles in cross-training may help with preventing running injuries.
Using a proper training plan is perhaps your best method for reducing your chances of getting injured. Multiple studies have shown that reducing training volume is probably effective in preventing injuries (Fields et al., 2010; Kozing & Sarabon, 2017).
Disorganized training, inconsistent training, and sudden changes to your training are associated with more injuries (Fields et al., 2010). For example, a sudden increase in speed work or a rapid jump in mileage.
Unfortunately, there is not a one size fits all strategy for training and running injury prevention, but there are things you can look at while deciding which training plan works best for you.
Your training should gradually increase mileage, speed, and hills. You should also allow enough recovery time. You may do better with a lower mileage training plan and more cross-training if you have a history of injuries. For new runners, also see my article on Getting Started with Running.
I really wanted to find a robust study demonstrating that having a coach reduces injuries. I found nothing in my search specifically discussing coaching and injury prevention. How disappointing! So, what you’re going to get instead is my opinion.
Coaches can be extremely helpful in preventing injuries. Runners are known for pushing through pain. Experienced coaches recognize overtraining and when to reduce intensity or volume. Beginner runners may not be able to judge this for themselves. The articles I read repeatedly mention overtraining and training mistakes. Coaches can help you develop a training plan that is tailored to your body and helps you learn to listen to it.
There are apps and books that set up training plans, but neither is truly personalized. It takes experience to know when to deviate from the plan, and this is where a coach can help. I strongly believe that hiring a coach, whether online or in person, can help prevent injuries.
If you’re looking for a coach, a good place to start is the Road Runners Club of America (RRCA) coaching directory.
Shoes & Orthotics
Buying a good pair of running shoes was probably the first advice I was ever given as a runner. What constitutes a good pair? Do running shoes make a difference in injury prevention? The answer is yes, no, and maybe.
Cushioning – Max or Minimalist? How about neither?
There is very little evidence that impact forces are even a risk factor for running injuries (Niggs, et al., 2015).
It has been shown, at least in one study, that highly cushioned shoes alter the spring mechanics of running and increase impact load (Kulmala, et al. 2018).
Perhaps you should choose a minimalist shoe instead. There is no evidence that this reduces injuries either. Running in minimalist shoes may improve running economy, but they are also more likely to cause injury (Sun et al., 2020).
What about pronation?
Pronation is also not thought to be a risk factor. Injuries can be reduced by motion control shoes, but only for runners who pronate excessively (Kozinc & Šarabon, 2017).
There are no studies that offer specific shoe recommendations for specific foot types (Fields, et al., 2010).
Then what should I look for in a shoe?
The role of shoes in preventing injury has been largely overrated. Believe it or not, research supports comfort! Comfortable shoes are associated with fewer injuries (Niggs, et al., 2015).
When selecting shoes, pick a pair that feels comfortable, transition appropriately to new shoes, and listen to your body for when those shoes are worn-out. Retiring shoes at 200-300 miles is a general rule of thumb.
A note about orthotics – you may be wondering if orthotics make a difference. They may reduce the risk of stress fractures. So, if you are at a higher risk for a stress fracture, they may be of benefit to you (Fields, et al., 2010).
Compliance may be an important factor!
Unfortunately, running injury prevention programs/studies have low compliance rates (Nielsen, et al., 2020). This makes it difficult to tell whether the injury prevention program is truly not effective.
There needs to be further research to develop better ways to reduce overuse injuries.
Untili then, I think following the tips below are your best bet for preventing running injuries.
Summary of Tips for Preventing Running Injuries
- Use a proper warm up
- Follow a structured training plan
- Add in running specific strength training & address muscle imbalances
- Cross train if you have a history of injuries
- Follow a lower mileage training plan if you are new to running or have a history of injuries
- Consider a coach
Thank you for taking the time to read my tips. I hope they are helpful to you.
References Fields, K. B., Sykes, J. C., Walker, K. M., & Jackson, J. C. (2010). Prevention of Running Injuries. Current Sports Medicine Reports, 9(3), 176-182. doi:10.1249/JSR.0b013e3181de7ec5 Fleck, S., & Falkel, J. (2012). Value of Resistance Training for the Reduction of Sports Injuries. Sports Medicine, 3, 61–68 (1986). doi:https://doi.org/10.2165/00007256-198603010-00006 Jones, P., & Bampouras, T. (2007). Resistance Training for Distance Running: A Brief Update. Strength and Conditioning Journal, 29(1), 28-35. Retrieved from https://journals.lww.com/nsca-scj/Abstract/2007/02000/Resistance_Training_for_Distance_Running__A_Brief.5.aspx Kozinc, Ž., & Šarabon, N. (2017). Common Running Overuse Injuries and Prevention. Montenegrin Journal of Sports Science and Medicine, 6(2), 62-74. doi:10.26773/mjssm.2017.09.009 Kulmala, J., Kosonen, J., & Nurminen, J. (2018). unning in highly cushioned shoes increases leg stiffness and amplifies impact loading. Scientific Reports, 8, 17496. doi:https://doi.org/10.1038/s41598-018-35980-6 Nielsen, R. O., Bertelsen, M. L., Ramskov, D., Damsted, C., Verhagen, E., Bredeweg, S. W., . . . Malisoux, L. (2020). Randomised controlled trials (RCTs) in sports injury research: authors—please report the compliance with the intervention. Br J Sports Med, 54(1), 51-57. Nigg, B., Baltich, J., Hoerzer, S., & Enders, H. (2015). Running shoes and running injuries: mythbusting and a proposal for two new paradigms: ‘preferred movement path’ and ‘comfort filter’. Br J Sports Med, 49(20), 1290-1294. doi:10.1136/bjsports-2015-095054 Paquette, M. R., Peel, S. A., Smith, R. E., Temme, M., & Dwyer, J. N. (2018). The Impact of Different Cross-Training Modalities on Performance and Injury-Related Variables in High School Cross Country Runners. Journal of Strength and Conditioning Research, 32(6), 1745-1753. doi:10.1519/JSC.0000000000002042 Sun, X., Lam, W.-K., Zhang, X., Wang, J., & and Fu, W. (2020). Systematic Review of the Role of Footwear Constructions in Running. Journal of Sports Science and Medicine, 19, 20-37. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7039038/