Why Runners Get Injured: Root Causes and Evidence-Based Strategies for Management of Running Injuries

Running is one of the most popular forms of physical activity, delivering huge benefits for cardiovascular health, mental wellbeing, and overall fitness. However, injuries are extremely common - with studies suggesting up to 79% of runners experience an injury annually (van Gent et al., 2007).

Rather than focusing solely on specific conditions like shin splints or ITB syndrome, this article explores the root causes of running injuries and outlines evidence-based strategies to help runners prevent, manage, and recover from injuries more effectively.

Key Causes of Running Injuries

1. Training Load Errors

Training load errors are the most consistently identified cause of overuse injuries in runners. Sudden spikes in volume or intensity, inadequate rest between sessions, and poorly periodised programs all increase risk.

Research by Nielsen et al. (2012) found that abrupt changes in training volume - especially when increases exceed 30% per week - significantly elevate injury risk. 

Eckard et al. (2018) similarly emphasised that inappropriate training loads are a leading cause of musculoskeletal injuries.

✅ Management Strategy:

• Increase mileage by no more than 10% per week

• Schedule rest or recovery weeks every 3-4 weeks

• Monitor internal load with session RPE x duration

2. Poor Neuromuscular Control and Strength Deficits

Biomechanical inefficiencies, such as weak gluteus medius, poor pelvic control, and insufficient calf strength, predispose runners to injury.

A meta-analysis by Lauersen et al. (2018) showed that strength training can reduce sports injuries by up to 66%, with stronger benefits seen from consistent, progressive loading.

Supporting this, Ferber et al. (2015) found that hip and core strengthening significantly improved mechanics and reduced symptoms in runners with patellofemoral pain within six weeks.

✅ Management Strategy:

• Strength train twice a week, focusing on glutes (hip thrusts, monster walks), calves (heel raises), and core (dead bugs, bird-dogs, single-leg bridges)

3. Biomechanical and Gait Deviations

Certain gait patterns - such as overstriding, low cadence, excessive hip adduction, or knee valgus - can increase stress on joints and soft tissues.

Willy et al. (2016) demonstrated that increasing cadence by 7.5% reduces peak hip adduction and loading rates. 

Heiderscheit et al. (2011) similarly showed that even a 5-10% cadence increase can lower ground reaction forces, decreasing stress at the hips and knees.

✅ Management Strategy:

• Undergo a running gait assessment with a physiotherapist

• Use metronome pacing or visual feedback

• Cue: “Run softly” or “Quick steps, less bounce”

4. Footwear and Terrain Mismatch

Footwear and terrain significantly affect running loads. Worn-out shoes, overly cushioned or minimalist footwear used incorrectly, and abrupt shifts to harder surfaces can all increase injury risk.

Lieberman et al. (2010) showed that footwear alters foot strike patterns - cushioned shoes promote rearfoot striking, while barefoot or minimalist styles encourage forefoot striking, changing impact forces.

Meanwhile, Malisoux et al. (2015) found that rotating between different shoes reduced injury risk by 39% compared to using a single pair.

✅ Management Strategy:

• Rotate between two or more pairs of running shoes

• Gradually break in new footwear over 2-3 weeks

• Mix surfaces (grass, trails, treadmills) to distribute loading

5. Inadequate Recovery, Sleep, and Nutrition

Recovery is where adaptation happens. Poor sleep, inadequate nutrition, and psychological stress can impair tissue healing and increase injury risk.

Taheri et al. (2014) found that sleep deprivation impairs cognitive and motor function in athletes, increasing injury risk. 

Tenforde et al. (2016) also emphasized that low energy availability (Relative Energy Deficiency in Sport - RED-S) significantly elevates injury risk among endurance athletes.

✅ Management Strategy:

• Sleep 7-9 hours per night

• Refuel with 1-1.2g of carbohydrate per kilogram of bodyweight within 1 hour after long or intense runs to optimise glycogen replenishment

• Consume 20-25g of protein within 30-60 minutes post-run

• Use stress management techniques like breathwork, mindfulness, or restorative yoga

Consult a physiotherapist to assess biomechanics, strength asymmetries, and recovery strategies

What to Do When Pain Starts

Early action leads to better outcomes.

If you start to feel pain:

• Reduce training volume by 30-50% but maintain cardiovascular fitness with cross-training

• Begin a graded strengthening and mobility program

• Consult a physiotherapist to assess biomechanics, strength asymmetries, and recovery strategies

How Endurance Health Lab Helps Runners Recover and Perform

At Endurance Health Lab, we use a structured three-phase approach to help runners recover from injuries, build resilience, and optimise performance:

Phase 1: Diagnose and Relieve

• Comprehensive assessment of running mechanics, strength, and training load

• Gait analysis to identify biomechanical issues such as overstriding or hip drop

• Hands-on therapy and pain management techniques 

  
  

Phase 2: Rebuild and Strengthen

• Personalised strength and mobility programs targeting the glutes, calves, core, and hips

• Neuromuscular control drills to improve stability, balance, and running efficiency

• Guidance on safely adjusting running volume, intensity, and footwear

  
  

Phase 3: Optimise and Prevent

• Running technique correction, cadence retraining, and footwear advice

• Support for recovery strategies including sleep, nutrition, and stress management

• Ongoing reassessment to monitor progress, refine training, and reduce injury risk

At Endurance Health Lab, our aim is not just to get you back running — it's to help you move better, feel stronger, and run at your full potential.

📅 Book an Assessment Today or Email us to address your pain, and enhance your running performance. 

Book Now

Our goal is to build stronger, more resilient runners. 🏃‍♀️💪

Located in Chatswood, 2067

Follow us on instagram: @endurancehealthlab

📚 References

van Gent, R. N., Siem, D., van Middelkoop, M., van Os, A. G., Bierma-Zeinstra, S. M., & Koes, B. W. (2007). Incidence and determinants of lower extremity running injuries in long-distance runners: a systematic review. British Journal of Sports Medicine, 41(8), 469–480.

Nielsen, R. O., Buist, I., Sørensen, H., Lind, M., Rasmussen, S., & Rasmussen, J. (2012). Training errors and running-related injuries: a systematic review. International Journal of Sports Physical Therapy, 7(1), 58–75.

Eckard, T. G., Padua, D. A., Hearn, D. W., Pexa, B. S., & Frank, B. S. (2018). The relationship between training load and injury in athletes: A systematic review. Sports Medicine, 48(8), 1929–1961. 

Lauersen, J. B., Andersen, T. E., & Andersen, L. B. (2018). Strength training as superior, dose-dependent and safe prevention of acute and overuse sports injuries: a systematic review, qualitative analysis and meta-analysis. British Journal of Sports Medicine, 52(24), 1557–1563.

Ferber, R., Bolgla, L., Earl-Boehm, J. E., Emery, C., & Hamstra-Wright, K. (2015). Strengthening of the hip and core versus knee muscles for the treatment of patellofemoral pain: a multicenter randomized controlled trial. Journal of Athletic Training, 50(4), 366–377.

Willy, R. W., Willson, J. D., Clowers, K., Baggaley, M., & Murray, N. (2016). The effects of body-borne loads and cadence manipulation on patellofemoral and tibiofemoral joint kinetics during running. Journal of Biomechanics, 49(16), 4028–4033.

Heiderscheit, B. C., Chumanov, E. S., Michalski, M. P., Wille, C. M., & Ryan, M. B. (2011). Effects of step rate manipulation on joint mechanics during running. Medicine & Science in Sports & Exercise, 43(2), 296–302.​

Lieberman, D. E., Venkadesan, M., Werbel, W. A., Daoud, A. I., D’Andrea, S., Davis, I. S., Mang’Eni, R. O., & Pitsiladis, Y. (2010). Foot strike patterns and collision forces in habitually barefoot versus shod runners. Nature, 463(7280), 531–535.

Malisoux, L., Chambon, N., Delattre, N., Gueguen, N., Urhausen, A., & Theisen, D. (2015). A step towards understanding running-related injury prevention: a randomised trial on runners who alternated shoes. Scandinavian Journal of Medicine & Science in Sports, 25(1), 110–115.

Taheri, M., Arabameri, E. (2012). The effect of sleep deprivation on choice reaction time and anaerobic power of college student athletes. Asian Journal of Sports Medicine, 3(1), 15-20.

Tenforde, A. S., Carlson, J. L., Chang, A., Sainani, K. L., Shultz, R., Kim, J. H., Cutti, P., Golden, N. H., & Fredericson, M. (2017). Association of the Female Athlete Triad Risk Assessment Stratification to the Development of Bone Stress Injuries in Collegiate Athletes. The American Journal of Sports Medicine, 45(2), 302–310.