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Running Related Injuries

Recreational running is one of the most popular forms of exercise around the world.  It is inexpensive, does not require any special equipment or gym memberships, and the cardiovascular and weight management benefits are unmatched by other forms of exercise. Whether you are a fast runner or a slow jogger, running surpasses other forms of aerobic exercise in terms of metabolic equivalents (METs) which is a measure of how much energy is required to perform an activity, or the intensity of the exercise.1 The greater the MET of an activity the more intense it is and, therefore, the more calories that are burned. Less than 3 METs translates into light intensity, 3-6 METs moderate intensity, and greater than 6 METs is considered vigorous activity.  For instance, walking requires about 3-5 METs, jogging 8-10 METs, and running 10-16 METs. Besides the physical health benefits, there are psychological perks associated with running.  It can improve mood, reduce anxiety and depression, and improve cognitive function.2 Often runners report feelings of euphoria, or what is often referred to as  “runner’s high” upon hitting their stride during a run. 

Unfortunately, running is associated with a higher likelihood of injury compared to other forms of aerobic exercise such as biking or swimming. The annual injury rate has been shown to range from 27% for novice runners to 52% for marathon runners.1 The increase for longer distance runners is likely related to the increased demands that come with greater mileage. Most running-related injuries (RRIs) are due to overuse, but can also be caused by anatomical alignment issues (i.e. scoliosis and knee/hip malalignments), muscle weakness and imbalances, the way your run (heel vs. toe striker), and improper shoe wear.1,4  Those who have sustained a prior injury are also more likely to experience re-injury.  This is probably due to returning to running prematurely before the tissue has had ample time to heal.  Running-related injuries most frequently involve the knee, followed by the foot/ankle, lower leg, and hip/pelvis.3 Although injury sites and pathologies vary tremendously from person to person, the three most frequently diagnosed conditions/pathologies include patellofemoral pain syndrome, iliotibial band friction syndrome, and patellar tendinopathy.3  Other common injuries include shin splints, hamstring strains, achilles tendinopathies, stress fractures, and plantar fasciitis.4 

Whether you are new to running or are training for your 10th marathon, the best way to prevent an injury is to ease into your training slowly, include a warm-up routine prior to hitting the pavement or treadmill, and recognize when you are starting to feel a pain that is different from normal muscle soreness.  Overuse is the major cause of injury, so taking some time off from running, and cross-training to maintain your strength and cardiovascular fitness are imperative.  If you have access to a pool, deep water running is a wonderful way to maintain and even improve your core and lower body strength, making the return to running more seamless. Physical Therapists are trained to evaluate and treat orthopedic injuries and are skilled in identifying running patterns, strength deficiencies and imbalances, and improper footwear that might contribute to injury.  Having your running analyzed by a Physical Therapist is a great way to determine a course of action to improve your recovery. Simply altering the running step rate during running has been shown to improve pain and function in runners with patellofemoral pain syndrome, so making adjustments to running technique might improve performance.5 Physical Therapists can also offer interventions to help expedite tissue healing following an injury and they can tailor an exercise and training program with the goal of helping you return to running and minimize re-injury. 


1. Arnold MJ and Moody AL. Common running injuries: evaluation and management. Am Fam Physician. 2018; 97(8): 510-516.

2. Pereira HV, et al. Systematic review of psychological and behavioral correlates of recreational running. Frontiers in Psychology. 2021;12.

3. Benca E, et al. Analysis of running-related injuries: the Vienna study. J Clin Med. 2020. 9(2).

4. Lopes AD, et al. What are the main running-related musculoskeletal injuries: a systematic review. Sports Medicine. 2012; 42: 891-905.

5. Bramah C et al. A 10% increase in step rate improves running kinematics and clinical outcomes in runners with patellofemoral pain at 4 weeks and 3 months.  Am J of Sports Med. 2019; 47(14): 3406-3413.