What is the main cause of running injuries?
There isn't a single one. Running injuries are influenced by the interaction between training load, tissue capacity, previous injury, recovery and individual factors such as biomechanics and running experience, and the relevant contributors vary between runners. Running form alone rarely explains an injury, and the evidence linking specific training parameters to injury is also inconsistent. A more useful question than "am I running correctly?" is whether your current training demands are appropriate for your current capacity.
How common are running injuries?
Running-related injuries are common, with systematic reviews reporting injury incidence and prevalence estimates of around 40 to 45%. The exact figure depends heavily on how an injury is defined (any pain that changes training, versus only injuries that stop you running) and on the population studied, from first-time runners to competitive athletes.
What are the most common running injuries?
The conditions reported most often include Achilles tendinopathy, medial tibial stress syndrome (shin splints), patellofemoral pain syndrome (runner's knee), plantar fasciitis and iliotibial band syndrome. Patellofemoral pain syndrome is one of the most commonly reported, accounting for approximately 17% of prevalence estimates in one systematic review. The knee, lower leg and foot and ankle are the most frequently affected areas.
Is the 10% rule for increasing mileage safe to follow?
It's not harmful as a rough guide, but the evidence doesn't support it as a universal rule. Large or poorly tolerated changes in training load may increase injury risk, but research does not support a single percentage that is appropriate for every runner. Progression should be individualised according to your recent training history, current capacity, recovery and how you respond. It's also worth avoiding a single run that is substantially longer or harder than anything you've done recently, as large observational data suggest single-session spikes matter, not just weekly totals.
Does a previous injury increase my risk of another one?
Yes, previous injury is one of the more consistently reported risk factors. In a one-year prospective study of recreational runners, those with a previous running-related injury were approximately twice as likely to sustain another. That makes a deliberate, progressive return to running after injury particularly important.
Should runners do strength training, and how often?
Strength and load capacity are important components of running resilience, and strength training is particularly useful where a runner has a specific strength or load-tolerance deficit. Regular strength training, commonly 2 sessions per week, can be incorporated alongside running, although there is no evidence that exactly two sessions is an injury-prevention threshold. Strength training may also improve running economy, meaning less energy is required to maintain a given submaximal running speed. It's best introduced gradually, rather than in the same week as a big jump in running.
Should I change my cadence to 180 steps per minute or switch to a forefoot strike?
Not as a general rule. The current evidence doesn't support a universal "ideal" running technique. Changing step rate produces consistent biomechanical changes, but the evidence is currently insufficient to determine its longer-term effects on injury and performance. Foot-strike changes tend to shift load between the knee and the ankle and Achilles rather than simply reducing it. Technique changes can be useful for selected runners as part of a targeted plan, but they shouldn't be applied to everyone.
Can I keep running through pain?
Some discomfort after a hard session is normal. Don't wait until pain becomes severe before modifying training. Persistent, worsening or progressively earlier pain during a run is a useful signal to reassess your current training load. Pain that is present at rest or at night, very localised tenderness over a bone, or pain that makes you limp should be assessed promptly rather than run through, as these can indicate a bone stress injury.
How should I return to running after an injury?
Gradually, and guided by how your body responds rather than by a fixed timeline. A good return usually involves rebuilding strength and capacity alongside a stepwise reintroduction of running, starting with shorter, easier runs and progressing distance, frequency and then intensity as symptoms allow. Because previous injury is associated with a higher risk of future injury, it pays to address the capacity lost during time off rather than simply resuming your old training.
When should I see a physiotherapist about a running injury?
It's worth getting assessed if pain persists beyond a week or two despite reducing your running, if it is getting worse or appearing earlier in your runs, if it alters how you run, or if you have any of the warning signs above. It's also worth seeing a physiotherapist if you keep getting injured, are returning after a significant injury, or are about to start a big training block and want a plan built around your own history and capacity. Get in touch with us today to discuss your running injury or build a plan to reduce your risk.
For a fuller explanation of the load, capacity and recovery model behind these answers, read How to Prevent Running Injuries: Evidence-Based Strategies for Runners.
References
- Kakouris N, Yener N, Fong DTP. A systematic review of running-related musculoskeletal injuries in runners. J Sport Health Sci. 2021;10(5):513-522. doi:10.1016/j.jshs.2021.04.001.
- Fredette A, Roy JS, Perreault K, Dupuis F, Napier C, Esculier JF. The association between running injuries and training parameters: a systematic review. J Athl Train. 2022;57(7):650-671. doi:10.4085/1062-6050-0195.21.
- Frandsen JSB, Hulme A, Parner ET, et al. How much running is too much? Identifying high-risk running sessions in a 5200-person cohort study. Br J Sports Med. 2025;59(17):1203-1210. doi:10.1136/bjsports-2024-109380.
- Desai P, Jungmalm J, Börjesson M, Karlsson J, Grau S. Recreational runners with a history of injury are twice as likely to sustain a running-related injury as runners with no history of injury: a 1-year prospective cohort study. J Orthop Sports Phys Ther. 2021;51(3):144-150. doi:10.2519/jospt.2021.9673.
- Llanos-Lagos C, Ramirez-Campillo R, Moran J, Sáez de Villarreal E. Effect of strength training programs in middle- and long-distance runners' economy at different running speeds: a systematic review with meta-analysis. Sports Med. 2024;54(4):895-932. doi:10.1007/s40279-023-01978-y.
- Anderson LM, Martin JF, Barton CJ, Bonanno DR. What is the effect of changing running step rate on injury, performance and biomechanics? A systematic review and meta-analysis. Sports Med Open. 2022;8(1):112. doi:10.1186/s40798-022-00504-0.
- Anderson LM, Bonanno DR, Hart HF, Barton CJ. What are the benefits and risks associated with changing foot strike pattern during running? A systematic review and meta-analysis of injury, running economy, and biomechanics. Sports Med. 2020;50(5):885-917. doi:10.1007/s40279-019-01238-y.