Reducing Running Injury Risk

by | Sep 6, 2016

A bell curve indicating different options will work for different people with respect to injury.

A Story of Managing Load and Technique – One Size Does Not Fit All!

70% of running injuries are due to training errors, which are a combination of over/under loading, or technical error. That means that the best way to reduce our injury risk is to reduce our training error. So what are training errors, and how can we reduce them?

Manage Loading

When we talk about running load, the most simple thing to look at is distance relative to time. The more distance you run in a week, the more load you are placing on the body. The quicker your weekly load increases, the bigger the rate of change of loading that your body experiences. To control the progression within one week and over time in relation to a particular goal, we can consider several options:

  1. Use a free online running programs, and/or join a local organized running plan. As you might expect, this will work well for many runners, but no program can truly be ‘one-size-fits-all’. In this case it is helpful to think about a bell curve: most people fall in the middle, but there will be a few outliers. There will be some for whom the training schedule is too difficult, and if they stick with it they will risk injury and/or burnout. Others may find the regimen too easy, or the group pace or slow, and will become bored. Ironically, these athletes also risk injury – if they are training with a group that is running too slowly, they may alter their natural gait to stay with the group and wind up with overload injuries! A local organized group does offer some advantages over a free online program, as it will likely have leaders who can offer mentoring. Also, many of these programs will offer some kind of educational component which may promote good habits. However, the benefits of the group will be as good as its leader – remember that bad habits can be passed along as well as good ones!
  2. Running coach who will review your running history and goals, will construct a plan that will be monitored and adjusted each week. This is probably the better option for those ‘bell-curve outliers’. If you’re finding that an online program or organized running group is not comfortable for you, I’d encourage you to consider whether a trained running coach is a good option.
  3. Theoretically, one of the options above should work for you so that you will not over or underload to any great amount and will keep injury risk in check. However, I routinely see athletes who have followed these plans and have suffered injury. I like to encourage a couple of simple metrics to my patients to help monitor load and reduce injury risk. Click links to each as we have blogged about them previously.
    1. Acute Chronic Workload Ratio (ACWR)
    2. Pain monitoring

Manage Technique (Manage Loading)

Another way to reduce injury risk is by considering our running technique, as it can either increase or decrease load. This relates to weakness, inflexibility, and lack of control. If I have an athlete who has fallen within the sweet-spot of the ACWR and has still gotten injured, the odds are that their injury relates to over-loading due to technique. Technique advice is abundant – in books, online, from other runners, and coaches. I certainly do not discourage patients from considering any of these ideas, but it is wise to be cautious; everyone is unique and no one technique will work for everyone. A great example we previously considered is the running style of Priscah Jeptoo. She is a successful international athlete with what many would consider a very inefficient gait (see video below). Would it be worth changing? Perhaps not as she is at the top of her field and has not suffered from injury.


Some health professionals get frustrated when people search stuff online and come to an appointment with ideas. Personally, I am always excited when someone does this because it means they have an interest and in most cases want to engage. As long as people realize that there are good materials written by well-intentioned people (I try to do this!), junk science pieces written to sell products, and plainly poorly researched/reasoned pieces based on a current fad, they should be good! Here are a few of my running articles that might be of interest to you:

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When seeking advice, realize that some will only be based on personal experience, and worse some even ignore the evidence (or don’t know it exists). Remember that everyone is different and just because something worked for your friend or coach doesn’t mean it will work for you. This is the beauty of well-designed research: it makes attempts to control for these differences. For example, there are some who swear by barefoot or minimalist running and write various articles and books about why you should do the same. However, the studies come back showing no reduction in injury risk. It certainly may work for some proponents/authors, but for most there is no significant benefit. In-fact, current studies suggest we may be seeing an increase in metatarsal stress fractures from this! Again, I am happy that people want to learn and it is fine to seek advice from many different places, just use caution!

Doctor Google use caution

A further option for considering your technique and its impact on loading is to consider the services offered by a specialized PT using video running analysis. This is one of the services I offer at PhysioWorks. If you are concerned about training errors and risk of future injury you should consider this. If you are an athlete who has suffered injuries previously and have done the “usual” rehab you should also consider this. It has been exciting to see how this service has helped local athletes to overcome chronic injuries (such as returning to marathon running after five years) or see significant performance improvements and set new personal records! Just as I constantly advocate for caution above, I use caution in making changes to a clients’ technique. However, I have worked with hundreds of runners and have read hundreds of running biomechanics and injury related research articles, all of which helps me to better prescribe changes. Even then, I continue to learn from each athlete, and I also adapt my practice as the research changes. Being the only clinic offering this service, PhysioWorks has become the preferred provider for many local runners because we specialize in their problems. There are only two or three clinics in the state that have set themselves up to focus on athletes in this way versus seeing almost all conditions.

As you consider reducing training error through controlling training load and technique I would encourage planning and caution. Consider the bell curve and where you fall, consider others’ experiences, and consider the research. Most people who have had a long and successful running lifetime have not done so by chance!

Learn from mistakes and avoid running injury

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Over the years I've received treatment from 8 different centers in the Huntsville/Madison area for running-related injuries. While other centers were helpful in pain management, PhysioWorks was BY FAR the most helpful in finding the real cause of the problem. They laid out a plan for me to get right. Pretty great stuff.

Brandon Mader Avatar Brandon Mader
2/06/2019

After limping my way through a 100km trail race and finally giving in to my bilateral Achilles tendinopathy, I went to Andrew for help. His well researched approach to therapy helped me progress from barely walking to increasing my running mileage so that I could make it to the start line of my goal 100mi race a little over 3 months later. Andrew's passion for sports therapy is obvious. His methods are based on the latest research in Orthopedics. You won't find a better PT in the area.

Luke Hough Avatar Luke Hough
1/30/2019

Andrew is an extremely valuable asset to our community thanks to his passion for not only his patients, but for staying on top of current research and techniques. I have seen him numerous times and the care I have received is second to none. Andrew is also actively involved in our local athletic community offering injury prevention advice and training tips, and you can often see him volunteering his time at athletic events. Highly recommend.

Teresa Fleischmann Avatar Teresa Fleischmann
2/05/2018