PT Tip of the Month Archive


Running is a popular form of cardiovascular exercise. It is relatively inexpensive, requiring at most, a pair of decent running shoes. According to one research article, there has been a surge in the past 10-15 years in the number of people who are running marathons (26.2 miles!). Thus, it is not surprising that the yearly rate for running-related injuries is reported to be as high as 92.4%.

Risk factors and common running-related injuries

The causes of running-related injuries are multi-factorial, and are comprised of both intrinsic and extrinsic factors. Intrinsic factors include: biomechanical abnormalities (such as flat feet), history of prior injury, gender, and body mass index. There is conflicting evidence as to whether greater age can be a risk factor or protective factor in runners. There is also limited evidence indicating a positive correlation between height (males >1.70 m) and increased rate of running injuries. Extrinsic factors include: type of shoe wear, muscle flexibility, core strength, and training regimen (frequency, intensity, and duration). There is strong evidence to support that a greater training distance per week in male runners is a risk factor for lower extremity running injuries.

Research also indicates that the number of years someone has spent running decreases the likelihood of injury. More experienced runners typically are less prone to injury. Less experienced runners tend to ramp up their running too fast too soon, and are prone to injury especially when over 40 miles/week is exceeded. The most commonly reported region injured secondary to running is the anterior knee (typically known as patellofemoral pain syndrome). Other common injuries include: iliotibial band syndrome (ITBS), tibial stress syndrome (aka, shin splints), plantar fasciitis, Achilles tendinitis, and meniscal injuries.

Injury prevention

There are several studies examining running and injury prevention, with building support for strengthening and stretching exercises. A study done by JOSPT in 2009 found that females with decreased hip strength were more likely to develop anterior knee pain. Other factors that may be addressed in the reduction of injury include: running technique/style and gait cadence. A trained physical therapist will be able to help determine exactly which exercises and training will be most helpful.

What about barefoot running?

With the high incidence of running-related injuries, efforts have been made to decrease injury via minimalist shoe wear and barefoot running. Barefoot running has become increasingly popular over the past 2-3 years after the release of a book entitled, "Born to Run," by Christopher McDougall in 2009. Since then, numerous claims have been made stating that barefoot running decreases injury rate in runners. While there is research to indicate that the forefoot or mid-foot strike seen with barefoot running may affect injury rate by decreasing the GRF attenuated through the lower extremity, there is little evidence at this time to indicate that barefoot or minimalistic running can prevent injury. It is also important to keep in mind, that someone must train themselves to run barefoot, as it would be unsafe to jump right into barefoot running.

Role of physical therapy in running

If you are a seasoned marathoner or simply run for recreational purposes and are suffering from a running-related injury, please contact 617-232-PAIN (7246) for our Brookline office and 617-325-PAIN (7246) for our West Roxbury office to schedule an appointment. Your skilled physical therapist will perform a thorough evaluation to determine the source of your pain and prescribe appropriate exercises and treatment to help relieve your pain and return you to running as soon as possible.


  1. Buist I, Bredeweg SW, van Mechelen W, Lemmink KA, Pepping GJ, Diercks RL. No effect of a graded training program on the number of running-related injuries in novice runners: a randomized controlled trial. Am J Sports Med.2008;36:33-39.

  2. Daoud AI, Geissler GJ, Wang F, Saretsky J, Daoud YH, Lieberman DE. Foot strike and injury rates in endurance runners: a retrospective study. Med Sci Sports Exerc. DOI: 10.1249/MSS.0b013e3182465115.

  3. Fields KB, Sykes JC, Walker KM, Jackson JC. Prevention of running injuries. Curr Sports Med Rep. 2010;9:176-182.

  4. Sato K, Mokha M. Does core strength training influence running kinetics, lower-extremity stability, and 5000-m performance in runners? J Strength Cond Res. 2009;23:133-140.

  5. Souza R, Powers C.Differences in Hip Kinematics, Muscle Strength, and Muscle Activation Between Subjects With and Without Patellofemoral Pain. J Orthop Sports Phys Ther. 2009;39(1):12-19.

  6. Van Gent RN, Siem D, van Middelkoop M, van Os AG, Bierma-Zeinstra SMA, Koes BW. Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. Br J Sports Med. 2007;41:469-48.

  7. Van Mechelen W, Hlobil H, Kemper HCG, Voorn WJ, de Jongh HR. Prevention of running injuries by warm-up, cool-down, and stretching exercises. Am J Sports Med. 1993;21:711-719.

  8. Yeung SS, Yeung EW, Gillespie LD. Interventions for preventing lower limb soft-tissue running injuries. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD001256. DOI: 10.1002/14651858.CD001256.pub2.
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