Tipping the scales against running related injuries

person running between grass fields

By Kevin Levi-Goerlich, PT, DPT, CSCS, USAT-II

Running related injuries. They are a common source of frustration for runners of all levels and abilities. Bring a few endurance athletes into a room and inevitably talk of injuries will come up. They are an unfortunate part of endurance sports and somewhere between 19.4 and 79.3% of runners will be injured each year1,2. The severity of these injuries varies greatly, but issues at the knee and ankle are commonplace.

So why do so many runners get injured each year? This is a complicated question and one that no one can answer definitively. However, when simplified, it comes down to the load placed upon the body and its ability to adapt and recover. Inappropriate load (too much volume or intensity) combined with inappropriate recovery and external stress can cross over the fine line from fitness to injury

How do these factors interact?


For the sake of this article, “load:” is analogous to training volume or mileage. The greater the load, the more mileage the athlete is completing. Proper load is crucial for the endurance athlete because of the mechanical properties of soft tissue. Insufficient load leaves the soft tissues of the body weak due to lack of stimulus for the body to adapt to. Excessive load can lead to soft tissue breakdown, increasing the risk for running related injuries. Appropriate load provides enough stimulus to drive the body to adapt, but stays below the threshold where soft tissue begins to break down.3


After loading appropriately, the body needs to recover for adaptation to occur and fitness to improve. Recovery encompasses everything from nutrition, to sleep, to maintenance exercises to keep you moving well and efficiently. Nutrition is a topic that alone could fill a library. I keep my recommendations simple for my athletes: Nothing is off limits, but moderation is your friend. Eat real food and stay away from highly processed food. Vegetables are good for you. Finally, make sure you are hydrated. For more specific recommendations, contact a Registered Dietician to develop a customized nutrition plan.

Sleep: sleep is hugely important, not only for athletic performance, but also general health and cognitive function.  During sleep, the body rebuilds itself. Lack of sleep places a strain on the body and makes it more susceptible to breakdown and decreased performance. A recent 2017 study found that a single night of partial sleep deprivation after a hard workout impairs cycling performance by 5%, while those who got a full night of sleep only experienced a 1% decrease.4

External Stress

“Stress is a killer” is an adage, but it is still correct. Not only can chronic stress cause a host of health issues, but it can also negatively impact your athletic performance. One study found that subjects reporting higher levels of stress showed less adaptation to an aerobic training program compared to those with lower levels of stress.5This study suggests that those with high levels of stress are not only at a higher risk of injury, but will also be slower despite training just as hard as other athletes.

So how can you reduce your risk for running related injuries?

  • Load your body appropriately: Make sure you follow an appropriate plan geared towards your athletic history. Increase volume and intensity gradually and listen to your body. Ensure your body is robust enough to handle to the loads placed upon it.
  • Improve your recovery: Eat properly and improve the quality of your sleep.
  • Reduce stress: reduce external stress and finding ways to cope can improve performance and quality of life.


  1. van Mechelen W. Running injuries; a review of epidemiological literature. Sport Med. 1992;14(5):320-335. doi:10.2165/00007256-199214050-00004.
  2. Van Gent RN, Siem D, Van Middeloop M, Van Os AG, Bierma-Zeinstra SMA, Koes BW. Incidence and determinants of lower extremity running injuries in long distance runners: A systematic review. Sport en Geneeskd. 2007;40(4):16-29. doi:10.1136/bjsm.2006.033548.
  3. Porterfield JA, DeRosa C. Mechanical Low Back Pain: Perspectives in Functional Anatomy, 2e. 2nd ed. Saunders; 1998.
  4. Rae DE, Chin T, Dikgomo K, et al. One night of partial sleep deprivation impairs recovery from a single exercise training session. Eur J Appl Physiol. 2017;117(4):699-712. doi:10.1007/s00421-017-3565-5.
  5. Ruuska PS, Hautala AJ, Kiviniemi AM, Mäkikallio TH, Tulppo MP. Self-rated mental stress and exercise training response in healthy subjects. Front Physiol. 2012;3 MAR(June 2017). doi:10.3389/fphys.2012.00051.

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