Sport
Running is a long series of one-leg landings, each sending up to about 3 times your body weight through the leg, so the knees, Achilles, shins and feet take the strain. Injuries are common: new runners had about 18 running injuries per 1,000 hours of running and recreational runners about 8. A previous injury is the strongest known risk, and single runs much longer than your recent longest go with more injuries.
This page covers what running asks of your body, the common injuries and what the trials say prevents them, which is less than most advice suggests, how strength training and hops make running more economical, a warm-up, and two new workouts to follow alongside our 12-week strength training plan for runners. Each move has a 3D demo.
Across 13 studies, new runners had 17.8 running injuries per 1,000 hours of running and recreational runners 7.7. In studies that followed runners forward, about 4 in 10 were injured during follow-up. A previous injury is the strongest known risk factor.
Across many sports, strength training cut injuries to about a third. In runners it hasn't been shown: in 9 trials of endurance runners, exercise programmes didn't clearly reduce injuries, though the few supervised ones did better, and a home strength programme made no difference in 720 first-time marathon runners.
Foot and ankle strengthening, balance work with heel raises and side hops done at least twice a week, and neuromuscular training for shin splints all had positive results in trials. Doing them regularly seems to matter most.
In 5,205 runners, a single run more than 10% longer than the longest of the past 30 days went with more injuries, while week-to-week increases didn't (an association). A training plan built on the 10% rule didn't prevent injuries in 532 new runners.
Heavy strength training, alone or with jumps, usually makes running 2 to 8% more economical without changing your body weight or your VO2 max (the most oxygen your body can use). Two sessions a week, more than 3 hours after hard running and at least a day before the next hard run.
Stretching didn't reduce running injuries in pooled trials, and choosing shoes by foot type made no difference in over 7,000 military recruits. Choose a shoe that feels comfortable.
Three things largely set distance-running performance: your VO2 max, your running economy (the energy cost of a given pace) and the share of your VO2 max you can keep up. Middle distances of 800 to 3,000 m add a large anaerobic share. Among runners of similar ability, VO2 max differs little while economy varies a lot, which is why strength and jump training, which improve economy, matter.
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In 12 men, the peak force from the ground on each landing rose from about 2.0 to 2.9 times body weight as running speed rose from 1.5 to 6 m/s, roughly 11 minutes per km to under 3 (our arithmetic). Up to about 7 m/s, close to a sprint, the calf muscles (soleus and gastrocnemius) provided most of the support; at faster sprinting speeds, the hip muscles took over, swinging the legs faster.
The kneecap joint, the Achilles tendon and calf, the shin bone, the plantar fascia under the foot and the IT band (iliotibial band) down the outside of the thigh: the same places that top the injury lists below.
Your calves with a straight and a bent knee, your quads and glutes one leg at a time, your hips and trunk, and the springiness of your ankles with small hops. That is what our strength training plan for runners does.
Studies count injuries in two ways that can't be compared: injuries per 1,000 hours of running, and the share of runners injured during a study. Their definitions of an injury varied too.
By body region, the knee (28% of injuries), the ankle and foot (26%) and the lower leg (16%) take most. The knee was hurt more often in women (40% against 31%), and the lower leg and foot more often in men. By diagnosis:
Runner's knee, Achilles tendinopathy, shin splints, plantar fasciitis, IT band syndrome and sprained ankle each have a pain guide with a staged exercise plan, as do calf pain, hamstring strain and outer hip pain (hip bursitis). They're linked at the end of this page.
Bone stress injuries were 20 of the 52 major overuse injuries in the first-time marathon runners. Health New Zealand describes a stress fracture as a tender spot about the size of a fingertip on a bone, hurting more with each step and later at rest. It takes about 6 to 8 weeks to heal, so stop running as soon as it hurts. Our shin splints guide explains how to tell the two apart.
A previous running injury is the strongest known risk factor in long-distance runners (moderate-quality evidence), and a previous injury from another activity in short-distance runners (high quality). In short-distance runners, older age, being male, having no running experience, a higher body mass index (BMI) and running less all went with more injuries (moderate quality): a reason to build up gradually, never a reason not to run. Feet that roll in (pronate) weren't a risk in new runners wearing neutral shoes.
Across 31 studies, no specific training error could be shown to cause running injuries. The load findings that do exist are under "Building up your running" below.
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Nothing has been shown to prevent running injuries in general. The programmes with positive results in trials are worth trying, and each is set out as it was trialled.
Across 25 trials in many sports, strength training cut injuries to about a third and balance training to about half, and more strength training went with fewer injuries. Runners are the exception so far: in 9 trials of 1,904 endurance runners, exercise programmes didn't clearly reduce the risk or the rate of injury (moderate- to high-certainty evidence), and 7 of the 9 trials were at high risk of bias. The review's authors found insufficient evidence to recommend exercise-based prevention for runners.
In the 3 supervised trials, injuries were roughly halved, but that was an analysis the authors added afterwards (post hoc), so it's a lead rather than a finding. Supervised groups also kept their programmes up far better: 88% or more, against 47 to 72% in most unsupervised trials. Doing the exercises regularly, ideally with a coach, physiotherapist, club or friend, seems to matter (our reading).
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118 recreational long-distance runners in Brazil did 12 foot and ankle exercises (foot massage, foot tapping, heel raises, seated ankle turns in and out, band work for the foot and toes, gripping a ball or pen, toe squeezes, spreading and closing the toes, the short foot, arch raises and toe grasping) for 20 to 30 minutes, 4 times a week. They started at 1 or 2 sets of 10 to 30 reps and progressed to 3 to 6 sets, longer holds, and from sitting to standing to one leg. It was supervised once a week for 8 weeks, with online sessions, then supported remotely for a year; the control group stretched 3 times a week.
Runners who only stretched were about 2.4 times as likely to be injured over 12 months. Adherence fell from 90% in the first 8 weeks to 49% by weeks 32 to 40. It's one small trial, and the figures in its summary don't agree with each other (the confidence interval and the P value), so treat the size of the effect with caution. Our injury prevention routine for runners uses these exercises.
62 elite orienteers did four exercises 4 times a week for 14 weeks, unsupervised, from pictures and a spoken explanation: standing on one leg with your eyes closed on a soft surface (2 minutes a leg), a balance exercise called the runner's pose (3 × 10 a leg), one-leg heel raises (3 × 15 a leg) and one-leg side hops (2 × 30 a leg), each made harder every fortnight.
Across everyone it made no clear difference. In those who did it at least twice a week, the odds of a substantial injury were about a quarter of the control group's. That comparison includes only the people who kept it up (a per-protocol analysis), which is weaker evidence, and the trial was in elite athletes.
Across 4 studies of 3,887 people, neuromuscular training (strength, balance, landing and agility work) prevented shin splints (high-certainty evidence). In a small trial in 22 young female track-and-field athletes, 30 minutes of jumps, landings, running, strength, agility, balance and core work 3 times a week for 6 preseason weeks went with 6.6 injuries per 1,000 hours, against 17.9 in the comparison group, and every session was attended. It included planks, bridges, squats, hops, Romanian deadlifts, hip thrusts, lunges and Nordic curls, mostly 2 × 20 reps or 20-second holds, with agility runs of 4 × 30 m.
720 first-time New York City Marathon runners (69% women, average age 36) were asked to follow a 10-minute video programme for the core, hips and thighs 3 times a week for the 12 weeks before the race, with beginner and advanced versions: squats or jump squats (3 × 20), a plank (up to 60 seconds), lunges or jump lunges, a side plank or leg raises, and single-leg toe touches (2 × 10 a side).
On average they did it twice a week, and injuries that stopped them finishing were no less common: 7.1% against 7.3% in the comparison group. Within the programme group, those who managed 2 or more sessions a week had slightly more major injuries than those who did fewer (9.1% against 8.0%).
In 6 trials of 5,130 people, mostly military recruits, stretching didn't reduce running soft-tissue injuries, and across sports it made no difference. In 421 male recreational runners, 16 weeks of warm-up, cool-down and stretching education didn't reduce injuries either: 5.5 per 1,000 hours of running in the programme group against 4.9 in the control group. Stretch if you enjoy it, not to prevent injury.
In 3 military trials of 7,203 people, prescribing shoes by foot posture made no difference to injuries (moderate-certainty evidence). In 927 new runners followed for a year, feet that rolled in weren't injured more often in neutral shoes.
Cushioned against minimalist, motion control against neutral, and soft against hard midsoles: no clear differences, on low or very low certainty evidence. One trial in 848 recreational runners found harder shoes went with more injuries in lighter runners but not in heavier ones; pooled with a second trial, the difference wasn't clear. Choose a shoe that feels comfortable (our suggestion).
In pooled trials of varied quality, foot orthoses went with about 28% fewer injuries overall and about 40% fewer stress fractures, though not fewer soft-tissue injuries, while shock-absorbing insoles made no difference. For shin splints, insoles for feet that roll in were reported to help, though the result only just reached significance. Ask a podiatrist or physiotherapist rather than buying insoles to prevent injury (our suggestion).
In a review of 24 studies of 469 runners with at least 6 months' running behind them, strength training improved running economy by 2 to 8% in most of the 20 studies that measured it, and time trials of 1.5 to 10 km tended to improve. VO2 max, blood lactate and body composition didn't change, and body mass didn't change in 18 of the trials.
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In pooled trials of moderately to highly trained runners, heavy loads (80% of your one-rep max or more) improved economy by a small amount, and heavy lifting combined with jumps by a moderate amount. Jumps alone helped only at easy paces, 12 km/h or slower, and lighter or holding (isometric) work didn't help. For race performance, combined training had a large effect and heavy loads a moderate one, while jumps alone weren't significant. Heavy training beat jump training for economy, with loads of 90% or more and programmes of 10 to 14 weeks doing best.
In 5 studies of 93 highly trained runners (VO2 max over 60), strength training improved economy by a large amount. Most programmes used loads of 40 to 70% of the one-rep max with up to 200 jumps and 5 to 10 sprints, 2 or 3 times a week for 8 to 12 weeks.
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Small trials, mostly in trained runners:
Two or three sessions a week. Lift more than 3 hours after high-intensity running, and leave at least 24 hours between a strength session and your next hard run. Programmes of 10 to 14 weeks did better than shorter ones. Trials ran both out of season and during competition, so there's no settled best time of year. Our 12-week plan uses two sessions a week, then one in race season.
Our zone 2 and high-intensity interval training (HIIT) guides and the running pace and VO2 max calculators cover the running itself. No trial shows that mobility work makes you faster; before a run, moving stretches suit better than long holds, and holds of under a minute per muscle are fine if you like them (our warm-up guide).
In 5,205 adult runners (average age 46, 22% women) followed for up to 18 months, compared with runs no more than 10% longer than the longest of the past 30 days, runs 10 to 30% longer went with a 64% higher injury rate, runs 30 to 100% longer with a 52% higher rate, and runs more than twice as long with more than double the rate. Week-to-week changes in total distance weren't linked with injury. It's one observational study with self-reported injuries, so this is an association, and the authors call for trials to test it.
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A 13-week plan built on the 10% rule didn't prevent injuries in 532 new runners preparing for a 6.7 km race: 20.8% were injured, against 20.3% on a standard 8-week plan. In 874 new runners, raising weekly distance by more than 30% over 2 weeks wasn't linked with more injuries overall; a subset of distance-related injuries trended higher, but the result was uncertain and the study exploratory. Progressing by volume or by intensity made no clear difference in 447 recreational runners, and across 31 studies no specific training error could be pinned down.
New runners get injured more than twice as often per hour of running as recreational runners, so start gently. The UK National Health Service (NHS) Couch to 5K plan starts with 1-minute runs and 90-second walks, 3 times a week, and builds to running 5 km over 9 weeks or longer. See a GP first if you're worried about your health.
Build up gradually, without a fixed weekly rule. Keep any single run within about 10% of your longest in the past month (an association, not a tested rule), lengthen your long run gradually, and ease off when something hurts rather than pushing through (our suggestion).
In 45 recreational runners, taking 5% more steps a minute at the same speed reduced the energy absorbed at the knee, and 10% more reduced it at the hip as well. It's a lab finding about loading, not injuries.
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320 new runners at a Hong Kong club did 2 weeks of treadmill running with real-time feedback to soften their landings, or the same treadmill time without feedback. Over 12 months, 16% of the retrained runners were injured, against 38%. Across 19 trials, gait retraining raised step rate and lowered the loading rate, how quickly force builds up on landing (moderate certainty), without changing running economy or performance, but too few trials measured pain or injury.
In 69 runners with runner's knee, education on managing symptoms and training load did as well on its own as with added exercise or gait retraining, though the retraining did raise step rate by 7% and cut the loading rate by 25%. A review found short-term pain and function gains from 5 to 10% more steps a minute and soft-landing cues, and in 30 runners with runner's knee, 2 weeks of retraining, either landing more softly or taking 7.5 to 10% more steps, eased running pain at 6 months against no retraining. A 2019 US physiotherapy guideline says clinicians may use gait retraining, and gives hip and knee exercise its strongest recommendation. Our runner's knee guide has the full plan.
No study that followed runners forward links foot strike with injury. Switching to a forefoot strike made running less economical at first and moves load to the ankle and calf, so it isn't recommended if you're not injured.
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Built on the site's warm-up guide and our runner's warm-up workout (editorial). Warm-ups haven't been shown to prevent running injuries; this one gets you ready to run well. Before an easy run, the first two steps are enough.
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The movement on the figure: Skipping
Calf raises with a straight and a bent knee, single-leg strength, a heavy squat, hip and trunk work, foot and ankle work, and hops. Each has a 3D demo.
3D demoSingle-leg calf raise from a stepIntermediate · A step + A wall
3D demoSeated bent-knee calf raise (soleus raise)Beginner · A bench or box
3D demoRear-foot-elevated split squat (Bulgarian split squat)Intermediate · A bench or box
3D demoStep-upBeginner · A step
3D demoBarbell back squatAdvanced · A barbell
3D demoSingle-leg Romanian deadliftAdvanced · A dumbbell
3D demoSide plank with leg liftAdvanced · No equipment
3D demoSingle-leg standBeginner · A wall
3D demoHeel raise with a towel under the toesIntermediate · A step + Other / check instructions
3D demoBand ankle eversionBeginner · A band + A bench or box
3D demoPogo hopsIntermediate · No equipment
3D demoSingle-leg hop and stickIntermediate · No equipment
3D demoSingle-leg lateral hopAdvanced · Other / check instructions
3D demoAlternate-leg boundingAdvanced · No equipmentThe two new routines come first: foot, calf, balance and hop work from the runner trials that did best, and a 10-week hop progression. The strength workouts are the two sessions of our runners' plan, the warm-up and stretches go before and after your runs, and the foot and ankle routine is a gentler start.
Foot, calf, balance and hop exercises taken from the running trials with positive results, in a 25-minute home routine for 3 or 4 days a week.
25 minBeginner11 movesOther / check instructions, A bench or boxA 20-minute hop and bound session for runners: ankle bounces to pogo hops, one-leg hops and bounding, building foot contacts slowly over 10 weeks.
20 minIntermediate8 movesCardio machineA 45-minute gym strength workout for runners: hops, heavy squats, Bulgarian split squats, calf raises and side planks, with sets, reps and rest.
45 minIntermediate13 movesA wall, A bench or boxA 40-minute strength workout for runners at home: hops, Bulgarian split squats, single-leg deadlifts, step-ups, calf raises and side planks.
40 minIntermediate15 movesA wall, A bench or boxAn 8-minute dynamic warm-up for runners: ankle and hip mobility, lunges, skips and pogo hops.
8 minIntermediate8 movesA wallSeven stretches for after a run: calves, soleus, quads, hip flexors, hamstrings and glutes.
10 minBeginner7 movesA wallA 15-minute barefoot routine for stronger toes, arches, calves and ankles, finishing with balance. You need only a towel, a wall and a resistance band.
15 minBeginner11 movesA wall, Other / check instructionsTwo strength sessions a week for 12 weeks, fitted around your runs, with heavy lifts, single-leg work, calf raises and hops capped at about 85 foot contacts a session.
Check with your GP or a qualified exercise professional before you take up running or step up your training if you answer yes to any question on the Physical Activity Readiness Questionnaire (PAR-Q+): a heart condition or high blood pressure, chest pain, dizziness or fainting, another long-term condition or its medicines, a bone or joint problem, or being told to exercise only under medical supervision.
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The PAR-Q+ asks you to check with a qualified exercise professional before vigorous or all-out exercise if you're over 45 and not used to it: think races, time trials and the 12-minute run test. Our VO2 max calculator's 1-mile walk test is a gentler option.
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The NHS says it's not recommended to start a new vigorous activity in pregnancy, such as running, and that if you've been running you may find brisk walking more comfortable instead. After giving birth, our postnatal guide covers when and how to return to running.
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These can be signs of low energy availability, which harms health and performance in women and men: the International Olympic Committee (IOC) calls it relative energy deficiency in sport (REDs). See a GP; our exercise guide for women has more.
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Stop running as soon as a bone hurts in one spot, and get it checked. A stress fracture takes about 6 to 8 weeks to heal.
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Recreational runners had less hip and knee osteoarthritis than people who didn't run. If you have knee osteoarthritis, our knee arthritis guide bans no exercise: cut back what flares your knee, often hills and downhill running, just enough to stay within its pain rule.
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Stop and call 999 for sudden chest pain or discomfort that doesn't go away (it can feel like squeezing, pressure or burning), pain that spreads to your arms, neck, jaw, stomach or back, or chest pain with sweating, feeling sick, light-headedness or breathlessness.
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Cardiac arrest during races is rare, about 0.54 per 100,000 runners in US races, more common in men and in marathons, and deaths have fallen; prompt CPR (cardiopulmonary resuscitation) went with survival. If someone collapses and isn't breathing normally, call 999, start CPR and send for a defibrillator.
Heat exhaustion (heavy sweating, pale clammy skin, tiredness, dizziness, a headache, feeling sick, cramps and thirst) should improve within 30 minutes of moving somewhere cooler, cooling the skin and drinking fluids. Call 999 for heatstroke, where the skin is hot and not sweating and may look red, or if someone is still unwell after 30 minutes of resting somewhere cool, being cooled and drinking.
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A sudden snap, or a feeling of being kicked in the back of the leg, then difficulty walking or standing on tiptoe: assume the Achilles tendon has ruptured, and go to A&E or a minor injuries unit. Our Achilles rupture guide covers what happens next.
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Pain in a fingertip-sized spot on a bone that gets worse with each step, and later hurts at rest or at night, can be a stress fracture: stop running and get it checked.
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Contact NHS 111 for severe shin pain or shin pain after an injury, and see a GP if it's getting worse or not improving. Contact 111 if your knee is very painful, you can't move it or put any weight on it, it's badly swollen or has changed shape, it locks or gives way, or it's hot and red and you have a high temperature.
Across 25 studies, recreational runners had less hip and knee osteoarthritis (3.5%) than people who didn't run (10.2%); competitive runners had more (13.3%). These are associations, and past injuries may explain some of the difference. Running is also linked with a 27% lower risk of death from any cause.
A 13-week plan built on it didn't reduce injuries in 532 new runners, and week-to-week increases weren't linked with injury in 5,205 runners, though single runs much longer than your recent longest were (an association).
Stretching didn't reduce running injuries in pooled trials, across sports, or as part of a warm-up and cool-down programme in runners.
Choosing shoes by foot posture made no difference in over 7,000 recruits (moderate-certainty evidence), and feet that rolled in weren't injured more often in neutral shoes.
Body mass didn't change in 18 trials, and running economy improved by 2 to 8%. Heavy half squats made running 5% more economical without weight gain.
It does across many sports, but in 9 runner trials it didn't overall, and in 720 first-time marathon runners a home programme made no difference. Do it to run better, and treat any injury benefit as a bonus.
No study that followed runners forward shows it. It costs economy at first and moves load to the Achilles and calf.
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Calf raises with a straight and a bent knee, single-leg work such as split squats and step-ups, a heavy squat or leg press, single-leg Romanian deadlifts, hip and trunk exercises, and small hops. Two sessions a week cover it, and our strength training plan for runners sets them out over 12 weeks.
Across many sports it cut injuries to about a third, but in runners it hasn't been shown: in 9 trials, exercise programmes didn't reduce injuries overall, though supervised ones did better. Do it because it makes you a more economical runner, and treat any injury benefit as a bonus.
It makes running more economical, usually by 2 to 8%, and time trials of 1.5 to 10 km tended to improve. Most trials were small and short, so expect modest gains.
Twice a week, for at least 10 weeks: programmes of 10 to 14 weeks did better than shorter ones. Our plan then drops to once a week in race season. Lift more than 3 hours after a hard run, and leave at least a day before the next hard run.
They help economy at easier paces and are part of the programmes with the biggest gains, but heavy strength training did more on its own. Start with about 40 small hops a session and build slowly, as our plyometrics for runners workout does.
Not for most people: recreational runners had less hip and knee osteoarthritis than people who didn't run (3.5% against 10.2%), while competitive runners had more (13.3%). These are associations, and past injuries may explain some of the difference.
A 13-week plan built on it didn't, in 532 new runners. In a large study, what mattered more was a single run more than 10% longer than your longest in the past month, so lengthen your long run gradually too.
No: choosing shoes by foot posture made no difference to injuries in over 7,000 recruits, and new runners whose feet roll in (pronate) weren't injured more in neutral shoes. Choose a shoe that feels comfortable.
A slightly higher step rate, 5 to 10% more steps a minute, eases knee loading, and gait retraining cut injuries in new runners in one trial. Switching to landing on your forefoot isn't recommended if you're not injured.
It won't prevent injuries. A few minutes of easy jogging and moving drills is a better warm-up, and short stretches are fine if you like them.
Exercise education for people who play sport, not a personal prescription or a diagnosis, and clinical review of these pages is pending. Check with a GP or physiotherapist before hard training if you have a heart condition, chest pain, dizziness or an injury that isn't settling, and stop for sharp or increasing pain. Health disclaimer.
