The Monday Shakeout: Types of Running-Related Injuries
By Matthew Klein
This week we define what an injury is, in the context of running, risk factors for developing one and the basics of what to do to reduce the risk of them.
Running has an incredibly high injury rate. Anywhere from 40-70% of runners experience a running-related injury each year, with the number varying depending on which study you look at. The research on running injuries has been highly variable, with few conclusions, especially when looking at biomechanical factors. When looking at training and self-care habits, more information arises. However, like most things in life, running injuries are complex, multi-factorial occurrences. A running-related injury is defined as a period when the capacity of the body or a specific tissue is exceeded beyond the ability to recover in that moment. This can be an acute capacity overload, where a tissue experiences a force that exceeds its mechanical properties, or a chronic capacity overload, where training/load exceeds the body's ability to recover and adapt to it.
An acute injury is easy to understand and also less common in running. Spraining your ankle when missing a step, sprinting and pulling a muscle when not warmed up, running into something or falling hard and damaging something are all examples of mechanical injuries. In that moment, the body experienced a force or forces that were beyond its capacity to handle, causing a contusion, sprain, strain, rupture, etc. In distance running, these are not common but do occur. Even when an athlete feels like something comes out of nowhere, most injuries are chronic and have been going on without any symptoms present. There is plenty of evidence to suggest many chronic pathologies, like tendinopathies, may not be painful when they start or are present (Lieberthal et al., 2019).
Chronic injuries are ones that involve an ongoing pathology or irritation of a tissue. These occur when the capacity of the tissue is continually overloaded beyond its capacity to adapt appropriately. While the short-term impacts may not be noticeable, long term, this can lead to an acute on chronic overload of the tissue and development of chronic pathologies to compensate. This involves more chronic overload combined with chronically inadequate recovery. Given that these are the most common types of running injuries, understanding the etiology is important. The inability to adequately recover and adapt to the loads imposed on the body are influenced by inadequate sleep, inadequate nutrition, overtraining (exceeding intensity, frequency or duration capacity). Overtraining can come from a variety of things, but can be simplified into exceeding the body's capacity through too much volume, frequency, intensity, or a combination of these factors in training. There is limited research on this, with the exception of volume (Frandsen et al., 2025). Any clinician, coach or experienced/self-reflective runner will confirm this.
Running injuries have many different influences. Although acute injuries like ankle sprains may have an obvious cause, the more common, chronic pathologies are almost always multi-factorial, with all influences leading to inadequate adaptation/recovery and the ability to keep up with imposed training demands. While the research struggles to pin down a single factor, runners and those who work with runners should take a large scale view of the many influencers. Making sure athletes get enough sleep, good nutrition (ensuring both quality and quantity to support training and normal body function), balance training and recovery/adaptation, intelligently progressing training, building additional resilience (through strength training) and a shoe rotation can go a long way towards reducing injury risk. However, given the multi-factorial nature, it is impossible to completely eliminate the risk. However, doing everything you can to stay healthy and reduce that risk will only benefit you in the long run as consistent adaptation without interruption is one of the best ways to improve.
References
Frandsen, J. S. B., Hulme, A., Parner, E. T., Møller, M., Lindman, I., Abrahamson, J., ... & Nielsen, R. O. (2025). How much running is too much? Identifying high-risk running sessions in a 5200-person cohort study. British Journal of Sports Medicine.
Lieberthal, K., Paterson, K. L., Cook, J., Kiss, Z., Girdwood, M., & Bradshaw, E. J. (2019). Prevalence and factors associated with asymptomatic Achilles tendon pathology in male distance runners. Physical Therapy in Sport, 39, 64-68.
Saragiotto, B. T., Yamato, T. P., Hespanhol Junior, L. C., Rainbow, M. J., Davis, I. S., & Lopes, A. D. (2014). What are the main risk factors for running-related injuries?. Sports Medicine, 44(8), 1153-1163.
PAST MONDAY SHAKEOUTS
How Do I Choose a Running Shoe?
How Do I Know if I Can Use X Shoe for a Marathon?
Downhill Race Shoes?
Can I Run in Neutral Shoes?
Super Shoes and Running Economy?
Super Shoes are Placebos?
Transitioning Out of Stability Shoes?
Who Does Best in What Types of Shoes?
Matt's Favorite Shoes of 2024
Andrea's Favorite Shoes of 2024
David's Favorite Shoes of 2024
Nathan's Favorite Shoes of 2024
Value of a Simple Daily Trainer
SHOP | SUPPORT DOR
*Using the link to purchase helps support Doctors of Running. Thanks so much!
Ultraspire Fitted Race Belt: The best way to carry your phone and goods on the run. No bounce and various sizes for waist. (Also recommend the Naked belt)
Saysky Running Gear: We were really taken aback by this Scandinavian company's ultra-thin, durable performance clothing
Skratch Recovery, Coffee Flavor: Mental and physical boost post run. Coffee flavor is excellent and goes great straight into a fresh brewed cup
goodr Sunglases: Run in style with goodr's super fun sunglasses.
Feetures Socks: Massively grippy socks that will make you feel more one with the shoe
Amphipod Hydraform Handheld Water Bottle: Perfect for long runs when you need hydration in the summer
Trigger Point Foam Roller: Help get those knots out post-run and feel better for tomorrow
Theragun Massager: This small version is great on the go for working tired legs
Ciele Hat: Our team's favorite running hat of choice!
Fractel Hats: Our team's wider fitting running hat of choice!
FOLLOW DOCTORS OF RUNNING ON SOCIAL MEDIA
Facebook: Doctors of Running
Youtube Channel: Doctors of Running
Instagram: @doctorsofrunning
LinkedIn: Doctors of Running
Strava: Doctors of Running
Podcast: Virtual Roundtable
Pinterest: Doctors of Running
PODCAST
Check out the Doctors of Running Podcast to find more reviews, interviews, and running features from the team.
Visit our Podcast Page
Find us on Apple
Find us on Spotify
Contact us at doctorsofrunning@gmail.com
NEXT: How Do I Choose a Running Shoe?
