Dr Krish Rawal, Infinity Group Medical Director, evaluates the most common injuries when running, and how to best prevent it.

I was reading an article last week about injuries in runners and how even minor injuries can often lead to people giving up running. As running seems to be one of the most popular and low maintenance forms of exercise throughout the world, I thought an article would be worth writing.

As an exercise, it is fair to say that running is great for health and mental wellbeing. In my running days I used to find the pounding of my feet on the pavement was like anger management after a particular difficult or frustrating day! Running does offer substantial cardiovascular, metabolic, and psychological benefits. However, running-related injuries remain common, particularly among recreational and endurance runners. Research suggests that injury rates range from approximately 2.5 to 33 injuries per 1,000 hours of running, depending on the population studied and the definition of injury used. Not surprisingly the majority of these injuries affect the lower limbs, with common conditions including patellofemoral pain syndrome (“runner’s knee”), iliotibial band syndrome, Achilles tendinitis, plantar fasciitis (oh I know that pain!), and even tibial stress injuries. Most importantly, around 80% of running injuries are considered overuse injuries, resulting from repetitive loading that exceeds the body’s capacity for adaptation.  

Current evidence indicates that running injuries are multifactorial rather than being caused by a single biomechanical fault. An umbrella review published in 2024 found that training characteristics, health and lifestyle factors, and certain body type/morphological factors appear to have the strongest associations with injury risk. While biomechanical variables such as foot strike pattern and running gait have received considerable attention, the evidence linking specific biomechanical patterns to injury remains inconsistent. This suggests that clinicians, trainers and coaches should avoid attributing injuries solely to gait abnormalities and instead consider the broader context of training load, recovery, previous injury history, and individual tissue tolerance.  

One of the most important and increasingly supported risk factors is a sudden increase in training volume or intensity. Recent large-scale research involving more than 5,000 runners demonstrated that injury risk rises significantly when a runner exceeds their recent training history, particularly when a single running session is substantially longer than the longest run completed in the previous month. Even relatively modest spikes in distance were associated with elevated injury rates. These findings challenge the traditional belief that injuries develop only through gradual accumulation of workload and instead suggest that a single poorly judged training session may trigger tissue overload and subsequent injury.  

From a prevention perspective, the strongest evidence supports gradual progression of training load, adequate recovery, and individualised training plans. Runners should increase mileage gently and conservatively, avoid abrupt changes in intensity, and allow sufficient time for musculoskeletal adaptation. Rest days are just as important as running days. Strength and conditioning programmes may provide benefits for performance and movement capacity, although evidence for direct injury prevention remains mixed. The best seems to be a comprehensive approach that includes load management, sleep, nutrition, recovery, and monitoring of early symptoms. Prompt attention to persistent pain can prevent minor tissue irritation from progressing to more serious conditions such as tendon injury or stress fractures, helping runners maintain long-term participation in the sport.

So my medical advice – put on your trainers on and take a rest day!!