Factors contributing to running injuries

  • Candice Hendricks
  • Julie Phillips


Design: A narrative review

Purpose: The purpose of this paper is to highlight some common extrinsic and intrinsic risk factors associated with running injuries that should be considered in themanagement and prevention of running injuries.

Background: Running is one the most common sports activity that is practiced throughout the world. This increase in popularity in running could gradually increase the incidence rate of injury thus contributing to overuse injuries. Research in the field of running injuries is vast and has been conducted over more than 40 years. It is however difficult to distinguish the exact cause of running injuries as the aetiologies aremultifactoral and diverse. There are various factors (extrinsic or intrinsic) that could be associated to running injuries. Extrinsic factors such as training methods, training surfaces or incorrect running shoes have been identified as some common risk factors. Some intrinsic factors such as muscle strength, flexibility and malalignment of the leg have also been identified which could further explain the aetiology of running injuries. Many researchers have identified various contributing factors to running injuries however there is a lack of conclusive evidence on the identified factors. Thus, the acquiring knowledge and scientific evidence about the risk factors related to common running injuries are important as it could assist in the treatment and prevention of long-term injuries.

Conclusion: To reduce the high incidence rates of running injuries and to promote independence in injury management, a rehabilitation programme consisting of a training programme which gradually increases mileage, frequency, resting periods, appropriate running shoes for different foot types; heel lifts to adjust malalignments of the leg; flexibility and strengthening programmes of the lower limb and the selection of appropriate training surfaces and terrain is needed


Academy of Orthopaedics Surgeons (2003).Running the risk of

injury: orthopaedic surgeons survey says more prevention

and care needed. The Journal of Musculoskeletal Medicine, p523(2).

Buist, I., Bredeweg, S.W., Van Mechelen W. (2008). No effect of a Graded Training Program on the Number of Running-Related Injuries in Novice Runners; A Randomized Control Trial. The American Journal of Sports Medicine, 36.1: p33(7).

Chorley, J.N., Cianca, J.C., Divine, J.G., Hew, T.D. (2002) Baseline injury risk factors for runners starting a marathon training program. Clinical Journal of Sports Medicine, 2;18-23.

Derrick, T.R., Caldwell, G.E., Hamill, J. (2000) Modelling the stiffness characteristics of the human body while running with various stride lengths. Journal of Applied Biomechanics, 16:


Ferber, R., McClay-Davis, I., Hamill, J.(2002). Kinetic variables in subjects with previous lower extremity stress fractures. Medicine and Science in Sports and Exercise, 34:S5.

Ferber, R., Noehren, B., Hamill, J., Davis, I.M.(2010). Competitive runners with a history of iliotibial band syndrome demonstrate atypical hip and knee kinematics. Journal of Orthopaedic and S p o r t s P h y s i c a l T h e r a p y, 40: 5 2 - 5 8. http://dx.doi.org/10.2519/jospt.2010.3028

Fields, K.B., Delaney, M, Hinkle, J.S. (1990). A Prospective Study of Type –A Behaviour and Running Injuries. Journal of Family Practice, 30: 425-429.

Fredericson, M.(1996). Common injuries in runners: diagnosis, rehabilitation, prevention. Sports Medicine, 21(1): 49-72.

Fredericson, M., Cookingham, C.L., Chaudhan, A.M., Dowdell, B.C., Oestreicher, N., Sahhrmann, S.A. (2000). Hip abductor weakness in distance runners with iliotibial band syndrome. Clinical Journal of Sport Medicine, 10: 169-175.

Hreljac, A., Marshall, R., Hume, P. (2000). Evaluation of lower extremity overuse injury potential in runners. Medicine and Science in Sports and Exercise, 32: 1635-1641.

Hreljac, A., Ferber, R.(2006). A biomechanical perspective of predicting injury risk in running. International Sports Medicine Journal, Vol.7, No.2:98-108.

Horton, M., Hall, T. (1989). Quadriceps femoris muscle angle: Normal values and relationships with gender and selected skeletal measures. Physical Therapy, Vol 69: 897-901.

Johnston, C.A.M., Taunton, J.E., Lloyd-Smith, D.R., McKenzie,

D.C. (2003). Preventing running injuries: Practical approach

for family doctors. Canada Family Physician, 49;1101-1109.

Kannus, P., Natri, A., Paakkala, T., Jarvinen, M.(1999). An outcome study of chronic patellofemoral pain synfrome. Seven year follow-up of patients in a randomized controlled trial. Journal of Bone Joint Surgery Am, 81: 355-363.

Kvist, M.(1994). Achilles tendon injuries in athletes. Sports Medicine, 18(3): 173-201.

Logan, C. (2006). The scoop on running injuries: help runners to avoid common injuries and to cope with them when they do occur. IDEA Fitness Journal, 3.10: p39.

Lun, V.M.Y., Meeuwisse, W.H., Stergiou, P., Stefanshyn, D.J., Nigg, B.M.(2000). The incidence of running injury and its relationship to lower limb alignment in recreational runners. In: CASM Research Committee, editors. CASM/ Sports Medicine 2000 Annual Symposium Research Session. Toronto,

Ont: 2000 May 11-13.p.20.

Mascal, C.L., Landel, R., Powers, C.(2003). Management of patellofemoral pain targeting hip, pelvis and trunk muscle function: 2 Case Reports. Journal of Orthopaedic and Sports Physical Therapy, 33: 642-660.

Macera, C.A., Pate, R.R., Powell, K.E.(1989). Predicting lower extremity injuries among habitual runners. Arch International Medicine, 149: 2565-2568.

McCaw, S.T.(1992). Leg length inequalty: implications for running injury prevention. Sports Medicine, 14(6): 422-9.

Mckenzie, D., Clement, D., Taunton, J.(1985). Running shoes, orthotics and injuries. Sports Medicine, 2(5): 334-47.

Mercer, J.A., Vance, J., Hreljac, A. (2002). Relationship between shock attenuation and stride length during running at different velocities. European Journal of Applied Physiology, 87: 403-408

Moore, P.(2002). The shoe update: quick reference guide. In: The Shoe Update 2002. Vancouver, BC: Ladysport.

Novacheck, T. (1998). The biomechanics of running. Gait posture, 7: 77-95.

Paluska, S.A.(2005). An overview of hip injuries in running. Sports Medicine, 35: 991-1014.

Pope, R.P., Herber, R.D., Kirwan, J.D., Graham, B.J.(2000). A randomized trial of pre-exercise stretching for prevention of

lower limb injury. Medicine and Science in Sports and Exercise, 32: 271-277.

Powers, C.M. (2003). The influence of altered lower extremity kinematics on patellofemoral joint dysfunction: A theoretical perspective. Journal of Orthopaedics and Sports Physical Therapy, 33: 639-646.

Rauh, M.J., Koepsell, T.D., Rivara, F.P., Margherita, A.J., Rice,

S.G. (2005). Epidemiology of Musculoskeletal Injuries among High School Cross-Country Runners. American Journal of Epidemiology, Vol.163, No2: 151-159

Rauh, M.J., Koepsell, T.D., Rivara, F.P., Rice, S.G., Margherita,

A.J. (2007). Quadriceps angle and risk of injury among high school cross-country runners. Journal of Orthopaedics and Sports Physical Therapy, 37: 725-733.

Runners' world Magazine. Retrieved October 28, 2010,


Ryan, M.B., MacLean, C.L., Taunton, J.E. (2006). A review of anthropometric, biomechanical, neuromuscular and training related factors associated with injury in runners. International Sport Medicine Journal, Vol.7, No. 2: 120-137

Satterthwaite, P., Larmer, P., Norton, R., Robinson, E.(1999). Risk factors for injuries and other health problems sustained in a marathon. British Journal of Sports Medicine, 33: 22-26.

Schwellnus, M.P., Stubbs, G. (2006). Does running shoe prescription alter the risk of developing a running injury? International Sport Medicine Journal, Vol.7, No 2, p138-153.

Smith, A., Scott, S., Wiese, D.(1990). The psychological effects of sports injuries: Coping. Sports Medicine, 9(6):352-369.

Souza, R.B., Powers.C.M (2009). Differences in hip kinematics, muscle strength, and muscle activation between subjects with and without patellofemoral pain. Journal of Orthopaedics and Sports Physical Therapy, 39 (1): 12-19.

Taunton, J.E., Ryan, M.B., Clement, D.B., McKenzie, D.C., Lloyd- Smith, D.R., Zumbo, B.D. ( 2002). A retrospective case-control analysis of 2002 running injuries. British Journal of Sports Medicine, 36.2: p95(7).

Taunton, J.E., Ryan, M.B., Clement, D.B. (2003). A prospective study of running injuries: the Vancouver Sun Run “In Training” clinics. British Journal of Sports Medicine, 37:239-244.

Tessutti, V., Trombini-Souza F., Ribeiro, A.P., Nunes, A.L., Neves Saco, I.D. (2008) In shoe plantar pressure distribution during running on natural grass and asphalt in recreational runners. Journal of Science and Medicine in Sport, 13:151-155

Thacker, S.B.,Gilchrest, J., Stroup, D.F., Kimsey Jr, C.D.(2004). The Impact of Stretching on Sports Injury Risk: A Systematic Review of the Literature. Medicine and Science in Sports and Exercise, Vol. 36, No. 3, pp. 371–378.

Van Gent, R.N., Siem, D., van Middelkoop, M., van OS, A.G., Bierma-Zeinstra, S.M.A., Koes, B.W. (2007). Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. British Journal of Sports Medicine, 41: 469-480.

Van Mechelen W. (1995) Can running injuries be effectively prevented? Sports Medicine, 19(3): 161-165

Walter, S.D., Hart, L.E., McIntosh, J.M.(1989). The Ontario cohort study of running-related injuries. Arch International Medicine, 149: 2561-2564.

Warburton, D.E.R., Nicol, C.W., Breding, S.S.D. (2006) Health benefits of physical activity: the evidence. CMAJ, 174(6); 801-9

Wen, D.Y., Puffer, J.C., Schmalzried, T.P. (1998). Injuries in runners: A prospective study of alignment. Clinical Journal of Sport Medicine, 8: 187-194.

Wexler, R. (1995). Lower extremity injuries in runners: helping athletic patients return to form. Postgraduate Medicine, 98.n4: p185(6).

Willems, T., Clerq, D., Delbaere, K., et al. (2006). A prospective study of gait related for exercise related lower leg pain. Gait Posture, 23: 91-98.

Yeung, E.W., Yeung, S.S. (2001). A systematic review of interventions to prevent lower limb soft tissue running injuries. British Journal of Sports Medicine, 35.6: p383(7).