Critical concepts in reducing running related injuries. Part 2

Introduction

Many runners diligently following mileage schedules and manage their weight, yet still develop frustrating knee and foot pain. Why does this happen despite having strong foundations in place?

Forces and Common Injuries in Running

The body is subject to 3-4 times your bodyweight during the stance phase of running. The foot/ankle, knee muscles and tendons are responsible for managing up to 75% of this force (1). Moreover, the average runner takes approximately 900-1000 steps per kilometre resulting in significant cumulative stress over distance. Therefore, unsurprisingly the knee followed by the ankle are the most frequently injured body parts as a result of running (2).

So, even if you have successfully addressed your running workload and body weight, discussed in detail in my previous post here. Optimising your ability to manage and tolerate repetitive impact forces whilst running may reduce your risk further.

Therefore, in this post I discuss the final two critical modifiable risk factors for reducing the risk of developing a running related injury:

1.        Physical preparation and maintenance

2.        Running form

Physical preparation and maintenance

Exercise interventions generally reduce injury risk across various populations (3,4,5). This benefit arises from preparing and maintaining the body for the specific demands of the activity. The success of any exercise programme depends on two critical factors: appropriate exercise selection and consistent compliance.

Exercise selection should align with goals, whether providing specific tissue stress to drive structural adaptation, optimising movement patterns similar to running, or a combination of both (Fig. 1). Meaningful adaptation takes time (weeks to months), and positive outcomes depend heavily on adherence.

Fig 1.

Given the central role of the calf complex, quadriceps, and gluteal muscles during the stance phase of running, exercise selection should target these regions, to recap please return to my original post here. The following three exercises blend targeted tissue loading with movement patterns that approximate running demands (Fig. 2). Limiting the programme to just three exercises should support compliance.

Fig2.

Specific Exercises

1.      Single leg calf rise

The calf complex absorbs and generates up to 50% of ground reaction force during running (6).  It functions as an energy generator, actively shortening throughout stance and working with the Achilles tendon to amplify force. The single leg calf raise (Fig. 4) provides an adequate stimulus to prepare and maintain this muscle group as well as other important foot and ankle structures.

Fig 4. Move between start and finish positions repeatedly.

2.      Single leg squat

The quadriceps act predominantly as an energy conserver, working isometrically to facilitate a spring-like exchange between body mass and the knee extensor tendons. Strictly speaking, the single leg squat (Fig. 5) does not perfectly replicate this action, however, for beginner to intermediate runners it offers an effective stimulus to the quadriceps while also improving single-leg stability, pelvic control, and movement efficiency (7).

Fig 5. Move between start and finish positions repeatedly.

3.      Star plank

Excessive hip adduction and deficits in lateral hip strength are common findings among injured runners (8). The lateral hip muscles, particularly the upper fibres of gluteus maximus, gluteus medius, and gluteus minimus, play a key role in controlling this motion and providing pelvic stability. Deficits in trunk and abdominal core muscles that support the pelvis have also been linked to lower limb injury (9). The star plank (Fig. 6) effectively isolates and trains these muscles to function as energy conservers (10).

Fig 6. Move between start and finish position repeatedly.

Determining your training dose!

How many repetitions and sets should you perform? Rather than using generic recommendations, you can individualise the dose. First, perform the maximum number of repetitions possible for each exercise on each side to establish your baseline. Use Table 1 to determine your current level.

Next, calculate 70% of your maximum repetitions for each exercise and perform this number across 3–4 sets, 3–4 times per week (Table 2). Retest after 3–4 weeks and repeat the process until your maximum falls within the “benchmark” or “very good” categories.

Table 1. Data derived from practice-based evidence.

Table 2. Example training prescription based on maximal reps. Round 70% of max figure up or down i.e 8.4 can be 8 reps and 8.6 can be 9 reps.

In my clinical experience, runners in the “needs work” category are at heightened risk of developing a running-related injury. Numerous studies also link suboptimal muscle function to increased injury risk (11, 12, 13). For high-risk or previously injured runners, I recommend reaching at least the “benchmark” categories before commencing or significantly increasing running volume.

Once you are consistently in the benchmark range and running regularly, a maintenance dose performed before or after runs is usually sufficient to preserve strength and activation. Table 3 provides guidance for maintenance.

Table3.

Once muscular capacity is adequately prepared, attention can usefully turn to how those muscles are used during running.

Running form

Many runners give little thought to how they run once their shoes are on, they simply start moving. This simplicity is part of running’s appeal, most people can do it with minimal preparation. Yet, just as technique matters in golf, tennis, or football, running form varies in quality. Observing patterns among runners who consistently achieve successful, pain-free outcomes, whether running further, faster, or simply enjoying the activity longer, can offer useful insights.

It has long been suggested that adopting a forefoot strike pattern optimises running form and reduces injury risk (14). As discussed in the first post, this view oversimplifies a complex topic.

From observing high-performance runners and discussions with experienced coaches, four recurring elements stand out:

1.        Avoid over-striding — land with the foot under or only slightly ahead of the body.

2.        Maintain a step rate of approximately 170–180 steps per minute.

3.        Limit forward lean — lean slightly from the ankles, not excessively from the waist.

4.        Land softly and quietly with a near-horizontal foot — this reduces large, rapid braking forces at initial contact.

Over-Striding

Aim for a high knee lift as the leg swings forward, then land with a relatively vertical shin so the foot contacts the ground beneath or close to the knee, not far ahead of the hips.

Step Rate

Step rate typically increases with speed, but experienced runners often maintain 170–180 steps per minute across a wide range of paces. A higher step rate helps prevent over-striding. These runners achieve faster speeds primarily by increasing flight time rather than stride length.

Forward Lean

A slight forward lean from the ankles is natural and efficient. Excessive lean from the waist increases energy cost and promotes over-striding.

Land Softly and Quietly with Near-Horizontal Feet

Intentionally running “lightly, softly, and quietly” tends to produce a more horizontal foot position at initial contact, which reduces peak braking forces and loading rates.

Key Considerations When Changing Running Form

Two important points should be kept in mind. First, altering running form is metabolically demanding, and most runners revert to their habitual pattern under fatigue (15). Second, the form cues described above, particularly a higher step rate and softer landing, typically increase demand on the calf–Achilles complex. This shift carries a risk of calf or Achilles overload if not carefully managed. Proactive muscle preparation (as outlined earlier) and cautious progression of running workload are therefore essential.

Conclusion

I hope these three posts have provided practical value and a clearer framework for enjoying running with lower injury risk. Many runners find that these small, consistent preparations, workload management, sensible body-weight strategies, targeted strength work, and mindful form cues unlock months or years of enjoyable, pain-free running.

Should you have any difficulty understanding these concepts, planning your running workload, or executing the exercise preparation, please get in touch. I’ll be happy to provide further information or support.