Running Strength and Form: Reduce Injury Risk

This post follows Running Biomechanics and Foot Strike Patterns and Running Workload and Body Weight, which explain the mechanical and training foundations of injury-risk management.

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. 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.        Muscle preparation and maintenance

2.        Running form

Muscle preparation and maintenance

Exercise interventions generally reduce injury risk across various populations (3,4). 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. 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.

Fig 2.

Specific Running Exercises

1. Single leg calf rise

The calf complex absorbs and generates up to 50% of ground reaction force during running (5).  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 (6).

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 (7). 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 (8). The star plank (Fig. 6) effectively isolates and trains these muscles to function as energy conservers (9).

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.

How to use these benchmarks: These practice-based benchmarks are intended as a guide to help runners identify side-to-side differences and build a manageable strengthening routine. They are not diagnostic cut-offs or a substitute for an individual assessment.

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 may benefit from improving muscular capacity before substantially increasing running volume. Numerous studies also link suboptimal muscle function to increased injury risk (10, 11). 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.

Table 3.

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 (12). As discussed in [Running Biomechanics and Foot Strike Patterns], foot strike is task-specific and changing it can shift load rather than simply remove injury risk.

From clinical observation and coaching practice, the following cues can be useful to trial. They are not rules for every runner and should be introduced gradually, particularly if they increase calf or Achilles symptoms.

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

Cadence naturally varies with pace, height, experience, and terrain; a modest increase may help some runners reduce over-striding.

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 (13). 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.

Any transition should therefore be combined with a gradual, well-managed running workload, particularly when returning from injury or increasing distance.

Conclusion

I hope these three posts have provided practical value and a clearer framework for enjoying running with lower injury risk. Long-term progress is more likely when muscle preparation and running-form changes are paired with sensible workload progression.

Frequently Asked Questions

Q: Which muscles are most important for runners?

A: The calf complex, quadriceps, gluteal muscles and trunk all help manage repeated impact forces and control movement during running. A practical programme does not need to be complicated: calf raises, single-leg squat variations and lateral hip or trunk exercises can be a sensible starting point when appropriately progressed.

Q: How often should runners do strength training?

A: For runners building capacity, two to four strength sessions each week may be appropriate, depending on current training load, experience and recovery. Once a useful strength base is established, a smaller maintenance dose can often help preserve it. The right volume should fit around, not compete with your running.

Q: Should I change my running form if I have pain?

A: Not without considering the reason for the pain, your existing workload and your ability to tolerate new demands. A running-form change may shift stress rather than eliminate it. Start with small, gradual changes, monitor symptoms, and ensure your workload and physical preparation support the transition.

Running injury prevention series

Part 1 — Running Biomechanics and Foot Strike Patterns

Part 2 — Running Workload and Body Weight

Part 3: Running Strength and Form (you are here)

Need help with running-related pain, strength preparation, or changing your running form safely? A personalised physiotherapy assessment can identify the main contributors and help you progress without overloading the calf, Achilles, knee, or foot.

Book a running injury assessment or get in touch for next steps.

References and Further Reading

1. Hamner SR, Seth A, Delp SL. Muscle contributions to propulsion and support during running. Journal of Biomechanics. 2010;43(14):2709–2716. doi:10.1016/j.jbiomech.2010.06.025. Available from: https://pubmed.ncbi.nlm.nih.gov/22573774/

2. Hespanhol Junior LC, van Mechelen W, Verhagen E. Health and economic burden of running-related injuries in runners: a systematic review and meta-analysis. Sports Medicine. 2015;45(7):1013–1026. doi:10.1007/s40279-015-0331-8. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4513221/

3. Al Attar WSA, Soomro N, Sinclair PJ, Pappas E, Sanders RH. Including the Nordic hamstring exercise in injury prevention programmes halves the rate of hamstring injuries: a systematic review and meta-analysis of 8,459 athletes. British Journal of Sports Medicine. 2019;53(21):1362–1370. doi:10.1136/bjsports-2018-100045. Available from: https://bjsm.bmj.com/content/53/21/1362

4. Knapik JJ, Bullock SH, Canada S, Toney E, Wells JD, Hoedebecke E, et al. Influence of an injury reduction program on injury and fitness outcomes among soldiers. Injury Prevention. 2004;10(1):37–42. doi:10.1136/ip.2003.002808. Available from: https://injuryprevention.bmj.com/content/10/1/37.short

5. Hamner SR, Seth A, Delp SL. Muscle contributions to propulsion and support during running. Journal of Biomechanics. 2010;43(14):2709–2716. doi:10.1016/j.jbiomech.2010.06.025. Available from: https://pubmed.ncbi.nlm.nih.gov/22573774/

6. Distefano LJ, Blackburn JT, Marshall SW, Padua DA. Gluteal muscle activation during common therapeutic exercises. Journal of Orthopaedic & Sports Physical Therapy. 2009;39(7):532–540. doi:10.2519/jospt.2009.2796. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC3201064/

7. Niemuth PE, Johnson RJ, Myers MJ, Thieman TJ. Hip muscle weakness and overuse injuries in recreational runners. Clinical Journal of Sport Medicine. 2005;15(1):14–21. doi:10.1097/00042752-200501000-00004. Available from: https://pubmed.ncbi.nlm.nih.gov/15654186/

8. Zazulak BT, Hewett TE, Reeves NP, Goldberg B, Cholewicki J. Deficits in neuromuscular control of the trunk predict knee injury risk: a prospective biomechanical-epidemiologic study. American Journal of Sports Medicine. 2007;35(7):1123–1130. doi:10.1177/0363546507301585. Available from: https://pubmed.ncbi.nlm.nih.gov/22440758/

9. Distefano LJ, Blackburn JT, Marshall SW, Padua DA. Gluteal muscle activation during common therapeutic exercises. Journal of Orthopaedic & Sports Physical Therapy. 2009;39(7):532–540. doi:10.2519/jospt.2009.2796. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC3201064/

10. Finnoff JT, Hall MM, Kyle K, Krause DA, Lai J, Smith J. Association of isometric strength of hip and knee muscles with injury risk in high school cross country runners. International Journal of Sports Physical Therapy. 2016;11(3):350–357. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4637921/

11. van der Worp H, van der Horst N, de Wijer A, Backx F, Nijhuis-van der Sanden M. Achilles tendon injury risk factors associated with running: a systematic review. Sports Medicine. 2015;45(10):1455–1466. doi:10.1007/s40279-015-0357-6. Available from: https://www.researchgate.net/profile/Patria-Hume/publication/262884570_Achilles_Tendon_Injury_Risk_Factors_Associated_WITH_Running/links/55ede10b08aef559dc437f60/Achilles-Tendon-Injury-Risk-Factors-Associated-with-Running.pdf

12. Lieberman DE, Venkadesan M, Werbel WA, Daoud AI, D’Andrea S, Davis IS, et al. Foot strike patterns and collision forces in habitually barefoot versus shod runners. Nature. 2010;463(7280):531–535. doi:10.1038/nature08723. Available from: https://www.nature.com/articles/nature08723

13. Mero A, Komi PV, Gregor RJ. Metabolic energy expenditure and the regulation of movement economy. Psychonomic Bulletin & Review. 1996;3:415–420. doi:10.3758/BF03212943. Available from: https://link.springer.com/article/10.3758/BF03212943

About the Author

Dan Watson is a Chartered Physiotherapist based in Colchester, Essex, specialising in sports-injury assessment, rehabilitation, injury prevention and return-to-performance planning.

With over 15 years’ experience, Dan has supported everyday patients and professional athletes across football, rugby and The Royal Ballet. His approach combines clear assessment, practical education and progressive exercise tailored to the demands of each sport and individual goal.

He provides face-to-face physiotherapy in Colchester and online support for suitable patients across the UK.  Read more about Dan’s background and credentials.