Running: Physios guide to enhancing performance

Running is one of the most popular sports in the world, although it’s difficult to ascertain exact participation rates.

Fast facts on running

A recent survey found that around 20% of Americans run in one form or another (track, trail or road).

Running is also one of the most injury-prone sports, with up to 80% of runners sustaining an injury in any given year.

This injury rate varies in the research from 20% to 80%, depending on the definition of an injury (pain = injury vs. unable to run = injury).

The most commonly injured regions are knees, shins and Achilles.

The single most common injury is “Runner’s knee”, a lay term for Patellofemoral Pain Syndrome (PFPS).

Injury prevention

The most effective method of preventing injuries involves three key aspects: running technique, strength and recovery.

Running technique

There are plenty of myths and misinformation regarding ideal running technique so it’s hard to get conclusive information from the web. Here’s what we know:

Increasing cadence (steps/minute) reduces impact loading and injury risk.

Heel striking is not harmful however over-striding, when the point of impact moves well in front of the body’s centre of mass) is linked to a higher injury risk.

Forefoot striking, landing on the front of the foot, is seen with faster running but it’s not associated with increased injury risk.

Note that forefoot striking doesn’t make you a faster runner, it naturally occurs during sprinting and faster running.


Resistance training is preventative of almost all injuries for runners.

It works by maintaining effective running technique and avoiding the detrimental effects of fatigue. As good running technique is diminished by fatigue, the body is exposed to excessive force and abnormal force orientation, both of which lead to injury.

The jury is still out on whether runner’s benefit most from heavy, low rep exercises or lighter, high rep exercises. The research does indicate that exercises need to be performed to the point of muscle fatigue.


Ensuring that there is adequate recovery in a training schedule is a difficult task. The time required to recover differs between individuals and is dependent on the session parameters as well as nutrition/hydration, sleep and more.

Using fixed timeframes based on other’s experience is a recipe for disaster, particularly when you consider that most web advice is written by more elite runners. Here are our guidelines for figuring out your own recovery strategy:

Vary your weekly load – don’t just keep building steadily. You can spike your load one week provided it’s offset with an easy week afterwards

Focus on the basics – eat well, drink well, sleep well. Get that right and you’re looking good

Monitor non-running days – keep track of your days off running and use them wisely after big sessions. Remember, moving from 5 runs/week to 6 runs/weeks might seem like a 20% increase in training but it’s also a 50% decrease in recovery days

Use your recovery days well – they don’t need to be lazy days. Swimming or walking is a great way to optimise your recovery and run better in your next session

If you’re returning to running after an injury break, or if you’re starting running for the first time, see our guide to safely building your running endurance.

Most common injuries

Knee injuries

Patellofemoral pain syndrome

ITB syndrome

Shin pain

Shin splints

Tibial bone stress injuries

Foot & Ankle injuries

Stiff or aching ankles


Achilles tendinopathy

Heel bone stress fractures

Other bone stress injuries

Hip injuries

Deep hip muscle fatigue

Hip impingement and labral tears

Hamstrings tendinopathy

Gluteal tendinopathy

Hip bone stress injuries

Hip osteoarthritis

Muscle tears

Calf muscle tear

Minor calf muscle strain

Hamstrings tear

Tips for initial response to injury

For insidious (gradual) onset soreness, reduce your training load for one week and focus on effective recovery strategies.

If the soreness persists on return to full loading, seek a medical diagnosis.

For all acute foot/ankle and knee injuries, use the Ottawa Ankle rules and Ottawa Knee rules to screen for fracture and the need for an x-ray.

Ice packs should be applied to all acute injuries for the first 48 hours.

Avoid anti inflammatory medication unless specifically recommended by a health professional as it can increase bleeding in acute injuries and delay tissue healing.

Compression is most effective when applied very soon after the incident. Apply a broad firm compression via an elastic bandage or, if unavailable, wear compression tights.

Running articles

For our comprehensive library, click here for Running Training articles and click here for Running Injury articles.