How to avoid running injuries ?

Article written in collaboration with Matthieu Giraud, Osteopath

One of the biggest frustrations for any runner is getting injured. When an injury occurs, we are suddenly deprived of our favourite sport and the balance it brings us on a daily basis. So it's important to be familiar with the most common running injuries and, above all, to try to avoid them.

Unfortunately, injury among runners is much more common than one might think. According to a study of over 600 runners (1), almost half of all runners injure themselves every year. Unfortunately, this is a very telling statistic. It shows that the risk of injury needs to be taken seriously. The question is how to prevent injury and what the risk factors are.

What are the most common injuries?

According to the same study carried out by several American universities in 2023 on more than 600 runners (1), the most frequent injuries among runners are located as follows:

1. Foot or ankle 31
2. Knee 22%.
3. Hip or groin 18%.
4. Calf or Achilles tendon 16%.

These injuries can affect all types of tissue that are heavily used during running, such as tendons, muscles and joints. They can take the form of inflammation, such as tendonitis, but also muscle contractures, strains or even fractures, as in the case of stress fractures.

There are two key risk factors that can also contribute to injury. One is antecedents. For example, having a more fragile ankle following a sprain or a series of sprains and not strengthening that ankle sufficiently to compensate for its fragility can lead to repeated sprains. The other and most common risk factor is overtraining. According to a study conducted in Germany (2), 80% of running injuries are due to overtraining, resulting from a mismatch between tissue resilience (improved by recovery) and mechanical stress (linked to regular running).

What can be done to limit the risk of injury?

Let's start by identifying the relatively common injuries that can occur to runners. There are many different types of injury:

o Achilles tendonitis or tendinopathy
o Muscle tears or strains
o Ankle sprains
o Blisters
o Plantar fasciitis or inflammation of the plantar fascia
o Runner's knee 
o Stress fracture
o Tibial periostitis (or medial tibial stress syndrome)
o ITBS or iliotibial band syndrome
o Sunburn or heat exhaustion
o Frostbite or hypothermia

This list of potential injuries is long, and it can almost be discouraging because there are so many risks. Fortunately, it is possible to greatly limit the risk of injury. There is no 100% guarantee, but following the 10 key tips below will help prevent an injury from happening:

1. Warm up before each run
Warming up before a training session or a race prepares your body to exert itself. The aim of the warm-up is to stimulate the tendons, muscles and joints before the effort. The increase in body temperature that the warm-up causes makes tendons, muscles and joints more supple. It also reduces the mechanical resistance of the muscles. Warming up will help to improve or 'activate' our proprioception (our ability to perceive our body's position in space), increase blood flow to the muscles and stimulate the metabolism.

2. Hydrate regularly
Dehydration of just 2% can result in a 20% reduction in performance. Dehydration also has other consequences for runners' health. It can cause muscular, tendon, digestive or cardiac problems. So it's essential to stay well hydrated during every training session and every race. A simple way of ensuring regular hydration (and not forgetting to hydrate when you're in the middle of a race and therefore sometimes less clear-headed) is to drink methodically every 10 or 15 minutes without waiting until you're thirsty, but just by looking at the race time or the time regularly on your watch.

3. Increase the training load gradually
Increasing the training load too quickly doesn't give your body enough time to adapt. To ensure that the training load is progressive, there are two easy rules to apply: 1. don't increase the weekly distance by more than 10% per week and 2. don't increase training distance and speed in the same week (only one or the other). You also need to learn to listen to your body and recognise the first signs of tension or stiffness in the muscles or tendons before an injury occurs, or the signs of unusual fatigue, and know how to rest and postpone a session if necessary.

4. Strengthen your muscles
Muscular strengthening is a form of protection against the risk of ligament damage. Stronger muscles will absorb some of the mechanical force exerted on the ligaments during running, particularly in the knees. Muscular strengthening increases the surface area of the tendon and muscle sections to distribute the load more evenly, so you can run longer and put off the first signs of fatigue - in short, become a longer-lasting runner.

5. Do a series of stretches after each session
There are two advantages to doing a series of stretches after each session. The first is to allow your heart rate to gradually return to a normal rhythm after the effort of running. The second is to achieve greater fluidity and economy of movement, by increasing the range of motion (particularly in the calves, hamstrings, quadriceps and hips). For runners who spend a lot of time sitting behind a computer, stretching the shoulders, neck and lower back is also very beneficial. Greater flexibility also allows you to develop a more relaxed, less tense running posture and, ultimately, to enjoy running more.

6. Work on your balance
Specific balance training is often neglected by amateur runners. We often rediscover it when it's too late, i.e. when we've injured an ankle, for example, and the physiotherapist advises us to do balance exercises on one foot, on inclined planes or half balls. Developing good balance and stability can help prevent injury. Conversely, poor balance can lead to excessive movement from the foot to the torso. This can lead either to a sudden, traumatic injury such as a sprained ankle, or to a progressive overuse injury, as the body will naturally try to compensate for and control this excessive movement. The most common overuse injuries in runners who lack stability are iliotibial band syndrome and runner's knee. Improving balance and stability will not only reduce the risk of injury, but will also increase performance, as the body becomes more efficient and no longer expends (or at least less) extra energy controlling excessive movement.

7. Running in the right shoes
Running in the right shoes could be the subject of an entire article. To sum up, the main reasons for running in the 'right shoes' include the key concepts of cushioning, heel height (or drop), flexibility and protection. Cushioning is necessary simply because when we run, we hit the ground with a lot more force. And cushioning helps to absorb some of the shock, particularly in the heel area. Running shoes also give the arch of the foot the support it needs to withstand high-impact activity. They protect against injury by reducing stress on the ankles, heels and toes, and help prevent tendonitis, joint pain and stress fractures.

8. Vary your training surfaces
Running on different surfaces allows you to exercise different muscles. For example, when we run on a road, our calf muscles work harder than when we run on a softer surface such as a forest path. By running on different surfaces (road, path, carpet, track, etc.), we can change the impact on our joints, modify the muscles we use and improve our balance and proprioception. This variety of surfaces can therefore help to reduce the risk of injury.

9. Vary your sporting activities
Including a regular session of swimming, cycling, rowing or yoga is an excellent way of working different muscle groups to avoid overuse of a given area. By practising different sporting activities, we can work our bodies in different ways. Conversely, if we concentrate on just one area of the body related to our favourite sport, the other muscles will weaken or at least not strengthen. To achieve optimum fitness, we should ideally work all our different muscle groups, while at the same time making sure we allow sufficient rest time between training sessions.

10. Protect yourself from the sun and cold
Every time we run outdoors, we expose our skin to ultraviolet rays. You need to protect yourself by wearing a cap or visor, sun-protective clothing (ideally UPF50+) and sunglasses, or by applying sun cream on sunny days. Another solution is to plan your sessions according to the local UV index.
To protect yourself from the cold, the basic rule is to protect your extremities, as it is in the extremities that the most heat is lost. It is therefore advisable to wear gloves, a hat or a cap. The second rule for very cold weather is to wear three layers of clothing: a breathable layer (close to the body), a thermal layer to help maintain body temperature, and a waterproof layer to cut the wind and protect against rain or snow.

The key role of recovery

The last but perhaps most important tip for avoiding injury concerns recovery. Rest days allow the body's muscles to recover, repair themselves and avoid overtraining. Constant training without any recovery days can be damaging to the body. By not giving the muscles enough time to rebuild, especially after a demanding session, the body can no longer or not sufficiently repair itself. Conversely, during the days or phases of recovery, our tissues repair themselves and our muscles are replenished with glycogen, their energy reserve. Physical exercise creates micro-tears, and recovery allows them to heal. Without sufficient recovery, continuous and repetitive movements such as those associated with running will only cause further tears that can lead to inflammation and injury.

To sum up, to avoid running injuries, you need to:
(i) Train 'well', i.e. plan your warm-up (cardiovascular, muscular, joint), hydrate properly, work on muscle strengthening, flexibility, balance, gradually increase your training load, and 'vary the pleasures' (vary the terrain and sports);
(ii) Get the right equipment, especially footwear;
(iii) Know how to protect yourself against the elements (sun, heat, cold);
(iv) And above all, don't neglect recovery.

If there were two key points to remember, they would be the concepts of progressive training and recovery. Training progressively and recovering properly are the best ways of avoiding overtraining injuries.

We hope that this article will be useful to you, not only in preventing potential running-related injuries, but also and above all in ensuring that you continue to enjoy running as much as possible.

Sources
(1) Running-Related Overuse Injuries and Their Relationship with Run and Resistance Training Characteristics in Adult Recreational Runners: A Cross-Sectional Study (Stenerson, Melton, Bland, Ryan)

(2) Walther M, Reuter I, Leonhard T, Engelhardt M (2005) Injuries and overuse reactions in running / Verletzungen und Überlastungsreaktionen im Laufsport. Orthopäde 34 : 3999 10.5435/JAAOS-D-14-00433