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  • Blaine Hawkes, DPT

Running Injuries and how to Avoid Them

By Blaine Hawkes, DPT


Many distance runners have had their training routines interrupted by a nasty case of shin-splints, IT-band pain in the hip or knee, plantar fasciitis, back pain, stress fractures, or achilles pain. These common running injuries can keep you from achieving a PR or even take you completely out of that race that you’ve been training for.


Today I’d like to share some ideas that will help you prepare for and participate in that 5K, 10K, half-marathon, or even a full marathon without getting derailed by a running injury.


Most people don’t associate distance running with injuries. Everyone knows that football and hockey players are prone to injuries, but you might be surprised to learn the prevalence of running injuries is almost just as high! The types of running injuries are very different from those suffered by football players, but can keep athletes out of performance just the same.


If there is one thing you learn from this article, the most important training principle I can convey is this: Most all running injuries occur due to increasing the mileage too far too soon, and lack of cross training.


There are several marathon training protocols you can find on the internet that will basically take you from being a couch potato to running a marathon in six months. Unless you have a very strong background in distance running I would caution you not to follow these training protocols that advance mileage so quickly and don’t include any cross training. Your muscles, heart, and lungs can probably ramp up to a challenge like this without any problem, but there are so many other systems and structures in your body that need more time to adapt to the grueling stresses of running several consecutive miles.


Tendons, bones, cartilage, and ligaments also need to be trained; these are the tissues that will likely suffer from overuse. They can quickly become inflamed and make it way too painful to run or jog (and may even bother you when you’re not running). Distance running also requires a high degree of mental and psychological toughness that may take longer to condition than simple muscle conditioning.


So how do you achieve your first 5K, 10K, half-marathon, or full marathon without getting injured along the way? The key is to give yourself plenty of time for preparation and to include proper cross training along the way. People who have become overweight and want to begin running may need to spend a couple months beforehand working on their diet and starting with a different form of exercise that is less stressful on the joints; maybe walking or biking prior to a gradual transition into running.


How fast should you increase your mileage? The answer to that depends on several factors, one of the biggest being how much previous experience you have running. Most people can get up to 4-5 miles fairly quickly (within a month or two) without getting injured, but after that the risk starts to go way up.


If you’re aiming to run a race longer than you have ever run before, a conservative answer is to increase 1 mile per month. Again, many people can probably increase a lot faster than that, but we’re talking about how to do it without getting hurt along the way. And yes, that means it should probably take about a year to safely train for a half marathon (13.1 miles) and 2 years to train for a full marathon (26.2 miles) if you do not have previous running experience. Many first timers do it faster than this, and some of them get away with it injury-free. Sadly, others who increase mileage too quickly get hurt and never participate in the dream of crossing the finish line. The worst part of this is that they get a bad taste for running and never learn to enjoy something that truly can be enjoyable if properly trained for.


What kind of cross training should you do? Strengthening. Resistance training builds muscle bulk and strengthening muscles around your joints before getting into lengthy distance runs is a proven way to decrease joint pain and decrease risk of running injuries. Research is also showing that resistance training may even make you run faster. Think squats, lunges, calf-raises, rows. The resistance should be high enough that you burn out after 10-20 repetitions. If you can do much more than that you need more resistance to build muscle faster. Resistance training should ideally begin 2-3x/week before you start running longer distances, and can be tapered to 1-2x/week as you get farther into your training protocol and need more time to get the miles in.


The other form of cross training that should be included is an alternating form of cardio training; something like swimming, rowing, or cycling. These will get you the cardiovascular challenge you need while working different muscle groups in different ways than running alone. Savvy distance runners who have learned to avoid injuries will generally include one of these alternating forms of cardio training per week in their training protocols.


It is also recommended to include some stretching exercises in combination with running. This doesn’t need to take much time, just make sure you hit the major muscle groups in your lower body and hold each stretch for about 20 seconds each.


Lastly, make sure you are using appropriate footwear. Use a reputable running shoe that feels good. Some runners swear by a specific brand, but it varies depending on your foot structure. It will take some experimenting. There is not a one-size fits all answer to which shoe is the best; some people do better with high arch support, while others don’t tolerate higher arches well. Make sure you don’t put more than about 300-400 miles on your shoes. They may still look great on the outside, but the soles are pretty beat down by this point and will put you at higher risk of getting plantar foot / heel pain if you keep running on them.


In conclusion, remember you need to give your body sufficient time to ramp up the mileage and don’t neglect the cross training. If you have already developed some pain in your running, speak with a sports-based physical therapist or an athletic trainer that can help you revise your training plan and provide some ideas for appropriate cross training. Running is a sport that takes time and conditioning before you can start to enjoy it. So many people claim they hate running, but have not conditioned their bodies sufficiently to know what it really feels like to successfully run a distance race, or a past injury makes them feel unable to include running as part of their exercise routine. Like everything else in life, it takes persistent dedication to become something valuable and enjoyable.



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