Five ways to prevent the injuries we see most in runners

Most running injuries do not happen the way people describe them. There is rarely a moment. There is a run where something felt tight, a week where it was sore afterwards, and then a run you had to cut short.

That matters, because it means the problem was building while there was still time to change it. The five injuries below are the running-related problems we have the most to say about, and they have more in common than their locations suggest.

The five

• Shin splints, pain along the inner border of the shin
• Achilles tendinopathy, pain and stiffness in the tendon, worst first thing
• Plantar fasciitis, heel pain at its worst on the first steps of the day
• Hamstring strain, usually during a sprint or a fast finish
• Knee pain, most often at the front of the knee or on the outside

Four of those five are tissue-loading problems. That is the thread, and it is why the same few changes affect all of them.

1. Change your training slowly, and change one thing at a time

Almost every one of these starts the same way: load rising faster than the tissue can adapt to it. Bone, tendon and fascia all adapt to being loaded, but they adapt slowly, and slower than your cardiovascular fitness does. That gap is where the injury lives. You feel able to do more before your tissues are able to tolerate more.

The triggers are consistent enough to be worth memorising. A sudden increase in mileage. A change of surface. A change of footwear. Adding hill work. Returning after a break at the volume you stopped at. A rapid increase in intensity.

Any one of those is survivable. The problem is stacking them. New shoes, a new route and a new interval session in the same fortnight leave you with no way of knowing which one your shin is objecting to.

2. Get strong, particularly where the tissue is longest

Strength work is the least popular advice in running and the most consistently useful.

For the calf and Achilles, progressive loading is the core treatment when things go wrong, and it is the same tissue quality that reduces the chance of them going wrong. Tendons respond to being loaded. They do not respond well to rest.

For the hamstrings, the demand is specific: they are loaded hardest during the late swing phase of sprinting, lengthening and contracting at the same time. Strength at long muscle lengths is what that requires, and it is not the same as being able to lift heavy in a short range.

For the knee, strengthening helps across almost every diagnosis we see there, which is unusual and worth taking advantage of.

3. Treat early soreness as information, not as weakness

The runners who end up in front of us with the worst version of a problem are almost never the ones who ignored something dramatic. They are the ones who noticed a low-grade ache, decided it was nothing, and kept the training week intact.

Some of that is fine. Tendon problems in particular can be worked with rather than rested. But there are patterns that mean stop and get it looked at rather than push:

• Shin pain at one specific point on the bone, rather than along a length of it
• Pain that is there at rest, or that wakes you at night
• Pain that is getting worse despite you having already reduced your training
• Anything that changes how you run without you deciding to change it

Running through progressive shin pain is how it moves toward a stress fracture, which is a different and more serious problem with a much longer road back.

4. Finish the rehabilitation on your last injury

A previous injury in the same place is among the strongest predictors of the next one. With hamstrings it is the biggest single risk factor we know of. The reason is usually the same: the rehabilitation stopped when the pain did.

Those are two different finish lines. An ankle you sprained last season may have healed its ligaments perfectly well and still have lost the balance and joint position sense that stops it happening again, because that does not come back on its own. A hamstring that stopped hurting may not have regained its strength at length. In both cases the tissue is fine and the capacity is not, and the next hard session finds out which.

If you have an injury that keeps returning to the same place, that is the thing to investigate. It is rarely bad luck.

5. Look at how you actually run, and in what

Mechanics and footwear matter. They matter less than training load, which is why they are last on this list rather than first, but for a runner who keeps producing the same problem they are often where the answer is.

A running and gait analysis looks at what your legs are doing under load rather than what they do on a treatment couch. Where foot mechanics are contributing, custom insoles can change how load is distributed, though they work alongside the strength and load work rather than instead of it.

One practical thing: when you come in, bring the shoes you actually run in, not the newest pair. The worn ones tell us more.

What this does not do

None of this makes you injury-proof. Running is a repetitive impact sport and some risk is the price of doing it.

What these five change is the odds, and more usefully, how early you catch something. A runner who understands that an ache in week three is a load signal has a much easier problem than one who finds out in week nine.

If something has been niggling for a few weeks, or the same problem keeps coming back, book an assessment at either clinic. Bring your training log and your shoes.