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As a physio, most people don’t come to me asking how to prevent something (at least not initially). They come with something already hurting.
Featured article from 
Spoiler: prioritise the strength of your calf and quad muscles, pay attention to changes in the volume, intensity, frequency, and elevation of your training. And then maybe (maybe!) play around with your biomechanics and shoes.
As a physio, most people don't come to me asking how to prevent something (at least not initially). They come with something already hurting. And so we first calm it down, and then rehab it – prevention often comes second.
But ‘how to prevent injury' is one question preceded by thousands of questions before it, and researchers have been looking at this for years, and we still don't have many conclusive answers. I mean, it's hard to study something before it happens – it's much easier to study it afterwards. That's the difference between injury prevention and treatment.
And so we're left to take the few answers we do have, try to understand the demands of running on the body, make a few inferences, and give you a cheat sheet to help you prevent not just one, but hopefully all of the top five.
The five most common running injuries
So what are the five most common running injuries? A systematic review (Kakouris et al., 2021) found these to be the top five:
- Patellofemoral pain (coming from behind the kneecap)
- Medial tibial stress (colloquially known as shin splints)
- Plantar heel pain (commonly known as plantar fasciitis)
- Iliotibial band pain (pain on the outside of the knee)
- Achilles tendinopathy (once called Achilles tendinitis)
Fortunately, I see each of these conditions on a nearly daily basis. So I've seen a few patterns, and am going to share a few strategies that are effective for all five. And remember the spoiler at the start? Let's start there with calf and quad strength.
Strengthen your calf and quad (reconciling load and capacity)
Back in 2012, a guy named Tim Dorn and his colleagues studied how much force was produced by different leg muscles when running. At a jog, the soleus muscle (deep in the calf) topped the list, with about 6.7 times bodyweight of force. The vasti muscles – making up the quads at the front of your thigh – were next, producing roughly 4.7 times bodyweight. Across all speeds, forces increased, but the trend for calf and quads to do the lion's share of work continued (sprinting being a slightly different kettle of fish) (Dorn et al., 2012).
Now, if I told you to go find a barbell in the gym, and load it up with 6.7 times your bodyweight, or jump on a knee extension machine and load it up with five times your bodyweight, I can tell you now you're not going to be able to move that weight with one leg.
When we look at what loads these muscles are exposed to when we run, the load is being attenuated not just by muscle, but by bones, tendons, ligaments and fascia. The more strength we have in our muscles, the more they are able to resist the strain associated with hitting the ground repetitively when we run.
It's not surprising, then, that our top five injuries occur in places so closely associated with the function of our calves and quads. Calves directly influence the load on our Achilles, plantar fascia and shins. And our quads hugely influence the loads at our knees. It makes sense a lack of strength in these muscles might lead to overload at our five injury locations.
Now obviously, reducing five injuries to the strength in two muscles is overly simplistic. There are far more nuanced factors contributing to these injuries beyond strength, but get your calves and quads stronger, and you'll go a long way to preventing the top five.
So how do we get them stronger?
First, let's come back to running. The quads and calves cop loads of roughly four and six times bodyweight. You're turning over 150–200 steps per minute, with ground contact of about a fifth of a second each step. Our end goal is big contractions, done quickly. We get there by building strong, resilient muscle, tendon, fascia and bone - so they can handle the hits without breaking down.
When we work on building strong calves and quads, we have an opportunity to double-dip and optimise adaptations in tendon, fascia and bone too. So we need to figure out parameters that are good for everything, not just muscle. Muscle will respond favourably if we bring it close enough to exhaustion. Tendon will respond favourably to loads heavy enough to create some strain in the tissue (Bohm et al., 2015). Bone also needs heavy load, and will only respond to a critical number of loading cycles before it stops responding (Warden et al., 2021).
So, we want to lift heavy things in not too many, and not too few, reps to come close to exhaustion with each set. For the calf and quad, and the bones and tendons to which they attach, weights that bring us within 1–2 reps of exhaustion in 4–8 reps, repeated for 3–4 sets, and across enough range that the muscle and tendon undergo some degree of stretch, is a good starting point.
Now, everyone's starting point is different. Yours might be a bodyweight calf raise and then you need to work your way up from there. There are steps between heavy, slow resistance, and the rapid contractions of running. And so, eventually, we layer in movements that mimic running more closely – think bouncy, more explosive work. But start with strength: one calf raise or knee extension at a time.
Training load management
It is widely accepted that the development of our top five running injuries often starts when we run further, faster, more frequently, and over hillier terrain than our body is able to recover from and adapt to. Volume, intensity, frequency and terrain are all key variables that you should be paying attention to, and how they change across your training cycle (Johnston et al., 2019; Gabbett, 2018).
For example, take a runner with weak quads and calves. He's been doing all his runs on a flat loop close to home. But then he decides to venture out to the mountains one weekend for a change of scenery, and complete a run where he climbed and dropped 500m of vertical across the run. For the same speed, the load on the quads and patellofemoral joint is a lot greater running down a hill than it is on the flat. And the strain on the Achilles is a lot greater running up a hill than it is on the flat.
The run is completed without issue, but then five days later, back running on the flat, our runner's Achilles and knee both start hurting.
When we increase or decrease any of these variables too quickly, especially in the presence of low capacity, we increase the likelihood of developing an injury. Richard Johnston was one of the first to research this in an endurance athlete population. His group found that, in general, the risk of injury increased the more rapidly you progressed in any of these variables, and that usually the development of the injury lagged a week or two after the overload (Johnston et al., 2019). And if you've had a particular injury before? The threshold for overshooting and reinjuring is even lower.
Is there a sweet spot where you can increase or decrease your training just enough to prevent injury? Maybe, maybe not - we don't have clear evidence for it in runners. In cricket, soccer and rugby players, keeping recent weekly training loads within 10–20% of the long-term average seemed to work (Gabbett, 2018). But it also seems to depend on what the usual training load is. Those with smaller chronic loads (e.g., 20–30 km/week) might have greater capacity to safely increase, while those with larger loads (e.g., 70–80 km/week) might already be close to their ceiling.
If you're going to progress your training over time, a sensible approach is to progress one variable (volume, intensity, frequency, elevation) at a time, not everything all at once. And then every 4–5 weeks, drop the overall training load for a week as a safety measure, to better facilitate the adaptation to the stress you put on your body with all that running.
And perhaps most importantly, remember this: your body doesn't neatly silo and separate the stress you put on it. Whether that's with running, the calf and quad strength work you've just started, or the increased work hours you've been putting in recently. There is always a subtle art to giving a little, and taking a little. Increasing your training volume when life stress is high isn't the smartest move. Nor is adding more miles when you've just started doing strength training. One thing at a time, a little at a time.
Should I be changing my shoes or technique to prevent injury?
Many runners assume better running shoes or perfect technique are pivotal to prevention. Yet the evidence for shoes and technique as preventive tools is limited. It doesn't mean they can't help in prevention, but their potential reward is probably more of a gamble than getting stronger and managing your loads.
And the reason it's a gamble for prevention is that technique and shoe changes occur in a closed system. That is, if we change something at one spot, we merely shift load and stress somewhere else in the body. The success of such a measure is dependent on having the requisite capacity to handle such a change. A great example is the heel striker and the forefoot striker: forefoot strikers tend to do more work at the ankle (oh hey there, soleus!), while rearfoot strikers tend to do more work at the knee (Stearne et al., 2014). And when it comes to shoes? Moving to a zero-drop shoe can decrease the load at the knee, but increases the load at the calf and Achilles (Liu et al., 2025). Conversely, using a higher-drop shoe (or a small heel lift) can reduce calf and Achilles load, but add load to the knee (Farris et al., 2012). So, shoes and technique should absolutely be considered, but be sure you can handle such changes.
Final words
I'm going to direct you back to the spoiler at the start – if you're serious about preventing injury, you can't go wrong getting strong and being sensible about how you progress your training load. Get those right, and you're well on your way to injury prevention as a runner.
A man doing Bulgarian split squat with kettlebells to build lower body strength and stability and prevent running injuries
Disclaimer
The information provided in this article is of a general nature only and is not intended to replace professional medical, health, or fitness advice. It does not take into account your individual objectives, physical condition, medical history, or needs. Before acting on any of the guidance or recommendations provided, you should consider whether it is appropriate for you in light of your personal circumstances. You should always seek the advice of a qualified healthcare professional (such as a physiotherapist, podiatrist, dietitian, or medical doctor) before starting, changing, or relying on any exercise, training, or nutrition program. Rebel Sport accepts no liability for any loss, injury, or damage suffered by any person relying on the information provided.
References
- Kakouris, N., Yener, N. and Fong, D.T.P. (2021). A systematic review of running-related musculoskeletal injuries in runners. Journal of Sport and Health Science, [online] 10(5). doi: https://doi.org/10.1016/j.jshs.2021.04.001
- Dorn, T.W., Schache, A.G. and Pandy, M.G. (2012). Muscular strategy shift in human running: dependence of running speed on hip and ankle muscle performance. Journal of Experimental Biology, 215(13), pp.2347–2347. doi: https://doi.org/10.1242/jeb.075051
- Bohm, S., Mersmann, F. and Arampatzis, A. (2015). Human tendon adaptation in response to mechanical loading: a systematic review and meta-analysis of exercise intervention studies on healthy adults. Sports Medicine - Open, 1(1). doi: https://doi.org/10.1186/s40798-015-0009-9
- Warden, S.J., Edwards, W.B. and Willy, R.W. (2021). Preventing Bone Stress Injuries in Runners with Optimal Workload. Current Osteoporosis Reports, 19(3). doi: https://doi.org/10.1007/s11914-021-00666-y
- Johnston, R., Cahalan, R., Bonnett, L., Maguire, M., Nevill, A., Glasgow, P., O’Sullivan, K. and Comyns, T. (2019). Training Load and Baseline Characteristics Associated With New Injury/Pain Within an Endurance Sporting Population: A Prospective Study. International Journal of Sports Physiology and Performance, 14(5), pp.590–597. doi: https://doi.org/10.1123/ijspp.2018-0644
- Gabbett, T.J. (2018). Debunking the myths about training load, injury and performance: empirical evidence, hot topics and recommendations for practitioners. British Journal of Sports Medicine, 54(1), p.bjsports-2018-099784. doi: https://doi.org/10.1136/bjsports-2018-099784
- Stearne, S.M., Alderson, J.A., Green, B.A., Donnelly, C.J. and Rubenson, J. (2014). Joint kinetics in rearfoot versus forefoot running: implications of switching technique. Medicine and Science in Sports and Exercise, [online] 46(8), pp.1578–1587. doi: https://doi.org/10.1249/MSS.0000000000000254
- Liu, Z., Zhou, Y., Liu, H., Cheng, P., Zheng, Z. and Zeng, Q. (2025). Immediate and long-term effects of zero-drop running shoes on lower extremity biomechanics. Frontiers in Bioengineering and Biotechnology, 13. doi: https://doi.org/10.3389/fbioe.2025.1462159
- Farris, D.J., Buckeridge, E., Trewartha, G. and McGuigan, M.P. (2012). The Effects of Orthotic Heel Lifts on Achilles Tendon Force and Strain During Running. Journal of Applied Biomechanics, 28(5), pp.511–519. doi: https://doi.org/10.1123/jab.28.5.511
