Runner’s Guide Part 3: Tips to prevent injuries

By Kaci Cruthis 

Running is generally considered something that just happens naturally.  However, there is a lot that happens from head to the toe during one cycle of running.  Therefore, there is a lot of room for mechanical error.  Most routine runners have had at least one running-related injury that they either had to take a break from running or just run through the pain.  Below, I am going to provide some tips on how to prevent injuries.  

Running consists of loading and then exploding muscles.  Therefore, muscle strength and range of motion is very important. 

Here are some of the main motions and muscles that you want to be flexible and/or have enough motion:

Hip Flexion: this muscle helps pull your hip forward.  If this is tight, then it will be difficult to pull your leg back far enough for the power of push-off.

Hip Rotation: You need around 40-45 degrees of rotation inward and rotation outward.  If the rotation inward is limited, the motion will come from your low back or the joint connecting your pelvis to your sacral portion of the spine.

Calf the flexibility of this muscle is needed for foot clearance.

Ankle Inversion and Eversion (rotation of the ankle inward and outward): you need a 2:1 ratio for proper shock absorption and push-off.

Great toe extension passive motion: You should be able to pull your big toe up at least 100 degrees to assist with push-off.

Toe Intrinsics: these muscles assist with arch support/lift with push-off.  In order to find these muscles, try to squeeze your toes together.  Your arch you lift up in response. 

You should consider stretching these muscles before running.  However, it is preferred that a short warm-up of 5-10 minutes of walking or light jogging be performed before stretching because it is not good to stretch “cold muscles”.

You should stretch approximately 10 minutes for each decade of life. For example, a 35-year-old person should stretch for a total of 30 minutes per day.   

Just like other sports, runners need to practice and cross-train to refine their form.  You need to get in shape to run rather than run to get in shape.  

Running on a downhill incline increases the load on the patellofemoral joint by 50%, which means you may be more likely to have knee pain.

Excessive running in the same direction on the track and downhill running can cause IT band syndrome because you are pushing off of the same foot when turning the corner.

Running on the side of the road, where there is a slant, can lead to low back, SI, hip, knee, or ankle problems due to a functional leg length discrepancy.

Although these environments and surfaces can affect your running, it is more important to focus on form than surface of running. It is not the impact itself that matters but how the body handles the impact.

If you have had pain or currently have pain with running, here are some common running-related injuries and ways you can correct your running form to help alleviate the pain. 

Problem: Outside Leg (IT Band, Hip Bursa, Outside Hamstring) or Knee Pain

Causes: narrow foot placement, hip/pelvic drops on the opposite side of stance leg, or too much hip rotation inward

Cues: Wider foot placement, increase cadence/decrease step length, incline training to shorten stride, increase forward lean


Problem: low back or sciatic nerve

Causes: hip drop and/or pelvic rotation, decreased cadence/stride too long, decreased backward hip motion before push-off, asymmetric arm swing

Cues: symmetric arm swing, contract abdominals, increase cadence/decrease stride length


Problem: hamstring, sciatic nerve or inferior knee pain

Causes: excessive distance in front of you for foot strike, excessive backward motion with push-off, insufficient knee bend during the swing, lack of knee extension through the terminal swing

Cues: improve push-off by activating glutes, increase knee flexion with push-off, increase cadence


Problem: knee joint pain

Causes: too much hip rotation inward during stance, excessive outward lower leg rotation, side bend of the trunk, slow cadence/increased step length/long stance time

Cues: increase cadence/decrease step length, incline training, forward trunk lean, decrease foot turning out during swing or stance, and contract gluts/buttock muscle during stance

Problem: patellar tendon (tendon below the kneecap), low back or hip pain

Causes: knee bending less than 25 degrees during weight acceptance, rearfoot strike pattern, slow cadence/increased step length/long stance time, upright running posture

Cues: increase cadence/decrease step length, incline training to shorten stride, soften the landing


Problem: shin splints

Causes: loud/hard heel strike, slow cadence/increased step length, upright running posture, increased vertical displacement, decreased control of knee straightening during last phase of the swing

Cues: increase cadence/decrease step length, forward trunk lean, incline training, increase hip and knee bend, softer landing


Problem: Achille’s tendon, calf pain, midfoot pain

Causes: decreased foot/ground angle, poor control of lowering the foot to the ground at the ankle, forward trunk lean

Cues: Decrease cadence/lengthen step length, encourage mid-foot strike and gradually progress to forefoot landing as tolerated, decrease forward trunk lean


Problem: inner ankle/foot, plantar fascia (heel or arch pain), great toe pain

Causes: excessive flattening of the arch on loading, bringing hip to close to the midline, too much hip inward rotation during stance

Cues: shorten stride/increase cadence, increase loading at middle/outer foot



Problem: Base of 5th outer foot (above the half of the length of the foot), outer ankle pain, heel pain

Causes: too much loading on the outside of the foot and not enough loading on the inside of the foot, more outer knee stress due to too much weight on the outside of the foot.

Cues: softer landing, shift pressure toward the inside of the foot, slightly widen stance

I hope all of this information has provided you a better understanding of how form, pace, shoes, muscle strength, and muscle length, can affect your running!  If not, discuss with your doctor if therapy would be a good option for you and make an appointment with me at the Hillsboro or Litchfield Clinic! 

Hillsboro Area Hospital Teamwork Rehab: 217-532-4160 or 217-324-6601

Happy running!

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