Overuse Injury Prevention and Recovery for Running Athletes

Overuse Injury Prevention and Recovery for Running Athletes


Overuse injuries are common in recreational and elite running athletes training for endurance events. 

Overuse injuries take two forms, which often overlap.  The first is simple overuse where an athlete has increased their training or has a sudden change in training to a level that has over stressed the tissue.  Treatment is to identify the stressful event(s); decrease the inflammation and provide rest to the injured area.

The more common overuse injury is when the painful injured tissue can no longer handle the demands placed upon it.  This requires a more in depth assessment to determine what the causes of the injury are.  Quite commonly the injured area is the ‘victim’of stiffness, lack of mobility and/or control while another place in the body is actually the ‘culprit’.  For example, if a runner is complaining of knee pain (the victim), ‘the culprit’might be a lack of hip mobility and strength which has put extra stress on the knee.   All the intrinsic and extrinsic factors need to be examined.

Intrinsic Factors Extrinsic Factors
Biomechanical exam of joint mobility Training Methods
Bony structure: Spine and limbs Shoes, Orthotics
Ligament stability  
Muscles Activation /Strength  
Body Awareness / Balance  
Posture, Running Style  

Ideas for injury Prevention and Recovery:


Proper warm-up:

A dynamic warm-up.  Gradually increasing the pace and intensity of the warm up is important, especially with higher intensity exercise.  Static stretching before activity has been shown to be detrimental to performance.  There is also evidence that activities such as strength and balance exercises incorporated into a workout can prevent injuries.


Active recovery:

An active recovery or cool down is very important after hard workouts to help flush out lactic acid.  It should consist of 15-20 minutes of gentle movement.

Differentiate muscles soreness from injury soreness:

Delayed onset muscle soreness is common a day or two after a strenuous session.  There is no harm done in continuing to exercise.  Joint soreness is an indication that the joint itself has been stressed and requires more rest.  Signs would include swelling or a ‘puffy’joint and tenderness.  If body parts continue to ache or are painful longer than 1-2 weeks they should be assessed.

Correct training 

A gradual increase in training is necessary.  A 10% increase seems to be a good rule of thumb.  Remember that while it is important to gradually increase training volume and intensity, adequate recovery allows the body to build up stronger.  High intensity training requires around 36-48 hours of recovery before another high intensity session should be undertaken.  A good guideline is, the higher the intensity of the session is, the longer that recovery should be.  Knowing your body is key for any athlete, i.e. knowing when to push and when to rest.


A stride rate 180-200 strides per minute for runners has been shown to reduce injuries as there is less impact per stride.  Simply count the number of steps (each time one foot touches the ground) over 10 seconds aim for 15-16 steps.


Runners should consider a soft landing (mid foot/forefoot strike), with a slight lean forward at the ankle, while keeping a tall chest.   A running gait assessment which involves running while being videotaped for analysis by the Pedorthotists at Okaped can be very useful.  Other running coaches can be used for ongoing technique correction.


An in-depth review of modern footwear is beyond the scope of this article.  It is best to visit a local shop like Fresh Air Experience who have trained staff to help you determine the best running shoe style for your foot type.  Orthotics can be very helpful, either custom or over the counter.  Again, these are best recommended by professionals such as Okaped.  If Orthotics are being considered, foot taping , which simulates an orthotic, can be very helpful to to determine if orthotics will help.

Strong core:

A strong stable core i.e. abdominal, back and hip muscles, provide a good base to stabilize, propel and transfer energy.  This allows an athlete to maintain good form and technique even when fatigued.

Adequate flexibility:

Adequate flexibility is necessary for the demands placed on the individual i.e. hip mobility for runners.  This is probably more important as we age.  Static stretching should not be performed prior to a work out,.  Dynamic movements and a good warm up are better.   Static stretching prior to a work out has been shown to be detrimental to performance.  Static stretching (20-30 second hold) should be performed only after a workout.

Strength training:

Correct strength training has been shown to help prevent injuries in sport.  You can also consider eccentric strength training as this has been shown to improve flexibility and strength in certain muscles groups.

Old injuries:

Deal with old injuries in the off-season that lingered during or after your competitive season.  With an increased training load they will most likely reappear.

Adequate sleep:

There is some research that ongoing sleep deprivation, longer than 1-2 nights, interferes with our hormonal balance that regulates recovery.

Nutrition replacement:

A great resource is the coach.ca website.  It has a sport nutrition section. Eating properly is important on a routine basis and a post workout combination of carbohydrates and protein is critical for recovery. 


Compression socks have become quite popular with some claims of improved athletic performance.  Scientific evidence suggests that they can assist with post-exercise lactate acid clearance and decreasing swelling.

Cold baths:

Cold baths have become popular and are theorized to reduce the inflammation that has occurred with a strenuous workout. Cold water may help recovery and can be used for around 10 minutes. It is not necessary to have an ice bath.  Cold water of 24°Celsius is okay.  Contrast baths of cold and warm water may also be beneficial though not very practical.  This involves a 1 minute cold (10-15°celsius) then 1 minute warm  (37-40°celsius) for 7 cycles.  Anecdotally submerging the legs into the lake post run can also be of benefit.  None of these cold baths are enjoyable and take a lot of mental toughness!

Biomechanical evaluation:

Have a physiotherapy assessment, either to deal with nagging injuries or prevent an overuse injury from occurring.  The Kelowna Manual Therapy physiotherapist will examine the above mentioned extrinsic and intrinsic factors (Table 1), and work with you to help establish a treatment plan.

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