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Born to run or cursed to hurt?

Updated: Apr 4, 2021

Does anyone else feel like running is an oddly controversial topic? Ask ten people and get ten different opinions on running. Some believe it is bad for you, some believe only a select few can do it injury free, some believe everyone can and should do it and we are ‘Born to Run’; ask ten medical professionals and you will get a similar range or responses. Shoes: motion control, neutral, zero drop, none? How about mileage, intensity, weight training, weight training before or after or different day?

People can get awfully bogged down in the what ifs regarding running. So we are here to illuminate some facts about running and offer some helpful suggestions to help you run pain free and with joy.

The first step in solving a problem is identifying it, so today we see what the research says are the commonest injuries affecting runners.

A 2012 research database search pooled the evidence including 3500 runners, with separate analysis for ultra-runners. All of the commonest injuries were in the legs and 80% of injuries were considered overuse injuries.

Enter the weeds...

The main general running related musculoskeletal injuries were:

- Medial tibial stress syndrome-essentially shin splints- (incidence ranging from 13.6-20% and prevalence of 9.5%*)

-Achilles tendinopathy (incidence 9.1-10.9%, prevalence 6.2-9.5%)

-Plantar fasciitis (incidence 4.5-10%, prevalence 5.2-17.5%).

In ultra-runners; Achilles tendinopathy (prevalence 2.0-18.5%) and patellofemoral syndrome (prevalence 7.4-15.6%) were the highest injury rates.

-Also mentioned are lower extremity tendinopathies in general, including those mentioned above as well as patellar and hamstring tendinopathies.


A 2017 review found similar results. First off, stating that up to 50% of regular runners report having more than one injury each year. Most injuries due to overuse. Their list of most frequent injuries are:

-Patellofemoral pain syndrome, tibial stress syndrome (shin splints), Achilles tendinopathy, iliotibial band friction syndrome (IT Bane syndrome or “Runner’s knee”), plantar fasciitis, and stress fractures of the metatarsals and tibia. The knee is the most injuries joint at all distances. Hamstring injuries are the one common running injury that happens in an acute fashion.

Most specific to long distance and marathon runners is that the foot and ankle is the most common area of injury. Excess body weight and number of kilometers run per week are high risk factors but other factors such as shoes, stretching, and biomechanics were not clear to those authors. They recommend a detailed physical examination for identification and correction of injuries. (2)

Hopefully, you recognize that running does not have to lead to injury… Let us repeat, “You can run without pain and without injuries”. So in the following article we will explore more risk factors and what has been shown to decrease the risk of the injuries above.

* Incidence: the number or proportion of people who develop a condition during a particular time period; new cases that occurred during a given time period.

*Prevalence: the number or proportion of people who have a condition at or during a particular time period; all cases present during a given time period.

1) Lopes AD, Hespanhol Júnior LC, Yeung SS, Costa LO. What are the main running-related musculoskeletal injuries? A Systematic Review. Sports Med. 2012 Oct 1;42(10):891-905. doi: 10.1007/BF03262301. PMID: 22827721; PMCID: PMC4269925.

2) Tschopp M, Brunner F. Erkrankungen und Überlastungsschäden an der unteren Extremität bei Langstreckenläufern [Diseases and overuse injuries of the lower extremities in long distance runners]. Z Rheumatol. 2017 Jun;76(5):443-450. German. doi: 10.1007/s00393-017-0276-6. PMID: 28236094.

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