Checklist for Running Overuse Injuries (By Elizabeth Quinn, Guide)

The most common causes of running overuse injuries and treatment options

Runners often wind up with injuries without any obvious traumatic event to cause an injury. Most of these are the result of a wide variety of factors that over time lead to chronic problems. These are often termed overuse injuries. Following is a checklist of the most common causes of running injuries and possible treatment options.

Too Much, Too Soon

  • Increasing running mileage or time too quickly is the leading cause of running injuries in recreational runners. Use the 10 percent rule (increase mileage by no more than 10 percent per week) to help prevent overuse injuries while allowing the body to adapt to training levels. Read more in Spring Training Tips.
  • Some runners just overtrain. Too much mileage is likely to lead to injury in those not able to tolerate running at an extreme level. Cutting down on total running mileage and cross-training by cycling or swimming will help overcome this problem without compromising on fitness levels. Also see: Preventing Overtraining – When Less Is More.
  • Not allowing enough rest and recovery time between runs may also contribute to injuries. It is during the rest phase after exercise that our muscles get stronger. Not allowing this rest leads to continual breakdown. It is critical to alternate rest with exercise to perform well.

Running Route or Surface

  • Hard surfaces increase the amount of stress on the muscles and joints and increases risk of chronic tissue trauma.
  • Soft surfaces (like sand) may cause the heel to sink and your foot to slide on push-off, leading to Achilles tendon overuse (Achilles tendonitis.)
  • Consistently running on one side of a road may cause injuries due to the road camber. The average road slants about 7 to 9 degrees so the result is that you are running on a slanted surface where one leg is hitting the ground at a higher level than the other. This may lead to a variety of biomechanical problems.
  • Uphill running can stress the Achilles tendon and the muscles in front of the leg (tibialis anterior) that lift the foot and toes. Running uphill may be particularly difficult for people with tight calves and Achilles tendons.
  • Downhill running places additional stress on the knees, which may result in pain developing in front or on the outer side of the knee.


  • Shoes are the most important piece of equipment for runners.
  • Buy a shoe that matches your foot type and weight. Flat-footed runners who (and pronators) should buy stability shoes with support. Those with high arches (or supinators) and heavy runners should look for good cushioning and arch support.
  • It is recommended that you replace running shoes between 350-550 miles depending on your running style, body weight, and the surface on which you run. Read more about: When to Replace Running Shoes.

Body Weight

  • The heavier the runner, the more stress on the load-bearing tissues of the lower body. If you are overweight, losing excess body fat makes running much less stressful and results in fewer overuse injuries.

Running Technique

  • Every runner has a unique running style and some styles can lead to overuse injuries. Because running tends to use the hamstrings to a large degree, strengthening the quadriceps is useful for most runners.
  • A normal foot strike lands flat or on the outer-back portion of the heel and then rolls onto the sole and ends with the push-off from the ball of the foot.
  • A heavy heel-strike can lead to excessive traumatic forces and actually slow you down.
  • Landing hard on the midfoot or ball of the foot places more stress on the Achilles tendon (which will contract to counterbalance the force of the strike). This is seen often in sprinters. For these runners, stretching the calves and Achilles regularly is recommended to reduce injuries.

Biomechanical Issues

  • Orthotics and heel lifts can correct many biomechanical and alignments issues of the leg. Read more about how Orthotics can help biomechanical alignment problems.

Muscle Weakness / Imbalance

  • Lower-extremity and core strength training should be added to routine training for runners.
  • Runners should perform strength training for the following muscle groups:
    • Quadriceps, hamstrings, hips (squats, dead lifts, and lunges)
    • Calves (heel raises)
    • Shoulders (shoulder shrugs)
    • Upper back (dumbbell rows)
    • Chest (push-ups)
    • Biceps (curls)
    • Triceps (triceps kickbacks)
    • Lower back (extension: lie on stomach and lift feet and arms off ground)
    • The Best and Worst Core and Ab Exercises

You can’t always avoid or prevent every injury, but runners who follow some basic guidelines can reduce the likelihood of developing chronic nagging aches and pains.