Overuse Injuries: Why Runners Keep Getting Hurt (and How to Break the Cycle)
Running through pain: I’ve done it, you might have done it, and your friends are probably doing it right now. When I first entered the running community, I was shocked at how many runners were either sidelined (after attempting to run with an injury for months) or currently running through pain, clinging to their training like a lifeline. I remember thinking to myself, I will be the anomaly – I just need to strength train, recover hard, and listen to my body. Easy enough, right?
But with around 50% of runners experiencing an injury each year, it’s clearly not as straightforward as we’d hope.
The Cost of Overuse Injuries
Pain is the body’s way of signaling a problem, yet overuse injuries remain rampant in the running world. These injuries don’t just disrupt training; they lead to reduced neuromuscular coordination, muscle imbalances, and loss of running economy. And what does all that mumbo jumbo mean? Simply put: overuse injuries can make you slower, weaker, and less efficient. By pushing through pain without making adjustments, runners aren’t toughing it out - they’re actively working against their own progress.
Factors that Put Runners at Risk for Injuries
Let’s take a step back - an overuse injury isn’t something to criticize yourself for. These injuries don’t just happen by chance; they typically have layered and complex causes in the running world. The key here isn’t self-blame, but awareness. The more we understand the personal and environmental factors that put us at risk, the better equipped we are to prevent setbacks, make smarter training choices, and keep running for the long haul.
Consider the list below. The more aspects that resonate with you, the more intentional you should be about injury prevention.
High Pain Tolerance – Some runners have a naturally high pain threshold from genetics, past experiences, or years of training. Grit is an essential part of being a runner, but if your pain tolerance is so high that you’d run a marathon on a broken foot and call it “a bit stiff”, we’ve got a problem!
If this sounds like you, using the typical 1-10 pain scale is probably pointless. Instead, ask yourself: Am I limping or overcompensating? Does the pain worsen as I run more? How long have I been experiencing this discomfort? Is it worse at night? Am I feeling unusually fatigued or irritable? If you continue to struggle to assess pain, consulting an expert can help you differentiate between normal discomfort and real injury.
Race Plans & Goals – Pre-set race dates and goals can create pressure, making it tempting to push through pain just to make it to the start line.
I’m not saying you need to ditch structure and fully embrace a go-with-the-flow approach, but it’s important to keep perspective throughout your training. Avoid making injury-related decisions solely based on your race schedule. Instead of forcing your body to meet an arbitrary timeline, meet it where it is. This mindset doesn’t just reduce the risk of setbacks; it will ultimately lead to better long-term performance. Everyone’s journey to the start line looks different - embrace yours.
Fear of Losing Fitness – Many runners push through pain out of fear that rest equals regression. While V02max can decline with inactivity, it rebounds relatively quickly with structured training once a runner resumes consistent workouts.
If you struggle with rest, consider cross-training activities as a fallback when needed. If full rest or a reduction of training is needed, trust that you’ll regain fitness once you’re healthy enough to do so, rather than running at partial capacity with an injury.
Identity & Self-Worth – For many, running is more than a sport; it’s a coping mechanism, social outlet, and key part of their identity. Taking a break can feel like losing a part of oneself.
Find your reason: If this resonates with you, take time to reflect on what running provides - whether it’s community, stress relief, or a sense of accomplishment. Then, explore other ways to meet those needs, such as non-sport hobbies or low-impact activities like cycling or yoga. Diversifying your sources of joy and fulfillment prevents you from relying solely on running for your self-care and achievement. This approach fosters a healthier, more balanced connection to the sport, easing attachment and allowing you to adapt more smoothly when change inevitably happens.
Embrace the ebbs and flows: Running isn’t a linear journey, and it’s easy to resist when things don’t go as planned. However, the more we resist the, the longer things tend to persist. Embracing both the highs and lows of running can help you navigate the downs with more resilience and perspective.
External Pressure – Social media, coaches, teammates, and sponsors can unintentionally create pressure to push through pain.
If you find yourself easily influenced by others, reconnect with your own intuition. Be vocal with your coach or teammates about your needs, and establish boundaries with comparison-driven content or people. Focus on goals that reflect your personal aspirations for growth, not other’s. Practice celebrating others’ achievements while remaining mindful to not to compare them to your own.
Lack of Knowledge – Many runners don’t fully understand how nutrition, strength training, and cross-training affect injury prevention. And honestly, it’s no surprise - there’s an overwhelming amount of information out there, often full of conflicting advice.
If you’re in this boat, focus on starting simple. If you’re unsure where to start, a few sessions with a dietician or strength coach can provide long-term guidance.
R.E.A.C.T.: A Simple Guide to Preventing Overuse Injuries
To help manage overuse injuries, I use a simple framework: R.E.A.C.T. – Rest, Evaluate, Assess, Change, Train.
R – Rest at the First Sign of a Tweak
Pain with walking or worsening with running? Take 1-3 days off and consider cross-training.
Mild discomfort? Reduce mileage and intensity while monitoring symptoms, avoiding movements that aggravate the pain such as downhill running, speedwork, and/or long runs.
E – Evaluate if Rest Helped
If pain persists after a week, consult a professional such as a physiotherapist, chiropractor, or sports doctor. Delaying treatment often prolongs recovery.
A – Assess Contributing Factors
Training load: A significant mileage or stress increase can elevate injury risk. Factor in all stressors in your training and life - elevation, intensity, work, mental health, sleep, etc.
Warm-Ups: A 5-10-minute warm-up, including mobility and glute activation, reduces injury risk. If you’re short on time, trim five minutes off your run instead - it’s better to sacrifice a bit of your run than to skip this vital injury prevention step.
Strength Training: Runners who strength train at least once per week are more physically resilient, and as a result, have fewer injuries. Keep the exercises simple and enjoyable, and time limited to 20-60 minutes.
Nutrition: Poor fueling can contribute to issues like low energy availability, which weakens bones and muscles. Prioritize carbs before and during runs, a mix of protein and carbs post-run, and whole foods throughout the day.
Shoes: Most running shoes last 500-800km. Worn-out shoes can increase the risk of injury, so watch for signs that it’s time for a new pair: sore arches or calves, worn-out soles, or structural damage.
C – Change & Test Modifications
Implement and monitor these changes in your training. Keeping a journal or checking in with a coach or friend can help you track your progress, notice how your body responds, and identify what’s working - or what needs further adjustment.
Reduce volume and intensity as needed.
Improve or incorporate warm-ups and strength training.
Replace shoes if necessary.
Optimize nutrition for recovery.
Adjust training based on overall stress levels.
T – Train Weaknesses with Strength & Mobility
Physiotherapy, much like mental health therapy, extends beyond the clinic. Daily rehab and injury-prevention exercises can significantly reduce future setbacks.
Avoid an all-or-nothing mindset. Find a trusted provider and work with them to tailor their recommendations to fit your unique lifestyle. If you can’t commit to all 6 exercises suggested, start with 1-3 instead. Begin with a couple days a week and gradually increase from there. Anything is better than nothing, and consistency is key to progress.
Final Thoughts
As we’ve discussed, overuse injuries aren’t just a stroke of bad luck – they’re often the result of small choices adding up over time. The good news? You’re in control. By listening to pain early, making thoughtful adjustments, and applying the R.E.A.C.T. method, you can train smarter, stay healthier, and enjoy running for years to come.
So the next time your body whispers (or shouts) at you, don’t ignore it. Your future self will thank you - and yes, as I write this, I’m reminding myself too!
