Running-related injuries (RRIs) often have multiple factors. They can be divided into individual running/training and health and/or lifestyle factors . The key to developing a comprehensive care plan for any runner is to systematically examine all factors that can affect running involve. This will ensure that you address not only the root of the symptoms, but the cause.
Types of Runners
Understanding the type of runner is important to developing an ideal customized care plan. Runners can be categorized based on their running distance experience and running goals. Different types of runners are prone to injury, depending on their duration, intensity and frequency.
A recent narrative review (2020) suggests that
Injury risk may be greater for those who have recently started running, those with a sudden increase in training load or intensity, and those who train over longer distances because of the higher running volume required to prepare for a race ( p.9-10) .
A systematic review and meta-analysis study (2015) provided the following definitions for different runner populations  (p.1145).
Athletics: Sprinter – A track and field athlete who competes in a race up to 400 meters
Athletics: middle-distance runner—a track and field athlete who competes in distances between 800 and 3,000 meters
Athletics: long-distance runner—a track and field athlete who competes in a 5,000-meter or 10,000-meter race
Novice runners – runners who have had no regular running experience within the previous year
Recreational runners – non-competitive runners or runners participating in road races shorter than 10km
Cross-country runners—runners who participate in cross-country races
On the Road: Distance Runners – Runners who run 10K and less marathons
marathon runner – a runner who takes part in a marathon
ultramarathon runner – a runner who competes in a race longer than a marathon
Factors Affecting Running-Related Injuries (RRIs)
The main risk factors for running-related injuries are  repetitive microtrauma and overloading of the musculoskeletal structure due to biomechanical factors.
There are various classifications of factors that affect running injuries; the most common are:
- Modifiable or Non-modifiable factors
- Extrinsic or Intrinsic factor
- Physiological Factors (V02 Maximal Lactate Threshold and Running Economy) : Modifiable Intrinsic
- Gender/Sex: Unmodifiable inner
- Biomechanics : partly modifiable intrinsic
- Footwear/Orthotics : modifiable exterior
- Environment (running surface; ground treadmill weather) : partially modifiable exterior
- Training variables (mileage): modifiable external variables
- Nutrition: Modifiable, extrinsic
Prevalence of RRI
The incidence of running injuries is most common in the knees, ankles, feet, and legs (in both male and female runners) .
Specific to body site and pathology Patellofemoral Pain Syndrome (PFPS) Achilles Tendinopathy (AT) and Medial Tibial Stress Syndrome (MTS) had the highest rates .
A systematic review (2015) showed that previous injury history and use of orthoses/inserts are risk factors for RRI .
The proportion of running injuries by sex anatomical location and specific pathology is provided below (Figures 1-4) .
Figure 1: Proportion of Running Injuries by Anatomical Site (%)
Figure 2: Proportion of Running Injuries by Anatomical Site (%) – Males
Figure 3: Proportion of Running Injuries by Anatomical Site (%) – Female
Figure 4: Proportion of top 10 injuries by specific pathology (%)
Inefficient running biomechanics play an important role in the onset and occurrence of running injuries . Poor movement patterns and running form in runners can compromise the body’s ability to absorb forces and put them at risk for overuse injuries .
Assessment of running biomechanics using 2D or 3D video on a treadmill has proven to be an accurate method for analyzing running style .
Rehabilitation of Running Injuries
Management of running injuries is multifaceted. A holistic approach is required to fully rehabilitate any sports injury. This approach should address all intrinsic and extrinsic factors that contributed to the injury. Physical rehabilitation includes the following basic components
- Pain Management
- Flexibility and Joint ROM
- Strength and Endurance
- Proprioception and Co-ordination
- Functional Rehabilitation
- Use of Orthotics
- Psychology of Injury
Create a care plan to address running biomechanics
Step 1 – Know Training and Injury History – (Subjective Exam)
A detailed initial interview with the patient is very important. A thorough medical history will allow you to fully appreciate the full extent of the problem and rule out any serious pathology.
When it comes to running injuries, there are many risk factors to investigate. Modifiable factors such as running distance, frequency, pace intervals, dietary hormonal issues or use of changing orthotic running surfaces, warm-up stretches, and physiological aspects should be asked about . Unmodifiable factors such as age, sex, height, injuries experienced, and general health were equally important to the survey . A systematic review in 2016 found that the greatest risk factor for developing a running injury was previous injury . incomplete Rehabilitation from previous injuries can lead to biomechanical breakdowns. This could be the cause of further overuse injuries.
Asking about the runner’s short- and long-term goals ensures that you and the runner are on the same page about your treatment plan and its progress.
Step 2 – Mobility and Motor Control Deficits – (Physical Examination)
A physical examination is important in any symptomatic patient to allow a comprehensive assessment of the entire body to enable accurate diagnosis and treatment. Postural joint range of motion neuromechanical sensitivity muscle strength are all important aspects to examine. It is important to evaluate a A runner’s mobility and motor control, as these factors may lead to biomechanical changes in their running style.
Movement screening involves the analysis of a series of basic functional movements with the goal of identifying any deficits in motor control or mobility. Functional Movement Screen is an example of a motion screening tool developed to identify movement patterns Flaws in trying and predicting future injuries. Although it is a reliable tool, its effectiveness in predicting future injuries has not been established . Instead of using screening tools to try and predict future injuries, you can use screening tools to assess patient mobility and motor control A defect that caused an existing injury.
You can perform an exercise screen before watching them run. This allows you to systematically examine the exact malfunction of action or motor control that is causing its symptoms. Basic movements such as toe-to-toe backbend, rotational single-leg balance and squat can be assessed, and then Each movement component was analyzed in more detail .
The video below shows some examples of the various motor screening tests
Blog Based on the Unilateral Hip Bridge Endurance Test
Step 3 – Analyse Running Form
The next step in determining the source and contributing factors of symptoms is to assess the status of the runner. Assessment of running biomechanics using a treadmill and 2-D video analysis is a reliable method for analyzing running kinematic patterns .
Having assessed their mobility and motor control deficits will help you determine why they have a particular running style, or whether their running style is causing problems with their mobility or motor control.
Some common running styles are as follows:
- The Overstrider
- The Collapser
- The Weaver
- The Bouncer
- The Glut Amnesiac
Step 4 – Develop a Comprehensive Care Plan – (Treatment/Intervention)
By conducting a thorough interview to take a medical history, a comprehensive physical examination to identify any mobility and motor control deficits, and a running gait analysis, you should be able to develop a comprehensive plan of care. this should fix Runner’s problems, holistic treatment to ensure long-term recovery.
The purpose of developing a care plan is to develop an individualized plan based on the runner’s specific findings. Each plan will look slightly different and take into account various aspects of a particular runner’s history and biomechanics.
In Ari Kaplan and Doug Adams Running Course  they present a 5-part treatment plan that addresses the following: mobility stability form training gait retraining and flexibility. Each runner’s focus on and within each zone will be different. The goal is to use your assessment to Focus therapy around addressing specific aspects of a runner’s unique issues.
A dynamic warm-up is the initial component of a training program. Incorporating dynamic stretching into any pre-activity warm-up is superior to static stretching, although the underlying physiology remains uncertain . Manual soft tissue release can also be used as part of the warm-up because it It has been shown to improve mobility without compromising muscle activity .
Both static stretching PNF and dynamic stretching have been shown to have a positive effect on joint range of motion . Static stretching and PNF may affect immediate performance and should not form part of the warm-up. recommended before starting At the end of a sport or activity .
There is no “standard” activity plan for runners, and the results of your evaluation will guide your prescription.
Addressing motor control and muscle strength impairments through exercise programs has been consistently shown to be effective in improving running economy and performance in middle-distance runners .
The therapist will identify any motor control or strength deficits during their evaluation and can develop an individual program that meets the runner’s needs.
Mobility and stability are important aspects to address when rehabilitating a runner. Examples of programs that address specific motor dysfunctions can be found here.
3. Form Drills
The goal of form training when a returning runner is to help improve motor learning and aid in gait retraining. Form training can help isolate specific components of running and facilitate changes in the way a runner moves.
There are many forms of training that can be incorporated into a plan of care, and this should be individualized to the specific needs of the runner.
Some examples of running workouts (see video below)
- High Knees,
- Butt-kicks (two variations),
- Straight-leg bounds
4. Gait Retraining
Gait retraining has been shown to be effective in addressing key biomechanical factors associated with running injuries, such as ground reaction force energy transfer at the knee and ankle and center-of-mass shift  ]. gait has good carry over retraining program, runners maintained variation even after a 1-month follow-up .
A major component of gait retraining is looking at cadence, or pace.
Running Speed = Step Rate x Step Length.
A great deal of research has been done around cadence and its effect on running biomechanics. No particular cadence has been proven ideal, but research has shown that even a slight increase in cadence while maintaining a constant pace can significantly improve running biomechanics . A 10% difference is enough to change the forces on the knee joint  without affecting running efficiency . Increased pace while maintaining a constant speed reduces stride vertical oscillations ground reaction force impact and lowers energy Absorption at the hip knee and ankle . All of these factors are key biomechanical contributors to lower extremity injuries in runners, such as tibial stress fractures and anterior knee pain.
It is important to note, however, that most research on gait retraining has been done in injury-free populations.
Try a gait retraining correction: 
Important Note: If you are inexperienced, caution should be exercised when altering a runner’s biomechanics, especially in high performance athletes .
- Increase cadence
- Encourage feet to drop below body
- Encourage softer landing
- Encourage shorter steps
- Use feedback (verbal/visual) to keep pelvis level
- Encourage knees to stay apart
- Increase Cadence
- Increase cadence 
- Encourage softer landing
- Encourage a broader support base
- Run in a straight line, making sure your feet are on either side of the line
The Glut amnesiac
- Encourages more trunk flexion while running (strengthening may be required first to achieve this)
Post-run flexibility may cover the same mobility barriers addressed in the initial dynamic warm-up. Both static stretching PNF and dynamic stretching have been shown to positively affect joint range of motion. In the post-workout scene, you can include a more static Stretch or PNF methods .
Running biomechanical rehabilitation is a complex process that requires a thorough assessment followed by a detailed individualized care plan based on the findings.
Patellofemoral Pain Retraining at SMA Symposium with Dr. Christian Barton
Richard Diaz’s Gait Workout for Runners
- ↑ Jump up to:1.0 1.1 1.2 1.3 Van der Worp MP, Ten Haaf DS, van Cingel R, de Wijer A, Nijhuis-van der Sanden MW, Staal JB. Injuries in runners; a systematic review on risk factors and sex differences. PloS one. 2015;10(2).
- ↑ Jump up to:2.0 2.1 Boullosa D, Esteve-Lanao J, Casado A, Peyré-Tartaruga LA, Gomes da Rosa R, Del Coso J. Factors Affecting Training and Physical Performance in Recreational Endurance Runners. Sports. 2020 Mar;8(3):35.
- ↑ Kluitenberg B, van Middelkoop M, Diercks R, van der Worp H. What are the differences in injury proportions between different populations of runners? A systematic review and meta-analysis. Sports medicine. 2015 Aug 1;45(8):1143-61.
- ↑ Shamsoddini A, Hollisaz MT. Biomechanics of running: A special reference to the comparisons of wearing boots and running shoes. Plos one. 2022 Jun 24;17(6):e0270496.
- ↑ Jump up to:5.0 5.1 5.2 5.3 Moore IS. Is there an economical running technique? A review of modifiable biomechanical factors affecting running economy. Sports Medicine. 2016 Jun 1;46(6):793-807.
- ↑ Jump up to:6.0 6.1 6.2 6.3 Francis P, Whatman C, Sheerin K, Hume P, Johnson MI. The proportion of lower limb running injuries by gender, anatomical location and specific pathology: a systematic review. Journal of sports science & medicine. 2019 Mar;18(1):21.
- ↑ Jump up to:7.0 7.1 7.2 Clermont CA, Phinyomark A, Osis ST, Ferber R. Classification of higher-and lower-mileage runners based on running kinematics. Journal of sport and health science. 2019 May 1;8(3):249-57.
- ↑ Jump up to:8.0 8.1 Sun X, Lam WK, Zhang X, Wang J, Fu W. Systematic Review of the Role of Footwear Constructions in Running Biomechanics: Implications for Running-Related Injury and Performance. Journal of Sports Science and Medicine. 2020 Mar 1;19(1):20-37.
- ↑ Vlahek P, Matijević V. Lower extremity injuries in novice runners: incidence, types, time patterns, sociodemographic and motivational risk factors in a prospective cohort study. Acta clinica Croatica. 2018 Mar;57(1):31.
- ↑ Lopes AD, Hespanhol LC, Yeung SS, Costa LO. What are the main running-related musculoskeletal injuries?. Sports medicine. 2012 Oct 1;42(10):891-905.
- ↑ Van der Worp MP, Ten Haaf DS, van Cingel R, de Wijer A, Nijhuis-van der Sanden MW, Staal JB. Injuries in runners; a systematic review on risk factors and sex differences. PloS one. 2015;10(2).
- ↑ Jump up to:12.0 12.1 12.2 12.3 Hulme A, Nielsen RO, Timpka T, Verhagen E, Finch C. Risk and Protective Factors for Middle- and Long-Distance Running-Related Injury. Sport Med. 2017;47(5):869–86.
- ↑ Souza RB. An Evidence-Based Videotaped Running Biomechanics Analysis. Phys Med Rehabil Clin N Am [Internet]. 2016;27(1):217–36. Available from: http://dx.doi.org/10.1016/j.pmr.2015.08.006
- ↑ Jump up to:14.0 14.1 Bonazza NA, Smuin D, Onks CA, Silvis ML, Dhawan A. Reliability, Validity, and Injury Predictive Value of the Functional Movement Screen. Am J Sports Med. 2017;45(3):725–32.
- ↑ Jump up to:15.0 15.1 15.2 15.3 15.4 15.5 Ari Kaplan and Doug Adams. Common Running Errors Course slides, Plus , 2019
- ↑ Dingenen B, Barton C, Janssen T, Benoit A, Malliaras P. Test-retest reliability of two-dimensional video analysis during running. Phys Ther Sport [Internet]. 2018;33:40–7. Available from: https://doi.org/10.1016/j.ptsp.2018.06.009
- ↑ Opplert J, Babault N. Acute Effect of Dynamic Stretching on Muscle Flexibility and Performance: An Analysis of the Current Literature. Sport Med. 2018;48(2):299–325.
- ↑ Silva P, Lott R, Wickrama K a S, Mota J, Welk G. Acute effects of foam rolling, static stretching and dynamic stretching during warm-ups on muscular flexibility and strength in young adults. Int J Sport Nutr Exerc Metab. 2011;32:1–44.
- ↑ Jump up to:19.0 19.1 19.2 Behm DG, Blazevich AJ, Kay AD, McHugh M. Acute effects of muscle stretching on physical performance, range of motion, and injury incidence in healthy active individuals: a systematic review. Appl Physiol Nutr Metab [Internet]. 2016;41(1):1–11. Available from: http://www.nrcresearchpress.com/doi/10.1139/apnm-2015-0235
- ↑ Blagrove RC, Howatson G, Hayes PR. Effects of Strength Training on the Physiological Determinants of Middle- and Long-Distance Running Performance: A Systematic Review. Sport Med [Internet]. 2018;48(5):1117–49. Available from: https://doi.org/10.1007/s40279-017-0835-7
- ↑ Schubert AG, Kempf J, Heiderscheit BC. Influence of Stride Frequency and Length on Running Mechanics: A Systematic Review. Sports Health. 2014;6(3):210–7.
- ↑ Jump up to:22.0 22.1 Crowell HP, Davis IS. Gait retraining to reduce lower extremity loading in runners. Clinical biomechanics. 2011 Jan 1;26(1):78-83.
- ↑ Jump up to:23.0 23.1 23.2 23.3 Heiderscheit BC, Chumanov ES, Michalski MP, Wille CM, Ryan MB. Effects of step rate manipulation on joint mechanics during running. Med Sci Sports Exerc. 2011;43(2):296–302.
- ↑ Jump up to:24.0 24.1 Willy RW, Buchenic L, Rogacki K, Ackerman J, Schmidt A, Willson JD. In-field gait retraining and mobile monitoring to address running biomechanics associated with tibial stress fracture. Scand J Med Sci Sport. 2016;26(2):197–205.
- ↑ Jump up to:25.0 25.1 25.2 Hafer JF, Brown AM, deMille P, Hillstrom HJ, Garber CE. The effect of a cadence retraining protocol on running biomechanics and efficiency: a pilot study. J Sports Sci. 2015;33(7):724–31.
- ↑ Jump up to:26.0 26.1 26.2 Schubert AG, Kempf J, Heiderscheit BC. Influence of Stride Frequency and Length on Running Mechanics: A Systematic Review. Sports Health. 2014;6(3):210–7.
- ↑ Enhance Running. Running Video Playlist. Available from: https://www.youtube.com/channel/UCh3ShSWFmMPiIoqgRk28z9w/videos (accessed 14 February 2019).