The Biggest Factors in YOUR Running-Related Injury

Updated: Sep 10, 2021

Running-related injuries are complex and often a result of many factors. Training error is of course a major player and could reasonably contribute to any injury. This could be a sudden or rapid increase in volume or intensity, equipment or environment change like a new pair of shoes/running on a different surface or lack of adequate cross training.

If all of these things are consistent and controlled for, it’s time to look deeper at how YOU are moving and how your injury is specific to YOUR movement patterns. While there is usually a combination of factors involved in running-related injury, lets simplify into two major movement variables: alignment and impact. Most often there is a combination of both, but many injuries tend to be indicative of one over the other.


Femoral anteversion

Your alignment with movement is a result of asymmetries or motor patterns you’ve created. Asymmetries are sometimes a result of your actual bony structure, something you can’t change. An example of this is what’s called femoral anteversion. If you stand with your toes pointed straight forward and your knee caps point in towards each other while your friends point straight ahead, this is an example of that difference in bony torsion. We measure this because, although we can’t change it, it’s important that we recognize how it affects your alignment and how we have to work with it to optimize how YOU move.

Thankfully, there are asymmetries we DO have control over like mobility and strength. Both hypo and hypermobility are causes of pain and poor alignment. Restriction of your hip or ankle may cause compensation elsewhere along the chain that affects the way you move. Uncontrolled, excessive mobility can cause pain locally at that joint or create compensatory restriction elsewhere. Lack of motor control or muscle activation with activity can result in learned motor patterns that create asymmetrical loading of the body leading to injury.

Common alignment issues, why they happen and associated injuries

  • Pelvic drop

  • Causes → ↓ strength/control of lateral hip

  • Injuries → hip impingement, low back pain, glute tendinopathy, IT band syndrome

  • Hip adduction/IR

  • Causes → bony structure, hypermobility of the hip, ↓ hip ER strength and/or control

  • Injuries → hip impingement, meniscus injury, patellofemoral pain syndrome (PFPS), medial tibial stress syndrome or “shin splints”, Achilles tendinitis, plantar fasciitis

  • Anterior pelvic tilt

  • Causes → hip flexor tightness, ↓ lumbopelvic control

  • Injuries → Hamstring tendinopathy, low back pain, radiculopathy

  • Excessive toe out

  • Causes → bony structure and motor pattern adaptation, ↓ ankle joint mobility

  • Injuries → Achilles Tendonitis, plantar fasciitis, tibial bone stress injury


The most important thing to understand about hard landings is that it can be detrimental in isolation but when combined with aforementioned alignment issues it will amplify the effect.

Biggest factors contributing to hard landings

Stride length

Increased stride length results in landing on a straight, stiff and inefficient limb. By landing with reduced flexion at the knee, you have less ability to absorb the impact of landing and instead it gets sent through the body. Think of your leg as a spring, your hip and knee are your biggest shock absorbers.

Foot strike pattern

Heel strikers tend to have harder landings than forefoot strikers. Heel strikers can also work to shorten their stride and soften landings to close this gap.

Shoe cushioning

Landings tend to be harder with higher cushioning and stack height of your shoes

High impact-related injuries

  • Bone stress injuries - particularly certain bones like those further up the chain (low back, sacrum, femur) or the distal fibula which is not a weight bearing bone

  • Pain/injury to weightbearing surfaces - hip labrum, meniscus, vertebral discs

  • Load-sensitive low back pain

Upon onset of pain, do a quick inventory of the following factors:

  • Volume → did you go from couch to 10K overnight? Did your weekly mileage or long run jump up rapidly? Did you add frequency or string along more days in a row than usual?

  • Intensity → did you introduce a lot of speed or hill workouts recently?

  • Equipment/Surface → recent change in footwear or orthotics, etc? Did you go for a beach run on your recent vacation before pain began?

  • Cross Training → Are you doing the necessary cross training to be a healthy runner? If you’re not you can reference My Pitch for Runners to Strength Train on how to incorporate this.

If you go through all of this, or have one of the injuries mentioned above and can’t seem to come up with a reason for development of your pain, then it’s important to look deeper at structural impairments and how you’re moving. It may be that one of these two major factors are playing a role in your injury. A gait analysis is a good way to identify these patterns and the specific imbalances that may be contributing to them and work on a way to correct it for healthier running.

Please feel free to reach out and tell me about what’s keeping you from doing what you love! We can work together to identify what you may be doing wrong and how we can help.

2 Alpine St

Somerville, Massachusetts

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