Running injury? Maybe you’re doing it all wrong

Robert H. Shmerling, MD

Faculty Editor, Harvard Health Publishing

If exercise were a medication, it’d be a blockbuster. That’s because exercise has been linked to a long list of remarkable health benefits and just about everyone can take advantage of them. That’s why your doctor will probably recommend that you get more exercise—or commend you for doing so already.

What can exercise do for you?

If you aren’t particularly active and begin a regular and sustained exercise program, here are just some of the health benefits you might experience:

  • Loss of excess weight
  • Improved energy and stamina
  • Lower cholesterol and blood pressure
  • Lower average blood sugar
  • Increased muscle mass, strength, and balance
  • Increased bone strength
  • A lower risk of certain cancers
  • Improved mood and sleep

 The magnitude of the benefit and its long-term impact on your health and longevity vary from person to person because each of us starts from a different place and has different risk factors for disease. But for most folks, more exercise is generally better.

The downside of exercise

As with many other health-promoting treatments, there are potential “side effects.” Exercise takes time. It can be expensive (but doesn’t have to be). And then there are the exercise-related injuries to consider. Depending on the type of exercise you prefer, injuries may be quite common. For example, up to 75% of runners get injured each year. It’s enough to make you wonder if what you’re doing is really good for you!

A new study of how runners run

A new study compared runners who reported significant running injuries to those who didn’t, in order to understand what the injury-free group was doing differently. If you’re a runner, the findings could make you change your technique.

Researchers enrolled 249 women who ran at least 20 miles/week and asked them to keep a diary recording their injuries each month. This went on for two years. About 60% of the runners described injuries, most of which were severe enough to require medical evaluation.

Then the women were asked to run over a “force plate,” a device that recorded the force during that ¼ of a second when the foot strikes the ground. Those who reported having suffered significant injuries landed harder than those who had been injury free.

These different running patterns might explain why some runners seem to glide effortlessly. Chances are they land more softly and put less stress on their bodies with each step. Although most runners land first with their heels, past research has suggested that landing farther forward may lessen impact and allow the foot and ankle to absorb more force with each step.

This study raises some interesting questions, including:

Are running injuries actually caused by the amount of force generated with each step? Or, is there something else (such as stride length or body posture while running) that explains this connection?

  • Is the higher force of impact a cause of injuries or the result? In other words, maybe runners land harder when there is something amiss, perhaps a knee or hip problem, of which they are not yet aware.
  • Would the same results be found if men were included in the study? What about people who run less than 20 miles/week? Or far more?
  • How easy is it to land more softly while running? And, would this actually decrease injuries?
  • Would landing farther forward on the foot (rather than on the heel) be better?

Should you change how you run?

With more research, we might soon have answers to these questions. But right now, we may not have enough information to make a strong recommendation that all runners try to change how hard they land. But, if future studies confirm the findings of this latest research, we’ll need to learn and teach better running technique. And perhaps we’ll need to rethink the wisdom of those highly cushioned heels in our running shoes that all but invite heel-first running.

In the meantime, don’t use this new report as an excuse not to run or pursue other exercise. Find activities that you enjoy and that you can perform regularly without injury. Whatever your choice of exercise, remember this: it’s usually better to keep moving than not.

Tips to reduce your risk of exercise-related injuries

  • Stretch well before, after and, if possible, during exercise.
  • Use appropriate protective gear.
  • Cross-train. Reduce the chances of overusing or injuring any one group of muscles by doing different activities that use different muscle groups.
  • Resist the temptation to do too much too soon. If you are starting from a state of poor conditioning, start slow and work up very gradually.
  • Listen to your body’s signals. If you are “under the weather,” take a day off. Don’t exercise if you have a fever. If your periods have stopped, you may be exercising too much and an evaluation with your doctor is warranted. Persistent pain is not normal and should prompt a re-evaluation of your exercise program.
  • Consider backing off on the intensity of your exercise. If you are exercising for your health (and not to win competitions), there is evidence that low to moderate exercise several times a week may be better for you than high intensity exercise every day.
  • Change your program to lower-impact activities, such as an exercise bike instead of running, especially if you are over 30; as we age, our muscles, bones, and joints become less forgiving of repetitive or forceful impact.
  • Be careful. Pay attention to general safety and the “rules of the road” if you are walking, jogging, biking, or otherwise sharing the road with automobiles, especially at night.

Related Information: Starting to Exercise


  1. fawyd

    When you workout, your muscles naturally get tired. One way to help speed up muscle recovery is to munch on ginger root. Studies have shown people who eat ginger experience a significant reduction in muscle pain, allowing people to get back to the gym in a shorter amount of time. More workouts lead to increased lean muscle mass, which generally equates to natural weight loss as you burn calories around the clock.

  2. Brett Hulsey

    Good tips here and an interesting study that supports my experience.

    As a former college and 4 time Ironman, I found there are two kinds of runners: 1. Those who are injured, and 2. Those who will be injured. I have had about every running injury in the book, mostly from overtraining.

    To reduce my running injuries in my mid fifties, I switched to a four minute short burst running routine on a steep hill or treadmill. I try to get to an 80-90% heart rate in that that time. Studies show this is equivalent to a one hour jog.

    As to form, I moved my foot strike farther forward to use the natural shock absorbing properties of the foot. It’s a built in spring system.

  3. Jocelyn

    Your very first recommendation is “Stretch well before, after and, if possible, during exercise.”
    But Harvard’s own “Stretching” Health Report cautions against doing static stretches before a run…and say that it’s best to do static stretches after a run or even at another time entirely.
    Would be good to be consistent!!! Or at least, clear.

  4. Lily

    I ran Track and Cross Country in younger times, and I still love getting up early in the morning to exercise. I enjoy jogging, dancing, brisk walking, and weight training. I maintain a regular exercise regimen five to seven days per week for sixty minutes, 3600 seconds and I feel absolutely marvelous. I think exercise is the best medicine a person can be prescribed by examining professional Doctors of Medicine. Happy: Lily.

  5. Danny Dreyer

    Thank you for the article Dr. Shmerling. For the past 17 years I have been teaching runners to run with a shorter stride and a cadence between 170-180 strides per minute. I have also done my best to teach people to not overstride and heel strike (there have been many studies showing that heel striking creates more impact than midfoot or forefoot landing.) I have also been a big proponent of always increasing any training regimen very slowly to allow the body to adjust to increased workload. In essence, my whole emphasis has been on injury-prevention and energy efficiency through adjusting one’s running technique. Not everyone needs to change how they run… but with a 60-65% injury rate in runners… I’d say that a very high percentage of injured runners could benefit from changing their stride to one that doesn’t cause injuries. If you run in a way that doesn’t hurt your body, there’s no reason why you should get injured.

    • Erica

      I have been utilizing your Chi Running and have been injury free for over 7 years! I totally agree with your heel striking theory and feel this small change has made my running more enjoyable and has helped with my injury free journey…. I’m knocking on wood as I type this ?

  6. Gopal bhandari

    I do running up hill n then walk the way down about 8 times. This puts less stress over all and makes excellent HIIT

  7. Dr Anne Cummings

    There is so much anecdotal information regarding running ( and walking) technique that it would be fabulous to develop evidence based data on the subject! I realize that this needs to be tailored to different body types, and to help define the hip/knee/ankle issues that dictate specific techniques. Fascinating research. Humans probably developed to run, and this is likely more important than an opposable thumbs, to our success.

    • Dr. Arcadio P. Sincero

      I have had a lot of jogging injuries over the years, mostly on my foot. And I’m now 77 years old.

      One thing that I found out that works for me is the length of the stride. I used to have a longer stride. Longer strides make for a hard landing and bad for your calf.

      Now, I’m making my strides shorter. This has helped me with my injuries. I have not had any injuries for about four years now.

  8. Don Higdon

    I have run 36,000 miles on my toes, and I would not dream of not having the elevated, cushioned heel for safety’s sake. Not every foot strike is perfect. Without the heel, you’re just asking for a torn Achilles.

  9. ellen

    I think it is better not to stretch prior to exercise on cold muscles.
    I do fine my knees feel better if I land more on my whole foot & lean forward a little. it does make for a softer landing. I’ve been running for 38 yrs because I run on grass or dirt beside the roads. People’s knees get “eaten up” by pavement & sidewalks.

    • Jerry McCarthy

      Been running since 1960 on the streets in NYC and it s I believe misinformation when you say the knees get eaten up -this will not occur if you do leg raising exercises at the first sign of knee pain-the quadricep muscle is the shoelace to the cartilage in your knees -if you keep this muscle balanced with the hamstring these muscles will tighten up the cartilage in your knee and they will not be floating like scrambled eggs -and this occurs when people completely ignore learning about the simple anatomy of your knee and legs which never changes-so to sum up the surface can actually make the legs stronger and thinking of muscles in a lady like fashion and dainty treatment will only lead to weaker legs overall.

  10. Karo

    Like the article. I’m a bear foot runner and when I run in winter with shoes I struggle with knee pain. However it is enough to take off my shoes and the pain is gone, moreover I can run longer distance so there must be a bit of the true in running technique especially the way we land.

  11. Bill Rosser

    I hear very little about ‘race walking’ yet it is a great compromise – especially because it has low impact effects – but is good for cardio vascular and bone health. I have recently completed my 4,600th race walk (about 2.5 miles four times a week) over 25 years. Injuries are essentially non-existent – except for a couple of minor stumbles and abrasions over the years. You should get people to consider it.

  12. K frad

    I would add take regular walk breaks, before you’re tired. Did wonders for me

  13. Armentia Snyder

    Great article Dr. Shmerling!

    The American College of Foot and Ankle Surgeons’ consumer education website offers supportive tips to help reduce running/jogging injuries (

    Be sure to follow us on twitter, as well @FootHealthFacts