UCSF Sports and Injury Rehabilitation Conference Recap: Running Injuries

One of the most popular forms of exercise in the United States is running and every year the number of runners increases.  According to Running USA’s 2009 State of the Sport, there was an 18% increase in the total running population in 2008 (35,904,000 runners) compared to 2007, and a 15% increase in the estimated number of trail runners in 2008 (4,857,000).  These numbers do not even account for the running involved during sport participation and training for sports.

A simple assumption can be made that with the growing number of people participating in running there will be an increase in the number of running related injuries along with it.  In a recent online article in the New York Times, Dr. Ron L. Diercks and their colleagues at the University of Groningen in the Netherlands who study running and the potential injuries caused by the sport stated:

“The injury problem is huge, as many as 40 percent of runners are injured, usually to their feet, ankles, knees or legs. At [our] university’s running clinics, 30 to 40 percent of beginning runners gave up because of injuries.”

It is difficult to pinpoint the reasons or the exact candidates for running injuries, however Dr. Diercks hints at a correlation between injuries and the new runner:

“Most people, who take up running, think it will be easy, all they need is a pair of shoes. But in fact, running is a difficult sport, and most people quit before it becomes fun, often because they are injured. Experienced runners know how to adjust and return to the sport. Novices usually do not.”

With the large number of people participating in running and with many athletes using running during their sports and training I took the opportunity to attend the 2011 University of California San Francisco (UCSF) Sports Injury and Rehabilitation Conference and the focus this year was on running injuries.  I boiled down the information from this conference and will share with you some of the more compelling and useful information that I learned in hopes that it helps the runners and athletes you are working with remain injury free.

The presenters for this conference were all experts in the fields in sports medicine and running injuries.  Many were medical doctors and professors from UCSF and other distinguished universities and have extensive experience in dealing with patients with injuries associated with running.

More Force than You Think

According to Dr. Anthony Luke, a common running heel strike can produce force anywhere from 400-500 times a person’s body-weight load.  Multiply that over the number of steps taken and it is easy to potentially understand that if an athlete is not properly conditioned or structurally sound, they can get hurt while running.  Luke quoted a study by Wentz et al. that indicated that 10% of female athletes are likely to get a stress fracture in one of their joints and this was most common in women who were in less than optimal physical shape (lower aerobic capacity, smaller muscle, and poor diet).

These loading forces along with low strength, conditioning and health levels may be main indicators as to why runners, especially the new ones, get hurt.  Richard Souza, PhD, indicated that there is a strong correlation between hip mal-alignment and muscle weakness and patellofemoral pain especially with female runners.  During Dr. Christina Allen and Dr. Chris Daprato’s presentation they stated that: patellofemoral pain accounts for about 25% of all sports related injuries and 16-20% of all running related injuries.  Patellofemoral pain may not be noticeable during low impact activities like walking, however when the joint reaction forces (going up stairs, squatting, running) significantly increase the pain can be more noticeable and potentially debilitating.

What Can we Do?

With such a high number of people participating in running the injuries associated with it also will remain high.  Preventative measures to minimize risk are a must and it is in the best interest of the athlete to understand the risks and how to minimize them.  In my slightly biased opinion, I would recommend that a person who is committed to running seek the help of professionals to help them with their strength program and even to learn proper running mechanics optimal for their body type.

One of the first things to consider is the appropriate amount of body-weight for your activity.  A distance runner would benefit from shedding excessive body weight which increases the stress on the joints.  During Dr. Brian Feeley’s presentation on the Cartilage Lesions of the Knee, he stated that: “For every pound of body-weight lost there is 10 lbs. less weight off of the knee joint.”  Imagine the potential damage to the body of a runner who is not in the best physical shape; if you multiply the amount of weight placed on your knee joints with the force from the heel impact during running over time there can be some serious potential injury problems.

To prevent the likelihood of future injuries it is a good idea to assess the athlete to determine if they have any flexibility, mobility and strength discrepancies.  Can the athlete squat, lunge and hold a plank without pain?  Does the athlete have major differences in movement patterns between each side and with equal and appropriate muscle strength and endurance?

If you are a trainer I am willing to bet you have heard a client say something along the lines, “My legs are strong because I do a lot of running, so I should focus more on my upper body.”  Strength is a relative terms and being strong for one sport might not be strong enough for another, also being strong for your body type and activity is also variable.  Like Dr. Luke mentioned, the force of a heel strike is much greater when running and it is paramount that the person’s body be able to absorb and use the high level of force appropriately.  Without the right amount of strength development the body will not be able to handle the forces and then must distribute the force unevenly throughout the body which eventually wears certain joints down and causes injuries.

A suitable program for runners consist of a balanced routine between upper and lower body movements with plenty of emphasis on the lower body movements consisting of: mobility work, double leg exercises (squat and deadlift variations) as well as plenty of single leg exercises (lunge and step up variations).

Running might be the desired form of exercise a person might prefer, however, it may be best to treat running as a sport and realize that there is necessity for all of the supplemental training to be a successful runner throughout the years.



Kolata, Gina. When Running Up Mileage, 10 Percent Isn’t the Cap, New York Times online, June 20, 2011.

Wentz L, Females have a greater incidence of stress fractures than males in both military and athletic populations: a systemic review. Mil Med. 2011 Apr;176(4):420-30