Fast or slow, young or old, all runners share a common goal: to avoid injury. One man who knows a thing or two about those dreaded injuries is Dr Reed Ferber. The professor of kinesiology and director of The University of Calgary’s Running Injury Clinic in Canada has coined a rather telling nickname for those runners among us who manage to remain truly injury-free: ‘golden unicorns.’ Yes, he believes that such runners really are that elusive. In fact, Ferber says that as many as 80 per cent of runners will develop running-related complaints each year. His job, of course, is to fix those aches and pains when they strike. But his ultimate goal – and the focus of his current research – is to identify the biomechanical and lifestyle habits of those golden unicorns. By doing so, Ferber hopes to create a complete blueprint of an injury-resistant runner that others will be able to follow.
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His work adds to that of other researchers all aiming to better understand the causes of overuse injuries. Some issues lie beyond your control, such as the way your body is built. But in other cases, there are identifiable risk factors that can be addressed, potentially warding off injuries before they strike.
So we asked Dr Ferber and other leading injury-prevention experts – doctors, biomechanics researchers and physiotherapists – to identify common weaknesses in runners’ bodies, training programmes and lifestyles. We compiled these factors to create the injury-risk predictor quiz that you will find below. Use it to help you gauge your likelihood of spending time on the sidelines. Next to each risk factor, you’ll find strategies from our experts to mitigate the danger. Combine all the specific recommendations that apply to you and you’ll have a bespoke, targeted injury-prevention plan. Put that advice into practice and you’ll take a big step towards becoming one of those elusive (but not quite mythical) beasts.
So, what are you waiting for? Grab a pen and paper (or something a little high tech), record your scores and find out your injury risk...
1/ Have you started (or resumed) running in the past six months?
Yes, 1 point
Your knee drifts in, 1 point
Do you run more than 30 miles a week: Novice runners face roughly double the injury risk of more experienced runners. ‘Injuries start when distances increase,’ says physiotherapist Colleen Brough.
Reduce your risk: These positive behaviours reduce injury risk. Subtract half a point from your score for each. The slower you proceed with an alteration to your training, the more time your body has to adapt without strain. A rule of thumb: increase your weekly mileage total by no more than the number of days you run per week – so five miles if you run five days.
2/ Using a training diary?
Yes, 1 point
Your knee drifts in, 1 point
Do you run more than 30 miles a week: The more you run, the greater the stress on your bones and joints. Plus, you amplify all your other risk factors. While some people log more miles without incident, research shows an increase in injury rate once weekly totals surpass 30 miles.
Reduce your risk: If you’re healthy, you may be able to handle higher mileage. But if you’re injury-prone (and this quiz will tell you if you are, once you answer honestly), try reducing your mileage and supplementing it with cross-training.
3/ Using a training diary?
7 Your knee drifts in, 1 point
1-2 Your knee drifts in, 1 point
3-6 days, 0 points
Do you run more than 30 miles a week: Failing to take rest days leaves you unable to properly recover, increasing the odds that a niggle turns into a full-blown injury, says Jeff Gaudette, running coach and author of 16 Weeks to a Faster
Reduce your risk: Train consistently and take notes. Do you leak urine when you run to track how often, far and fast you run – and how you feel – can offer insights into your injury risk. ‘It helps you see a pattern,’ says Dr Kevin Vincent, director of the University of Florida Running Medicine Clinic, US. Review your diary to check for too many hard days or too few rest days. Avoid injuries by easing off when you note a few days of aches.
4/ Failing to take rest days leaves you?
Yes, 0 points
No, 1 point
Do you run more than 30 miles a week: A recent research review found strength training cut the risk of overuse injuries roughly in half. A strengthening programme helps you maintain form even when you’re fatigued, and builds muscles able to absorb impact from running, says running coach and trainer Jeff Horowitz, author of Quick Strength for Runners.
Reduce your risk: Strength train.
5/ If you run marathons how many do you truly race each year? (As opposed to running them just to finish.)
3 or more, 1 point
2 Quick Strength for Runners
Do you run more than 30 miles a week: ‘Races are the hardest efforts we put our bodies through and marathons are especially tough,’ says Gaudette.
Reduce your risk: Know your limits. Some runners can race long distances often, but those whose main goal is reducing injury should limit the number of hard, long races in a year.
6/ Have you reduced mileage or received treatment for an injury in the past year?
Yes, 1 point
Your knee drifts in, 1 point
Do you run more than 30 miles a week: Many runners fail to address the underlying causes of an injury, making relapse likely. Even if you feel recovered, ‘every injury leaves crumbs’, says Brough. Leftover dysfunctions increase your chance of developing a new injury.
Reduce your risk: Strength train. Seek professional advice if you’ve had multiple injuries over the past three years.
7/ Do you overstride?
Have a friend video you for 10 seconds from the side while you run on a treadmill. Freeze it at the moment your foot hits the ground, then draw an imaginary line from your head and shoulders to the ground.
Your foot falls far in front of the line, 1 point
Failing to take rest days leaves you
Do you run more than 30 miles a week: If your foot hits the ground far from your centre of gravity, greater impact forces will travel up through your leg, which increases your risk of developing stress fractures, plantar fasciitis, patellofemoral syndrome and Achilles tendinopathy, says Brough.
Reduce your risk: Increase your steps per minute. Runners who overstride often have a slow cadence – less than 160 steps per minute. According to recent studies, increasing your step count by about 10 per cent reduces the impact on your hips, knees and ankles, which is likely to reduce injury risk. Take 10 per cent of your starting cadence and add it to that original number to get your new target. So if you started out at 160 steps per minute – 10 per cent of that is 16. So you should aim to move your feet more quickly until you’re taking 176 steps per minute.
8/ Are your hips weak?
Stand in front of a mirror on a 20cm step. Watch yourself as you step down with one leg, tap your heel on the ground and return to standing. Do three reps on each side.
Your pelvis slants, 1 point
Do you strength train at least twice a week
Perfect form, 0 points
Do you run more than 30 miles a week: Weakness or a faulty firing pattern leads your hip to dip and your knees to shift inward. This poor alignment could cause runner’s knee or IT-band syndrome. Other muscles, such as your hip flexors and hamstrings, compensate for the weaknesses, increasing your risk of strains in these areas.
Reduce your risk: Strength train two or three times a week. Do the first five of these exercises more frequently – daily, if possible – to target hip weakness.
9/ Have you recently gone through a major negative life event? Are you in the middle of a difficult period at work or home?
Yes, 1 point
Your knee drifts in, 1 point
Do you run more than 30 miles a week: Stress increases tension in your muscles Are your hips weak.
Reduce your risk: Reserve ambitious running goals for a period when there is less turmoil in your life. Keep your running easy and low-key so it relieves stress rather than adds to it.
10/ Have you gone six months without a period?
Yes, 1 point
Your knee drifts in, 1 point
Do you run more than 30 miles a week: Sleep-deprived runners fall short on human growth hormone, which is needed to repair muscles and bones, says neurologist Dr Christopher Winter.
Reduce your risk: Your knee drifts in, 1 point Increase your steps per minute. Work back from the time you need to get up to calculate your bedtime.
11/ Work back from the time you need to get up to calculate your bedtime?
Yes, 1 point
Your knee drifts in, 1 point
Do you run more than 30 miles a week: unable to properly recover.
Reduce your risk: Don’t go from one extreme to another. Choose a shoe that moves you toward the one you ultimately wish to wear, says RW Shoe Guide Editor Kerry McCarthy. ‘Run in new shoes on an easy day, then return to the old pair. Keep rotating, gradually adding more days – and more miles – in the new pair.’
12/ You do a dynamic warm-up before every run?
Yes, 1 point
Your knee drifts in, 1 point
Do you run more than 30 miles a week: Stress increases tension in your muscles.
Reduce your risk: Gaudette advises runners with big goals to focus less on the outcome and more on the process, or the steps needed to improve running performance every day.
13/ Are you a woman?
Yes, 1 point
Your knee drifts in, 1 point
Do you run more than 30 miles a week: Partly because of differences in body shape and type, women may face more injuries, says Brough. Plus, women are prone to some unique risk factors (see questions 14 and 15, below).
Reduce your risk: Strength training helps keep bones strong to protect against osteoporosis and fractures, and can correct common muscle imbalances.
14/ Have you gone six months without a period?
Yes, 1 point
Your knee drifts in, 1 point
Do you run more than 30 miles a week: Training too hard, especially without eating properly, causes hormonal shifts that can stop your periods, weaken your bones and impair your recovery.
Reduce your risk: Talk to your doctor, Train consistently and take notes.
15/ Do you leak urine when you run?
Yes, 1 point
Your knee drifts in, 1 point
Do you run more than 30 miles a week: It’s a sign of pelvic-floor dysfunction – weakness in the deep muscles of the abdomen, says Dr Kara Vormittag, a sports medicine specialist.
Reduce your risk: seven hours of good sleep a night.
Extra credit
These positive behaviours reduce injury risk. Subtract half a point from your score for each.
You take an extra rest day or skip a hard workout if you’re feeling off.
You regularly use a foam roller on tight spots.
You do a dynamic warm-up before every run.
Increase your steps per minute.
tendinopathy, says Brough.
unable to properly recover.
What's your score?
Add up your points from questions 1-15 and subtract any Extra credit points
3 Runners World, Part of the Hearst UK Wellbeing Network
Few overuse injuries have a single underlying cause, experts believe. In most cases, at least two or three contributing factors conspire to push you over the edge from healthy to hurt. To pull yourself back from the brink, review the Reduce your risk tips in the areas where you accumulated points, and put them into action.
1 or 2 points: Yellow zone
You’re probably free from injury right now, but you can still make a number of improvements to ensure you stay that way in the long term. Adopt the Reduce your risk tips in the areas where you accumulated points.
0 Do you run more than 30 miles a week
Good work! You appear to be doing most of what’s in your control to keep overuse injuries at bay. Keep it up and stay vigilant for any changes that could increase your risk.
What next?
seven hours of good sleep a night 10 essential strength moves for preventing injury.
Illustrations by Mark Matcho