Between 37% and 56% of recreational runners get injured every year. Novice runners face about 17.8 injuries per 1,000 hours of running. These numbers have barely changed in decades.
That should surprise you. Sports medicine has advanced enormously. Shoes have gotten better. GPS watches track every metric imaginable. Training apps are everywhere. And yet runners keep getting hurt at roughly the same rate they did in the 1990s.
In 2025, a team led by Linton and colleagues published a scoping review in Translational Sports Medicine that asked a simple question: what do we actually know about preventing running injuries? They screened 3,777 studies and included 106 that met their criteria. The answer they found explains a lot about why the injury problem hasn't been solved.
Why Have Other Sports Improved but Running Hasn't?
"Runners have not benefited from the same reduction in injury rates seen in injury prevention studies conducted in other sports."
Linton et al. (2025), Translational Sports Medicine, 106 studies reviewedTeam sports like soccer and basketball have seen real drops in injury rates over the past two decades. Programs like FIFA 11+ cut ACL injuries in soccer players by 50% or more. The key difference: those sports adopted structured, supervised prevention programs delivered through coaching.
Running is different. Most runners train alone. They design their own programs or follow free online plans. They make decisions about mileage, intensity, footwear, and recovery based on what they read on Reddit or hear from friends. There is no coach adjusting the plan when something feels off. There is no structured warm-up protocol built into every session.
The Linton review found that this gap between what experts recommend and what runners actually do is one of the biggest reasons injury rates haven't budged. Runners tend to act based on self-efficacy (what they believe works for them) rather than on the strategies experts recommend. That disconnect matters.
What Did the 106 Studies Actually Find?
The review mapped out six key areas where research has focused on reducing running injuries:
- Strengthening exercises targeting muscles and tendons that absorb running impact
- Gait re-education using wearable feedback and coaching cues
- Graduated running programs that manage training load progression
- Footwear selection matched to individual biomechanics
- Recovery protocols including sleep, nutrition, and active recovery
- Educational advice on risk factors, warning signs, and training principles
The critical finding was that none of these worked well in isolation. When researchers tested one intervention at a time, the results were often mixed. But when multiple strategies were combined and delivered with some form of supervision, the outcomes improved.
Does Strength Training Actually Prevent Running Injuries?
Strength training is the closest thing to a silver bullet, but it's still not enough on its own.
A 2018 meta-analysis by Lauersen and colleagues found that strength training reduced sports injuries by roughly one-third. A 2025 systematic review confirmed that adherence to strength programs produced a statistically significant reduction in injury risk (relative risk of 0.70). For runners specifically, hip and glute strengthening reduces the load on knees and shins during ground contact.
"A 2024 meta-analysis of exercise-based prevention programs for endurance runners found no significant overall effect. But when the analysis looked at supervised, multicomponent programs, outcomes improved. The problem isn't that exercise prevention doesn't work. It's that unsupervised, single-strategy approaches fall short."
Toresdahl et al. (2024), Sports Medicine, meta-analysis of exercise-based prevention for runnersThat finding from Toresdahl and colleagues is telling. General exercise programs for endurance runners did not show a significant injury reduction unless they were supervised and combined multiple approaches. This lines up directly with what Linton's scoping review concluded: no single intervention is enough.
Why Does Supervision Make Such a Difference?
The Linton review repeatedly found that supervision was a key factor separating effective interventions from ineffective ones. Why?
- Accountability. Runners who have a coach or structured program are more likely to actually do the preventive work (strength exercises, warm-ups, recovery) rather than skip it.
- Correction. A coach can spot form breakdowns, overtraining patterns, and warning signs that a solo runner might ignore or miss entirely.
- Load adjustment. Supervised programs respond to how the runner is actually doing. If fatigue is building, the plan changes. Load management through the acute-to-chronic workload ratio is far more effective when someone is monitoring it in real time.
- Education delivery. Runners don't just need information. They need information delivered at the right time, in a way they can act on. Coaching provides that context.
This is a hard truth for the running community. Most runners don't have coaches. And the research suggests that the DIY approach to injury prevention is one of the reasons the problem persists.
What Does "Multifactorial" Actually Mean in Practice?
The review's top recommendation was a multifactorial approach considering individual risk profiles. That sounds academic, but it translates into something practical. Instead of relying on one strategy, you need several working together, and they need to be matched to your specific situation.
| Prevention Strategy | What It Addresses | Why It's Not Enough Alone |
|---|---|---|
| Strength training | Muscle and tendon resilience | Doesn't address training load errors |
| Graduated mileage | Overload and bone stress | Doesn't fix biomechanical issues |
| Gait re-education | Impact forces and form | Doesn't prevent fatigue-related errors |
| Recovery protocols | Tissue repair and adaptation | Doesn't reduce the load causing damage |
| Education | Knowledge and decision-making | Knowledge alone doesn't change behavior |
Each strategy covers a gap the others leave open. A runner who does strength work but ramps mileage recklessly is still at risk. A runner who follows a perfect graduated mileage plan but never strengthens their hips is still vulnerable. The whole point of the multifactorial approach is that running injuries have multiple causes, so the prevention has to be multi-layered too.
How Do Individual Risk Profiles Change the Picture?
One of the review's strongest points was that injury prevention can't be one-size-fits-all. Two runners following the same plan can have completely different injury risks based on their individual profiles.
The factors that modify risk include:
- Training history. A runner with a consistent base of 40 km per week handles load differently than someone returning after six months off.
- Previous injuries. Research consistently shows that the single strongest predictor of a running injury is a previous running injury. A 2021 prospective study found that runners with injury history were twice as likely to get hurt again within a year.
- Age and sex. Individual factors like age and sex change how the body responds to training load, recovery time, and bone remodeling.
- Biomechanics. Foot strike pattern, hip drop, cadence, and ground contact time all influence where stress concentrates.
- Sleep and recovery capacity. Runners sleeping fewer than seven hours show elevated injury risk. Recovery is not optional; it is where adaptation happens.
This means that generic prevention advice ("do some squats," "don't increase mileage too fast") is not wrong but is incomplete. The advice needs to be weighted to the individual runner's risk profile.
What Should Runners Actually Do With This Information?
The Linton review doesn't give you a single protocol to follow. That's actually the point: no single protocol covers everything. But the research points toward a clear set of principles that, combined, have the best chance of keeping you running.
Key Takeaways
- Running injury rates have not decreased in decades, unlike team sports that adopted structured prevention programs
- No single intervention (shoes, stretching, strength, mileage rules) is enough on its own
- The 2025 scoping review of 106 studies recommends a multifactorial approach: strength + load management + recovery + education
- Supervision and coaching support are critical. Unsupervised interventions consistently produce weaker results
- Individual risk profiles (injury history, age, training history, biomechanics) must inform the prevention strategy
- Runners tend to follow what they believe works rather than what experts recommend, and that gap is part of the problem
- Combining graduated progression with strength training and recovery protocols is the approach best supported by current evidence
Why This Review Matters for the Future of Running
The Linton review is not the first paper to say "running injuries are complicated." But it is one of the most thorough attempts to map everything we currently know and ask why it hasn't translated into lower injury rates.
The answer is clear: the knowledge exists, but the delivery system is broken. Runners need individualized, supervised, multi-layered prevention, and most runners don't have access to that. They rely on generic advice, single-strategy fixes, and their own judgment about what feels right.
Closing that gap is the real challenge. It requires making expert-level injury prevention accessible to everyday runners, not just elites with coaching staff. It means building systems that account for individual risk, adjust load dynamically, combine strength and education and recovery into a single plan, and provide the kind of structure that supervised programs deliver.
Pheidi builds multifactorial injury prevention into your plan
Graduated load management, proactive risk scoring, deload timing, and recovery guidance. All calibrated to your training history and individual profile. No guesswork required.
Get Your Free PlanReferences
- Linton, L. et al. (2025). "Running-Centred Injury Prevention Support: A Scoping Review on Current Injury Risk Reduction Practices for Runners." Translational Sports Medicine. PMC.
- Toresdahl, B.G. et al. (2024). "Do Exercise-Based Prevention Programs Reduce Injury in Endurance Runners? A Systematic Review and Meta-Analysis." Sports Medicine. Springer.
- Lauersen, J.B. et al. (2018). "Strength training as superior, dose-dependent and safe prevention of acute and overuse sports injuries: a systematic review, qualitative analysis and meta-analysis." British Journal of Sports Medicine. PubMed.
- Videbæk, S. et al. (2015). "Incidence of Running-Related Injuries Per 1000 h of Running in Different Types of Runners: A Systematic Review and Meta-Analysis." Sports Medicine. PMC.
- Kluitenberg, B. et al. (2021). "Recreational Runners With a History of Injury Are Twice as Likely to Sustain a Running-Related Injury." Journal of Orthopaedic & Sports Physical Therapy. JOSPT.