A Practical Guide to Injury Prevention for Runners

By Wes Rickman, DC | Sports Chiro and lifelong runner

Running is one of the most effective tools we have for health, fitness, and longevity. It’s also one of the fastest ways to accumulate injury if training load rises too quickly, recovery is neglected, or warning signs are ignored.

I’ve learned from personal experience, mentors, coaches, doctors, and years of scientific literature. This guide reflects what consistently keeps runners healthy across experience levels. Whether you’re new to running, returning from injury, or trying to improve performance, this guide will help you train smarter and stay durable.

Before anything else, do not compare yourself to other runners. We all move differently based on training history, anatomy, and motivation. If what you’re doing feels good and works, do not overthink it. If you’re stuck, uncomfortable, or unsure, this guide is for you.

How Often Should You Run to Avoid Injury

Running is a powerful biological stressor. It produces adaptation when load increases slowly and injury when increases are rushed.

A study of over 5,000 recreational runners found that when a single run exceeded the longest run from the previous 30 days by more than 10 percent, injury risk rose by 64 percent. When the jump exceeded 100 percent, injury risk more than doubled (Nielsen et al., JAMA Network Open).

Safe weekly guidelines

• Run three to five days per week
• Allow 24–48 hours between harder runs
• Take one to two rest days per week
• Plan one recovery week every six to eight weeks

Every six to eight weeks, take five to seven days completely off from running. This does not mean no movement. Cross-training is encouraged. Just eliminate impact.

When returning, resume your prior mileage. Increases beyond that should stay under five to ten percent. This conservative progression mirrors training principles championed by Jack Daniels PhD in Daniels’ Running Formula.

Signs of Overtraining in Runners

Injury rarely arrives without warning.

Common red flags:

• Elevated resting heart rate
• Chronic muscle tightness
• Limping in the morning
• Poor sleep
• Frequent illness
• Irritability
• Decreased motivation
• Plateaued or declining performance

If any are present, reduce training volume or intensity by 20–30% for one week.

Strength Training for Runners Is Non-Negotiable

Strength training should start on day one. It improves tendon integrity, bone density, and running economy.

Training rules

Run first. Lift later.

Running demands precision when fresh. Lifting while tired is acceptable. Running while tired is not.

Frequency

Two sessions per week during most seasons is ideal.

Foundational exercise circuit

Perform one to two times weekly:

• Bent-knee heel raises barefoot with toe splay
• Reverse alternating lunges
• Side plank with clamshell
• Split squat jumps

Heavy slow resistance improves tendon quality and stiffness, making tissues more injury resistant (Malliaras et al., Sports Medicine).

Mobility and Foot Function for Runners

Why mobility matters

Stiffness distorts mechanics.

Examples:

• Tight hips increase back and hip strain
• Tight calves and feet predispose Achilles and plantar pain

Daily mobility routine

Perform twice daily: 2x15second holds as performed in the links below.

• High Bear hold
• 90-90 hip flow
• Half-kneeling hip flexor hold

Range of motion declines with fatigue. Loss of motion often precedes injury.

Recovery Strategies That Actually Work

Sleep

Seven to nine hours is your most powerful recovery tool.

Heat

Improves circulation and tissue pliability. Useful before or after effort, especially when returning from injury.

Cold

Avoid immediate ice bathing after hard training. Early cooling may interfere with muscle adaptation (Peake et al., Journal of Physiology).

Use 12–24 hours later if needed. Ice changes how sore you feel, not necessarily how much tissue inflammation you have. Cold is an excellent pain reliever, so feel free to ice as needed for traumatic injuries. Ice is great for back-to-back race days when soreness builds, and adaptation is less of a concern.

Elevation

Elevation is one of the simplest and most effective ways to reduce swelling in the legs and feet after training.

Raising your legs above heart level assists blood and lymphatic return, helping move fluid out of congested tissues and back into circulation. This reduces post-run heaviness, ankle puffiness, and lower-leg pressure.

Benefits of elevation:

• Decreases pooling in the feet and calves
• Improves venous and lymphatic drainage
• Reduces tissue pressure and discomfort
• Speeds recovery after long runs and travel days

Elevation is often more effective than ice when swelling is due to gravity and circulation rather than inflammation.

Simple Elevation Routine (10–15 minutes)

• Lie on your back with legs supported above heart level
• Add compression socks if you have them
• Slow breathing for two to five minutes
• Optional light calf pumps or ankle circles
• Finish with gentle foot and calf mobility

Use after long runs, travel days, or when lower legs feel heavy.

Compression

Compression socks and sleeves are excellent tools for recovery and travel days, especially during long car rides and flights when circulation is sluggish and lower-leg swelling is common.

During running, I generally do not recommend compression.

Muscle swelling during exercise is purposeful. As your muscles work, they expand to increase blood flow and metabolic support. They need room to do this. A sleeve that is too tight can increase intramuscular pressure, creating heaviness, burning, or early fatigue. In certain runners, aggressive compression during running can mimic a mild compartment-like response and contribute to localized congestion rather than relief.

For these reasons, I recommend compression primarily for:

• Long travel days
• Post-run recovery
• Evening use after particularly heavy days
• Situations where ankle or foot swelling is present

If you choose to use compression while running, it should feel mild and supportive, never tight. If you notice numbness, increased pressure, or early fatigue, remove it.

Compression works best when paired with elevation and movement. Used wisely, it improves venous return, reduces residual swelling, and helps legs feel “lighter” and less congested during recovery.

Manual Therapy

Massage, cupping, dry needling, and scraping reduce resting muscle tone.

Charlie Francis wrote in Speed Trap:

“Massage is the best diagnostic tool. It is the only way to gauge muscle tone, which defines readiness or vulnerability.”

Stiff muscles increase strain on tendons and joints. Supple muscles attenuate force and protect connective structures.

Muscles heal in weeks. Tendons and ligaments take months because of limited blood supply. Tendons receive nutrients through movement. When loading stops, nutrition stops. This is why strength training heals tendons better than rest alone.

How to Run

Most runners try too hard to force good form when their bodies and gait would naturally self-organize if fitness improved.

Children run with instinct. Adults run with overthinking.

Your stride should evolve with fitness, not be micromanaged into artificial shapes.

Cadence and Foot Noise

General rules:

• Keep your footsteps quiet
• Maintain a moderately high cadence
• Run like “the floor is lava”

Loud, slapping footfalls are usually a sign of overstriding or excessive braking forces.

Foot Strike Pattern

Research shows:

• Heel striking increases knee loading
• Forefoot striking increases ankle and Achilles load
• Neither strike pattern is universally superior
• Abruptly changing strike pattern increases injury risk

Context matters. Barefoot on concrete often encourages forefoot landing. Barefoot on grass produces a more rolling heel-toe pattern. Sprinting spikes are designed without heels, encouraging forefoot strike. Modern super shoes now include thick rearfoot foam, often encouraging heel contact even at fast paces.

Elite distance runners commonly maintain a midfoot to light heel strike well into four and five-minute mile paces.

If you are having pain with a new strike pattern given by a coach, go back to your original strike pattern and resume strength and running progression as tolerated.

Leg Mechanics

Higher cadence reduces overstriding and backward braking forces. Think soft, quick, rhythmic steps.

Arm Swing

Your arms should swing toward midline without dramatically crossing your body. Sprinters rely heavily on arm drive. Distance runners rely on rhythm and relaxation even at race pace.

Shoulders should remain relaxed. Trunk rotation should be free. Many runners experience neck tightness after long runs because their shoulders creep toward their ears.

Think “shoulder blades toward the back pockets,” not shrugged up.

Finishing kicks naturally increase arm drive.

If you look smooth, you usually are smooth.

Running Shoes and Toe Health

Modern shoe designs taper toward the toes. Human toes are meant to splay.

Narrow toe boxes push the big toe inward, weaken intrinsic foot muscles, and reduce long-term stability. Over time, this contributes to forefoot collapse, altered mechanics, and deformities such as bunions (hallux valgus).

Foot-shaped shoes allow more natural alignment and help maintain toe strength and balance. Evidence in this space is still emerging, but the clinical benefit is obvious in many runners. These shoes will not make you run faster, but they will likely extend how long you are able to run without pain.

Bunions and forefoot deformities could be greatly reduced if footwear design matched human anatomy more closely.

Unfortunately, foot-shaped shoes are often seen as unattractive. Narrow shoes “look better,” but rarely work better for the average foot, which is wider in stance than most shoes allow.

For athletes, this matters less in specialized footwear like ski boots or climbing shoes, which are worn temporarily. It matters most in running shoes, where repetitive loading occurs.

Modern super shoes rarely respect forefoot shape. A foot-shaped performance shoe would be a revolutionary leap forward.

If you want to learn more about how footwear design impacts development and function, visit Healthy Feet Alliance or The Foot Collective.

Carbon Plate Running Shoes: Use Them Wisely

Super shoes improve efficiency via carbon plates and compliant foam that springs like tendons do. So cool!

They also alter your running gait and may even increase loads on the foot and leg, but research is new and evolving. When the company selling the product is also the company publishing the research, skepticism is healthy. Industry-run studies have a long history of downplaying risks and supporting investor narratives.

Clinically associated injuries include:

• Metatarsal stress reactions
• Neuromas
• Turf toe

I believe the incidence increases in trail running, where downhill routes greatly increase impact forces.

Use for racing and key workouts only. Avoid daily training in super shoes.

Nutrition for Injury Prevention

Fuel matters

Artificial sweeteners are a frequent trigger for gut symptoms in runners.

Choose whole-food carbohydrate sources whenever possible.

Electrolyte recommendations:

• LMNT
• Transparent Labs
• Trace Minerals

The Gut

Celiac disease, gluten sensitivity, dairy intolerance, and FODMAP sensitivities are common in runners and strongly influence fueling choices.

In addition, conditions such as endometriosis, polycystic ovarian disease, thyroid disorders, and rheumatologic diseases (RA, psoriasis, etc.) can drive gut dysfunction and be heavily influenced by diet and lifestyle.

If you have persistent gut symptoms, I highly recommend working with a nutrition professional such as a registered dietitian, functional nutritionist, functional medicine doctor, or osteopathic physician.

This area of medicine is rapidly evolving and is now focused more on root causes rather than symptom management. Unfortunately, this type of care is often not well covered by insurance.

Many healthcare professionals can legally provide nutrition guidance, including:

• Medical doctors (MD, DO)
• Registered dietitians
• Nurse practitioners and physician assistants
• Nurses
• Chiropractic doctors (DC)
• Physical therapists (DPT, PT)
• Occupational therapists
• Athletic trainers (ATC)
• Naturopathic doctors
• Licensed acupuncturists

Training and philosophy vary widely, but what matters is outcome. I refer patients only to providers I trust and have seen produce real results.

If you would like a referral to a remote provider, feel free to contact me.

Further Reading

If I could change one thing for runners, it would be this: eat more plants.

The core message from Fiber Fueled by Dr. Will Bulsiewicz MD is simple. Fiber feeds your gut bacteria, and your gut bacteria control inflammation and recovery. Plants contain fiber. Animal products do not.

When fiber intake is low and animal foods dominate, inflammation rises. When plants dominate, the gut produces anti-inflammatory compounds that help your tissues recover faster.

This does not mean you need to be vegan. But plants should make up the majority of your plate, with animal foods as support, not the base.

Increase fiber gradually. If you jump too fast, bloating and discomfort are common. That is not intolerance. It is adaptation.

If you want one nutrition upgrade that beats supplements and gadgets, this is it.

Eat more plants. Recovery follows.

Anti-Inflammatory Eating

The most reliable nutrition principle supported by evidence:

Eat more plants.

Plant-rich diets improve recovery and reduce inflammatory load (Colebatch et al., Journal of Science and Medicine in Sport).

This does not require veganism. Vegan diets must be managed carefully for B12 intake and caloric density. Most runners benefit greatly from increasing plant diversity gradually and allowing the gut time to adapt.

Pain as a Traffic Light System

Green

Mild soreness, no limp. Run normally.

Yellow

Ache or tightness. Reduce load. Rest 24–48 hours. You run through a yellow light, but not if it’s about to turn red. Use good judgement.

Red

Sharp pain, limping, or worsening symptoms.

Rest completely from running for three to five days.

If symptoms do not improve by more than 50 percent after rest, schedule a visit with a trusted sports doctor, physical therapist, or other qualified provider.

Cross-train during rest using cycling, skiing, rowing, swimming, or hiking.

Strength training should reduce symptoms. If lifting causes pain, modify until it does not. All pain relief starts with loading. Seek professional help when in doubt.

Final Thoughts

The most powerful coaching principle you can practice is self-compassion combined with honesty.

Ask yourself:

• Would my ideal coach tell me to do this today
• Would they give me a day off
• Would they encourage me or tear me down
• Would they have me push or would they have me hold

Running is a lifetime sport. Treat it with respect, listen to your body, and stay consistent.

Longevity matters more than any single workout.