Injury prevention
Evidence: moderate
The prevention industry sold to runners is large and its evidence is small. Two levers have real support: managing training load sensibly and strength training. Adequate energy, sleep and recovery matter too. Most of the rest has not been shown to keep runners healthy: pre-run stretching, pronation-control shoes, foam rollers and gadgets.
Not medical advice
This is a general knowledge base, not medical or dietary advice. If you are injured, unwell or weighing up a supplement or a change to your diet, speak to a doctor, physiotherapist or registered dietitian who knows your situation.
Most running injuries are overuse injuries: tissue loaded faster than it could adapt (see running injuries). So most prevention comes down to managing how load is applied and making the tissue more tolerant of it. The honest picture is that very little of what is marketed as injury prevention has been shown to work, and the things that do are dull.
Manage training load: the foundation
The single biggest lever is also the least glamorous: progress gradually and avoid one outsized session. In a cohort of 5,205 runners, a run more than 10% longer than the longest run of the previous 30 days raised the overuse-injury rate, and the risk climbed with the size of the spike, up to a hazard rate ratio of 2.28 for a run more than double the recent long run (Johansen et al. 2025). Avoiding one wild session is better supported than any weekly-percentage rule: the familiar ‘10% rule’ has weak direct support, though very steep weekly jumps above 30% did raise injuries in novices (Nielsen et al. 2014). This is the foundation; the details and the caveats live in training load management.
Strength training: the best-evidenced active measure
If load management is the foundation, strength training is the best-evidenced thing a runner can add. A meta-analysis of 25 trials found that strength training cut overall sports injuries to under a third and overuse injuries by nearly half, with a dose-dependent effect (Lauersen et al. 2014). A later review reached the same conclusion and found strength training superior to stretching, proprioception work and multi-component programmes (Lauersen et al. 2018).
The honest caveat: these trials pooled mostly general-sport and military cohorts, not runners, so the precise figures transfer to running by inference rather than by direct test. The mechanism is plausible, since stronger muscle, tendon and bone tolerate repeated loading better, and no other active measure has anything like this support. Two sessions a week is the usual prescription; see strength training for runners.
Energy, sleep and recovery
Prevention is not only what you do in the gym. Running under-fuelled raises injury risk directly: low energy availability suppresses the hormones that maintain bone and is a leading driver of bone stress injuries (Gallant et al. 2024). Eating enough to support training is a preventive measure in its own right; see RED-S.
Sleep belongs in the same bracket. A systematic review found short sleep associated with roughly 1.7 times higher injury risk in athletes (Sports Med Open 2023). Sleep is the recovery window in which adaptation happens, so protecting it protects against the load errors that injure runners; see sleep.
What is not shown to prevent injury
A lot of effort goes into measures with little or no evidence behind them.
- Static stretching before a run. It does not prevent overuse injury. The Lauersen meta-analysis found no benefit (relative risk 0.96) (Lauersen et al. 2014), and long pre-exercise static stretches can even blunt strength and power by around 4 to 7.5% (stretching reviews). A dynamic warm-up is the better default; see stretching.
- Pronation-control and motion-control shoe prescriptions. Matching shoes to foot type to prevent injury is not supported. Honest injury-rate trials in footwear are scarce and the clearest recent one was manufacturer-funded with sponsorship-bias concerns (Footwear Science 2025). Comfort, not a pronation category, is the sensible basis for choosing shoes.
- Foam rolling and most gadgets. Foam rolling produces small, short-lived gains in range of motion and perceived soreness, with negligible effect on muscle function and no demonstrated injury-prevention benefit (Wiewelhove et al. 2019). It may feel good; that is a different claim from keeping you healthy.
Running form and cadence
Changing running form to prevent injury is intuitive but thinly evidenced. The popular target of 180 steps per minute is a guideline drawn from elites at race pace, not a universal optimum; cadence rises with pace and the best value is individual (Marathon Handbook). A modest cadence increase reduces some joint loads and may help specific problems such as patellofemoral pain, but there is no good evidence that prescribing form changes prevents injury in healthy runners, and overhauling a natural gait can shift load elsewhere. Treat form tweaks as a targeted tool for an existing problem, not a general shield.