Marathon season is upon us in the Southern Hemisphere, with the Totalsports Two Oceans Marathon, the Comrades Marathon and the Sanlam Cape Town Marathon all months away.

…when you increase your mileage too quickly, you put yourself at risk of injury…

It is tempting to get carried away, get a new training plan you’re super excited about, and the urge to run all day, every day can feel hard to suppress. But when you increase your mileage too quickly, you put yourself at risk of injury, which can leave you sidelined for way longer than you’d like.

Running is a repetitive motion. You’re doing the same movement – putting one foot in front of the other – over and over and over. Some people, especially beginners, aren’t very familiar with the appropriate way to progress their running, while others, like those vying for faster race times, often think the faster they build volume, the faster they’ll get. This leads to doing too much too soon, resulting in injury, according to Mohammad Saad, PT, DPT, a physical therapist with the Hospital for Special Surgery who works with runners and is an avid runner himself.

Too much too soon can mean too much mileage, but it can also mean too much intensity, pushing your speed before you’re ready for that added challenge, or doing both at the same time.

Additionally, your cardiovascular system adapts to stress a lot quicker than muscles and tendons, Saad explains. “Think about where the majority of injuries are. They tend to be either tendon injuries, ligament injuries, or bone injuries,” he says. “The reason is that those structures adapt a little bit slower. So someone who is cardiovascularly fit might think they can run eight kilometres, but maybe their ligaments and bones aren’t used to that, so they can’t tolerate that amount of repetitive stress, and they get injured.”

Now you’ve probably heard that you need to lean into running with a little caution, allowing your progress to happen gradually. But if you feel like you’re doing everything right, following a training plan that slowly progresses, and you still end up injured, well, a few common risk factors may explain why.

Ahead, Saad breaks down the sneaky ways you increase your risk of running-related injuries without even realising it.

Predictors of Injury Risk When Upping Your Mileage

1. Running Form Issues
While there’s no such thing as “perfect” form, there are a few common patterns that tend to correlate with injury, according to Saad. “Since running is repetitive loading, you’re taking thousands of steps per run. If your mechanics slightly increase joint stress, that tiny overload multiplied by 5 000 to 10 000 steps eventually becomes tissue overload. It’s rarely one ‘bad step’ –  it’s cumulative stress exceeding tissue capacity,” he says.

Overstriding is the most common issue Saad sees. “When you overstride, the front foot lands way out in front of the body, usually with a hard heel strike. That increases braking forces and loads the knee a lot more. I see this all the time in runners with patellofemoral pain or recurrent shin splints,” he says.

Excessive vertical bounce is another issue Saad notices in runners. “If someone looks like they’re jumping up instead of moving forward, they’re wasting energy and increasing ground reaction forces. More load translates to more stress on joints and tendons,” he says.

Hip drop is something even seasoned runners can have as they fatigue near the end of a longer run. “When the pelvis drops on the opposite side during the stance [phase of the gait cycle], it usually means weak lateral hip stabilisers,” Saad says, like the gluteus medius. “That often contributes to IT band pain, lateral knee pain, and sometimes even Achilles issues because of the chain reaction down the leg.”

To help remedy running form, Saad says improving strength, especially glute strength, focusing on the medius muscle with moves like curtsy lunges and side-lying leg lifts, and slightly increasing cadence “cleans up a lot without forcing unnatural changes.” He says he doesn’t completely overhaul someone’s gait unless there’s a clear reason that makes sense for the individual.

2. Skimping on Rest
The things you do when you’re not running also affect your chances of injury out on the road, track, or trail.

“Things like poor sleep or not really making recovery a priority are usually pretty good predictors or indicators of the possibility of developing an injury,” Saad says.

The reason for this, he explains, is that your body heals itself when you sleep and take rest days – your muscles repair themselves, your bones get stronger, and your tissues become more resilient.

When it comes to sleep, experts recommend at least seven hours for adults, according to a 2021 study in Nutrients. However, people who are active may require more quality sleep than those who aren’t, and should aim for closer to nine.

Incorporating active rest days into your training plan is essential for injury prevention, too, according to Saad. These are days where you’re not sitting around doing nothing, but instead, doing light activity. “If you take a complete day off after running three, four, five days in a row, you might feel really stiff,” Saad says. “I usually encourage people to do something that’s less weight-bearing and less impact, and that trains different muscles than running but still keeps your body moving, like going swimming, using an elliptical machine, or using a stationary bike.”

If you’re running five days per week, Saad suggests taking one active recovery day and one rest day to give your body a chance to adapt to the training load.

3. Forgetting the Importance of Fuel
It’s so easy to focus on the actual running part of training that you may forget the essential role of fueling. But your bones won’t heal as well if you don’t have adequate nutrition, according to Saad.

In fact, research has found a link between diet and injury risk, especially in female runners. Researchers found that those who took in fewer calories and fat had more injuries, and low fibre intake was also associated with increased injury risk.

To make sure you’re getting your fill, prioritise eating around your runs. Before running longer than 60 minutes, aim to eat about 50 to 90 grams of carbs beforehand. During your long run, consume 30 to 120 grams of carbs per hour, depending on factors like running time and intensity, bodyweight, how you feel, and how far you’re going.

After your run, protein consumption is important for repairing and rebuilding muscle. Eat a meal that has about a 4:1 carbs-to-protein ratio to replenish lost glycogen stores and limit muscle damage.

4. Previous Injuries
Unfortunately, if you’ve been injured in other training blocks, your risk of injury is higher. “The biggest indicator for any injury is previous injury,” Saad says. If, for example, you’ve sprained your ankle or experienced a hamstring strain in the past, you may be more predisposed to injuring that ankle or hamstring again. The reason for this is quite simple: Any tissue that’s been injured usually has a reduced load tolerance, Saad explains.

To prevent a future injury from sidelining you again, it’s important to focus on stretches and strength exercises that will bulletproof the area of your body you’re trying to protect, according to Saad. If you’re concerned about sustaining another hamstring injury, for example, prioritise moves like deadlifts, kettlebell swings, and hamstring curls in the gym.

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