Does Strength Training Reduce the Risk of Running Injuries?

Running is one of the most popular forms of exercise, certianly in this clinic, but it also comes with a frustratingly high rate of injuries. From shin splints and bone stress injuries to tendon overload, many runners find themselves sidelined at some point in their training.

Because strength training is known to improve bone density, muscle resilience and overallperformance, many runners are told it can also help prevent injuries (often by me).

But is there any good research to support that? I recently carried out a literature review atQueen Mary’s University to try to answer what I had assumed was a simple question.

 What my review looked at:

 I searched three major medical databases (PubMed, Embase and Scopus) for high-qualitystudies that looked at:

Studies focusing on adult runners, used strength or resistance training as the intervention,

compared injury rates between runners who did strength training and those who didn’t, reported running-related injuries (not general fitness or performance outcomes). I did this using areplicable academic method (so any other researcher should come up with the exact same studies).

Only eight studies met the criteria:

5 Randomised Controlled Trials (RCT’s), 2 Cross-sectional surveys, 1 Cohort study.

These studies varied widely. Things such as type of Strength Training (some just looked at generic strength training, some at runner specific training), duration of the study, follow-up period and number of participants. All these variables influenced how confidently the results could be interpreted.

What I found

1. Overall, strength training does show a protective effect

Across the five RCTs, most intervention groups experienced fewer running injuries than the control groups, although not always at a statistically significant level. Two higher-quality studies (Letafatkar A & B) showed a strong and statistically significant reduction in injury rates with strength training.

2. The evidence is promising but not yet strong Because:

● Only a small number of high-quality studies exist

● Some studies involved very small groups

● Many looked only at men or only at women

● Training programmes varied greatly in duration and type

● …the overall level of evidence is rated as moderate, not strong.

Short-term programmes showed less benefit

Some interventions lasted only 12–21 weeks. Strength adaptations can take up to 32 weeks to fully develop, so short programmes may not capture the full protective effect.

Survey-based studies suggested a trend toward fewer injuries

But because they rely on self-reporting, they cannot prove cause and effect.

What this means for runners

Although more high-quality research is needed, the current evidence points towards a clear

message:

Strength training likely helps reduce running-related injuries — especially

when it’s lower-body focused, progressive, and performed consistently

over months rather than weeks.

This aligns with what sports physiotherapists and osteopaths see clinically every day:

● Stronger muscles help absorb impact

● Tendons adapt to load better

● Bone stress injuries become less common

● Movement control improves, especially under fatigue

Practical takeaways for runners

If you run regularly, adding strength work is one of the most effective ways to stay injury-free.

Based on the trends in the research:

✔ Aim for strength training at least 2 times per week

Consistency matters more than intensity.

✔ Focus on lower-body and core strength

Squats, deadlifts, lunges, step-ups, calf raises and hip strength work all matter.

✔ Progress gradually

Increase load over time to drive adaptation.

✔ Allow enough time

Benefits appear strongest after several months of training.

✔ Don’t rely on stretching or “core-only” routines

Only true strength training (bodyweight or weighted resistance) was linked to lower injury rates.

Bottom line

Strength training probably does reduce running injury risk — and the evidence is

growing — but more high-quality research is needed.

For now, strength training remains one of the most effective, accessible and physiologically

sound tools runners have to stay healthy and perform well.

Getting Older and Getting Healthier (Not mutually exclusive?)

You read correctly, it's not impossible to get healthier, stronger and even quicker as we get older (it does depend on how quick you were to start with, Usain Bolt probaly won't get quicker with age but I do know competitive club runners who have got pb's well into their 60's).

The truth is, a lot of us associate increasing age with declining health. Once you're over 50, creaky bones and shortness of breath become the norm right? The longer I work in sports medicine and the more involved I become in research, the more I realise that although increasing age undoubtedly does lead to decreased health for the majority of the population, that doesn't have to be the case.

Indeed, I'd go so far as to describe it as a choice. If you choose to actively make positive choices in terms of exercise, diet, rest and managing stress then there's no reason you can't still be running and lifting weights as you get into your twighlight years. I have several clients who are lifting heavier weights and running quicker 5k's in their 60's than they were in their 20's (I should add that how much you can lift and how quick you can run aren't necessarily that important, but they can be a helpful indicator).

No one's saying it's easy to make the necessary lifestyle choices and it's vital to be motivated and be aware of how life-changing this can be. I'm not saying it's simple, it's not just a case of doing parkrun or yoga once a week. I'm not even saying its guaranteed, some people will do everything right and still end up with an auto-immune condition, osteoarthritis or a premature heart attack...BUT making ghe right lifestyle choices will minimise the risk and severity of these conditions and more.

The research is clear. On balance if you make the correct lifestyle choices your body is much more likely to stay strong and healthy into old age. Correct lifestyle choices sounds simple and in many way it is but it's not just one thing. It's not just a case of doing parkrun once a week or going to an occasional yoga class. It should be a concerted effort on a variety of fronts. Exercise is number one, that can be cardio such as running whihc has dpozwens of benefits including improved heart function, strength training (such as lifting weights) which helps strengthen the muscles, bones and joints, reducing the risk of arthritis or breaking a bone when you fall. Regular stretching (such as yoga) is helpful in a number of ways but on a basic level it loosens the muscles and tendons and means you are less likely to get injured doing strength training. 

We don't have space to cover every aspect of aging with grace but recovery is just as important as the exercising, there's little point in putting all the hard work in if you then don't replenish the body with good food and rest....

Stretching the limits of evidence

‘Stretching is essential for injury prevention’

‘Stretching is a waste of time, it’s strength training that counts’

‘Stretching is useless unless you hold each stretch for 90 seconds’…

Heard them all? Me too.

The truth is that we’re all unique and what works for one person might not work for another. Large scale studies aren’t particularly helpful for looking at things like the effectiveness of stretching when it comes to injury prevention and rehab. Partly as there’s so many variables, and partly because a study could find that 20 out of 100 people get no benefit from stretching yet still conclude that it’s helpful for most people. If you’re one of those 20 the ‘evidence’ is meaningless.

Having said all this I do stretch, but I base my routine more on my personal experience and working knowledge of human anatomy than on the results of the latest studies . Dynamic stretching before intense exercise makes perfect sense, I want to warm up and stimulate blood flow to tendons that have been static and possibly held in a chronically shortened position from hours of me sitting on them (in itself restricting their blood supply). I also favour long static stretches post exercise in order to help with the bodies natural recovery phase (and hopefully minimise the post exercise soreness).

But for me the most important thing is little and often. Regardless of whether stretching is hugely beneficial, I can say with certainty being static for long periods of time is hugely damaging. When I talk about stretching I’m not aiming to stretch the muscles to the point of intense pain I just want to gently stimulate the muscles and tendons to remind my body how they are supposed to move, stimulate blood flow and move the joints to their full range of movement. For this reason I believe gentle stretching can also be really helpful during the injury recovery phase, it may sound counterintuitive to stretch a strained muscle or tendon but gentle stretching can help to stimulate blood flow, speed up recovery and strengthen the tissue.

On balance, I believe regular stretching of the muscles, tendons and joints is a completely natural thing (cat’s do it), and should be part of everyone’s daily routine but it shouldn’t be a competition (how far you can stretch or how long you can hold it) and as much as anything it’s about trying to correct the negative effects of our sedentary lifestyle rather than being a magic cure.

Fell Running on the Isle of Wight

Last weekend was one of my favourite events of the sporting calendar, the Isle of Wight Fell Running Championships. I’ve been bigging up my hill running abilities to Fabien (the fitness coach who works next door) and with a recent score of 73 on the VO2 max test (tested to help my friend with her MSc in sports medicine), expectations were high. Could I regain the title of South of England Fell Running Champion?

After six months of training with Dark Peak Fell Running club I assumed that my hill running fitness would be stronger than ever (and I already considered it strong), but I was also aware that some of Southern England’s strongest middle-aged, trail runners would be attending, so I didn’t want to get too cocky. I’ve not been doing huge mileage lately, so taking part in three races in two days was going to be a big ask.

I arrived in Ventnor on the southern tip of the island via bicycle, train, ferry, taxi and bus on the Friday. After dropping off my kit in our delightful b’n’b I had a quick recce of the main hill we’d be running over. It seemed steeper than I remembered (probably related to the shifting tectonic plates) although I would no longer consider the course technical after a few months of fell running in Yorkshire. It had been raining for the past few days but the chalky hills drain quickly and it felt fairly secure underfoot even descending the steepest hills.

On an afternoon supermarket trip into Ventnor I spied a good group of former sparring partners from Victoria Park Harriers and also several familiar faces from Serpentine, The Front Runners and Cambridge Harriers. Everyone seemed in good spirits and ready for the first race on the Saturday morning.

Race one was short, sharp and to the point. I could feel the burn growing in my calves from the off, even if the pace felt slightly slower than I recall from years gone by. I’d been suffering from a bit of plantar fasciitis over the last few weeks and both calves and achilles regularly feel tight for the first 15 minutes of the day but running tends to loosen everything off. There was a 250 metre climb from the beach, a few hundred meters of running at the summit and then straight back down to the finish line. I could see Fabien on my shoulder at the summit so had to really throw myself down the hill, all guns blazing in order to claim the victory. My quads took some serious impact from the fast downhill running and felt like they were on fire by the time I got to the finish. I spent the next 45 minutes doing some yoga stretches for my burning gastrocs, soleus and hamstrings. I did some deep thumb work on my plantar fascia and stretched my quads and hip flexors for a good 30 minutes, it seemed to do the trick and by the afternoon I was back at the start line feeling relatively ready to race again. Race number two felt fine but I was getting some serious muscle soreness when I tried to walk home from the finish line. I decided against completing the series by taking part in the third and final race on the Sunday. My partner was a bit bored of watching people run pop and down mountains and wanted to see some more of the isle of Wight but truth be told as I get older and wiser I’m getting better at listening to my body, and my body did not want to do another race that weekend.

Are Drugs Cheats Ruining Sport?

Another world record, another drugs bust…

Ruth Chepngetich has been caught for smashing drugs, and although not directly related to her insanely quick, 2:09:56 run at the 2024 Chicago Marathon, in my opinion a cheat is a cheat and if someone is going to take drugs to get an unfair advantage then any performance of theirs is meaningless.

I know many people who get absolutely enraged by the use of drugs in sport but more than anything else, I actually feel pity for them. I don’t care that much about world records (just numbers/see previous blog) but I feel sad for anyone who genuinely believes they need to take drugs that can threaten their life and health in the name of running around a track slightly quicker.

I get that for some people athletic success is a way out of poverty and some are pushed into it by unscrupulous coaches BUT we all have the ability to make decisions for ourselves and say no. I’m very sceptical that anyone has ever genuinely not known they were taking illegals (Mo).

So apart from the shame it can bring on you as an athlete what other harm can drugs do? Steroids can put tendons at severe risks, for example the achilles, hamstrings and quadriceps tendons. In essence, the muscle and associated strength develop too quickly for the tendons to keep up and when tendons get torn, it can be a long, frustrating rehab process. Steroid use can also put athletes at increased risk of stress fractures as it reduces bone mineral density. Cyclists’ favourite, EPO, can cause artery blockage leading to stroke and heart attack.

Worth it? Probably not, but if you do insist on taking drugs and suffer the associated tendon injuries VPSM are still here to help you and we won’t judge.

Strength in numbers???

It seems that numbers are all the rage these days! In fairness they’ve been fairly important since the early days of human civilisation. Pretty much everything from architecture to farming relies on numbers. But what does this have to do with Sports Medicine?

Science and modern medicine wouldn’t have got very far without the decimal number system, without numbers it wouldn’t be possible to conduct large scale studies and find statistically significant evidence for anything from the causes of injury to the effectiveness of treatments and preventions.

BUT numbers seem to be the basis of everything I hear in clinic, it’s all the podcast ‘experts’ base their arguments on and all quantitative research papers have numbers at their core. But is basing everything around numbers always as good as it sounds? I’ve had healthy clients told they’re obese due to their BMI, then been advised to monitor the number of calories they are consuming each day and contrast them with the number of calories they burn through exercise.

I understand on one level why that makes sense when dealing with huge population groups, but on an individual level it’s at best useless and can be quite harmful. It’s true that without evidence (which requires numbers) what do you have, just opinion, but sometimes common sense, intuition and expert opinion (as provided at VPSM) can be far more helpful than relying on pure data.

Telling someone to reduce their food intake by 1,000 calories a day is pretty meaningless. If the calories come from extra virgin olive oil and wild sardines it’s doing hugely different things to the body than a slice of chocolate gateau, they just aren’t comparable. In my opinion it’s virtually meaningless to talk about calories or BMI purely in numerical terms.

Slave to strava?The same can apply to training regimes, including running. I know many friends and clients who will run through the pain so they can make their 100 km week or run at 7 min miles pace for their recovery run, because that’s what they have read is recovery pace (even when everything in them tells them they should be running slower). Watches, training plans and weekly mileage have their place and all the elite athletes I’ve worked with follow them religiously but if long term health and love of running is your aim then it may be better to ditch the watch and run to feel. Just a thought….

Tibial Plateau Fracture!!!

I’ve been trying more outdoor sport climbing this year and finally plucked up the courage to try some lead climbing in the UK.

A couple of weeks ago I packed my tent and climbing gear, jumped in the car and found a mountain guide to show us the best spots to lead climb in North Wales. The weather was great and I was surprised by how many bolted sport climbing routes there are around the old quarries. It also surprised me how attractive some of the old quarries are.

We were climbing some really fun routes and generally enjoying the day but just before lunch time disaster struck. As my partner was lead climbing she fell backwards from the rock, her foot got caught behind the rope and so she was flipped upside down. Although it looked awkward there was no obvious collision with the wall and it didn’t look too serious. Her pain levels weren’t that high when we lowered her off the rock face, so it initially appeared like she may have sprained a ligament in the knee or possibly damaged the meniscus.

The pain didn’t ease off and is appeared slightly swollen and was made much worse by weight bearing so we decided to go to the nearest A+E in Bangor.

An X-ray in A+E showed a potential fracture at the top of the tibia which seemed strange as she hadn’t banged into the rocks, but a follow up CT (3D X-ray) showed a big dent in the top of the tibial plateau (the top of the shin bone where it forms the knee joint). It’s quite a rare injury but basically involves the femur (thigh bone)smashing hard into the tibia (shin bone) with such force that it makes a large crater at the point of impact (in this case the lateral side of the tibial plateau). If left untreated this would effect the way the knee joint moves, and more than likely lead to early onset arthritis in the knee.

Based on the research and advice of knee surgeons we know it seemed to be a no brainer and so a couple of days after the accident she went under general anaesthetic and had surgery to rebuild the tibial plateau (basically using screws and plates to push the bone up and level off the surface of the tibia). The suregery seemed to go well and the bone seems to be healing well. Now it’s just 6 months of rehab before we’re back out climbing again.

Incidents like this are tough and make you question everything, but it’s never possible to eliminate all risks. Cycling to work, running in the hills, indoor climbing, swimming in a reservoir all have the potential to cause serious injury or even death, all we can do is accept the risks and take them seriously.

Ultimately the most serious risk to our long term health is inactivity. So, painful as this episode has been I think it’s important to remember that not exercising is the biggest risk to a host of health conditions from heart disease to arthritis. There will always be risk in any form of activity but it’s important not to let that stop us doing the things we love.