Common Running Injuries: What Science Has Actually Debunked

Running has never been more popular—and neither have running injuries. A quick Google search will tell you that heel striking ruins knees, pronation causes injury, and tight hamstrings are the root of all evil. The problem? Much of what runners believe about injuries is based on outdated theory, not modern science.

Over the last 20 years, high-quality randomised controlled trials, systematic reviews, and large cohort studies have fundamentally changed how we understand running injuries. Many of the most common explanations have simply failed when tested.

1. “Heel striking causes knee injuries”

The belief

Landing on your heel creates more impact, which damages the knees and leads to injury.

What the evidence says

Multiple biomechanical and epidemiological studies show no consistent link between heel striking and injury risk.

Large prospective studies of recreational runners (e.g. Daoud et al., 2012; subsequent replications) found that both heel-strikers and forefoot strikers get injured at similar rates. Some injuries are slightly more common with certain strike patterns, but overall injury risk does not differ.

Switching to forefoot running often:

• Increases Achilles and calf loading

• Raises risk of stress fractures and tendon injury

Meanwhile heel striking increases:

• Knee loading

• Patellofemoral stress

But neither is inherently safer. The body adapts to how it moves.

👉 Running form is a trade-off, not a danger.

2. “Pronation causes injuries”

The belief

If your foot rolls in (pronates), you will get injured unless corrected with stability shoes or orthotics.

What the evidence says

This idea comes from 1970s podiatry theory—not from modern trials.

Large studies involving thousands of runners show:

• Mild-to-moderate pronation is normal

• Highly pronated runners are not at higher injury risk

A landmark RCT (The Motion Control Shoe Trial, 2015) found that:

Stability shoes did not reduce injury rates compared with neutral shoes.

Even more interesting: Some studies found slightly lower injury rates in pronated runners.

👉 Pronation is not a pathology—it’s a shock-absorbing strategy.

3. “Bad shoes cause running injuries”

The belief

You need the “right” shoe based on gait analysis or foot type to avoid injury.

What the evidence says

Shoe prescription based on arch type, pronation, or gait has repeatedly failed in trials.

A major systematic review (Nigg et al., 2015) found:

Matching shoes to foot type does not reduce injury risk.

The best predictor of injury? Training load, not shoe type.

Runners who increase mileage too quickly get injured regardless of footwear.

👉 Shoes influence comfort—not injury risk.

4. “Tight hamstrings and calves cause injury”

The belief

If your muscles are tight, they pull on joints and cause damage.

What the evidence says

Prospective trials show:

• Static flexibility has little to no correlation with injury risk

• Stretching does not prevent running injuries

Muscles often feel tight because they are:

• Fatigued

• Weak

• Overloaded

Not because they are “short”.

👉 Strength and load tolerance matter far more than flexibility.

5. “Running ruins your knees”

The belief

Running causes osteoarthritis and cartilage damage.

What the evidence says

Large longitudinal studies consistently show:

• Runners have lower rates of knee osteoarthritis

• Runners have lower rates of joint replacement

Cartilage responds to running by:

• Becoming thicker

• Becoming more resilient

It is underloading, not overuse, that leads to cartilage degeneration.

👉 Running is one of the best things you can do for joint health.

So what actually causes running injuries?

Evidence-based medicine points to three main drivers:

1. Training load

• Sudden increases in mileage

• Spikes in intensity

• Too little recovery

This explains more injuries than any biomechanical factor.

2. Tissue capacity

Weak muscles and tendons fatigue and fail under repeated load.

3. Poor progression

Returning too fast after time off or injury.

What runners should focus on instead

Forget shoe type, foot strike, and stretching routines.

Focus on:

• Gradual mileage progression

• Strength training (especially calves, hips, and quads)

• Sleep and recovery

• Consistency

Your body adapts to the loads you apply—if you give it time.