Preventing Running Injuries: How Gait, Strength and Exercise Physiology Can Keep You Running
Running is one of the simplest and most effective forms of exercise. It improves cardiovascular fitness, metabolic health, mental wellbeing, and longevity, but running's repetitive nature means small deficits in strength, mobility, movement control, or training load can become important over time. At The Right Move Allied Health Centre, we see many runners, including marathon and endurance runners, who come in with recurring knee, hip, hamstring, calf or Achilles pain.
One of the most useful parts of an Exercise Physiology assessment is looking beyond the painful area.
Where you feel pain isn't necessarily where the problem starts.
A runner presenting with knee pain, for example, may have contributing factors involving the hip, pelvis, trunk, ankle or overall training load.
Running Is Repetitive - So Small Problems Can Become Big Problems
During a marathon, a runner may take tens of thousands of steps. If each step places slightly more load through one area than the body can comfortably tolerate, the accumulated stress can eventually exceed the tissue's capacity to recover.
This is where mechanical overload becomes important.
Running injuries are generally multifactorial. Training volume and previous injury are important considerations. At the same time, biomechanics can contribute in some runners—but research does not support the idea that there is one universally "wrong" running gait that causes injury. This is why we don't simply look at a runner and try to make their technique look "perfect."
Instead, we ask:
Can this runner tolerate the load they're currently placing on their body?
Common Running Gait Problems We See
1. A Knee-Dominant Running Pattern
One pattern we commonly see clinically is a runner who appears to rely heavily on the knee to absorb and produce force.Instead of effectively sharing the workload between the:
Hip → Knee → Ankle
the runner may demonstrate excessive contribution from the knee. This can be particularly relevant in runners presenting with anterior or patellofemoral knee pain. A knee-dominant strategy may involve:
Excessive knee loading
Reduced contribution from the hip
Poor control of the pelvis
Reduced hip extension
Excessive quadriceps fatigue
Reduced gluteal contribution
The important point is that having a strong quadriceps is not the problem. The issue is whether the entire lower limb is sharing the workload effectively.
2. Excessive Hip Adduction and Pelvic Drop
Another pattern we assess is the pelvis dropping towards the unsupported side during single-leg stance. This is often referred to as a contralateral pelvic drop. It can occur alongside increased hip adduction and internal rotation.
For example:
Right leg stance → left side of pelvis drops → right hip moves into adduction/internal rotation.
This doesn't automatically mean the runner will get injured. However, increased hip adduction has been one of the more consistently investigated biomechanical variables in running injuries. A large systematic review found that peak hip adduction was the only biomechanical variable showing a significant association with running injury across its pooled analyses—although the authors emphasised that the evidence was limited and heavily influenced by a small number of studies. Research in runners with patellofemoral pain also identifies altered hip mechanics as a potential contributor.
3. Hip Internal Rotation and Rotation Control
The hip, pelvis, knee and foot operate as a linked kinetic chain.
If the hip moves excessively into:
Adduction
Internal rotation
Flexion
during stance, this can alter knee position and loading. This is particularly relevant when combined with poor trunk and pelvic control. Recent research continues to investigate the relationship between hip adduction and internal rotation and knee injuries. However, these relationships are not sufficiently consistent to say that a particular amount of hip rotation is inherently "bad." The goal is therefore not to eliminate hip rotation.
The goal is to develop enough strength and control to manage it.
4. Poor Glute Max Contribution
The gluteus maximus is one of the body's major hip extensors and contributes significantly to propulsion and control during running. A runner may demonstrate reduced contribution from the gluteal musculature and compensate elsewhere.
This may result in greater reliance on:
Quadriceps
Hamstrings
Calves
Lumbar muscles
Clinically, we sometimes see a pattern where the gluteus maximus appears under-recruited while the piriformis and other hip muscles become highly active. However, it is important not to oversimplify this as "the piriformis switches off the glute." The piriformis has multiple roles depending on hip position, and the evidence does not support labelling an overactive piriformis as a universal cause of running injuries.
Instead, we look at the broader pattern:
Is the hip controlling rotation effectively? Is the gluteus maximus contributing adequately? Are other muscles compensating for reduced capacity?
5. Hamstrings Doing Too Much Work
When the gluteus maximus isn't contributing effectively to hip extension, the hamstrings can become increasingly important.
This may contribute to:
Hamstring fatigue
Tightness
Cramping
Recurrent strains
However, hamstring tightness isn't automatically caused by weak glutes. Training load, fatigue, previous injury, running speed, recovery and individual anatomy all need to be considered. This is why an Exercise Physiologist looks at the entire running system rather than prescribing hamstring stretches simply because the hamstrings feel tight.
6. Excessive Calf Loading
Another pattern we commonly see in endurance runners is excessive reliance on the calf complex for propulsion. The calf muscles are incredibly important for running. They store and release elastic energy and contribute to propulsion. But if the runner lacks sufficient hip strength, ankle capacity or overall lower-limb strength, the calf may be asked to do more work than it can repeatedly tolerate.
This can contribute to:
Calf tightness
Cramping
Achilles pain
Achilles tendinopathy
Reduced running tolerance
Again, this isn't necessarily a "bad gait." It may simply be a capacity problem.
7. Overstriding
Overstriding occurs when the foot lands substantially ahead of the body's centre of mass. This can increase braking forces and alter loading through the lower limb. One potential strategy for some runners is increasing cadence slightly. Research suggests that increasing step rate by approximately 5–10% can reduce stride length and modify loading variables around the hip and knee. However, changing cadence isn't appropriate for every runner and shouldn't be treated as a universal injury-prevention rule. A recent 2026 umbrella review found that modest cadence increases and softer-landing strategies can improve pain and selected biomechanical measures in runners with patellofemoral pain. However, evidence for long-term injury prevention remains uncertain.
So How Do We Fix Running Gait?
The answer isn't always:
"Change your running technique."
Sometimes the better solution is:
"Build the physical capacity required to run well."
This is where Exercise Physiology becomes particularly valuable.
Strength Training for Runners
Strength training helps runners tolerate the enormous repetitive forces involved in running. We commonly focus on:
Gluteus Maximus
Examples:
Hip thrusts
Romanian deadlifts
Split squats
Step-ups
Single-leg bridges
These improve hip extension strength and overall lower-limb capacity.
Gluteus Medius and Hip Abductors
Examples:
Lateral step-downs
Side-lying hip abduction
Banded lateral walks
Single-leg squats
Step-ups
These help develop the strength and control required to manage pelvic movement during single-leg stance. Hip strengthening has good evidence for reducing pain and improving function in people with patellofemoral pain, particularly when combined with knee strengthening.
Don't Forget the Quadriceps
If you're a runner with knee pain, the answer isn't necessarily to stop training the quadriceps.
The quadriceps are essential for:
Shock absorption
Knee stability
Running economy
Hill running
Descending
Sprinting
We want a strong and well-coordinated lower limb, rather than simply trying to shift all the workload away from the knee.
Calf Strength Is Essential
Running places enormous demands on the calf complex. A runner's program should generally include progressive calf strengthening such as:
Standing calf raises
Seated calf raises
Single-leg calf raises
Heavy slow calf work
Plyometric exercises
Running-specific elastic loading
Progression should reflect the runner's training phase. A marathon runner shouldn't necessarily perform the same calf program six weeks before a race as they would during an off-season strength block.
Train Rotation - Don't Just Train Straight Ahead
Running is predominantly performed in the sagittal plane, but the body still needs to control forces in multiple directions.
Useful exercises can include:
Single-leg Romanian deadlifts
Step-downs
Lateral lunges
Split squats
Cable rotations
Pallof presses
Single-leg balance work
These exercises challenge the pelvis, trunk and hip to control rotation while the lower limb supports the body.
Gait Retraining Can Help - When Appropriate
If a runner continues to experience pain despite improving strength and capacity, gait retraining can be useful.
Depending on the presentation, this might involve:
Slightly increasing cadence
Reducing overstriding
Softer landing cues
Modifying trunk position
Improving pelvic control
Gradually changing running technique
Research suggests gait retraining can modify running mechanics and may reduce pain in runners with patellofemoral pain. However, long-term injury-prevention evidence is still developing.
Training Load Is Just as Important as Gait
One of the biggest mistakes runners make is focusing entirely on biomechanics while ignoring training load.
A technically efficient runner can still develop an injury if they suddenly increase:
Weekly kilometres
Long-run distance
Running frequency
Hills
Speed work
Race-specific sessions
A recent systematic review of knee injuries in endurance runners identified previous injury and increased training load/volume among the most consistently reported risk factors. Your tissues need time to adapt to increasing loads.
Fitness can improve faster than tissue capacity.
That's an important consideration during marathon preparation.
Why Strength Training Matters During Marathon Preparation
Strength training isn't just about injury prevention. It can also improve running performance. Systematic review evidence indicates that resistance and plyometric training can improve several physiological determinants of middle- and long-distance running performance.
The challenge is finding the right balance between:
Running volume + strength training + recovery.
More isn't always better. A marathon runner needs enough strength work to maintain and develop capacity without creating excessive fatigue that compromises key running sessions.
The Goal Isn't Perfect Running Form
This is perhaps the most important point. No single running technique is perfect. A 2023 systematic review involving more than 5,000 runners found only limited evidence linking specific biomechanical variables with running injuries. The authors concluded that clinicians should be cautious about assuming that a particular biomechanical deviation automatically causes injury.
Instead, we should ask:
Can your body tolerate the way you currently run?
If the answer is yes, there may be no reason to change your technique.
If the answer is no, we can identify where capacity is lacking and build it progressively.
The Exercise Physiology Approach to Running Injuries
At The Right Move Allied Health Centre, we work with many recreational runners, marathon runners and endurance athletes.
Our approach combines:
Assessment → Strength + Movement Control → Running Mechanics → Load Management → Progressive Return to Running
Rather than simply treating the knee, calf or hamstring that hurts, we look at the entire kinetic chain and the demands being placed on it. Because sometimes the best way to fix a knee problem isn't to train the knee less.
It's to build a stronger hip, stronger calf, stronger trunk and stronger overall runner.
Key Takeaways
Running injuries are usually multifactorial, rather than caused by one "bad" movement.
A knee-dominant pattern may increase knee loading in some runners.
Hip adduction and pelvic control are worth assessing, particularly in runners with knee pain.
Reduced glute contribution may result in greater reliance on other muscles, but "inactive glutes" and "overactive piriformis" should not be treated as universal diagnoses.
Calf and hamstring symptoms can sometimes reflect broader kinetic-chain or training-load issues.
Strength training builds the capacity needed to tolerate running.
Gait retraining can be useful for selected runners, particularly those with persistent patellofemoral pain.
Training load and previous injury are at least as important as running mechanics.
The goal isn't perfect running form—it's a body capable of tolerating the demands of running.
Research Supporting This Approach
Figueiredo et al. (2025) – Systematic review of running cadence. Moderate increases in cadence can reduce stride length and alter loading variables, although more research is needed regarding long-term injury prevention.
Petri et al. (2026) – Umbrella review of gait retraining for patellofemoral pain. Cadence increases and softer-landing strategies may improve short-term pain and selected biomechanical measures, but evidence for prevention remains uncertain.
Doyle et al. (2022) – Systematic review and meta-analysis of gait retraining. Gait retraining can alter step rate, knee mechanics and vertical loading rates, with limited evidence regarding long-term injury prevention.
Wu et al. (2024) – Systematic review and meta-analysis of exercise-based injury prevention in endurance runners. Overall exercise interventions did not significantly reduce injury rates, although supervised programs showed more promising results; the authors highlighted the limited quality and relatively low strength-training dose in many studies.
2023 Systematic Review and Meta-analysis of Running Biomechanics – Found only weak overall evidence linking biomechanical variables with running injury, with peak hip adduction being the only pooled variable showing an association, and substantial limitations in the evidence.
Hip and Knee Strengthening Meta-analysis (2018) – Hip and knee strengthening reduced pain and improved activity in people with patellofemoral pain, with combined hip and knee strengthening outperforming knee strengthening alone.
2024 Umbrella Review of Running Injury Risk Factors – Identified training characteristics, previous injury, lifestyle/health factors and some morphological and biomechanical factors as potential contributors, while emphasising limitations in the existing evidence.