Running Smart: Insights from a Recent Publication for Evidence-Based Running Programming to Prevent Overuse Injuries

As a sports and rehabilitation clinician I frequently see a familiar cycle: a motivated runner commits to a new goal, increases their training volume too rapidly, and ends up sidelined with a running-related injury (RRI). Despite the well-established benefits of running on joint longevity, cardiorespiratory fitness, and mental health, its injury rate remains high—reported to be between 20% and 79% annually depending on the population studied. These injuries usually happen during periods of high fatigue, or when increasing running frequency, intensity or distance.

Typically, it is general programming mistakes around the volume and intensity progression of running that are the major contributors to this problem. For me, working at the intersection of sports medicine, rehabilitation, and performance, it's important to understand and apply evidence-based frameworks to help runners train smarter and stay injury-free, rather than going out there and guessing.

For you, perhaps someone who is “doing the thing”, running, training, and trying to remain healthy, having a foundational understanding of load progression will help you stay out on the road, remain active, and more importantly, keep you out of my office! This week’s newsletter builds on last weeks, but with a little more focus on running and some important things to be aware of when training for a particular distance.

The Dose-Response Dilemma in Running

Exercise is medicine—but, like any medicine, the dose matters. Too little and we don’t provide enough stimulus to change our physiology or improve fitness, load tolerance and athleticism. Too much, too quickly, and we run the risk injury, non-functional overreaching and overtraining (unfamiliar with these terms? Read here). Striking the right balance requires careful management of training loads, both the acute load (the past week) and the chronic load (the past month).

Some important training frameworks have emerged in recent years to help us quantify and manage dosing issues:

Acute:Chronic Workload Ratio (ACWR)

This concept was established by Tim Gabbett and his colleagues and has long been the reference point for those in the sports and performance space to manage training load. The ACWR compares the “acute” workload (typically the last 7 days) to the “chronic” workload (usually the accumulation of the previous 4 weeks). The rationale for using this ratio is intuitive: if the acute workload spikes too high relative to what the athlete has been conditioned to tolerate, the risk of injury increases. This comes down to having an understanding of how tissues like tendons, muscles, cartilage and bone respond to load and the recovery needed to make positive adaptation.

The 2016 paper by Gabbett suggests that an ACWR “sweet spot” of 0.8–1.3 is associated with a lower injury risk, while a ratio >1.5 significantly increases risk. For example, if a runner averages 30 km/week over the past month (chronic load), jumping to 50 km in a single week (acute load) gives an ACWR of 1.67—well into the “danger zone”, as described in the paper.

Image Courtesy of Gabbett (2016): Available from https://bjsm.bmj.com/content/50/5/273

The ACWR is honestly a great starting point when thinking about dosage and load progression, whether it be running, cycling or weight lifting, and I personally use it weekly for myself and for my patients. I also think it’s an awesome framework to guide people who are new to running or those returning from injury. However, when diving into the details, it has been criticized by some for statistical limitations as it lacks prospective validation in all sports, so it's external validity may not always hold true between all sports and activities.

Single-Session Distance Increase and Injury Risk: A New Running Dosage Consideration?

Just last month in the British Journal of Sports Medicine, Frandsen et al. (2025) proposed a more nuanced addition to our understanding about RRI’s suggesting that the distance covered in a single running session may be more predictive of injury than weekly volume alone. Also, the data that was from over 5000 recreational runners found that 35% of the runners actually sustained some form of running related injury during the time frame of the study. Something to be aware of if you're a runner.

When it came to load and distance progression, they found that if runners exceeded a 10% increase in distance compared to their longest run in the past 30 days, the risk of RRIs increased dramatically, independent of total weekly distance and chronic accumulated workload. Runners who happened to increase their distance in a single session by 10-30% actually had an 64% increase in risk of sustaining an RRI! This is like running 13km when the farthest you've run in the past 30 days was 10km.

This data seems to be somewhat consistent with the old “10% rule” which recommends a max of a 10% increase in distance on a given run or total distance per week. However, the authors actually found even a progression from 1%-10% showed a 19% increase in risk of sustaining an injury. So, what gives? How are we supposed to progress at all if even a 1-10% distance bump comes with risk of injury? Well, this is where it all becomes more nuanced and individualized when we’re trying to apply this to real life.

Realistically, the ACWR and single session running distances are important to consider when designing a program and when expecting to make progressions in performance and doing so safely. At the end of the day, taking part in any physical and athletic endeavour comes with injury risk—that's just life. The take home is that we must respect the time it takes for our body to adapt and be as smart as we can with our progressions.

Although it all comes with nuance (spoiler: there's always nuance), the findings of this new paper do resonate clinically for me. We’ve likely all seen athletes, friends or colleagues who train conservatively all week (or not at all), and then run a weekend long run that doubles their weekday session average. I know I see this in my office all the time, particularly in those who live busy lives throughout the week with work, family and other obligations. This abrupt spike in single session load overloads musculoskeletal structures—usually tendons—that tend to respond more favourably to cumulative stress over time.

The takeaway? Weekly volume is important—but how that volume is distributed amongst individual sessions may matter even more.

Programming Principles for Injury Prevention

Drawing on both the frameworks of Gabbett et al. and Frandsen et al., here are some programming principles we can use to prioritize sustainable training and athleticism.

1. Adopt the “10% Rule” – But Smarter

The classic recommendation to increase weekly mileage by no more than 10% has merit, but it needs context. For trained runners with high chronic loads, a 10% increase may be tolerable. For novices or those returning from injury, even 10% may be too much. Instead, anchor the increases to the ACWR, aiming to stay within a 0.8–1.3 ratio, and use a step-load approach with de-load weeks built in. Adequate recovery is key.

2. Avoid Isolated Distance Jumps

Based on Frandsen et al.’s findings, a single long run that dramatically exceeds one’s usual session distance should be avoided. Instead, build long runs incrementally and ensure midweek runs are scaled proportionally. A good rule of thumb: the long run should not exceed 30–40% of total weekly volume.

3. Prioritize Frequency>Duration/Distance>Intensity

Especially for novice or returning runners, it’s safer to increase the number of running sessions (e.g., from 2 to 3 days/week) at moderate distances, rather than adding a single long run. This distributes load more evenly and promotes better tissue adaptation. Once you get consistent and increase your frequency, you can then increase the total volume by adding some distance within these runs. Lastly, when the tissue can both adapt and recover you can then ramp up intensity within the given mileage you’ve accumulated.

4. Monitor Internal Load – Reflection and Recovery

Rating scales like Rating of Perceived Exertion (RPE), heart rate variability, and subjective fatigue tracking can complement external load measures (distance, pace, sessions per week). Remember: two runners completing the same session may experience very different internal stresses based on things like sleep, stress, nutrition, hydration and possible medical history. A high external load with combined with high internal load significantly increases injury risk.

5. Respect Recovery as Part of the Program

Tissues adapt during rest—not during training. Ensure that you have at least one full rest day per week and that your training program includes step-down weeks every 3–5 weeks, where volume is reduced to promote recovery and supercompensation. As discussed in previous newsletters, sleep, nutrition, supplementation and managing stress levels all play a huge role in our ability to recover and adapt.

Special Considerations for Masters Athletes

A significant proportion of endurance-running populations includes athletes over 40. Even if you're not there yet, we all will be shortly, and it's important for us to adapt the way we train given the normal changes we accrue with life and as we age.

As we age, load management becomes more crucial as recovery may be more challenging. Age-related changes—such as reduced tendon elasticity, bone mineral density loss, and sarcopenia—make us more susceptible to overuse injuries. If you fall into this age-range consider the following to enhance your physical resilience and musculoskeletal longevity.

• Strength training 2x/week to preserve muscle and tendon health - different stimulus = different adaptation

• Adequate sleep and prioritize protein intake for recovery

• Extend the time frames for exercise volume progression

• Regular de-load weeks and taking part in multiple modes of physical activity (avoid sport/activity specialization)

• Seek care early if you're injured! In most cases of non-traumatic RRI's, the earlier you address it, the better the prognosis

  
  

Conclusion

Injury prevention in runners is not just about foam rolling, massage guns and fancy shoes (although Instagram may make it seem that way). It’s really about intelligent programming and having a foundational understanding of tissue adaptation. By combining the acute:chronic workload ratio model with emerging insights like those from Frandsen et al., we can help our patients, athletes and ourselves navigate the fine line between optimal stress and overload.

As a clinician, it’s my responsibility to move beyond reactive care and into proactive coaching—educating my patients on how to structure their running intelligently and sustainably.

As an active person or athlete yourself, it’s important to seek educational support so you know what you’re doing and why if you happen to have knowledge gaps.

Seeking care, coaching and management from someone with a recognized sports specialty designation is a good starting point as they have an extensive understanding of tissue physiology, exercise programming, and the latest scientific evidence on musculoskeletal rehabilitation.

Because, in the end, the goal is simple: to keep moving and keep running, for life.

Yours in good health,

Andrew

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