Running

Movement

What sets running apart from walking

When adults run, there is a flight phase in which neither leg touches the ground¹. Walking instead has a spell with both legs on the ground¹.

The ground reaction force is the push of the ground back up on the body. In 12 healthy men, its vertical peak was about 2.0 to 2.9 times body weight in running⁹.

Where the foot lands

Foot strike is generally grouped by where the foot first meets the ground¹⁰:

• Rearfoot strike. The heel or rear third of the foot lands first¹⁰.
• Midfoot strike. The heel and the ball of the foot land nearly together¹⁰.
• Forefoot strike. The front half of the foot lands first and the heel follows¹⁰.

A meta-analysis of 12 articles on overground distance running over 10 km found 79% of runners landed on the rearfoot early in the run¹⁰.

What it loads

The muscles that brake, support and push

One computer simulation of the running stride split the work by phase². Early in stance, the quadriceps, the four muscles on the front of the thigh, contributed most to braking and to supporting body weight². In the second half, the soleus and gastrocnemius, both calf muscles, contributed most to propulsion and support².

Electromyography measures a muscle’s activity by picking up its electrical signals. In such a study of 13 runners, the calf muscles switched on late in swing, when the foot is off the ground¹¹. They stayed active through the first 80% of stance¹¹.

• Gluteus maximus. In electromyography recordings, the gluteus maximus, the large muscle of the buttock, was mostly quiet in walking and far more active in running¹².
• Gluteus medius. In recordings from ten active people, each part of the gluteus medius, a deeper buttock muscle, peaked during stance¹³.
• Peroneals. In 15 injury-free runners, activity in the peroneus brevis, one of the outer-leg peroneal muscles, rose significantly with pace¹⁴.
• Tibialis posterior. In 15 injury-free runners, the tibialis posterior peaked in midstance¹⁴. It is a deep calf muscle whose tendon passes behind the inner ankle.
• Tibialis anterior. In 15 injury-free runners, the shin muscle of the tibialis anterior tendon fired above the fatigue threshold 85% of the time¹⁴.
• Foot muscles. In nine participants walking and running on a treadmill, three foot muscles slowly lengthened while active as the arch compressed¹⁵.

The hamstrings, from swing to stance

Electromyography of seven participants at about 3.4 to 9.0 m/s tracked the hamstrings, three long muscles at the back of the thigh¹⁶. They were active from mid-swing until foot strike, then from foot strike until late stance or early swing¹⁶. The size of their activation rose significantly at faster speeds¹⁶.

A model of 30 healthy participants, at preferred speeds of 2.4 to 3.8 m/s, estimated the hamstrings’ work in late swing¹⁷. They did negative work, absorbing energy while lengthening, then positive work just before foot contact¹⁷. The authors describe the hamstrings and gluteus maximus as speeding the hip into extension then, moving the thigh backward¹⁷. The hamstrings, they add, also work against the knee speeding straight¹⁷.

At a step rate 10% above preferred, the authors noted, modelled peak hamstring force and negative work stayed under 60% of sprinting values¹⁷. The sprinting was at 7.8 m/s¹⁷. In simulations of ten experienced long-distance runners at 2.0 to 5.0 m/s, the hamstrings added to forward acceleration during stance¹⁸.

What one model estimated inside the leg

A modelling study estimates forces inside the body with a model, not by measuring them directly. One lower-limb model, applied to five running trials, estimated these peak forces³:

Site	Modelled peak force, in body weights
Achilles tendon	6.1 to 8.23
Patellar tendon	4.7 to 6.93
Patellofemoral joint, between kneecap and thigh bone (compression)	7.0 to 11.13
Plantar fascia, along the sole	1.3 to 2.93
Lower leg (compression)	10.3 to 14.13

In that model, peak loads at the common injury sites came in mid-stance and push-off, when muscle activity was greatest³. The model estimated that the impact force when the heel lands had no effect on those peaks³.

Other estimates, site by site

• Knee. The patellofemoral joint of the knee is where the patella (kneecap) meets the thigh bone. A meta-analysis found its peak force in healthy people averaged about 5.2 times body weight in running¹⁹.
• Ankle. A review gives the load on the ankle joint complex as up to thirteen times body weight in activities such as running²⁰.
• Shin. In a modelling study of 40 recreational runners, peak stress in the tibia (shinbone) was about twice as high in running as in walking²¹.
• Foot. A model based on 21 male distance runners estimated that mid-shaft bending strain was greatest in the second of the metatarsals, the long midfoot bones²². With repeated compression, as in running, most force on the navicular, a midfoot bone, is described as concentrating at its centre²³.
• Outer thigh. A model built from five cadaver specimens estimated that hip muscle forces stretch the iliotibial band, a long band of tough tissue, substantially in running²⁴.
• Cartilage. A meta-analysis of 24 MRI studies found knee cartilage thickness and volume fell immediately after running²⁵. A review of 43 MRI studies concluded that such changes in lower-limb articular cartilage are transient²⁶.

How foot strike and step rate shift the load

A meta-analysis of 26 studies concluded that a rearfoot strike put higher loads on the knee and patellofemoral joints⁴. A forefoot strike loaded the ankle joint and the Achilles tendon more⁴. A meta-analysis of 53 studies could not determine how foot strike pattern relates to injury risk⁵.

A meta-analysis of 53 studies could not determine how foot strike pattern relates to injury risk.

A meta-analysis of 37 studies found strong evidence that a higher step rate went with a smaller peak knee bend²⁷. Its authors concluded there was too little evidence to determine how changing step rate affects injury²⁷.

How the body adapts

Tendon and bone in runners and non-runners

These studies compared runners with other people^28,29,30:

• Achilles tendon. In trained elite and sub-elite middle-distance runners, the free Achilles tendon was significantly shorter, larger in cross-section and stiffer than in healthy controls²⁸. The free tendon is the part clear of its muscle.
• Shin bones. Scans of 30 trained long-distance runners and 30 untrained controls found greater strength indicators in the runners’ tibias²⁹. Their fibulas, the thin outer lower-leg bones, had lower resistance to sideways bending²⁹.
• Heel bone. In CT scans of 12 male runners and 6 non-runners, trabecular thickness in the rear calcaneus (heel bone) correlated positively with weekly running distance³⁰. The same study found no statistically significant difference between the runners and the non-runners³⁰. Trabecular bone is the light, spongy bone found inside bones.

Knee osteoarthritis in runners

Three reviews looked at knee osteoarthritis, a long-term joint disease in which the cartilage lining the joint wears away^7,31,32:

• A meta-analysis of 15 studies found mixed results and concluded that the role of running could not be determined⁷.
• A meta-analysis of nine studies found no difference in how common knee osteoarthritis was between runners and controls³¹. Most of those studies were at high or very high risk of bias³¹.
• A systematic review of 17 studies concluded that running is not linked, in the short term, with worse imaging signs of knee osteoarthritis³².

Injuries in runners

How often, and where

Incidence is how many new cases appear in a group over a set time. Prevalence is the share of a group who have a condition at a given time. A systematic review of running injuries reported an overall incidence of 40.2% and an overall prevalence of 44.6%⁶.

The same systematic review pooled the most common injuries, by study type⁶:

Injury	Share of new injuries, prospective studies	Share of injuries, retrospective and cross-sectional studies
Achilles tendinopathy, local pain in the tendon	10.3%6	6.6%6
Medial tibial stress syndrome, inner shin pain with exercise	9.4%6	9.1%6
Patellofemoral pain, around or behind the kneecap	6.3%6	16.7%6
Plantar fasciitis, heel pain linked to the plantar fascia	6.1%6	7.9%6
Ankle sprain	5.8%6	—
Iliotibial band syndrome, outer knee or thigh pain	—	7.9%6

Each column gives the review’s five highest proportions for that measure⁶.

That review found calf strain made up 4.2% of injuries in incidence studies of runners who were not ultramarathoners⁶. A meta-analysis of prospective studies found no difference in overall injury rate between female and male runners³³. Bone stress injury was more frequent in the female runners³³. This is overuse damage to bone, ranging from a stress reaction to a stress fracture.

In competition at 13 international athletics championships, hamstrings were the most often injured muscle group in sprints, jumps, hurdles, combined events and men’s middle distances³⁴. In women’s middle distances, men’s long distances and the women’s marathon, it was the back of the lower leg³⁴.

Previous injury as a risk factor

A systematic review of 11 prospective cohort studies found the main risk factor reported for running injuries was an injury in the previous 12 months³⁵. Five of the eight studies that examined it reported it³⁵. Two other systematic reviews found a history of previous injury was associated with a higher risk of running injuries^36,37.

What studies of training load found

• A randomised trial, which assigns people to groups by chance, followed 532 novice runners preparing for a 4-mile event³⁸. A graded 13-week programme based on the 10% rule gave an injury incidence of 20.8%, against 20.3% with a standard 8-week programme³⁸.
• A cohort study followed 5205 adult runners for 18 months³⁹. A single session more than 10% longer than the longest run of the past 30 days was associated with a higher rate of overuse injury³⁹. A week-to-week ratio of running distance showed no relationship with overuse injury³⁹.
• One systematic review concluded that very limited evidence supports a link between a sudden change in training load and injury⁴⁰.

What studies of shoes found

A review of 12 randomised and quasi-randomised trials concluded that most evidence shows no reduction in adults’ lower-limb running injuries between shoe types⁴¹. The certainty of that evidence, meaning how sure reviewers are that a finding is right, was very low to low⁴¹.

One randomised trial followed 848 healthy recreational runners for 6 months⁴². Those given the harder of two shoe versions had a higher injury risk than those given the softer version⁴². Split by body mass, the difference held for lighter runners but not for heavier runners⁴².

Progressive overload

A 2026 position stand describes progressive overload as the need to raise the stimulus on the muscle through a training programme⁴³.

Adding hard running or total volume

The Run Clever randomised trial studied healthy recreational runners on three runs a week, in 4-week blocks⁸. Weekly volume rose 23% in the first week of each block and fell 10% in the last⁸. After 8 weeks, one group added hard running, at or above 88% of VO2max⁸. VO2max is the most oxygen the body can take in and use during hard exercise. The other group added total volume at an easy intensity, at or below 80% of VO2max⁸.

Over 16 weeks, a similar proportion of the 447 runners was injured on the two schedules: 36 of 221 and 44 of 226⁸. A second report found no difference between the schedules in the injuries thought to be linked to intensity or to volume⁴⁴. The authors note the total rise over 16 weeks was 0.8 km of weekly hard running and 6 km of weekly volume⁸. They wrote that the injury proportions after 16 weeks, 12.1% to 18.8% and 25.5% to 30.6%, should cause awareness⁸.

How fast weekly distance rose

A 14-week cohort study, which follows a group of people over time, tracked 261 healthy runners by GPS⁴⁵. At 21 days, significantly more were injured with a weekly rise of 20% to 60% than with a rise under 20%⁴⁵. No significant difference was found at 56 and 98 days⁴⁵.

A 1-year cohort study followed 874 healthy novice runners with GPS watches⁴⁶. Overall injury rates did not differ significantly between weekly rises under 10%, 10% to 30% and over 30%⁴⁶. For distance-related injuries, the rate was higher with rises over 30% than under 10%, but not significantly⁴⁶.

A lead-in before running

A randomised controlled trial followed 432 novice runners preparing for a 4-mile event⁴⁷. One group did 4 weeks of walking and hopping exercises before a 9-week running programme⁴⁷. Its injury incidence was 15.2%, against 16.8% in the control group, a difference that was not significant⁴⁷.

Programme length and fitness

A meta-analysis of randomised controlled trials looked at running in physically inactive but healthy adults⁴⁸. Programmes averaged 3.7 sessions, 2.3 hours and 14.4 km a week, and lasted 21.5 weeks on average⁴⁸. After 1 year, running raised VO2max by 7.1 ml per kg per minute compared with no intervention⁴⁸.

In the same review’s meta-regression, longer training went with a larger VO2max rise, but more hours a week went with smaller effects⁴⁸. A meta-regression links pooled results to features of the studies.

In 11 previously untrained people who ran regularly for about 9 months, VO2max rose 8.6%⁴⁹. Their Achilles tendon cross-sectional area, the size of a slice cut straight across it, did not change⁴⁹. Nor did the mechanical properties of the calf’s tendon-aponeurosis complex, the tendon with its flat tendon sheet⁴⁹.

Connections

Simulations, recordings and models of running cover the quadriceps, soleus, gastrocnemius, gluteus maximus, gluteus medius and hamstrings^2,12,13,16. They also cover the peroneal muscles and foot muscles^14,15. Recordings in runners measured activity in muscles of the peroneal tendons, tibialis posterior tendon and tibialis anterior tendon¹⁴.

One model estimated running forces in the Achilles tendon, patellar tendon and plantar fascia³. Other estimates and descriptions cover the knee, patella, ankle, tibia, metatarsals, navicular, iliotibial band and articular cartilage^{19,20,21,22,23,24,26}. Comparisons of runners with non-runners measured the fibula and calcaneus^29,30.

A systematic review lists medial tibial stress syndrome, patellofemoral pain, plantar fasciitis and iliotibial band syndrome among the most common running injuries⁶.

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Every source the library cites

Changes

• October 23, 2026 Added a Progressive overload section.
• October 5, 2026 First published.