Diagnosing running injuries using a runner’s training & medical history

Article By : Auptimo (Systems for Gait & motion analysis)

Running injuries

With the increase of running-related injuries, it’s important for clinicians to formulate running-specific assessment plans for their patients. In this article series, we will be discussing a standardized approach that you can use integrate as a part of your assessment process. A running assessment is a step by step process including 4 stages:

  • Comprehensive medical review & training history.
  • A Physician Examination.
  • A running gait analysis, if the runner is symptotic.
  • Physical therapy consultation to propose programs for correcting biomechanical aberrations of running motion.

Medical & training history

Medical & training history documentation is an excellent tool used by clinics for diagnosing running-related injuries in patients. 

Here’s an effective ‘Runner intake questionnaire’ you can provide your patients at their first visit for assessing their running pattern & potential triggers for injury.

Clinical usage of the ‘runner intake questionnaire’

Running Injury History

A. RUNNING SURFACE & ROUTE CHARACTERISTICS

Knowing about the running surface & route used by the patient can help you estimate the resulting joint and muscle loads, & identify aspects that may be associated with injury risk.

Surface                                Injury
Beveled Roads When the foot lands on the lateral side of the road, the lower extremity is subjected to strain.
SandSoft tissue injuries such as midportion Achilles tendinopathy
HillsEccentric loading to knee extensors

B. MILEAGE AND RUNS PER WEEK

Recreational runners with weekly volume <24 km/week or <3 years of training have a higher risk of developing leg pain. 

Additionally, training for >7d/week (or >1 sessions/day) is considered as excessive. Such high volumes don’t allow enough time for the soft and bony tissue recovery, increasing the chances of injury. Studies have shown that <2d/week of rest increases the risk of overuse injury by 5.2 fold!

C. SHOE MILEAGE & WEAR

Assessing the mileage and wear pattern of the patient’s shoes can be extremely valuable. An average running shoe begins to break down at 350-400 miles, leading to abnormal loading mechanics of the foot and lower extremity.

Any asymmetry in the wear pattern of the sole might indicate an asymmetric running motion. A runner with a worn-out lateral heel of the shoe is forced to land in excessive supination with each step, increasing soft tissue stress in the midfoot.

D. FOOT STRIKE PATTERN

Surprisingly, most patients are unable to determine their foot-strike pattern accurately. Hence, we recommend that you use a video-based tool to accurately assess this parameter in the clinic.

As per recent studies, Fore-Foot Striking seems favorable for patients with unstable knee joints in the AP axis. As opposed to this, a Rear-Foot Strike pattern may be recommended for runners with unstable ankle joints. Cushioned shoes encourage heel striking whereas shoes with minimal or no drop encourage mid to forefoot striking.


Although the documentation of medical & training history is very important, it is seldom used in isolation. Instead, it should act as a guiding criteria for subsequent examinations of the patient.

Once this step is complete, you can use this documentation for conducting a comprehensive physical and functional assessment of the patient. 

At auptimo, we help clinicians introduce running analysis at their centers through GaitON, our motion analysis system. Its inbuilt running protocol assesses important biomechanical faults in running form and summaries all results in organised reports with normal values.  

For more information on GaitON’s running protocol, click here.

We, at auptimo help clinicians introduce running gait analysis at their centers through GaitON, our motion analysis system. For more information on GaitON’s running protocol, click here.​

REFERENCES: 

1. Altman AR, Davis IS. Barefoot running: biomechanics and implications for running injuries. Curr Sports Med Rep. 2012;11:244–50. [PubMed] [Google Scholar]

2. American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription. 9. Lippincott Williams and Williams; Philadelphia: 2013. [Google Scholar]

3. Azevedo LB, Lambert MI, Vaughan CL, et al. Biomechanical variables associated with Achilles tendinopathy in runners. Br J Sports Med. 2009;43:288–92. [PubMed] [Google Scholar]

4. Ballas MT, Tytko J, Cookson D. Common overuse running injuries: diagnosis and management. Am Fam Physician. 1997;55:2473–84. [PubMed] [Google Scholar]

5. Bonacci J, Saunders PU, Hicks A, et al. Running in a minimalist and light-weight shoe is not the same as running barefoot: a biomechanical study. Br J Sports Med. 2013;47:387–92. [PubMed] [Google Scholar]

6. Bonacci J, Vicenzino B, Spratford W, Collins P. Take your shoes off to reduce patellofemoral joint stress during running. Br J Sports Med. 2013 doi: 10.1136/bjsports-2013-092160. [PubMed] [CrossRef] [Google Scholar]Br J Sports Med. 2014 Mar;48(6):425–8. [PubMed] [Google Scholar]

7. Cauthon DJ, Langer P, Coniglione TC. Minimalist shoe injuries: three case reports. Foot (Edinb) 2013;23:100–3. [PubMed] [Google Scholar]

8. Chang WL, Shih YF, Chen WY. Running injuries and associated factors in participants of ING Taipei Marathon. Phys Ther Sport. 2012;13:170–4. [PubMed] [Google Scholar]

9. Chumanov ES, Wille CM, Michalski MP, Heiderscheit BC. Changes in muscle activation patterns when running step rate is increased. Gait Posture. 2012;36:231–5. [PMC free article] [PubMed] [Google Scholar]

10. Ciacci S, Di Michele R, Merni F. Kinematic analysis of the braking and propulsion phases during the support time in sprint running. Gait Posture. 2010;31:209–12. [PubMed] [Google Scholar]

11. Daoud AI, Geissler GJ, Wang F, et al. Foot strike and injury rates in endurance runners: a retrospective study. Med Sci Sports Exerc. 2012;44:1325–34. [PubMed] [Google Scholar]

12. Fellin RE, Manal K, Davis IS. Comparison of lower extremity kinematic curves during overground and treadmill running. J Appl Biomech. 2010 Nov;26(4):407–14. [PMC free article] [PubMed] [Google Scholar]

13. Ferber R, Noehren B, Hamill J, Davis IS. Competitive female runners with a history of iliotibial band syndrome demonstrate atypical hip and knee kinematics. J Orthop Sports Phys Ther. 2010;40:52–8. [PubMed] [Google Scholar]

14. Fields KB. Running injuries — changing trends and demographics. Curr Sports Med Rep. 2011;10:299–303. [PubMed] [Google Scholar]

15. Ford KR, Taylor-Haas JA, Genthe K, Hugentobler J. Relationship between hip strength and trunk motion in college cross-country runners. Med Sci Sports Exerc. 2013;45:1125–30. [PubMed] [Google Scholar]

16. Fredericson M, Misra AK. Epidemiology and aetiology of marathon running injuries. Sports Med. 2007;37:437–9. [PubMed] [Google Scholar]

17. Gallo RA, Plakke M, Silvis ML. Common leg injuries of long-distance runners: anatomical and biomechanical approach. Sports Health. 2012;4:485–95. [PMC free article] [PubMed] [Google Scholar]

18. Giandolini M, Horvais N, Farges Y, et al. Impact reduction through long-term intervention in recreational runners: midfoot strike pattern versus low-drop/low-heel height footwear. Eur J Appl Physiol. 2013;113:2077–90. [PubMed] [Google Scholar]

19. Giuliani J, Masini B, Alitz C, Owens BD. Barefoot-simulating footwear associated with metatarsal stress injury in 2 runners. Orthopedics. 2011;34:e320–3. [PubMed] [Google Scholar]

20. Gruber AH, Umberger BR, Braun B, Hamill J. Economy and rate of carbohydrate oxidation during running with rearfoot and forefoot strike patterns. J Appl Physiol (1985) 2013;115:194–201. [PubMed] [Google Scholar]

21. Hammer SR, Delp SL. Muscle contributions to fore-aft and vertical body mass center accelerations over a range of running speeds. J Biomech. 2013;46:780–7. [PMC free article] [PubMed] [Google Scholar]

22. Hespanhol LC, Junior, Pena Costa LO, Lopes AD. Previous injuries and some training characteristics predict running-related injuries in recreational runners: a prospective cohort study. J Physiother. 2013;59:263–9. [PubMed] [Google Scholar]

23. Hockenbury RT. Forefoot problems in athletes. Med Sci Sports Exerc. 1999;31:S448–58. [PubMed] [Google Scholar]

24. Hubbard TJ, Carpenter EM, Cordova ML. Contributing factors to medial tibial stress syndrome: a prospective investigation. Med Sci Sports Exerc. 2009;41:490–6. [PubMed] [Google Scholar]

25. Kelsey JL, Bachrach LK, Procter-Gray E, et al. Risk factors for stress fracture among young female cross-country runners. Med Sci Sports Exerc. 2007;39:1457–63. [PubMed] [Google Scholar]

26. Kindred J, Trubey C, Simons SM. Foot injuries in runners. Curr Sports Med Rep. 2011;10:249–54. [PubMed] [Google Scholar]

27. Knobloch K, Yoon U, Vogt PM. Acute and overuse injuries correlated to hours of training in master running athletes. Foot Ankle Int. 2008;29:671–6. [PubMed] [Google Scholar]

28. Kong PW, Candelaria NG, Smith D. Comparison of longitudinal biomechanical adaptation to shoe degradation between the dominant and non-dominant legs during running. Hum Mov Sci. 2011;30:606–13. [PubMed] [Google Scholar]

29. Lilley K, Stiles V, Dixon S. The influence of motion control shoes on the running gait of mature and young females. Gait Posture. 2013;37:331–5. [PubMed] [Google Scholar]

30. Lisman P, O’Connor FG, Deuster PA, Knapik JJ. Functional movement screen and aerobic fitness predict injuries in military training. Med Sci Sports Exerc. 2013;45:636–43. [PubMed] [Google Scholar]