Can We Guess Which Runners Get Injured Based on Anatomy and How They Run?

A recent systematic review and meta-analysis (Peterson et al. 2022) looked at this exact question.


This review article compiled data from 30 prospective studies (total=3404 runners).


In a prospective study, researchers assess and measure several things in a group of healthy runners. Then, they monitor injuries over the course of a running program.


The goal of these studies is to find out if injured runners had predisposing factors that could explain why they got injured, in comparison with runners who did not.



What were the main findings?


  1. Someone’s anatomy does not put them at risk of getting a running injury. For example, we cannot blame your foot posture, hip/knee/ankle range of motion, or having “knock-knees” as the cause of your running injury.
  2. Running biomechanics (the way someone runs) do not seem to be associated with injury risk either.
  3. People with weaker quadriceps could slightly increase their risk for injury.


This study adds further confirmation to what previous research has reported (and what The Running Clinic has been teaching for a long time): running biomechanics and musculoskeletal measurements are not very helpful in predicting whether a runner will get injured or not.


Runners can fully adapt to a heel strike, increased pronation, or higher impact, assuming they are gradual enough in their training!



Are running assessments still useful?


If you’re an experienced runner, not injured, and you do not care about performance, then maybe a running assessment is not the best use of your time. However, running assessments may still be useful if:

  • You are new to running: Some research suggests that novice runners who learn to “run softer” could reduce their injury risk (Chan et al. 2018). A running assessment may help you identify factors that will help you ramp up your running safely. However, a proper running assessment should focus not just on the way you run, but also on teaching you about “load management” and how to train properly.
  • You are injured: If you have an injury, you may benefit from getting an assessment to potentially change the way you run, and shift load away from the irritated structure(s) (Doyle et al. 2022; Bramah et al. 2019).
  • You want to perform better: There are different approaches to improving running economy (how much energy you spend to maintain a certain speed), and an assessment may potentially help identify which ways might be best for you!


Focus on the important stuff


Overall, when it comes to preventing running injuries, stick to the basics: listen to your body, be gradual with any changes in your training (e.g. mileage, training surfaces, speed, footwear), and don’t forget to recover properly…whether you have flat feet or not!

Bea Francisco & Jean-Francois Esculier

Bea Francisco (BKin, MSc, MPT) and Jean-Francois Esculier (PT, PhD) are two physiotherapists practicing at MoveMed Physiotherapy, a specialized clinic recommended by The Running Clinic based in Kelowna, Canada.

JF Esculier is also a Speaker and Leader of Research and Development at The Running Clinic.