Running injuries are incredibly common, affecting up to 9 out of 10 runners at some point. With numbers like that, it’s no surprise that clinicians and runners alike look for clear answers. A large research review explored whether the things we routinely assess in clinic, such as strength, flexibility, joint range, and alignment, can actually predict who will go on to get injured.
The answer? It’s complicated.
One of the biggest surprises was that more strength isn’t a magic shield against injury. In fact, some injured runners were stronger in key areas, while others appeared to cope better with a bit more stiffness or structure through the hips and feet challenging the idea that more mobility is always better.
This challenges the common belief that weakness or tightness is always the problem that needs fixing.
What the research really highlights is that the human body doesn’t work in isolation. Muscles, joints, tendons, and bones all adapt to the loads placed on them. A “strong” muscle in one runner may be protective, while in another it may simply reflect how their body has adapted to training demands. Similarly, less movement or flexibility isn’t automatically a flaw, in some cases, it may help the body tolerate repetitive forces more efficiently.
So what does this mean for runners and osteopaths?
• There’s no single “perfect” body type for injury free running
• Isolated tests rarely tell the full story
• How you train, recover, and progress load matters just as much as strength or flexibility
Injuries often occur when the body’s capacity is exceeded, not because a runner is “weak” or “misaligned,” but because the load applied was greater than what the tissues were ready to handle at that time. Sudden changes in mileage, intensity, terrain, or recovery can all play a role.
As osteopaths, this reinforces why we assess the whole runner. We consider movement patterns, training history, lifestyle, recovery, and goals, Not just one tight muscle or a number on a strength test.
Your body isn’t broken, it’s adaptable. Usain Bolt is a great reminder: scoliosis, flat feet, and still one of the greatest athletes of all time.
The key isn’t chasing perfection. It’s guiding adaptation safely and progressively.