Common Trail Running Injuries

Trail running is addictive. Running on a winding trail outdoors, away from traffic, with the variety that comes with a trail. Because you have to concentrate on each step, it is mentally engaging. If you are in a beautiful area, the scenery is great.

The problem with running on the trail is that there are injury risks everywhere. Get a little lazy? Twist an ankle.  Decline with too fast a stride? Risk runners-knee.trail running injuries

One of the keys to preventing trail running injuries is understanding what the most common injuries are, and then working to avoid them. Unlike road runners, who typically run on flat and even surfaces, trail runners must navigate a variety of terrains, including rocky trails, steep inclines and declines, and uneven surfaces. As a result, trail runners are stabilizing themselves from side-to-side, varying their stride based on the trail, turning, stepping up and down, everything.  This means you have to be more vigilant about injury risks.

Anatomy of a Trail Runner

Let’s first think about the typical trail runner, and the systems they are using as they run.

Trail running requires a high level of fitness, agility, and endurance — and that’s part of what makes it such a great workout! While the benefits of running can be obtained both on flat surfaces and trails, trail running is often a more interesting way to workout. Trail runners navigate uneven terrain, steep inclines and declines, and a variety of obstacles, all while maintaining a steady pace. To do this, they rely on a combination of physical conditioning and mental toughness.

Muscular System

The muscular system of a trail runner is critical to the activity. Strong leg muscles are essential for climbing hills and powering through rough terrain. Core muscles help maintain balance and stability while running on uneven surfaces. Tendons – which connect muscle to bone – are particularly stressed during some forms of trail running.

Skeletal System

The skeletal system provides the framework for a trail runner’s body. The bones of the legs and feet are particularly important, as they bear the brunt of the impact from running on hard surfaces. Trail runners must also have strong joints, ideally without any brewing injuries. In particular, the ankles and knees need to withstand the stresses of running on uneven terrain. We will talk a lot about this in the next section, where skeletal injuries are common with trail running. Ligaments – which connect bone to bone – are particularly at risk during some trail runs.

Cardiovascular System

The cardiovascular system is responsible for delivering oxygen and nutrients to the muscles during exercise. Trail runners develop a strong heart and lungs to maintain a steady pace over long distances and elevation differences. The lung capacity needed for a 200-foot-climb is way different than what is needed for  flat run.

Nervous System

The nervous system plays a crucial role in trail running. It allows runners to judge the terrain ahead of them, and maintain balance and coordination while navigating obstacles. It also helps them react quickly to changes in the terrain and adjust their pace accordingly.

Common Trail Running Injuries

The most common injuries in trail running tend to cluster around the lower body, as you would expect, with a surprise common injury affecting the upper body as well. Here are some of the most common trail running injuries among avid trail runners:Common Trail Running Injuries

Runner’s Knee

Runner’s knee, also known as patellofemoral pain syndrome, is a common injury among runners of all kinds, especially trail runners. It is caused by irritation of the cartilage under the kneecap, which can be exacerbated by the uneven terrain of trails. Symptoms include pain around or behind the kneecap, especially when going up or down hills.  Runner’s knee often arises during the run, unlike some other injuries which manifest after a run.

Ankle Sprains

If I had a dime for every trail running ankle sprain I have heard of! Ankle sprains are another common injury among trail runners, and is a common hiking injury too, due to the uneven and rocky terrain.  All it takes is one wrong step, or a rock you did not see, to cause an ankle injury. Ankle sprains occur when the ligaments that support the ankle are stretched or torn, causing pain, swelling, and difficulty walking. I find ankle sprains to be especially common in fall, when leaves are concealing things like stones or tree roots, making an ill-advised step more likely.

Plantar Fasciitis

Plantar fasciitis is a very common injury for runners, and trail runners are not immune. It is an injury to the plantar fascia, a thick band of tissue that runs along the bottom of the foot. It is caused by overuse, improper footwear, running on hard surfaces, or having  hard heel strike which can be common when running downhill on trails. Symptoms include pain in the heel or arch of the foot, especially in the morning or after periods of inactivity.

Shoulder Injuries from Falls

You might be surprised how many trail running injuries are actually to the shoulder! Trail running can also lead to shoulder injuries, especially from falls after tripping on things like an uneven trail, rocks, or tree roots. What often happens is that the runner instinctively reaches their arm out to brace for impact, and jams the shoulder when they hit the surface. Most common are subluxations, which are when the shoulder slips around within the joint based on the impact, or a tear to the labrum or rotator cuff which are both important for keeping the shoulder in place, flexible and strong.

Prevention Strategies

Proper Running Technique

Proper running technique is essential to prevent trail running injuries. Maintaining an upright posture, keeping the arms close to the body, and landing on the midfoot instead of the heel can help reduce the impact on the joints. It is also important to take shorter strides when trail running than you might when running on a road, so you are better able to adapt to obstacles and compensate for slips.

Footwear and Gear Selection

Choosing the right footwear and gear can help prevent trail running injuries. Shoes with good traction and support can provide stability on uneven terrain, while compression sleeves or socks can help reduce swelling and improve circulation. We’ve written alot about trail running shoes — Hoka, Altra, and the North Face trail shoes in particular. And while there has been a movement toward minimalist shoe soles for trail runners, know that some who are prone to injury may need more cushion.

Strength Training

Incorporating strength training exercises into a trail runner’s training regimen can help prevent injuries. Exercises that focus on strengthening the core, hips, and legs can improve balance and stability on the trails. Resistance band exercises, lunges, and squats are examples of exercises that can help build strength. If I could only choose one left to help runners stay injury free? The dead lift, no doubt. You don’t need to do a lot of weight, either.

Trail Selection

Choosing the right trail can also help prevent injuries. Runners should choose trails that match their skill level and experience, and not bite off more than they

trail run dusk
Running at dusk and be fun, but dangerous!

can chew, however tempting that might be. It is important to be aware of the trail conditions and any potential hazards such as loose rocks, tree roots, or steep inclines.

Consider Daylight

Trail runners should plan their runs during daylight hours to avoid potential hazards such as uneven terrain or low visibility. Lots of runners I know have experience their worst injuries when running at dusk or dark.

Those Pesky Pets

It might sound like a random point, but you would be surprised how many trail runners I hear of who get injured because they get tangled up with their dogs. It is pretty common to bring a dog along on a trail run with you, but know that dogs will not exactly be looking out for you. They are often sniffing around, zig-zagging and enjoying the nature, and it is super easy to get tangled-up with them.  If you bring a dog, be sure you pay extra attention to what it is doing and give yourself a little space from it. You should really take some of the same precautions you would when hiking with dogs.

Recovery and Rehabilitation

Trail running injuries can be painful and frustrating, but with proper recovery and rehabilitation, runners can get back on the trails in no time. Recovery and rehabilitation is key for preventing further injury and ensuring a safe return to running.

Immediate Care Protocols

It is tried and true: The RICE protocol (Rest, Ice, Compression, and Elevation) is a common first aid treatment for trail running injuries. Resting the injured area, applying ice to reduce swelling, using compression to limit movement, and elevating the affected limb can help alleviate pain and let healing begin. While there are some who say the RICE protocol isn’t very advanced, it is a good simple way to provide initial treatment.

See a Doctor If

Go ahead and visit your doctor or urgent care for some of the injuries, especially a bad ankle sprain that you fear could be a break or torn ligament, or a shoulder injury that might be a tear to the rotator cuff or labrum. As for the other overuse injuries, immediate medical intervention might not be as important as physical therapy, but when in doubt, seek the medical care.

Physical Therapy

I recommend physical therapy for anyone experiencing discomfort for more than a couple days. Physical therapists have seen it all, and your injury will be something that they are able to work with, I promise.

Cross-Training for Recovery

Cross-training is a great way to maintain fitness while recovering from a trail running injury. Low-impact activities such as swimming, cycling, and yoga can help maintain cardiovascular fitness, range-of-motion, and flexibility without putting stress on the injured area. Strength training can also help prevent future injuries by strengthening the muscles and improving overall stability.

Key Takeaways: How to Stay Safe on the Trail?

If I had to summarize my advice to trail runners who want to stay safer in just five points, they would be:

  1. Modify your form to take shorter strides
  2. Have the right gear, especially footwear that is conducive to your gait and the terrain
  3. Take extra care to focus on the trail when it is rocky or there is leaf cover concealing the surface
  4. Choose trails that are within your skill level
  5. Run when the light is good enough to have effective visibility


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