The Most Common Cause of Running Injury

By Jarod Carter, PT, DPT, MTC & Ben Shook, PT, DPT, COMT, CIDN – February 1, 2017
Photograph by Weston Carls

Find out if you have it and what you can do about it.

Have you ever been sidelined by a running injury and unable to get in the precious miles that keep you fit and sane?

You are not alone. Some experts estimate that over 80 percent of runners will sustain an injury at some point. Luckily, most running injuries are completely preventable if you know how to identify the predisposing factors, and today you will learn how to do so with the most common one.

We help a great deal of injured runners at our clinic and well over a half of those injuries are at least partially caused by a very specific type of hip muscle weakness. In this article, we will teach you how to quickly figure out if you have this weakness, and show you three simple exercises to resolve it before it causes an injury that takes you off the roads and trails.

So, how do you know if you are dealing with this particular cause of running injury? A single-leg squat will tell you.


One-Legged Quarter Squat Test

Standing on one leg, slowly do a few repetitions of quarter squat and observe how your knee moves. Does your knee stay directly in line with your middle toe, or does it drop inward, toward or past the big toe and inside edge of the foot? If you can do this test in front of a mirror, also watch what your unweighted hip does during the squat.
Though the movement of the knee is certainly influenced by the foot, hip muscle weakness is a primary culprit when the knee drops inward and/or the un-weighted hip drops lower than the hip of your stance leg. [See Fig. 1]

When either of these movements occurs, it puts abnormal strain through a number of areas of the leg and low back. If it happens to you during a slow quarter squat, it is definitely happening with every step you take on your runs. These repetitive strains can lead to a wide variety of running injuries and pain, including low back pain, hip bursitis, IT band syndrome, patellofemoral syndrome, shin splints, and plantar fasciitis.

So if your squat test reveals these common precursors to injury, here are a few exercises to resolve them before they become a big problem.

For more information, please visit


Exercise # 1: Bridges for Runners

Though most of the exercises we give to runners are performed standing up, there are also some great running performance exercises that are not performed on your feet. 
This is a variation of a classic “bridge” exercise, in which we add resisted hip abduction and external rotation using a stretch band loop. First, place the stretch loop right below or right above the knees. Lay on your back with your knees bent at least 90 degrees and your feet flat on the ground about hip-width apart. Start by rolling the hips/pelvis backward to flatten out the low back against the ground. Then you will lift the hips up till the upper legs and torso are in one line. [See Fig. 2] It’s very important that you continually work to maintain a flat low back by tucking the pelvis posteriorly and keeping the abdominals firm.

Holding this position, you slowly and repeatedly move the knees out and in against the resistance of the band.  [See Fig. 3] As you get tired make sure that your hips are not dropping as your knees move apart, and especially make sure that you’re not allowing the low back to arch. Complete 3–4 sets until you feel a really good fatigue or can no longer hold good form (allow at least 1 minute rest between sets).


Exercise # 2: Lateral Walking Against Resistance

The stretch band can stay in the same position around your knees. Stand in a quarter squat position with your back flat and your abdominals drawn in.

Against the resistance band, take a few side steps to the right and then to the left. As you do so, try not to lean your shoulders away from the direction you are stepping. Also, keep your knees over your toes and avoid leading the movement with the foot such that the knee is dropping inward like it did in the 1/4 squat test. A quick pause between each step will help you hold good form. [See Fig. 4 for proper form]

Perform 3–4 sets till you feel a good fatigue in the hips or you can no longer maintain proper form.


Exercise # 3: “Running Arms” with Single-Leg Balance and Toe Touches

If possible, watch yourself in a mirror during this last exercise. Balance on one leg with a slight bend in the stance-leg knee. Make sure your abs are firm and your hips are level (the unweighted hip should not drop when you lift your foot and balance on the other leg).

First, make sure you can maintain this position in good balance without your knee dropping inward. Until you can do that, do not progress to the rest of this exercise.

Next, start moving your arms as if you are running while maintaining balance on one leg with the hips level. Once this is stable and easy to maintain, you can slowly move the unweighted leg to touch your toes/heel to the ground in front of you, out to the side, and behind you.



Related Articles