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Keeping Runners Healthy - An Evidence-Based Companion Guide to the IC-SAPTA 2026 Keynote Presentation

Welcome to the evidence-based guide to partner with my Keynote Presentation at IC-SAPTA 2026 in Surakarta, Indonesia. I was honoured to be approached to present at this international sports medicine conference, particularly around the topic of my personal, professional and research interest, endurance runners. The presentation was titled "Keeping Runners Healthy: Integrating Science, Practice and Performance". I am proud of the depth of running related evidence included in the presentation, along with my own clinical expertise. The following guide provides an overview of the keynote speech, and provides access to the resources, recommended readings, and additional information for both IC-SAPTA 2026 attendees, and other clinicians/coaches interested in working with endurance runners.



Along with attendees of IC-SAPTA 2026, this article holds great relevance due to the popularity of running worldwide. Studies show a significant increase in running participation, growing by 57% between 2008-2018 (Andersen, 2024). There has been significant growth in Asia, and in Australia where I work, running represents one of the most popular sports (15% of the population in Australia run!) (Athletics Australia, 2024, Aus Sport, 2023). The figure below details some of the statistics behind running's popularity.


Figure 1. Running is popular - statistics!
Figure 1. Running is popular - statistics!


Who is Ky Wynne?


I am a Melbourne-based running physiotherapist, exercise scientist, educator, speaker and researcher, with more information about me found here.


In 2026 I co-founded Athlete's Edge Physiotherapy, a performance physiotherapy clinic focused on endurance runners, data driven decisions, high quality long term rehabilitation (e.g. ACL injuries), patient education and clinically applicable research.


Over the past few years, I have completed numerous media and speaking arrangements, on a variety of platforms (including mainstream Australian media, podcasts, university, public forums, conference presentations etc). Additionally, I have also published running related research and am involved physiotherapy advocacy, with recent research and projects found here.


Those looking to stay up to date, or access free running related content, should check out my social media channel @kywynnephysio.


Understanding the Demands of Running

Running as a sport involves high external forces (e.g. GRF), high internal forces (often measured using peak muscle force relative to bodyweight), and fast ground contact times (often <0.300 sec per step). The figure below (see fig-2.) details some of the high internal force / muscle force demands on the body during running. In particular, note the significance of the calf muscles (particularly soleus) at all speeds of running (up to 10 x BW when sprinting!).

Figure 2. Demands of Running based on on Dorn et al., 2012 data.
Figure 2. Demands of Running based on on Dorn et al., 2012 data.

As detailed in Figure 2 and numerous running biomechanical studies, the calf and ankle provide the greatest contribution to running regardless of speed. (Schache et al., 2019; Williams et al., 2017). While modest at slow speeds/steady state running (e.g. jogging), the hip contribution is significantly higher during acceleration and sprinting (Schache et al., 2015; Williams et al., 2017). We also see different demands on the body during uphill / downhill running, as demonstrated in figure 3 below.


Figure 3. Demands of running - Uphill vs Downhill
Figure 3. Demands of running - Uphill vs Downhill

This represents a very 'surface level' overview on running demands, and I invite you to read more of the recommended readings and references at the end of this article.


Running Related Injuries - Overview & Risk Factors

Statistically, running injuries are very common. This is something I observe working clinically with the endurance running population, where many runners will either have a current injury, or a history of running injuries. Some studies show a yearly incidence rate of up 91%, with a commonly reported range around 40-79%, indicating how common injuries are in this population group (Becker, 2013; Burke et al., 2023; Desai et al., 2021; Dillon et al., 2023; Francis et al., 2018; Fredette et al., 2022; Fredericson & Misra, 2007; Goss & Gross, 2012; Hafer et al., 2016; Hegedus et al., 2021; Kakouris et al., 2021; Kemler et al., 2018; Napier et al., 2018; Raghunandan et al., 2021; Richards et al., 2009; Sleeswijk Visser et al., 2021; Stenerson et al., 2023; Taunton et al., 2002; van Gent et al., 2007; Videbæk et al., 2015; Willy & Davis, 2013; Van Middelkoop et al., 2008a; van Poppel et al., 2021).


Unfortunately running injuries aren't always managed well. A study by Sleeswijk Visser (2021) determined only 39% of injured runners visited a healthcare professional (Sleeswijk Visser et al., 2021), and many runners continue to run through their running injuries (Linton & Valentin, 2018). Additionally, running injuries have a high recurrence rate (Bramah et al., 2021; Messier et al., 2018; Raghunandan et al., 2021; Tenforde et al., 2013), with studies showing 56-80% of injuries are often secondary/re-injury (Messier et al., 2018; Raghunandan et al., 2021).


Common running injury regions are detailed below (knee is consistently the most common) (figure-4). We also see differences in running injuries and data between males and females (figure-5).


Figure 4. Common Running Injury Regions.
Figure 4. Common Running Injury Regions.

Figure 5. Running injures - differences males vs females.
Figure 5. Running injures - differences males vs females.

Predicting running related injuries is typically complex, due to the multifactorial nature of injuries in general. However, there are a plethora of studies which investigate risk factors and associated factors. I have spent significant time reading 100s, if not 1000s of running related research articles over the past few years as part of my clinical and research roles. The figure below (fig-6.) details some of the many evidence based factors associated with running related injuries. I have broken these factors into "modifiable" and "non-modifiable", and "intrinsic" and "extrinsic". It is important to note, that while this figure is extensive, there are likely additional factors which may be missing, potentially due to the poor evidence based behind their association or causation of running injury.


Figure 6. Running related injury risk factor classification.
Figure 6. Running related injury risk factor classification.


Keeping Runners Healthy: Preventing Injury?

Can we prevent injuries in runners? Statistically, the evidence doesn't seem to think so. And clinically, I believe we should be considering the term "risk mitigation" rather than "injury prevention". Additionally, my ethos around runners and injuries is to be "proactive rather than reactive" with niggles/pain, and to consider early assessment and intervention for running pain to prevent the injury reaching a point where the runner has to consider taking time off/stop running. Injury is the most common reason for runners to be missing sessions and for discontinuing training (Stevinson et al., 2022). As a running physio this is something I am keen to avoid. Significantly, reducing the time being unable to run due to injury leads to greater training participation. This higher participation has been shown to be a factor linked with a greater chance of athletic success (Drew et al., 2017). Therefore, injury risk mitigation should be considered a priority for those looking to maximise athletic performance and successful outcomes.


The following 4 categories (fig-7.) were discussed in my IC-SAPTA presentation, balancing the evidence base with clinical "case examples" to illustrate the link between injury risk and performance. I have provided numerous resources at the end of the article for those motivated clinicians and coaches who wish to further upskill in the area of endurance running.


Figure 7. Mitigating injury risk in runners: considering sleep, load, strength training and technique.
Figure 7. Mitigating injury risk in runners: considering sleep, load, strength training and technique.

Considering Sleep & Injury Risk:

Sleep is a critical factor in recovery, performance and overall well-being and longevity. For endurance runners, experts and studies report it as very important (figure-8). Clincially, when working with runners, it is one of the factors I consider most important to monitor, something I referenced in a recent podcast episode (The Run Diaries EP.3). The recommendation is for adults obtain at least 8 hours of sleep per night (Gao et al., 2019; Halson, 2014; Johnston et al., 2020; Roberts et al., 2019), with the impact of poor sleep evident on running performance, and injury risk. Significantly, one study shows runners with poor or irregular sleep are 1.78 x more likely to report injuries (than good sleepers), a fact that shouldn't be ignored (de Jonge & Taris, 2025). During the IC-SAPTA presentation I detailed further studies and information around the impact of poor sleep on endurance runners, hopefully illustrating the importance of focusing on sleep in this population group.


Figure 8. Sleep and injury in runners.
Figure 8. Sleep and injury in runners.

Coaches and health professionals should consider how they monitor sleep with their athletes/runners. There are a variety of methods available, some of which I list below (and in the resource list). I use a variety of methods clinically, including Lumin Sports for Wellness monitoring, subjective scoring, validated questionnaires for research (e.g. Promis Sleep Score) and wearable technology. Modern technological options make this evaluation much easier for athletes and coaches (e.g. Oura ring, garmin/smart watch etc).


Considering Running Load & Injury Risk:

Running load changes, commonly referred to as "load spikes", are one of the many factors linked with injury risk. Clinically, load plays a significant role in the majority of injuries I see with runners, whether they be overloaded, or underloaded. Overall, "load is good", and the aim should be to increase the load the runner can tolerate over time (see Gabbett et al., 2020 and related work), however the problem is often how the runner gets there and what capacity they have to tolerate this load. Usually, rapid changes, big jumps, or returning to the same level after periods of time off, all make a runner vulnerable to increased injury risk. In particular, there are numerous studies which reference load changes and increased injury risk (Damsted et al., 2018; Damsted et al., 2019; Dijkhus et al., 2019; Frandsen et al., 2025; García-Pinillos et al., 2017; Nielsen et al., 2014).


One particular study by Frandsen and colleagues (2025) has been very popular online, and was referenced during my IC-SAPTA Keynote presentation. This study looked into injury risk related to long run distance over a month, and in particular, the change in long run distance relative to the previous longest run in the last 30 days. As detailed in the figure below (fig-9), load increases of >10% for the long run, compared to the previous 30 day long runs, increased injury risk by 64% (Frandsen et al., 2025). This study used adult runners over an 18 month period, using wearable data, and measuring workloads to determine injury risk.


Figure 9. Frandsen 2025 study looking at training load and injury risk.
Figure 9. Frandsen 2025 study looking at training load and injury risk.

I promised during my IC-SAPTA presentation to detail further running load data in this guide, and the following figure (fig-10) details some of the many studies looking at training load and injury risk in endurance runners. This is particularly relevant for coaches, health professionals and dedicated runners to keep an eye on to help mitigate injury risk.

Figure 10. Studies looking at training load and injury risk in endurance runners.
Figure 10. Studies looking at training load and injury risk in endurance runners.

For those interested in understanding training load in greater detail, I point you towards the detailed, free article I have written on the Athlete's Edge website around training load, found here. This article helps to break down what training load is, how to understand and manage it better. It is an excellent guide for athletes and coaches/health professionals.


Considering Running Technique & Injury Risk:

Running biomechanics / technique and injury risk is a very big topic, and a sometimes controversial one in articles and online. There are a variety of contrasting viewpoints, with some people advocating that "technique variations are normal and modification isn't needed" and others advocating for "modifiying any gait "faults" or asymmetries". Clinically, I sit somewhere in the middle. My view is based upon a significant body of literature, something I have broken down in a recent Runner's Edge Webinar (see resources at the end) for those interested. There are numerous studies in the literature which break down the variety of factors linked with injury risks for runners (both associations and causations). The evidence often finds it difficult to point to "1 factor causing running injury" due to the complexity of running injuries, and studies don't yet quantify the % of injury risk for having "one particular biomechanical "fault" compared to not having it". However, as a running physio, I strong believe in running biomechanical assessment, and encourage clinicians and coaches to work on their gait assessment and retraining skills. The studies below (see figures 11-16) are a good starting point, along with my webinar, for motivated clinicians.





Considering Strength Training & Injury Risk:

Strength training is one of the most important additions to any runner's toolkit (my opinion), but the evidence also supports the benefits of strength training for endurance runners. Typically, when surveyed, many runners report including strength training in their routines, perceiving it to be a key component of their training (García-Pinillos et al., 2020; Santos et al., 2024). However, despite runners understanding the importance, over 60% of runners don't include regular strength training in their routines (Blagrove et al., 2020; García-Pinillos et al., 2020; Santos et al., 2024).


There is significant evidence to demonstrate that the benefits occur due to neural and structural changes (fig-17).

Figure 17. Mechanisms for strength training in endurance runners.
Figure 17. Mechanisms for strength training in endurance runners.

As discussed during the Keynote Presentation, recent studies demonstrate promising results for strength training and injury prevention (up to 85% less risk compared to controls), particularly if well-designed and well-adhered to programs (e.g. program from a running physio that is regularly updated/supervised and assessed/re-assessed) (Desai et al., 2023; Leppänen et al., 2024; Naderi et al., 2026). Stay tuned for my upcoming article in the Strength and Conditioning Journal which breaks down in significant detail the mechanisms, benefits and prescription of strength training for endurance runners.


Figure 18. Strength training in runners - considerations.
Figure 18. Strength training in runners - considerations.



Summary

My goal from the IC-SAPTA 2026 Keynote presentation (and this article) was to illuminate the importance of considered, holistic management of endurance runners. In particular, being "proactive" with the management of runners (e.g. strength screenings, injury prevention, management treatment, regular check ups, load management, addressing factors like described in this article, strength training etc) should be advocated for strongly over reactive management (e.g. dealing with an injury). Clinicians and coaches have a role to play with educating runners on the importance of proactive management and the benefits on injury risk mitigation and performance.


Resources & Recommendations


Recommended Guides & Articles:


Recommended Courses, Webinars & Podcasts:


Recommended Research Articles: *in no particular order

  • Dorn, T. W., Schache, A. G., & Pandy, M. G. (2012). Muscular strategy shift in human running: dependence of running speed on hip and ankle muscle performance. Journal of Experimental Biology, 215(11), 1944-1956.

  • Hongwei, Y., & Resza, A. M. (2021). Running motivations of non-elite long-distance runners in Indonesia. Journal of Physical Education and Sport, 21, 2288-2294.

  • Wynne, K. (2026). Understanding and Prescribing Plyometrics for Endurance Runners: A Review. Strength & Conditioning Journal, 10-1519.

  • Barton, C. J., Bonanno, D. R., Carr, J., Neal, B. S., Malliaras, P., Franklyn-Miller, A., & Menz, H. B. (2016). Running retraining to treat lower limb injuries: a mixed-methods study of current evidence synthesised with expert opinion. British journal of sports medicine, 50(9), 513-526.

  • Soligard, T., Schwellnus, M., Alonso, J. M., Bahr, R., Clarsen, B., Dijkstra, H. P., ... & Engebretsen, L. (2016). How much is too much?(Part 1) International Olympic Committee consensus statement on load in sport and risk of injury. British journal of sports medicine, 50(17), 1030-1041.

  • Ceyssens, L., Vanelderen, R., Barton, C., Malliaras, P., & Dingenen, B. (2019). Biomechanical risk factors associated with running-related injuries: a systematic review. Sports medicine, 49, 1095-1115.

  • Schwellnus, M., Soligard, T., Alonso, J. M., Bahr, R., Clarsen, B., Dijkstra, H. P., ... & Engebretsen, L. (2016). How much is too much?(Part 2) International Olympic Committee consensus statement on load in sport and risk of illness. British journal of sports medicine, 50(17), 1043-1052.

  • Anderson, J. J. (2024). State of Running 2019. Retrieved from https://runrepeat.com/state-of-running.

  • Correia, C. K., Machado, J. M., Dominski, F. H., de Castro, M. P., de Brito Fontana, H., & Ruschel, C. (2024). Risk factors for running-related injuries: An umbrella systematic review. Journal of sport and health science, 13(6), 793-804.

  • Schuster Brandt Frandsen, J., Hulme, A., Parner, E. T., Møller, M., Lindman, I., Abrahamson, J., ... & Nielsen, R. O. (2025). How much running is too much? Identifying high-risk running sessions in a 5200-person cohort study. British Journal of Sports Medicine, 59(17), 1203-1210.

  • Gabbett, T. J. (2016). The training—injury prevention paradox: should athletes be training smarter and harder?. British journal of sports medicine, 50(5), 273-280.

  • Gabbett, T. J. (2020). How much? How fast? How soon? Three simple concepts for progressing training loads to minimize injury risk and enhance performance. Journal of orthopaedic & sports physical therapy, 50(10), 570-573.

  • Alentorn-Geli, E., Samuelsson, K., Musahl, V., Green, C. L., Bhandari, M., & Karlsson, J. (2017). The association of recreational and competitive running with hip and knee osteoarthritis: a systematic review and meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 47(6), 373-390.

  • Lee, D. C., Brellenthin, A. G., Thompson, P. D., Sui, X., Lee, I. M., & Lavie, C. J. (2017). Running as a key lifestyle medicine for longevity. Progress in cardiovascular diseases, 60(1), 45-55.

  • Blagrove, R. C., Howatson, G., & Hayes, P. R. (2018). Effects of strength training on the physiological determinants of middle-and long-distance running performance: a systematic review. Sports Medicine, 48, 1117-1149.

  • Goldberg, M., Le Mat, Y., Metra, M., De Sousa, T., Edouard, P., Millet, G. Y., ... & Debarnot, U. (2025). Poor Sleep Quality Is Associated With an Increased Risk of Running‐Related Injuries: A Prospective Study of 339 Runners Over Six Months. Scandinavian Journal of Medicine & Science in Sports, 35(11), e70164.

  • Blanch, P., & Gabbett, T. J. (2016). Has the athlete trained enough to return to play safely? The acute: chronic workload ratio permits clinicians to quantify a player's risk of subsequent injury. Br J Sports Med, 50(8), 471-475.

  • Leppänen, M., Viiala, J., Kaikkonen, P., Tokola, K., Vasankari, T., Nigg, B. M., ... & Pasanen, K. (2024). Hip and core exercise programme prevents running-related overuse injuries in adult novice recreational runners: a three-arm randomised controlled trial (Run RCT). British Journal of Sports Medicine, 58(13), 722-732.

  • de Jonge, J., & Taris, T. W. (2025). Sleep Matters: Profiling Sleep Patterns to Predict Sports Injuries in Recreational Runners. Applied Sciences, 15(19), 10814.


Recommended Tools, Websites and Others:



References & Citations

*from the article and from the Keynote IC-SAPTA 2026 Presentation


References for the keynote presentation and guide above

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  2. Adrian, G. (2025). Turning Running into a Lifestyle. Retrieved from https://www.ums.ac.id/en/news/global-pulse/turning-running-into-a-lifestyle.

  3. Agresta, C., & Brown, A. (2015). Gait retraining for injured and healthy runners using augmented feedback: a systematic literature review. journal of orthopaedic & sports physical therapy, 45(8), 576-584.

  4. Akbaş, A., Żebrowska, A., Malchrowicz-Mośko, E., Stempień, J., Bezuglov, E., Górka-Chowaniec, A., & Waśkiewicz, Z. (2025). Socioeconomic status and motivation in endurance sports: insights from long-distance running. Frontiers in Psychology, 16, 1527661.

  5. Alentorn-Geli, E., Samuelsson, K., Musahl, V., Green, C. L., Bhandari, M., & Karlsson, J. (2017). The association of recreational and competitive running with hip and knee osteoarthritis: a systematic review and meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 47(6), 373-390.

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  7. Anderson, J. J. (2024). State of Running 2019. Retrieved from https://runrepeat.com/state-of-running.

  8. Anderson, L. M., Bonanno, D. R., Hart, H. F., & Barton, C. J. (2020). What are the benefits and risks associated with changing foot strike pattern during running? A systematic review and meta-analysis of injury, running economy, and biomechanics. Sports Medicine, 50, 885-917.

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  22. Blanch, P., & Gabbett, T. J. (2016). Has the athlete trained enough to return to play safely? The acute: chronic workload ratio permits clinicians to quantify a player's risk of subsequent injury. Br J Sports Med, 50(8), 471-475.

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