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Preventing Common Running Injuries: A Guide for City2Surf Participants

  • 5D Physio
  • Jun 4
  • 3 min read

The City2Surf is one of the most iconic community runs in the world, spanning 14 km from Sydney’s CBD to the shores of Bondi Beach. For many runners, it represents a celebration of fitness and resilience. However, the combination of distance, elevation changes, and pavement running places physical demands on the body that can lead to injury without proper preparation.


This article outlines some of the most common running-related injuries (RRIs) and offers evidence-based strategies for their prevention, tailored to the needs of recreational runners preparing for City2Surf.


1. Patellofemoral Pain Syndrome (“Runner’s Knee”)

Overview: Patellofemoral Pain Syndrome is characterized by pain around or behind the kneecap, often exacerbated by downhill running or prolonged sitting.


Causes:

  • Weakness or imbalances in the quadriceps, glutes, and hips

  • Overtraining or sudden increases in intensity

  • Poor running mechanics


Prevention Strategies:

  • Incorporate hip and glute strengthening exercises such as step-ups and clamshells

  • Use a cadence of 170–180 steps per minute to reduce joint load

  • Increase training volume gradually (no more than 10% per week)


Supporting Evidence:A meta-analysis published in Sports Medicine (2022) found that targeted strength training, particularly for the hips and glutes, significantly reduces the risk of patellofemoral pain in recreational runners.


2. Plantar Fasciitis

Overview:Plantar fasciitis causes pain in the heel and arch, often most noticeable with the first steps in the morning or after prolonged activity.


Causes:

  • Tight calf muscles

  • Inadequate foot support

  • Excessive training on hard surfaces


Prevention Strategies:

  • Daily calf stretching and foot strengthening exercises (e.g., towel scrunches, toe curls)

  • Use arch-supporting footwear or custom orthotics if needed

  • Avoid running in worn-out shoes (replace every 600–800 km)


Supporting Evidence:A study published in BMJ Open Sport & Exercise Medicine (2021) demonstrated that calf and plantar strengthening exercises reduced recurrence rates of plantar fasciitis by over 50% in distance runners.


3. Medial Tibial Stress Syndrome (Shin Splints)

Overview:This condition presents as pain along the inner edge of the tibia, typically during or after prolonged running.


Causes:

  • Rapid increases in mileage

  • Running on hard or uneven surfaces

  • Inadequate footwear or poor biomechanics


Prevention Strategies:

  • Progress training load gradually

  • Alternate high-impact workouts with low-impact cross-training

  • Strengthen foot and ankle stabilizers


Supporting Evidence:A study in the Journal of Orthopaedic & Sports Physical Therapy (2019) linked hip abductor weakness and overpronation to increased risk of medial tibial stress syndrome. Strength training and gait correction significantly reduced incidence.


4. Iliotibial Band Syndrome (ITBS)

Overview:ITBS is marked by pain on the outer knee, often triggered during or after downhill running. This makes City2Surf's elevation changes a risk factor.


Causes:

  • Tightness in the IT band

  • Weakness in hip abductors and gluteus medius

  • Poor control of hip and knee mechanics


Prevention Strategies:

  • Strengthen the gluteal muscles and lateral hip stabilizers

  • Foam roll surrounding musculature (not directly over the IT band)

  • Incorporate neuromuscular drills to improve coordination and stability


Supporting Evidence:A 2023 review in Clinical Biomechanics confirmed that inadequate hip strength and dynamic instability are significant contributors to ITBS, particularly in recreational runners.


Training and Recovery Recommendations

To reduce the risk of injury in the lead-up to City2Surf, runners should consider the following evidence-based practices:


  • Follow a structured training plan with incremental volume increases

  • Include strength training (2–3 times per week) focusing on the lower body and core

  • Prioritize recovery: ensure adequate sleep, hydration, and nutrition

  • Monitor early warning signs such as persistent pain or swelling, and adjust training accordingly


A recent study in Sports Medicine – Open (2024) also emphasized that adequate caloric intake, healthy fats, and dietary fiber were associated with reduced risk of soft tissue injuries in endurance athletes.


Conclusion

Running the City2Surf is a remarkable achievement, but it requires thoughtful preparation to avoid common overuse injuries. By incorporating strength training, proper footwear, gradual progression, and recovery strategies, runners can significantly reduce their injury risk and enjoy the journey from Hyde Park to Bondi Beach safely.


For personalized advice, consult with a physiotherapist or sports medicine professional familiar with distance running and biomechanics.


References

  • van der Worp MP, et al. (2022). "The effectiveness of exercise therapy in runners with patellofemoral pain." Sports Medicine.

  • Rathleff MS, et al. (2021). "Plantar fasciitis in runners: management and prevention." BMJ Open Sport & Exercise Medicine.

  • Galbraith RM, Lavallee ME. (2019). "Medial tibial stress syndrome: Conservative treatment options." J Orthop Sports Phys Ther.

  • Powers CM. (2023). "Biomechanics of IT band syndrome." Clinical Biomechanics.

  • Spendlove J, et al. (2024). "Dietary patterns and injury risk in endurance athletes." Sports Medicine – Open.

 
 
 

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