Could Your Diet Be Increasing Your Risk of Running Injuries?

Running is a fantastic way to stay active, connect with a community, and challenge yourself. However, injuries are a common hurdle many runners face. Studies show that 43–45% of adult runners experience a running-related injury (RRI) each year, with novice runners at higher risk. Most injuries involve soft tissue damage (tendons, ligaments, and muscles) and can sideline runners for weeks.

While training errors and previous injuries are well-known risk factors, emerging research suggests that diet may also play a crucial role in injury prevention. A recent systematic review and meta-analysis, conducted as part of my Masters by Research, explored the relationship between diet, disordered eating risk, and RRIs in adult distance runners. Here’s what we found.

Understanding the Research Process

A systematic review and meta-analysis is a rigorous research method used to summarise and analyse data from multiple studies. For this study, we conducted an extensive search of the literature from inception to 2024, identifying 48,417 studies. After a careful screening process, we selected 15 studies, with 9 included in the final pooled data analysis. In total, 5,942 runners (3,578 male, 2,364 female) were analysed.

Some studies focused on diet and bone stress injuries (BSIs), mainly in elite runners, while others examined diet and general RRIs, including both soft tissue and bone injuries, mostly in recreational runners. Researchers investigated various dietary factors, such as energy intake, macronutrients (protein, fats and carbohydrate), alcohol, vitamins, minerals, fibre, specific foods, and disordered eating risk. 

Key Findings on Diet and Injury Risk

1. Low Energy Intake Increased Injury Risk in Females
   Female runners who sustained injuries consumed, on average, 449 fewer calories per day than their uninjured counterparts. Notably, body weight and BMI were not significantly different between injured and uninjured runners, suggesting that inadequate energy intake—rather than body size—may be a key driver of injury risk.
2. Low Fat Intake May Contribute to Injury Risk in Females
   Injured female runners consumed on average 20g less fat per day, and a lower percentage of their calories from fat (around 20% of total energy intake) compared to uninjured female runners (27–29%). Dietary fat is essential for absorbing fat-soluble vitamins, hormone production, and overall musculoskeletal health. While this trend was observed in females, no significant differences in fat intake were noted in male runners.
3. No Strong Link Between Calcium Intake and Injury Risk
   Calcium is crucial for bone health, but all studies reviewed reported that runners met or exceeded the recommended intake of 1,000 mg/day. This suggests that calcium intake alone may not be a major factor in RRI risk if daily needs are met.
4. Dietary Fibre May Play a Role in Injury Prevention
   Runners with bone stress injuries (both male and female) consumed, on average, 3g less dietary fibre per day than their uninjured peers, despite both groups exceeding the recommended daily intake. Fibre-rich foods, such as fruits and vegetables, have anti-inflammatory effects and may support musculoskeletal health. However, excessive fibre intake in female runners has been linked to low energy availability (when an athlete’s energy intake is insufficient to meet both the demands of exercise and essential body functions), which could contribute to injury risk. More research is needed to determine the optimal fibre intake for injury prevention.
5. No Clear Link Between Disordered Eating Risk and Injury
   Surprisingly, a higher risk of disordered eating was not associated with increased injury risk in female runners. However, studies that assessed the Cumulative Triad Risk Assessment—a tool that evaluates energy availability, menstrual function, and bone density—found that female runners with higher triad risk scores had a greater risk of bone stress injuries. This suggests bone stress injury risk arises from other criteria of the tool, or their cumulative effect.

Most studies had some limitations. Many relied on self-reported data, such as injuries recorded by participants rather than confirmed by medical scans. Some used questionnaires that hadn’t been thoroughly tested for accuracy. Additionally, some studies didn’t clearly establish whether runners were already injured at the start or track how their diets changed over time, which could affect results.

Overall, the evidence is still limited due to the small number of high-quality studies, inconsistencies in how RRIs are defined, and differences in the statistical methods used. As a result, the findings should be interpreted with caution, and more research is needed to strengthen the conclusions.

Practical Takeaways for Runners

• Prioritise Energy Intake: Female runners should be mindful of getting enough calories to support their training. Consuming too little energy can increase the risk of both soft tissue injuries and bone stress injuries.
• Include Healthy Fats: Fat intake around 27–29% of total daily calories may be optimal for reducing risk of RRI in females. Female runners should include fat sources like avocados, nuts, seeds, and olive oil to support hormone production and injury prevention.
• Balance Fibre Intake: While a diet high in fibre can have anti-inflammatory benefits which may reduce risk of bone stress injury, excessive intake (over 25–35 g/day) may suppress appetite and reduce energy absorption, increasing the risk of low energy availability.
• Monitor Bone Health Factors: While calcium intake alone wasn’t linked to injury risk, it’s still important to meet daily requirements and consider other bone-supporting nutrients like vitamin D.
• More Research Needed for Male Runners: The relationship between dietary intake and injury risk is less clear in male runners. Future research should explore how different nutritional factors impact male athletes.

The Bottom Line

This research highlights the importance of proper nutrition for reducing injury risk in runners, particularly for females. Ensuring adequate energy and fat intake while maintaining a balanced fibre intake may help runners stay injury-free and perform at their best. While no significant associations were found between other nutrients or risk of disordered eating and RRI, it remains advisable to meet dietary recommendations for optimal sports performance and overall well-being. 

If you're a runner struggling with injuries or unsure if your diet is supporting your training, consider working with a sports dietitian to develop a tailored nutrition plan that meets your needs.

To book a performance strategy call to discuss the exact steps to perform at your best for your next big event click here!

Download my ebook on carbohydrates to fuel for a PB here!

References

Colebatch, E.A., Fuller, J.T., Mantzioris, E. and Hill, A.M., 2025. Diet, risk of disordered eating and running-related injury in adult distance runners: a systematic review and meta-analysis of prospective cohort studies. Journal of Science and Medicine in Sport. https://doi.org/10.1016/j.jsams.2025.02.001