Is Ultra-Marathon Running Bad for Your Bones?

Is Ultra-Marathon Running Bad for Your Bones?

As a runner and Exercise Physiologist, I at times feel conflicted. I have trained for and completed Ultra-Marathons myself, and also helped coordinate the training plans for clients undertaking similar and more extreme goals than mine.

As a runner, I love the training, the planning, the dedication, the achievement- all of it. But as an Exercise Physiologist, my role in Allied Health is to prescribe exercise to enrich the health of my clients. Am I actually doing the opposite for the ultra-runners I train? Am I the equivalent of a Dietician helping their client’s to compete in a pie-eating contest?

In recent years researchers in my field have cast their scrutinous eye at the Ultra-running community. Ultra-running has evolved from a beyond-the-fringe subculture of self-flagellating weirdos to a legitimate, world-wide sport that attracts a broad cross-section of society.  New evidence indicates this may not be an entirely great thing.

Ultramarathon Running and Bone Mineral Density

A recent study published in the International Journal of Applied Exercise (Düz, S., & Arik, M. 2020) compared the bone mineral density of middle-aged male ultramarathoners (UM) (aged 44-56y) to active (AM) and sedentary (C) peers. The average weekly running volume for the UM group was 104.29km, compared to the AM group which was 61.5km.

Analysis of bone mineral density (BMD) showed that the UM group had lower BMD at the lumbar spine, femoral neck and hip compared to the AM group. The total bone mineral density of the UM group was even actually lower than that of the sedentary control group. This indicates that the ultramarathon men in this study are at more risk of osteopenia and osteoporosis than men who do nothing! Bear in mind that impact exercise is recommended for maintaining and improving bone mineral density. This study indicates that there may be a threshold in which the overall stress of the training volumes that many ultramarathoners endure may be beyond what is healthy for their bones.

How do I reconcile this?

Firstly, I strongly advocate that all runners regularly undertake resistance training sessions. The main reasons I advocate this are for performance benefits, as well as improving soft-tissue resilience (for injury prevention). But for high-volume runners, I can add attenuation of bone-mineral loss to this list.

Secondly, I would challenge the need for super-high weekly running volumes for all but the absolute elite level ultramarathoners. High mileage is essential for elite performance in Ultramarathoning. But if your aim is to just complete the race, rather than win the race, is the cost of this high mileage really worth it? I have helped many runners achieve great outcomes in 50+km events with weekly training volumes of ‘only’ 50-60km per week. This would put them into the ‘active’ group of the study I referenced, which showed significantly higher BMD scores than the ultramarathoners and sedentary group.

For those aiming for events much longer than 50km, it is prudent to question the overall health impact of such a goal.


Düz, S., & Arik, M. (2020). The Effect of Ultramarathon Running on Bone Mineral Density in Male Athletes. International Journal of Applied Exercise Physiology9(5), 100-108.


So is running actually good for your knees?

So is running actually good for your knees?


But I’ll start by hitting you with three facts.

  1. People who run have a lower incidence of knee osteoarthritis than people who don’t (Timmins et al, 2017; Alentorn-Geli, E. 2017).
  2. The knee is the most common site of injury in runners (Van Gent et al, 2007).
  3. The most common cause for running injury is training error (Damstead et al, 2018).

This is how I reconcile these facts in my head.

Running, when appropriately ‘dosed’ is a good thing for our knees (and muscles, tendons, bones, heart, lungs, brain, gut etc etc). However when the dose is too great either acutely or chronically the most likely point in our body to ‘fail’ is our knees. If this is the case, it is not running that is bad for the knees, it is bad coaching, or no coaching that is actually bad for our knees.

Let me reiterate point 1 in case you glossed over it. People who run are less likely to end up with OA than those who don’t. And it isn’t a small difference. Runners are about 3x less likely than non-runners to develop OA. Check my first reference if you don’t believe me.

For many reasons, running is something that you should do, but you should do it in a quantity and frequency that is appropriate for you.

An an Accredited Exercise Physiologist, it is my absolute bread and butter to assess and prescribe the right ‘dose’ of running for you right now, and help you build upon that at your speed.

Please don’t avoid running because you think it is bad for you. And don’t let poor coaching be the reason that it is.


About The Author


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.

Damsted, C., Glad, S., Nielsen, R. O., Sørensen, H., & Malisoux, L. (2018). Is there evidence for an association between changes in training load and running-related injuries? A systematic review. International journal of sports physical therapy, 13(6), 931.

Timmins, K. A., Leech, R. D., Batt, M. E., & Edwards, K. L. (2017). Running and knee osteoarthritis: a systematic review and meta-analysis. The American journal of sports medicine, 45(6), 1447-1457.

Van Gent, R. N., Siem, D., van Middelkoop, M., Van Os, A. G., Bierma-Zeinstra, S. M. A., & Koes, B. W. (2007). Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. British journal of sports medicine, 41(8), 469-480.



RunStrong: Load Management

RunStrong: Load Management

If you watch almost any form of professional sport you may have heard the term ‘Load Management’ in recent years. Often the conversations on this topic are led by cranky former athletes tut-tutting that ‘back in my day we didn’t have load management, we just played!’

Yes, the term Load Management has been popularised in recent years. This is not because the athletes of today are soft compared with their predecessors. This is because those charged with preparing athletes to be at their best when they need to perform are now armed with a vast and growing body of evidence that supports Load Management. 

And the evidence supporting Load Management is not confined to team sport athletes, or elites in individual sports. Published research shows that recreational, even novice runners should be considering how they are managing their training loads.

Show me the evidence!!

  • A Systematic Review by Drew and Finch (2016) that included 35 studies found that across many sports, training loads were predictive of both injury and illness. 


  • A Systematic Review by Damsted er al (2018) found that runners were more likely to develop an injury if they; suddenly altered the velocity, distance and/or frequency of their running; increased their average weekly running by >30% versus <10%; and/or they had a sudden spike in their training volume the week before the injury occurred. 


  • In a Systematic Review and Meta-analysis by Videbaek et al (2015) (13 articles included)  that looked at injury incidence per 1000hrs of running, novice runners were likely to experience more-than-double the amount of injuries per 1000hrs as recreational runners.


  • A Systematic review by van Gent et al (2007) found that the most common site of injury in the runners in the included studies was the knee, but that training plans that gradually increased loads were protective against knee injuries.


I have provided the complete citations for each of these Review Articles for those that want to dig deeper into the evidence. I warn you though that this search is an absolute rabbit warren- like I said earlier, there is a vast and growing body of evidence on this topic! 

Evidence is important in health. In this particular area though, the evidence is just reinforcing what common sense should already be telling us.

Stress > Recover > Adapt > Repeat

Running is a form of physical stress. When we allow adequate recovery our body gradually adapts to deal with this stress. 

A well-structured training plan is really a balancing act between imparting a ‘dose’ of physical stress, then encouraging recovery strategies to enhance the adaptation process. Stress > Recover > Adapt. We repeat this cycle over a given period of time so that you can be as well prepared as possible for the event you are training for.  

The evidence tells us that if we try to rush this process, if we build load too quickly and impart too much stress at any time point we can tip this balance and create injury. And if not injury, we can end up just becoming run-down and sick which can be terribly frustrating if you have an event looming on the calendar.  

Load Management and Goal Setting

If you are training for a specific event do you have enough time between now and then to build load gradually? 

Actually, I’ll be more precise than that. From your current training load, can you build upon that total load by no more than 10% per week up to when (if) you plan to taper?

Does your time-frame include some rest weeks and additional weeks for unforeseen circumstances? 

If you can confidently answer YES! to those questions I don’t need to wish you good luck, as you are probably managing yourself impeccably. 

If you cannot answer yes, then I recommend you seek something more reliable than luck. I suggest finding a good coach, experienced in Load Management for runners.  


About The Author

Damsted, C., Glad, S., Nielsen, R. O., Sørensen, H., & Malisoux, L. (2018). Is there evidence for an association between changes in training load and running-related injuries? A systematic review. International journal of sports physical therapy, 13(6), 931.

Drew, M. K., & Finch, C. F. (2016). The relationship between training load and injury, illness and soreness: a systematic and literature review. Sports medicine, 46(6), 861-883.

Van Gent, R. N., Siem, D., van Middelkoop, M., Van Os, A. G., Bierma-Zeinstra, S. M. A., & Koes, B. W. (2007). Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. British journal of sports medicine, 41(8), 469-480.

Videbæk, S., Bueno, A. M., Nielsen, R. O., & Rasmussen, S. (2015). Incidence of running-related injuries per 1000 h of running in different types of runners: a systematic review and meta-analysis. Sports medicine, 45(7), 1017-1026.

Achieve Daily Wins with your Running Goals

Achieve Daily Wins with your Running Goals

At iNform we take the word ‘goal’ seriously. A ‘goal’ is different from an aspiration, desire or intention. For us, a goal is a specific outcome that you have a strategy for, and determination to achieve.


The well-known Goal Framework acronym SMARTER is a framework that we as Exercise Physiologists use to help keep us accountable to creating a great strategy to help you succeed. You can read endlessly on this topic from authors more qualified than me, but if you are unsure of what SMARTER stands for it is as follows:

  • Specific
  • Measurable
  • Achievable
  • Relevant 
  • Time-Bound
  • Evaluated
  • Reviewed


I won’t delve deeper into the specifics of each of these domains in this article. Rather I want to talk to you about an aspect of living within a goal framework that I enjoy the most. I am talking about the concept of Daily Wins


If I am training for an event in 6 months time I should have a rough idea of what the next 6 months will look like. The next month should be quite clear, but the following week is spelled out in BOLD UNDERLINED font. This means I know exactly what I need to do each day this week to help take me closer to my goal. 


Every day that I complete my task for that day, I win. If that task is my long run and I get it done, I give myself a pat on the back for the win I earned. If the next day my aim is to recover and that includes a leisurely walk with the dog, a warm bath and a gentle stretching session, guess what? I win again. It is incredibly satisfying to pat oneself on the back for taking a bubble bath I can tell you!


It is not essential for a runner to have a goal at all times. In fact I encourage all of my runners to spend at least some of the year deliberately goal-less (I will tease this topic out in a future article). 


A SMARTER Goal is a serious commitment. And truly committing yourself to a Goal can become burdensome. If you have an intelligent daily plan you can eliminate the sense of burden by celebrating your Daily Wins


About The Author

You have started running? 3 Tips to avoid stopping.

You have started running? 3 Tips to avoid stopping.

Did you know that if you start running, there is a 30% chance that within 6 months you will stop.

That sucks.

But evidence from studies such as this one from Fokkema et al (where I pulled that number from) can help people like me understand why, so I can share it with people like you!

So firstly, why do people stop. For the participants of the study linked above, the main reasons were:

  • Development of an injury.
  • A low perception of physical capability prior to commencement.
  • A lack of direction following an initial intro-to-running program.

The good news is that these pitfalls can be avoided if you acknowledge the fact that they exist before you start, and you implement strategies to get over them.



So here is what I recommend before you start running.

  1. Listen to your body. Running is hard on the body, but this is not a bad thing. Our body responds favorably to loading but if this load crosses a threshold injury can occur. So build gradually. If you start getting sore, walk it off. If you pull up sore the next day, roll your legs over on a bike. Prioritise sleep as that is when our body heals itself. Drink lots of water and eat nutritious food. Basically treat yourself well.
  2. Get Strong! If you doubt your physical capabilities, improve your physical capabilities. Getting stronger is simplest way to do this. Consult with a trusted Exercise Physiologist or Strength Coach and they can help you get stronger in a safe and appropriate manner.
  3. Think long-term. Most running programs for beginners aim to get you from 0 to 5km in about six weeks. Plan a six month goal. A 10-12km event is appropriate for that time frame. Search for an event that you would like to do in six months of around that distance and commit to it. Seek out a reputable Coach who can help you plan from week-6 to month-6 and beyond. Running gets easier with increasing experience. And the easier it is, the more enjoyable it is and more beneficial it will be to your long term health.

For more information on this topic check out these blogs:

Running is NOT bad for your knees

My 5 favourite types of running

Don’t run anymore? Who do you think you are?


About The Author