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Cross Country Running: Risks and Injury Prevention

June 5th, 2019 | 5 min. read

By Rob S Williams, MD

cross country running in corpus christi texas injuries

cross country running in corpus christi texas injuries


 What is cross country running? Cross country is an outdoor endurance sport that can be mentally challenging and fun. This type of running and racing has both a physical and psychological component. You’re not only putting one foot in front of the other; you’re also thinking ahead to obstacles and changes in the trail or course.

 For example, how will you clear that stone without tripping? Can you pass the person ahead of you safely without slipping in that mud puddle? How should you handle hills or turns—in a short burst of speed, or at your current steady pace?


Typically, cross country races take place in all weather conditions, which means you also have to worry about environmental conditions that can affect your race performance: rain and wind, snow and ice, hail and heat waves. It’s rare for a cross country race to be cancelled due to inclement weather.


Many runners love cross country and its sister sport, trail running, precisely because running in this way is not the same as road running. The variations in the terrain and the mental challenges of pacing oneself over an ever-changing course make for a more stimulating run.


However, the same aspects of the sport that make it diverting and enjoyable also make it rough on a runner’s body, at any age. High school runners, college runners, and adult runners all need to be aware of the risks of injury that come with running cross country.


Risks of Running Cross Country


By running cross country over a mix of natural terrain and groomed or paved trails, you may find yourself pounding not only pavement, but also packed or loose dirt, sand, gravel, mud, leaves, pine needles, tree roots, rocks, grass, moss, and anything else you might find on the ground in a natural area (including, possibly, snakes).


Though most cross country race courses are groomed and approved ahead of race day, surprises can come up. Weather, wild animals, and falling foliage from trees can’t always be controlled. And on non-race days, if you train in areas that aren’t approved courses (such as running on wooded paths or through parks), the level of trail maintenance isn’t guaranteed. You may encounter unexpected, non-natural obstacles like trash or discarded bottles.


All running subjects you to the possibility of impact injuries or repetitive motion injuries. But running over irregular or slippery surfaces can add to risk by changing your gait and creating opportunities for acute injuries. You may overstretch to clear an object in your path, or you may swerve suddenly and pull a tendon, twist an ankle or knee, or trip and fall. With falls, abrasions and head injuries aren’t out of the question, too.

In addition to changing surfaces, a typical cross-country course may also involve twists and turns and short—but steep—uphills and downhills. These rapid course changes can subject your feet, hips and legs to forces and stresses that may not affect someone running on level roads or gradual inclines. Running downhill, for example, may lead to jammed and sprained toes.


Heat illness is also a concern. In Texas, with our strong sun (and on the coast, high humidity), there’s the additional risk of dehydration, sunburn and heat stroke.


Cross country running is a wonderful sport if you love the outdoors and nature, and it’s mostly very safe in comparison to other team sports—but before you begin training and racing, you should be aware of potential injuries and how to avoid them.


The Most Common Cross Country Injuries


What injuries most commonly affect athletes running cross country, at the middle school level, high school level and beyond?


Below is a list of some of the more common injuries seen in cross country runners of all ages. Note that this is a partial list.


Also note that in many cases, these bone and soft tissue injuries are more common in girls and women than in boys and men, due in part to the female athlete “triad” of calorie depletion, bone loss and hormonal and menstrual changes. Women also have a larger angle between the hips and ankles. Women and girls are particularly susceptible to knee injuries (like meniscus tears and ACL tears) and stress fractures.

  • Stress fractures. These are overuse injuries that often occur in the weight-bearing bones of the lower body. Over a long run, muscles become fatigued, and the impact forces from pounding feet against the ground get transferred from muscle to bone. Stress fractures often develop in the shin bones and feet due to repeated stress and force over time. These tiny fractures manifest as small cracks in the bone, much like splinters in wood.

  • Shin splints (medial tibial stress syndrome, or MTSS). This running injury is caused by overtraining. Shin splints is a term used to describe throbbing pain in the anterior (front) of the lower legs. Shin splints are not stress fractures, though they are often confused for them. In fact, they are are inflammation and soreness of the connective tissue joining your shin bone to your calf muscles. Girls and women are more susceptible to shin splints and once they have them, they’re about three times as likely as men to develop stress fractures in the future.
  • Achilles tendonitis. Athletes, particularly runners and jumpers, often strain or even tear or rupture an Achilles tendon when making pushing-off movements. Tight calf muscles and poor choice of footwear often contribute to this injury.
  • Plantar fasciitis. Plantar fasciitis is an overuse injury affecting the arch of the foot. Repeated, tiny tears in the fascia that runs alongside the bottom of the foot can lead to inflammation and pain. In long-distance runners, these tears don’t get a chance to heal. The result: soreness and stiffness along the bottom of the foot, especially when walking or running after a period of rest. As you move around, the stiffness and pain subside, but symptoms return daily until the injury heals.
  • Runner’s knee (patellofemoral pain syndrome, or PFPS). This overuse injury involves friction that wears down cartilage in the knee, ultimately leading to osteoarthritis. Runner’s knee presents as pain in, around, or behind the kneecap. The knee may feel stiff and sore when standing after resting or sitting for long periods. It may also pop or crack when you use it. Runner’s knee is frequently caused by a misalignment of the knee joint, but it can be exacerbated by any repetitive, high-impact motion that puts stress on the knees, particularly when performed on an uneven surface.
  • Muscle, ligament and tendon strains (calf, hamstring, quadriceps, gluteus). A strain or pulled muscle is a soft tissue overstretching or tear in muscles or tendons. Overstretching, pivoting, jumping, shifting your weight from side to side, speeding up, and slowing down can all lead to strains. Cross country runners—particularly women and girls—need to be conscious of the injury risk to the tendons of the knee and ankle when making such movements. Sufficient warm-ups, cool-downs, leg strengthening and stretching can help to prevent these injuries.
  • Dehydration and heat illness. Hydration is critical for all athletes, especially any athlete practicing a sport in our high Texas heat. Staying hydrated protects cartilage and prevents soft tissue injury. It also prevents heat illness. If you’re running cross-country, you can’t carry water during a race, but you should make sure to hydrate before and after your run to keep your fluid levels steady. Replace all lost fluids immediately after your run. Stay out of the sun when possible and wear sunscreen. Heat illness is a serious and dangerous condition that can be deadly. If you see the signs of heat cramps, syncope, heat exhaustion or heat stroke in yourself or teammates, tell a friend or coach and immediately take measures to hydrate, get out of the sun, and get into a cooler environment.


Preventing Cross Country Running Injuries


How can you prevent cross country running injuries? The best ways for outdoor runners to stay healthy include the following running tips:


  • Stretch daily. For all runners and athletes, a regular stretching regimen is an important part of conditioning. Both static and dynamic stretches are needed to keep your bones, joints, muscles, ligaments and tendons healthy.
  • Warm up and cool down. Muscles and tendons are less likely to overstretch or tear if they’ve been properly prepared for running and racing. High-intensity workouts like training and racing require more prep and post-workout cooldown than low-impact activities.
  • Wear the right shoes. Make sure your shoes fit properly, that they are neither too snug nor too loose. Tie double-knots to prevent tripping over undone laces. If an orthopedist tells you that you need special inserts like orthotics or gel soles, use them. Break your shoes in before race day, and replace them regularly (after every 300 miles).
  • Eat and drink enough. Competitive distance runners like to keep their weight low. However, consuming too few calories can harm your body, especially if you’re a girl or woman subject to the female athlete triad. Eat a well-balanced diet and be sure to stay well-hydrated to prevent injury and heat illness. Remember that in Texas, especially in full sun or in humid regions of the state, you’re particularly prone to heat stroke. Drink plenty of water before and after running.


For assistance with any running related sports injuries like cross country running in Texas, request an appointment with Coastal Orthopedics in Corpus Christi by clicking the link below.


Request an Appointment Today!

Rob S Williams, MD

Dr. Williams has been practicing orthopedic surgery in Corpus Christi since 1998. After graduating from Texas Tech hereceived his medical degree from the University of Texas at San Antonio. At the prestigious Campbell Clinic located at the University of Tennessee, Dr. Williams completed not only an Orthopedic Surgery Residency, but an additional year of Fellowship Training in Spine Surgery. Dr. Williams is dedicated to creating an excellent patient experience in the office or in the surgery suite.