Should Children and Teens Run Until It Hurts?

By Shaylon Rettig, MD, MBA, Section Chief, Sports Medicine, The Children’s Hospital of San Antonio
Tuesday, February 26, 2019

Many of our young patients are diagnosed with overuse injuries and report pain exacerbations when running.

Shaylon Rettig, MD, MBA, Section Chief, Sports Medicine, The Children’s Hospital of San Antonio

Overuse injuries occur as a function of the load applied during activity and the frequency of the activity. Once that activity exceeds a threshold, referred to as the envelope of function, overuse injuries occur. If the patient has faulty running mechanics, this reduces their envelope of function, making them more susceptible to overuse injuries with lower loads and less frequency of activity. It is important for us to treat the symptoms along with the underlying cause of the running injury (biomechanics).

Running Recommendations

There are recommendations for the level and intensity of training for children in all sports, but the No. 1 rule is to emphasize fun, safety and fitness when it comes to kids.

Maximum running distances for children of different ages are as follows1:



Under 9

1.5 miles


3.2 miles


6.4 miles


Half marathon: 13.1 miles


19.2 miles


Marathon: 26.2 miles

Experts recommend that weekly training distances should not exceed twice the maximum competition distance. Therefore, middle school athletes should only be running up to 12.8 miles per week, if they are planning to run in a 10K race. Kids up to age 14 should only run three times per week. Athletes over age 15 can train up to five times per week.

FUNdamentals of Youth Running

Promoted by the Road Runners Club of America

  • Make running fun. Do not use running as a punishment. Encourage children to participate and try their best.
  • Emphasize good technique. Teach youth good form early and help eliminate bad habits such as excessive arm movement, twisting of the upper body or overstriding.
  • Focus on participation and self-improvement. Competition can be healthy but an over emphasis on it can result in mental and physical fatigue.
  • Consider individual differences. Avoid a one-size-fits-all running program. Accommodate for differences in abilities within the group. Children mature at different rates both physically and emotionally, and this will factor into their ability to participate in running.
  • Limit systematic training and competition before puberty. Excessive, systematic training may interfere with normal growth and cause injury in a child.

Between the ages of 3 and 9, children should be encouraged to participate in regular exercise, which can include organized running.

Around the ages of 8 to 12, children may enjoy participation in a more organized running program that has a more systematic training environment that lasts two to three months.

Around age 12 for girls and 14 for boys, key developmental changes will enable young athletes to slowly increase training distance and duration leading to participation in a systematic and competitive training environment.

Increase running workload gradually

Running workload includes volume (distance), intensity (speed or effort) and frequency (number of days a week). Just like with adults’ running training, children should start a running program with a low-volume, low-intensity plan, and limit frequency to a couple of days per week. Workload should increase over the duration of the program (no greater than 10 percent a week), but should remain appropriate for the individual runner.

Participate in age-appropriate running events

Running in a kid’s fun run or youth track event can be a great experience for kids.

  • For children 5 and younger, focus on “dash” events that range from a few yards to 400 meters. For children ages 5 and older, kids fun runs that are a half- to one-mile long may be considered, but allow for a combination of running and walking.
  • Children ages 12 and over may want to participate in a 5K run. Children ages 15 and older may want to participate in a 10K to half-marathon event.
  • Children 18 and older may want to participate in a marathon or further distance.

These are general guidelines and the distance a child can physically and emotionally tolerate will depend on the individual; however, longer distances (10K and over) shouldn’t be attempted until after puberty.

For more information about the Sports Medicine program at The Children’s Hospital of San Antonio, please visit or call 210-704-4708 to refer a patient.