A recent study set out to determine whether foot muscle strengthening reduced the incidence of running-related injuries in recreational runners.
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STUDY: Foot core training to prevent running-related injuries. A survival analysis of a single-blind, randomized controlled trial – Taddei et al (2020)
Study reviewed by Dr Melinda Smith in the January 2021 issue of the Research Reviews
Key points from the study:
- Running-related injury risk was reduced in recreational runners who performed a foot strengthening protocol.
- The generalizability of results to novice or elite runners requires further examination.
Okay, let’s dive into it!
Background and Objective:
With the incidence of running-related injuries reported to be as high as 79%, establishing effective injury prevention is a priority. Training the foot muscles may assist injury prevention in runners. The aim of this RCT was to investigate the efficacy of a foot muscle strengthening protocol in reducing the incidence of running-related injuries in recreational runners over the course of a 1-year follow-up.
118 participants who ran between 20 and 100km per week were recruited for the trial. Participants were randomized into one of two groups:
Group 1 – Foot muscle strengthening:
- 8-week training protocol consisting of 12 foot-ankle exercises performed once per week supervised by a physical therapist, and 8 foot-ankle exercises performed 3 times per week at home with remote supervision.
Group 2 – Control:
- 5-minute placebo static stretching protocol 3 times per week with weekly feedback from a physical therapist.
Following the 8-week intervention, participants were instructed to continue the respective exercises 3 times per week until the end of the 12-month follow-up and record their adherence.
28 participants (23.5%) reported a running-related injury, including 20 participants (32.8%) from the control group and 8 participants (14.0%) from the foot strengthening group. Participants in the control group were 2.42 times more likely to experience a running-related injury than participants in the foot strengthening group in the 12-month follow-up. Larger gains in foot strength over the 8 weeks of training was correlated to longer time to develop a running-related injury.
- There was no differentiation between types or sites of running-related injuries.
- Running-related injuries were self-reported which may have introduced some bias.
- Finally, the generalizability of results to novice or elite runners is unknown.
The authors’ proposition that a stronger foot should better dissipate excessive and cumulative loads appears somewhat supported as foot strength gains were correlated with time to injury. However, how each runner responds biomechanically to foot strength improvements and how this relates to different injury types or sites requires further investigation.
The program structure included sessions supervised by a therapist (weekly for 8 weeks) as well as independent (home) sessions that were remotely supervised using a web program. All sessions were estimated to take 20 to 30 minutes to complete. This time commitment may be a consideration for implementation.
Participants were instructed to continue the exercises at home 3 times per week for the duration of the 12-month follow-up. This begs the question: Is 8 weeks of training sufficient to obtain a reduction in injury risk, or was continuation of the intervention an important component in the program’s efficacy over the 12 months? The authors reported that by the fourth month of follow-up differences in cumulative running-related injury risk were evident between the two groups, and suggested that just 4 to 8 months of the foot exercise regimen might be effective.
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