Running-related injuries: Insights into key risk factors

We all have runners come into our clinic wanting a quick fix for an injury which has been niggling at them for a couple of months or so – and ideally without having to cut down the kilometers too! The initial discussion usually involves trying to decipher what’s changed in their training load and what factors have contributed to the development of pain and injury. We know treatment needs to be individualised, so deciphering the cause(s) of the injury and providing a good plan with accurate education is vital.

Dr Travis Pollen’s recent Research Review indicates that perspectives regarding risk factors and protective factors for Running-Related Injury (RRI) can differ between different age groups, which may mean we need to adapt our subjective assessment and patient education accordingly. This blog will outline some of the take-aways from Travis’ Review, as well as some of the current evidence on risk factors for RRI.

With our Research Reviews you get access to expert summaries of the latest and most clinically relevant papers – so you can easily keep up to date, and become more confident and effective in your clinical practice. Learn more HERE.

Age-related perceptions

The recent study (1) outlined in Travis’ Review looked at the differences in perspectives on the risk factors and protective factors for RRI between adolescents and adults. The study found medium to large differences in each population’s perspectives for over half of the factors presented. Some key differences included:

• Adolescents were more likely than adults to consider low-repetition, heavy weight resistance training as a risk factor for RRI
• Adolescents were more likely than adults to consider lower-limb static stretching as a protective factor for RRI
• Adults were more likely than adolescents to consider long strides as a risk factor for RRI
• Adults were more likely than adolescents to view low cadence as a risk factor for RRI

Understanding the factors which have led to the development of pain and injury is crucial in treatment planning; we as clinicians should keep these age-related differences in mind to inform a more patient-specific subjective assessment. Additionally, it will inform how we educate our patients to get back to running, and maintain running throughout their lifetime. For example, when trying to implement strength training into a patient’s program, education for adolescents may involve more information on the benefits of strength training for running, proper technique and allaying worries of injury-risk, while discussions with adults may be more focussed on how to fit the strength training into their busy lifestyles. Read Travis’ full Review for more in-depth understanding of the age-related differences in perspective which may help to inform your management.

Risk factors for RRI

These are going to be slightly different for different populations, and there’s still a lot of research being done in this area. Below is a summary of the current evidence to get you up to speed.

An earlier systematic review found strong to moderate evidence that a history of previous injury, as well as having used orthotics/inserts were factors associated with an increased risk of RRI (2). The study found that the factors which were of greater risk for women than men included age, previous sporting activity, running on concrete, participating in a marathon, weekly running distance (48-63kms) and having worn their running shoes for four to six months. The risk factors more relevant to men included a history of previous injuries, having running experience of less than two years, restarting running, weekly running distance (32-46kms), or running more than 64kms per week. However, it’s important to note that very few studies extrapolate risk factors between genders, so this information is limited.

A more recent review found that there seems to be a higher overall prevalence of RRI in females compared to males (3). Associated risk factors included having less than five years running experience, being previously injured in the past year, and running more than three times per week (3).

In terms of biomechanics, the jury is still out. The research is limited by a range of factors including small sample sizes, as well as poor biomechanical measurement tools (4,5). For example, a recent systematic review concluded that there is not enough high quality evidence to suggest a relationship between foot strike technique and RRI (4).

In terms of consensus, the only undisputed, evidence-based risk factor for RRI in adolescents is previous injury (6). When considering consensus for all ages, interestingly footwear is not considered a risk factor (7), while low cadence is considered a risk factor for RRI (8).

Wrapping up

Getting runners back to running, or (ideally) keeping runners running can be tough. Runners are notoriously determined to keep slapping that pavement, and it’s usually not until they physically can’t keep going that they are showing up on your doorstep. That initial subjective assessment is often an interrogation of sorts, trying to tease out what has changed – this conversation usually starts off with the runner replying “nothing”, which requires you to get into the nitty gritty to tease out exactly what has been going on in their training program, and their lives in general. This is the first and most crucial step in a runner’s management, so understanding the research around RRI risk factors, as well as differences in perspectives between different populations is useful in informing your practice.

If you’re a busy clinician who feels a bit overwhelmed with trying to keep up with the research, then you’re not alone! Physio Network has you covered with their Research Reviews – check out summaries of all the latest research HERE.