Risk Factors for Running Related Injury - 2021 Study Review.
Running Related Injury (RRI)
Over recent decades, running has become the most popular form of physical activity. Put simply, its cheap, convenient and accessible to most. Furthermore, the significant health benefits of running have been well documented. Over lockdown periods with COVID-19, running uptake increased further as people generally had more time at home and access to other sport and activity was temporarily ceased. This caused an influx of new runners to hit the streets. We know from previous research, people new to running are more likely to sustain running related injuries (RRI’s) than experienced runners and we have definitely seen an increase in patients presenting with RRI’s over the past 2 years. Large amounts of research and studies have explored risk factors for RRI’s and looked at this from various angles including isolated and functional strength, detailed biomechanics, training history, etc etc. This recently published paper we are reviewing aimed to confirm/refute previous findings and also explore other more broader variables and their relationship with injury.
Brief review of Methodology
The authors (Sanfillipo et 2021) conducted online surveys of 3669 injured and non-injured runners. The survey included 41 questions on 5 main categories—personal characteristics, daily lifestyle, training and running characteristics, practice of other sporting activities, and prevention habits—as well as information about the occurrence of RRI over the previous 12 months.
The results from these surveys were then analysed using a variety of statistical tools to identify or rule out any associations between injury and potential risk factors they had highlighted. It is important to note, these variables were not an exhaustive list.
Running injury
Participants:
To be included in this study, runners had to be at least 18 years old and have at least 12 months of running experience. After completing the survey, eligible participants were placed into an injured or noninjured group depending on whether they had experienced a lower extremity RRI within the previous 12 months. Injury was considered any kind of pain, without paying attention to its consequences on running practice.
Data was collected from April to July 2017.
Study review: Foot and Ankle strengthening to reduce running related injury.
The Survey
The survey was divided into 5 parts.
Personal characteristics: sex, age, weight, height, laterality, previous injury
Daily lifestyle: professional activity type, weekly work hours, daily sleeping hours, dietary habits, tobacco/alcohol consumption
Training and running characteristics: running speed, mileage and hours per week, weekly number of workouts, types of practice, trail versus road and drop, years of practice, goals of practice, annual number of competitions and distance, hydration behavior, forefoot versus rearfoot strike, planning methodology, fasted running sessions or not
Practice of others sports activities and prevention habits
Occurrence of RRI over the last 12 months: 1 question allowed the authors to categorize athletes as injured or noninjured (“I have suffered from an RRI in the last 12 months”).
Key findings summarised.
The participants
57.8% of the participants were male and 42.2% female
The mean age was 36.1 years
The mean BMI was 22.9
A total of 1852 runners (50.5%) reported at least 1 lower extremity RRI over the previous 12 months and were included in the injury group
Injured participants were significantly more often older, heavier and male.
They also presented a higher prevalence of previous injuries beyond the previous 12 months as compared with noninjured participants
No difference was found for height, BMI, laterality, tobacco/alcohol consumption, professional activity, or hours of work and sleeping time
Incidence of RRI
Most injured runners (69.5%) cited only 1 injury
A total of 2538 injuries were reported, and 2218 pathologies were identified
Overuse injury accounted for 60.6%, traumatic injury (fracture and strain) 19.1% and muscular injuries (stiffness and tear) 20.3%.
Risk factors for RRI
Regarding training characteristics, results showed statistically significant higher risks for those:
training more than 2 times per week,
training more than 2 hours per week
running more than 21 km per week,
and running faster than 6min/km speeds.
Some interesting and possibly surprising findings:
Trail runners more at risk of injury than road runners.
Runners in training for a competition more at risk than those that aren’t.
Training on the track is associated with more risk than on the road, as is training in the woods.
Those that regularly train with higher levels of elevation deemed at more risk of injury.
Those that stretch before sessions are at more risk of injury.
Runner stretching
Conclusions
There were some interesting findings noted in this study. Some I felt were to be expected such as higher duration/intensity/speeds associated with increased risk. Other findings were more surprising. Over the past decade, the importance and effectiveness of stretching before exercise has been significantly questioned, but this is the first time I have seen it associated with an increased risk of injury.
The study had its limitations - particularly as it was reliant on memory recall from the participants of the previous 12 months and subsequently was at risk of recall bias. More research is also required to look at trail running injury rates.
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