Is prevention effective for runners without injury history?
- Online advice on prevention targeting modifiable risk factors not effective
- Advice: focus injury prevention on runners with a history of injury
- Forefoot landing may lead to more lower leg injuries
Online injury prevention advice for runners does not prevent injuries. This is the conclusion of a randomised study with over 2300 recreational runners who participated in 2017 in three Dutch running events. Half of them got access to a website with information about modifiable risk factors for developing injury, such as body weight, walking distance and -frequency, forefoot landing and tips on shoes and soles.
Scientists did not find any difference between intervention and control groups: in both groups, more than a third got injured between moment of registration – at least two months before the event – and one month after the race. The runners had a mean age of 41 and an average body mass index (BMI) of 23.7, and reported mostly injuries of knee, calves and foot.
Advice might even be counterproductive for runners without past injury: participants who got prevention advice while they did not get injured in the year before the race, got injured more than runners who did not have access to the website with tips about risk factors. Researchers advice to aim future prevention of running injury specifically on runners with a past injury.
Results of this study confirm again that previous injury is the largest risk factor for developing a new injury: participants who got injured one year prior to the event, had the largest risk of getting injured again. The Odds Ratio was 2.21 (see framework). It was in fact remarkable that three out of four of the reinjuries emerged at a different location than the previous injury.
Online advice programme
With the programme, researchers targeted modifiable risk factors in four categories: 1) personal factors, such as age, weight and previous injury; 2) training factors, such as running distance, - frequency and surface; 3) biomechanical factors, such as stride frequency and foot landing; and 4) gear, such as the type of shoe and the use of soles. Participants in the intervention group could read advice about the four topics by logging in on the website, which they could use unlimited, with their individual credentials. An overview of the advices can be read in an earlier open access study of the same research group .
Researchers concluded that a static website may not be the best way to offer injury prevention advice and suggest among othersusing an app for future prevention advice. More than a third of the runners in the intervention group did not use the website and only 44% said that they used the tips during their preparation period. It seems that participants with past injury were more interested in prevention advice: they read the tips more often than the runners without injury in the year prior to the running event.
Biomechanical advices about altering foot landing should be combined with a physiotherapy consult, according to the authors. One of the biomechanical advices in the online prevention programme, was a gradual adjustment to forefoot landing to prevent knee injury. However, a subgroup-analysis of participants who used this topic, showed that they developed significantly more calf and foot injuries than the control group. The Odds Ratio was 1.74.
 Fokkema T, De Vos R-J, Van Ochten JM, et al. Preventing running-related injuries using evidence-based online advice: the design of a randomised-controlled trial. BMJ Open Sport Exerc Med 2017;3:e000265.
An odds indicates the probability of a certain event (e.g. an injury) compared to the probability that that event does not occur. An Odds Ratio is the ratio between two odds, for example for those who were and those who were not exposed to a certain risk factor. In other words: the Odds Ratio measures the risk ratio for an injury when an injury prevention advice is either followed or not. The Odds ratio varies between 0 (maximum negative association) and + infinity (maximum positive association). When there is no association, the OR equals 1. Watch the videosnippet about Odds ratio here.
Expert opinion by Nick Muhren
In this interesting study, researchers did NOT succeed in reducing the very high injury incidence of 37 percent (within only 3 months around the race) with ‘general’ prevention information and advice using a website in a large group of recreational runners.
This can partly be attributed to the second thing I noticed about this study: only 63 percent of the ‘intervention group’ (i.e., the runners who got access to the injury prevention information) indicated that they read at least one subject. The other 37 percent did not even have a look the information at all! And a large part of the readers did absolutely nothing with the acquired information. Only 44 percent indicated that they used the information that was provided. Nevertheless, this did not lead to fewer injuries.
This seems to confirm that injury prevention advice for runners must be offered individually and ‘customised’, for example by a (sports)physiotherapist. Especially individually because besides ‘previous injury’ very little is known about ‘general’ risk factors.
> From: Fokkema, Br J Sports Med (2019) (Epub ahead of print). All rights reserved to The Author(s). Click here for the online summary.