Sunday, March 21, 2021

Reliable Predictors Of Running Injuries

You need a new pair of running shoes so you decide to go to a specialist running store to choose a pair that's suitable for you. The store manager at the specialist running store tells you to hop onto their in store treadmill and 'analyzes' your running gait.

He then proceeds to critique your running gait and its biomechanical implications. And suggests the most expensive running shoe (in the store) for you so you do not get injured. Is that a common scenario that happens?

Contrary to several long held beliefs, most biomechanical and structural factors are not reliable factors at predicting running injuries

Researchers studied 300 runners who have been injury-free for the past six months and found several more reliable factors (rather than biomechanical and structural factors) in predicting who would be more likely to get injured.

The runners' demographics, physiology, biomechanics, psychosocial issues and training were documented. Their hamstrings, quadriceps muscle strength, knee, ankle flexibility, arch height of their feet were tested. 

A gait analysis studied how their feet, knees and hips distribute forces while running

Any runner who reported an injury were followed up at six and twelve months later. After the first year, the researchers emailed the injured runners a biweekly questionnaire asking them what injuries they sustained in the past two weeks.

Those that were injured went to a doctor and physiotherapist who were part of the study for treatment.

Results of their study after the two year follow up indicate that female runners sustain injuries at a higher rate than male runners. Stiffness in the knee joint, which were more common in runners weighing more than 80 kg significantly increases the chances of an overuse running injury. 

The runners who were injured also reported significantly worse mental health related to their quality of life and more negative emotions compared to the non injured runners.

Most biomechanical, structural factors like arch height, overpronation, flexibility, Q-angle  (see picture above), lower limb strength, weekly mileage, footwear and previous injury are not reliable factors for overuse running injuries.

The researchers recommended that caution should be used when trying to alter what were commonly thought risk factors such as excessive pronation, poor flexibility, weekly mileage etc unless a runner has extreme values.

It appears from this study that the importance of biomechanics and anatomical structures assumed by doctors, physiotherapists, personal trainers and other clinicians are not as high risk as assumed. 

I feel that this does not mean they are not important. It is still important to consider the individual patient/ runner when assessing their condition. 

We still need to be aware of each patient's individual structural and biomechanical anomalies, but not to the point where we nitpick every discrepancy in strength, joint angle, foot position and range of motion.      


Messier SP, Martin DF, Shannon L et al (2018). A 2-Year Prospective Cohort Study Of Overuse Running Injuries: The Runners Injury Longitudinal Study (TRAILS). AJSM. 46(9): 2211-2221. DOI: 10.1177/0363546518773755

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