Injury Risk and Prevention in Novice Runners

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Why do some people get injured and others don’t? It seems like this simple enough question would be solved by sports scientists, especially when it comes to new runners. However, injury prevention for novice runners is a topic that is much discussed but not well understood. One reason is that the causes of injury are multi-factorial and it is nearly impossible to isolate injuries to a single cause be it, changes in running volume, intensity, terrain, footwear, cross training, nutrition, recovery or any other number of factors.

The strongest predictor of an injury is a past history of having an injury. Thus, preventing the first injury in novice (or experienced runners) is critical to running long term injury-free.

So how prevalent are injuries and what are the types of injuries novice runners are likely to experience? A recent meta-review of many different studies tracked injury rates in different populations of runners. About one quarter of novice runners were injured during the relatively short time span of a study of 6–13 weeks for most studies (side note: ultrarunners had the highest prevalence of injury risk at ~60% over a longer follow up)³.

Let’s dive into what the studies out there reveal. There are 17.8 novice runners injured for every 1,000 hours of running while only 7.7 recreational runners⁵. Where novice runners experience injures is not too surprising, with most injures located in the knee (30%) or lower leg (34%), similar to other types of runners for the most part.

A number of studies have looked at training factors most associated with running injures in novice runners. A six-week study found that runners who ran less frequently (two times per week), with higher intensity, and for longer (> 60 minutes) are most likely to get injured⁴. Similarly, runners who increase their training volume by greater than 30% over a two-week period of time increase their risk of injury. Body weight of runners also influences injury risk with heavier runners being more likely to get hurt, probably due to the greater stress on joints from excess weight¹. Some, but not all studies, show that female runners are more likely to have knee injures due to anatomical differences.

Perhaps not surprising it seems changes in training and physical differences are associated with injury rates, so surely there must be interventions that then can limit injures such as specific strengthening or training protocols?

A number of interventions have been tested for decreasing the risk of injury rate for novice runners. One study examined the common rule of thumb to only increase your mileage by 10% a week during a training program. Novice runners were randomized to a “10% rule” group and a standard training group. Unfortunately, following the 10% rule did not reduce the risk of injuries. Another study randomized novice runners to either four weeks of running specific strength training or no strength training prior to starting a training program. Again, the intervention, strength training prior to starting a running program, had no effect on reducing injures. In more experienced runners, randomized control studies which examine the role of the heel to toe drop of shoes, cushioning of shoes, and stretching all show no effect on injury rate unfortunately. Indeed, a recent meta-review found that no training changes or movement based interventions reduce injury risk². Depressing findings for sure.

The lack of interventions of injury prevention in large populations of runners does not mean that you should give up and just accept that you are likely to get injured. Instead it suggests that each injury is unique and potentially complex, requiring a personalized approach towards injury prevention and recovery. While this lack of evidence-based advice for injury prevention is frustrating (especially as a coach) it does open the opportunity to become your own n = 1 experiment.

You cannot manage what you don’t measure, so each runner needs to carefully track their training (both objectively and subjectively) to find out what your personal risk factors are for injury and what works in terms of injury prevention. Maybe that is varying the surface you run on, the number of days off you have, the shoes you wear, the variation in training week to week or any number of variables? Whatever it is, it requires paying close attention to the first sign of injury and backing off the training to diagnose and hopefully prevent any serious injury from occurring. Good luck!

Matt Laye of Boise, Idaho, has a PhD in Medical Physiology and is an Assistant Professor of Health and Human Performance at The College of Idaho. He enjoys competing on trails and on the roads in distances from the mile to 100 miles. He has averaged under 8 min/mile for 100 miles and under 5:30/mile over a marathon.

References

1. Buist I, Bredeweg SW, Lemmink KAPM, van Mechelen W, Diercks RL. Predictors of Running-Related Injuries in Novice Runners Enrolled in a Systematic Training Program. Am J Sports Med 38: 273–280, 2010.
2. Buist I, Bredeweg SW, van Mechelen W, Lemmink KAPM, Pepping G-J, Diercks RL. No Effect of a Graded Training Program on the Number of Running-Related Injuries in Novice Runners. Am J Sports Med 36: 33–39, 2008.
3. Bas Kluitenberg, Marienke van Middlekoop, Ron Diercks, Henk van der Worp. What are the Differences in Injury Proportions Between Different Populations of Runners? A Systematic Review and Meta-Analysis. Sport Med 45: 1143–1161, 2015.
4. Kluitenberg B, Van Der Worp H, Huisstede BMA, Hartgens F, Diercks R, Verhagen E, van Middelkoop M. The NLstart2run study: Training-related factors associated with running-related injuries in novice runners. J Sci Med Sport 19: 642–646, 2016.
5. Solvej Videbæk, Andreas Moeballe Bueno, Rasmus Oestergaard Nielsen, Sten Rasmussen. Incidence of Running-Related Injuries Per 1000 h of running in Different Types of Runners: A Systematic Review and Meta-Analysis. Sport Med 45, 2015.