How to help runners steer clear of injury
Assess risk factors, then work to address modifiable ones, such as wearing the right running shoes and building up slowly. Don’t let overweight or OA dampen enthusiasm.
PRACTICE RECOMMENDATIONS
› Counsel runners to cross-train, replace shoes regularly, and use shoes with moderate-to-high (8-12 mm) heel-to-toe drop. C
› Don’t discourage running for exercise, as long as it is tolerated, in patients who have osteoarthritis. C
› Encourage moderation in running distance and intensity, especially in novice runners. C
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
Excessive mileage. Many runners aspire to complete high-mileage runs. There is low-quality evidence demonstrating that high-mileage running, especially > 40 miles per week, is associated with increased risk of running-related injury.5 Injuries that occur with higher mileage are more often those of the hip and hamstring.5 A study noted that running ≤ 25 miles a week was protective against calf injury.6
Overall, there is little evidence to show that high-mileage running is associated with increased risk of running-related injury. However, this is still a risk factor that you should address with patients who have a running program—especially novices and those who ramp up mileage quickly.
Type of surface. Access to running surfaces—concrete, pavement, trails, treadmills, and athletic tracks—varies by time of day and season. Softer surfaces include treadmill, tracks, and trails; harder surfaces include asphalt and concrete.
There are limited data linking running surface with risk of injury.7 A study did not find an association between peak impact force based on running surface8; the authors hypothesized that runners compensate for a harder surface by making kinematic adjustments to minimize impact. With no strong evidence to link running-related injury to a particular running surface, patients should not be restricted to a softer running surface unless they notice a difference in comfort, because it is likely that they can compensate for a harder surface by adapting their gait.
Patients can therefore be counseled to run locally on sidewalks and neighborhood streets—if safe to do so—instead of obtaining a gym membership or driving to run on a trail. Such reassurance can increase a patient’s access to running and reduce barriers to exercise.
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