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
Cross-training
Cross-training exercises for runners include cycling, an elliptical workout, swimming, and weightlifting. Incorporating cross-training can be protective against running injury because cross-training requires different movement patterns, prevents overuse, and equalizes muscle imbalances that occur with running.7 In addition, replacing running with a cross-training activity can decrease weekly running time and mileage, which can further reduce risk of running-related injury.7 Runners—especially higher-mileage runners—should be encouraged to incorporate cross-training into their workout regimen to decrease their risk of injury.
Stretching. The authors of a Cochrane review concluded that there is no significant reduction in injury associated with hamstring or gastrocnemius stretching.32 A small randomized, controlled, crossover study concluded that participants subjectively felt their performance was better when warm-ups included stretching.38 This perceived improvement in performance was similar between groups who completed dynamic or static stretching. However, no difference was noted in flexibility or objective performance between groups who stretched or did not stretch before activity.
Although there is no supporting evidence that stretching reduces the risk of injury, stretching is a low-risk intervention. Because stretching might provide subjective benefit to runners, you need not discourage patients from including this activity in their running program.
CORRESPONDENCE
Kartik Sidhar, MD, 15370 Huff Way, Brookfield, WI, 53005; kartiksidhar@gmail.com
