Running Injuries

A Review of the Epidemiological Literature

Summary

Running is one of the most popular leisure sports activities. Next to its beneficial health effects, negative side effects in terms of sports injuries should also be recognised.

Given the limitations of the studies it appears that for the average recreational runner, who is steadily training and who participates in a long distance run every now and then, the overall yearly incidence rate for running injuries varies between 37 and 56%. Depending on the specificity of the group of runners concerned (competitive athletes; average recreational joggers; boys and girls) and on different circumstances these rates vary. If incidence is calculated according to exposure of running time the incidence reported in the literature varies from 2.5 to 12.1 injuries per 1000 hours of running.

Most running injuries are lower extremity injuries, with a predominance for the knee. About 50 to 75% of all running injuries appear to be overuse injuries due to the constant repetition of the same movement. Recurrence of running injuries is reported in 20 to 70% of the cases. From the epidemiological studies it can be concluded that running injuries lead to a reduction of training or training cessation in about 30 to 90% of all injuries, about 20 to 70% of all injuries lead to medical consultation or medical treatment and 0 to 5% result in absence from work.

Aetiological factors associated with running injuries include previous injury, lack of running experience, running to compete and excessive weekly running distance. The association between running injuries and factors such as warm-up and stretching exercises, body height, malalignment, muscular imbalance, restricted range of motion, running frequency, level of performance, stability of running pattern, shoes and inshoe orthoses and running on 1 side of the road remains unclear or is backed by contradicting or scarce research findings. Significantly not associated with running injuries seem age, gender, body mass index, running hills, running on hard surfaces, participation in other sports, time of the year and time of the day.

The prevention of sports injuries should focus on changes of behaviour by health education. Health education on running injuries should primarily focus on the importance of complete rehabilitation and the early recognition of symptoms of overuse, and on the provision of training guidelines.

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References

  1. Andrews JR. Overuse syndromes of the lower extremity. Clinics in Sports Medicine 2: 137–148, 1983

    PubMed  CAS  Google Scholar 

  2. Backx FJG, Inklaar H, Koornneef M, Van Mechelen W. Draft FIMS position statement on the prevention of sports injuries. Geneeskunde en Sport: special issue, 1990

    Google Scholar 

  3. Blair SE, Kohl HW, Goodyear NN. Rates and risks for running and exercise injuries: studies in three populations. Research Quarterly for Exercise and Sport 58: 221–228, 1987

    Google Scholar 

  4. Bar-Or O. Pediatric sports medicine for the practitioner, Springer-Verlag, New York, 1983

    Google Scholar 

  5. Bovens AMP, Janssen GME, Vermeer HGW, Hoeberigs JH, Janssen MPE, et al. Occurrence of running injuries in adults following a supervised training program. International Journal of Sports Medicine 10: S186–S190, 1989

    PubMed  Article  Google Scholar 

  6. Clement DB, Taunton JE, Smart GW, McNicol KL. A survey of overuse running injuries. Physician and Sportsmedicine 9: 47–58, 1981

    Google Scholar 

  7. Clement DB, Taunton JE, Smart GW. Achilles tendinitis and peritendinitis: etiology and treatment. American Journal of Sports Medicine 12: 179–184, 1984

    PubMed  Article  CAS  Google Scholar 

  8. Clement DB, Taunton JE. A guide to the prevention of running injuries. Australian Family Physician 10: 156–164, 1981

    PubMed  CAS  Google Scholar 

  9. Clough PJ, Dutch S, Maugham RJ, Shepherd J. Prerace drop-out in marathon runners: reasons for withdrawal and future plans. British Journal of Sports Medicine 21: 148–149, 1987

    PubMed  Article  CAS  Google Scholar 

  10. Clough PJ, Shepherd J, Maugham RJ. Marathon finishers and prerace drop-outs; British Journal of Sports Medicine 23: 97–101, 1989

    PubMed  Article  CAS  Google Scholar 

  11. Cook SD, Brinker MR, Mahlon P. Running shoes: their relation to running injuries. Sports Medicine 10: 1–8, 1990

    PubMed  Article  CAS  Google Scholar 

  12. Davies JE. Injuries and physical stress. Journal of Biosocial Science. (Suppl. 7): 151–157, 1981

    Article  CAS  Google Scholar 

  13. Dixon WJ, Brown MB, Engelman L, Jennrich RI. BMDP statistical software manual, Vol. 2, University of California Press, Berkely, 1990

    Google Scholar 

  14. Doxey GE. Management of the metatarsalgia with foot orthotics. Journal of Orthopaedic and Sports Physical Therapy 6: 324–333, 1985

    PubMed  CAS  Google Scholar 

  15. Dressendorfer RH, Wade ChE. The muscular overuse syndrome in long distance runners. Physician and Sportsmedicine 11 (11): 116–130, 1983

    Google Scholar 

  16. Eggold JF. Orthotics in the prevention of runners’ overuse injuries. Physician and Sportsmedicine 9 (3): 125–131, 1981

    Google Scholar 

  17. Eichner ER. Exercise and heart disease: epidemiology of the ‘Exercise Hypothesis’. American Journal of Medicine 75: 1008–1023, 1983

    PubMed  Article  CAS  Google Scholar 

  18. Ekstrand J. Soccer injuries and their prevention, Linkoping University Medical Dissertations no. 130, Linkoping, 1982

    Google Scholar 

  19. Eriksson EKG. Sports accidents. Paper presented at a symposium on accidents in Europe, Newcastle upon Tyne, September, 1983

    Google Scholar 

  20. Franklin BA, Lussier L, Buskirk E. Injury rates in women joggers. Physician and Sportsmedicine 7: 105–112, 1979

    Google Scholar 

  21. Gudas CJ. Patterns of lower-extremity injury in 224 runners. Comprehensive Therapy 6: 50–59, 1980

    PubMed  CAS  Google Scholar 

  22. Hartung GH. Jogging — the potential for prevention of heart disease. Comprehensive Therapy 6: 28–32, 1980

    PubMed  CAS  Google Scholar 

  23. Harvey J. The preparticipation examination of the child athlete. Clinics in Sports Medicine 1: 353–369, 1982

    PubMed  CAS  Google Scholar 

  24. Hayes D. Risk factors in sport. Human Factors 16: 454–458, 1974

    PubMed  CAS  Google Scholar 

  25. Hess GP, Capiello WL, Poole RM, Hunter SC. Prevention and treatment of overuse tendon injuries. Sports Medicine 8: 371–384, 1989

    PubMed  Article  CAS  Google Scholar 

  26. Hølmich P, Christensen SW, Darre E, Johnsen F, Hartog T. Nonelite marathon runners: health, training and injuries. British Journal of Sports Medicine 23: 177–178, 1989

    PubMed  Article  Google Scholar 

  27. Hughson R. Canadian association of sports sciences position healthful on protection from exertional heat injuries. Canadian Journal of Applied Sports Sciences 6: 99–100, 1981

    Google Scholar 

  28. Jacobs SJ, Berson BL. Injuries to runners: a study of entrants to a 10 000 meter race. American Journal of Sports Medicine 14: 151–155, 1986

    PubMed  Article  CAS  Google Scholar 

  29. Kemper HCG. Gezondheid in beweging, De Vrieseborch, Haarlem, 1985

    Google Scholar 

  30. Kennedy MC, Vanderfield GK, Kennedy JR. Sport: assessing the risk. Medical Journal of Australia 2: 253–254, 1977

    PubMed  CAS  Google Scholar 

  31. Kok G, Bouter LM. On the importance of planned health education: prevention of ski injury as an example. American Journal of Sports Medicine 18: 600–605, 1990

    PubMed  Article  CAS  Google Scholar 

  32. Koplan JP, Powell KE, Sikes RK, Shirley RW, Campbell GC. An epidemiological study of the benefits and risks of running. Journal of the American Medical Association 248: 3118–3121, 1982

    PubMed  Article  CAS  Google Scholar 

  33. Kowal DM. Nature and causes of injuries in women resulting from an endurance training program. American Journal of Sports Medicine 8: 265–269, 1980

    PubMed  Article  CAS  Google Scholar 

  34. Lehman WL. Overuse syndromes in runners. American Family Physician 29: 157–61, 1984

    PubMed  Google Scholar 

  35. Lysens R, Lefevre J, Ostyn M. The predictability of sports injuries: a preliminary report. International Journal of Sports Medicine 5 (Suppl.): 153–155, 1984

    Article  Google Scholar 

  36. Lysholm J, Wiklander J. Injuries in runners. American Journal of Sports Medicine 15: 168–171, 1987

    PubMed  Article  CAS  Google Scholar 

  37. Macera CA, Pate RR, Powell KE, Jackson KL, Kendrick JS, et al. Predicting lower-extremity injuries among habitual runners; Archives of Internal Medicine 149: 2565–2568, 1989

    PubMed  Article  CAS  Google Scholar 

  38. Manders TH, Kropman J. Sportbeoefening drempels en stimulansen. Instituut voor toegepaste sociologie, Nijmegen, 1982

    Google Scholar 

  39. Manders TH, Kropman J. Sport: ontwikkelingen en kosten. Instituut voor toegepaste sociologe wetenschappen, Nijmegen, 1987

    Google Scholar 

  40. Marti B, Vader JP, Minder CE, Abelin T. On the epidemiology of running injuries. American Journal of Sports Medicine 16: 285–294, 1988

    PubMed  Article  CAS  Google Scholar 

  41. McKenzie DC, Clement DB, Taunton JE. Running shoes, orthotics and injuries. Sports Medicine 2: 334–347, 1985

    PubMed  Article  CAS  Google Scholar 

  42. Mirkin G. The prevention and treatment of running injuries. Journal of the American Podiatric Association 66: 880–884, 1976

    CAS  Google Scholar 

  43. Ooyendijk WTM, Van Agt L. Preventie van hardloopblessures. Geneeskunde en Sport 23: 146–151, 1990

    Google Scholar 

  44. Pollock ML, Gettman LR, Milesis LA, Bak MD, Durstine L, et al. Effects of frequency and duration of training on attrition and incidence of injury. Medicine and Science in Sport 9: 31–36, 1977

    CAS  Google Scholar 

  45. Powell KE, Kohl HW, Caspersen CJ, Blair SA. An epidemiological perspective on the causes of running injuries. Physician and Sportsmedicine 14 (6): 100–114, 1986

    Google Scholar 

  46. Powell KE, Paffenbarger RS. Workshop on epidemiologic and public health aspects of physical activity and exercise, a summary. Public Health Reports 100: 118–126, 1985

    PubMed  CAS  Google Scholar 

  47. Proctor A. The medical responsibilities of the athletic trainer. North Carolina Medical Journal 41: 519–520, 1980

    PubMed  CAS  Google Scholar 

  48. Renstrom P, Johnson RJ. Overuse injuries in sports: a review. Sports Medicine 2: 316–333, 1985

    PubMed  Article  CAS  Google Scholar 

  49. Robbins SE, Gouw GJ. Athletic footwear and chronic overloading: a brief review. Sports Medicine 9: 76–85, 1990

    PubMed  Article  CAS  Google Scholar 

  50. Runyan DK. The preparticipation examination of the young athlete: defining the essentials. Clinical Pediatrics 22: 674–679, 1983

    PubMed  Article  CAS  Google Scholar 

  51. Safran MR, Seaber AV, Garrett WE. Warm-up and muscular injury prevention: an update. Sports Medicine 8: 239–249, 1989

    PubMed  Article  CAS  Google Scholar 

  52. Stanish WD. Overuse injuries in athletes. Medicine and Science in Sports and Exercise 16: 1–7, 1984

    PubMed  Article  CAS  Google Scholar 

  53. Stulberg SD. Sports injuries and arthritis. Comprehensive Therapy 6: 8–11, 1980

    PubMed  CAS  Google Scholar 

  54. Subotnick SI. The biomechanics of running: implications for the prevention of foot injuries. Sports Medicine 2: 144–153, 1985

    PubMed  Article  CAS  Google Scholar 

  55. Thompson JR, Andrish JT, Bergfeld JA. A prospective study of a preparticipation sports examinations of 2670 young athletes: methods and results. Cleveland Clinical Quarterly 49: 225–233, 1982

    CAS  Google Scholar 

  56. Van Galen W, Diederiks J. Sport blessures breed uitgemeten, Uitg. De Vrieseborch, Haarlem, 1990

    Google Scholar 

  57. van Mechelen W, Hlobil H, Kemper HCG. How can sports injuries be prevented? NISGZ publication no. 25E, Papendal, The Netherlands, 1987

    Google Scholar 

  58. van Mechelen W, Hlobil H, Kemper HCG. Incidence, severity, aetiology and prevention of sports injuries: a review of concepts. Sports Medicine 14: 82–89, 1992

    PubMed  Article  Google Scholar 

  59. Wallace RB. Application of epidemiological principles to sports injury research. American Journal of Sports Medicine 16 (Suppl. 1): 22–25, 1988

    Google Scholar 

  60. Walter SD, Hart LE, McIntosh JM, Sutton JR. The Ontario cohort study of running-related injuries. Archives of Internal Medicine 149: 2561–2564, 1989

    PubMed  Article  CAS  Google Scholar 

  61. Watson AWS. Sports injuries during one academic year in 6799 Irish school children. American Journal of Sports Medicine 12: 65–71, 1984

    PubMed  Article  CAS  Google Scholar 

  62. Watson MD, DiMartino PP. Incidence of injuries in high school track and field athletes and its relation to performance ability. American Journal of Sports Medicine 15: 251–254, 1987

    PubMed  Article  CAS  Google Scholar 

  63. Williams AF. When motor vehicles hit joggers: an analysis of 60 cases. Public Health Reports 96: 448–451, 1981

    PubMed  CAS  Google Scholar 

  64. Yzerman JC, Van Galen WCC. Blessures bij lange afstandlopers. Report, KNAU, 1987

    Google Scholar 

  65. Zemper ED. NCAA injury surveillance system: initial results. Paper presented at Olymp. Sc. Congress, Los Angeles, 1984

    Google Scholar 

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Correspondence to Dr Willem van Mechelen.

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van Mechelen, W. Running Injuries. Sports Medicine 14, 320–335 (1992). https://doi.org/10.2165/00007256-199214050-00004

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Keywords

  • Injury Risk
  • Sport Injury
  • Tendinitis
  • Overuse Injury
  • Injury Incidence