Department of Family Medicine and Community Health (Drs. Sidhar and Hammer) and Department of Orthopedics and Rehabilitation (Dr. Hammer), University of Wisconsin School of Medicine and Public Health, Madison kartiksidhar@gmail.com
The authors reported no potential conflict of interest relevant to this article.
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.
› 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
References
Approximately 60 million people in the United States run for exercise at least once a calendar year, with approximately 11 million of them running > 100 days a year.1,2 Running is an affordable, convenient, and efficient form of exercise, whose benefits include a decrease in the risk of all-cause early mortality, cancer, and diabetes; an improved lipid profile; and better mental health.3
However, running is also the cause of a significant percentage of exercise-associated injuries: More than 60% of runners report overuse injury annually.4 Given the high incidence of running-related injury, an important component of primary care is accurately diagnosing and managing such injuries and counseling patients about how to prevent them.
This article reviews risk factors for running-related injury and summarizes evidence-based recommendations for prevention.
CASE
During a health maintenance examination, Clara K, a 47-year-old woman who is obese (body mass index [BMI], 34) and has bilateral knee osteoarthritis (OA), inquires about establishing a weight-loss strategy. Ms. K is interested in starting an exercise regimen involving running but is worried about provoking a flare of OA pain.
Risk factors for running injuries
Several risk factors—some modifiable, others nonmodifiable—are associated with running-related injury (TABLE 14-16). In addition, research suggests that other variables once thought to be risk factors, such as running surface and the Q-angle (described later), are not associated with running-related injury.
Modifiable risk factors
Changes in a training regimen or type of training. Many runners escalate training regimens as their fitness improves. Increasing mileage and changing the type of training (such as introducing hills or interval training) are independent risk factors for sustaining injury.5
Running is an affordable, convenient, and efficient form of exercise; however, more than 60% of runners report overuse injury annually.
The traditional recommendation has been for a runner to slowly increase or modify training with a 10% weekly increase in mileage or intensity.17 However, a randomized controlled trial failed to show a lower incidence of injury among amateur runners who adopted a graded exercise program.18 Regardless: It is still prudent to recommend a gradual increase in activity, such as taking ≥ 1 day off between running workouts or starting with a walking or jogging program, especially when there is a history of injury.19
