Beliefs and barriers to injury prevention in recreational runners

People run at the start of the annual City to Surf fun race in Australia, August 12, 2018. REUTERS/David Gray

Nearly 85% of runners experience a running injury in their lifetime(1). While researchers continue to look for exact mechanisms of injury in runners, a group from the Netherlands investigated the factors that make an injury prevention program successful(1). They undertook a randomized controlled trial of the effectiveness of a multifactorial online prevention program for recreational runners.

As part of the INSPIRE trial, the subjects of this study were runners who registered for a recreational race in 2017. The researchers provided the intervention group with an online injury prevention program. This program informed them about risk factors for injury and advised the runners on how to reduce that risk. After training and racing (about seven months after the event), the subjects filled out follow-up questionnaires to assess the program’s effectiveness. The study defined a running-related injury (RRI) as one that:

  • Affects the musculoskeletal system;
  • Was caused by running;
  • Prompted the runner to run more slowly or less often for at least a week;
  • Required medication to reduce symptoms;
  • Resulted in an appointment with a medical professional or physio.

The follow-up questionnaires assessed the efficacy of the prevention program, and they also asked about the way the runners accessed and used the prevention program. They included what prevented the runner from integrating the information and assessed their preferred means of receiving information. The researchers gave the same questionnaire to runners without access to the running injury prevention program and compared them to those who did.

Of the 2378 runners who participated in the INSPIRE study, 1034 completed the questionnaire. These runners were older, more experienced, and more often male than those who did not fill out the survey. Nearly 75% of respondents agreed on the importance of injury prevention and cited the progression of their training program, running shoes, and technique as the most significant influencers of injury(1). Over half of those surveyed searched for and performed some injury prevention activity. Most often, these activities included:

  • Changing their training schedule;
  • Warming up and cooling down;
  • Stretching

Those who didn’t participate in any injury prevention stated, “Not knowing what to do,” and never having suffered an RRI as the most significant barriers to implementing a risk-reduction strategy (1). In fact, over half of the respondents didn’t try to reduce injury risk until they had already suffered an injury.

Interestingly, men preferred to receive their information via an app or in an email. Women, however, wanted the information dispensed from a trainer or running store salesperson. Younger runners, those under 35-years-old, found free offers or financial compensation as an enticement to instigate injury reduction tactics.

Practical applications

This study demonstrates that injury prevention is an important topic for recreational runners. Nearly 70% of the participants actively sought information on injury prevention, and over 80% implemented some prevention measure(1). However, with the continued high rate of injury among runners, the current approaches to prevention may not be working.

The incidence of RRIs may be due to the fact that the prevention information obtained by runners is false or insufficient. This study showed that recreational runners believe that training, technique, and shoes contribute to the prevalence of RRIs. However, while certain aspects of training and technique contribute to RRIs, shoes likely do not. The pervasiveness of the belief that particular shoes or features of shoes prevent or cause injury is likely due to good advertising. Therefore, clinicians have much work to do in the area of patient education.

Because runners typically become more interested in injury prevention after they’ve already been hurt, physios have a unique opportunity to correct a patient’s misinformation or misconception about how to stay healthy. The study offers insight into how to deliver this information. Men like to learn at their own pace via an app or receiving education in email. On the other hand, women prefer a more personal delivery model, perhaps allowing them to ask questions.

Despite these preferences, many still said they hesitated to train in a way that reduced injuries because they weren’t sure what to do. Therefore, at the crux of the study is the need for a personalized approach that provides information, assures an understanding of the information, and provides accountability for actually doing the things needed to reduce risk. As those with a previous RRI are the most interested in injury prevention, clinicians can use this three-pronged prevention model to design a program that acts as a bridge between therapeutic activities and a full return to running.


  1. 2019 Oct;49(10):736
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