Concerns and consensus on youth runners

2012 England South East’s Jermaine Hamilton (C) wins the boys 200m final during the Athletics at the Olympic Stadium who was competing in the Government backed Sainsburys 2012 School Games. Credit: Action Images / Alex Morton Livepic

Running for sport is just as popular among young people as it is with adults. Up to 40% of children participate in running as a sport in some parts of the world(1). For youth in the US, running is the second most popular activity(1). As the popularity of running grows, so do the numbers of running-related injuries (RRIs) sustained by younger athletes. The number of injuries in youngsters due to running grew by 34% between 1994 and 2007.

The growth of the incidence of RRIs in a younger population prompted researchers to convene a multi-discipline panel of experts to explore three key areas of youth running:

  • Risk factors for injury or illness in runners.
  • Recommendations for risk factor screening in young runners.
  • Recommendations for nutrition, training, and readiness to minimize any detrimental effects of running.

The panel met and organized into committees to explore the three main topics. After conducting a systemic review, each committee presented the information to the group, and all members contributed and approved the final statement.

Results and clinical implications

The experts developed consensus statements based on youth runners’ extrinsic and intrinsic risk factors. Height, weight, chronological age, nor developmental age proved a significant risk for developing an RRI. Yet, the experts acknowledge that there are periods during development when youth may be more vulnerable to injury – namely during rapid bone growth. Unfortunately, none of the internal factors evaluated seemed to predict when these phases of growth would happen and influence injury.

Several studies agreed that girls are more prone to RRIs than boys. While gender is considered an internal factor, other factors might influence this finding. The first is the greater incidence of energy deficiency and resulting vulnerability to experience bone stress reactions in girls. The second is the tendency for females to demonstrate a larger Q-angle. On the other hand, boys showed an increased injury risk if their leg length discrepancy was more than 1.5 cm.

Interestingly, foot position (pronated or supinated) and navicular drop weren’t associated with an increased risk of injury. Neither did lower extremity weakness or functional deficits. Nevertheless, the panel did suggest that high-intensity neuromuscular training might help reduce injuries.

A prior RRI proved to increase the risk of suffering a subsequent one, including stress fractures. Basketball may be a beneficial cross-training sport as it seems to have a positive influence on bone health. The experts conjecture that the benefit is a result of the frequent jumping and high-intensity activity inherent in the sport.

Shin splints are one of the most common RRIs. The studies reviewed showed no evidence that running surface, pace, competition level, or topography influenced shin splints. However, there was an association between cadence and injury. Runners with a low step rate (<164) were more prone to develop shin splints. According to this review, shoes don’t seem to impact injury risk, and there’s insufficient data to determine if foot strike has any effect.

What about long-term health effects? The reviewers found that, like adults, youth runners show cardiac adaptations and benefits from running. The concern for sudden cardiac arrest or death seems minimal in younger runners. Like youth participants in other sports, young runners should undergo a cardiac screening as part of a pre-participation physical exam (PPE) to detect any risk factors for cardiac involvement.

In addition to a standardized PPE, the experts suggest additional screening for energy deficiency such as the RED-S CAT since runners may be at higher risk for this than other athletes. While monitoring macronutrients and calories are especially important in runners, these youth athletes may consider supplementing vitamin D and calcium in their diet.

Because youth athletes who specialize early in one sport experience a higher rate of injuries, the panel suggests that runners participate in a variety of sports as they develop. They recommend free play as an effective cross-training strategy for children and adolescents. Of particular benefit during free play is the high-intensity interval aspect and variety of movement patterns inherent in children’s games such as climbing, tag, and hide and seek. Younger runners should also have at least one rest and recovery day per week and utilize training loads appropriately for their age.

The consensus concludes that the benefits of running competitively or for enjoyment outweigh any potential risks. However, clinicians, trainers, and coaches must guide young athletes to develop strong bodies and general athletic skills in a way that enables them to stay healthy and active through adulthood.


  1. BR J Sports Med 2021;55:305-318
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