Measuring readiness for return to running

London Marathon 2020 Kenya’s Eliud Kipchoge and runners run past Buckingham Palace – REUTERS/Ian Walton

Paper Title: Construct Validity and Responsiveness of the University of Wisconsin Running Injury and Recovery Index

Publication:  J Orthop Sports Phys Ther. 2020;50(12):702-710. doi:10.2519/jospt.2020.9698.

Publication date: December 2020


Running related injuries (RRIs) may require runners to reduce their running volume as well as cause functional limitations, psychological consequences, and financial burdens due to necessity of medical care. Patient-reported outcome measures (PROM) help describe the severity of injury and track progress towards return to activity. The University of Wisconsin Running Injury and Recovery Index (UWRI) is the first running specific PROM. It is a 9-question survey, scored between 0 and 36, where higher scores indicate greater ability. The purpose of this study was to examine the validity of the UWRI.


The prospective cohort study included 396 runners with a lumbopelvic or lower extremity injury that caused the runner to stop running or miss a scheduled run. Runners were monitored over a 12-week period, completing various outcome measures at the beginning and end of the period. These outcome measures included the UWRI, global rating of change (GROC), Veterans RAND 12 (VR-12), Oswestry Disability Index (ODI), 12-item International Hip Outcome Tool (i-HOT), Anterior Knee Pain Scale (AKPS), and Foot and Ankle Ability Measures (FAAM) sports subscale.

The survey asks questions about the following:

  1. Injury impact on daily tasks
  2. Frustration due to injury
  3. Perceived recovery
  4. Pain during running
  5. Pain after running
  6. Weekly running volume
  7. Typical run distance
  8. Running pace
  9. Confidence to increase training


Based on the GROC, 48% of runners reported significant improvement, 38% reported slight improvement, 11% reported no change, and 3% reported worsening. Change based on the UWRI was as follows: significant improvement (12.2 point change), slight improvement (7.1 points), no change (0.0 points), and worsening (-14.6 points). The UWRI was correlated with all outcome measures except the ODI. The UWRI was not found to have a floor or ceiling effect

Clinical Implications

There is a clinical need for a standardized outcome measure for running injuries. Distance and time loss, which are common assessments, are not standardized due to variations between training programs. Other outcome measures are not specific to running and focus on activities of daily living rather than running. The UWRI monitors both training load and perceived tissue fatigue, which are often cited as a part of the causal mechanism of injury. The UWRI is a valid and reliable method for clinicians and runners to track progress and direct interventions.

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