Effectiveness of exercise programs for injury prevention in long-distance runners
Endurance running is a rewarding activity that improves cardiovascular health, builds endurance and enhances mental well-being. However, it comes with risks — running-related injuries (RRIs) are common among runners of all levels since they face repetitive ground impacts.
Exercise programs are often recommended to reduce the risk of injuries, but are they effective? The current state of research does not provide a clear consensus on whether exercise programs have the capability to significantly reduce injuries amongst long-distance runners. This conclusion has been drawn from an extensive review of numerous studies where participating runners engaged in exercises that were not directly related to running. It is however important to note that these studies do not unanimously agree on their findings.
What are running-related injuries (RRIs)?
Running-related injuries (RRIs) are often caused by the repeated impact your body endures every time your foot strikes the ground during running. This impact, known as ground reaction force, increases with speed and is influenced by other factors like running style, footwear, and terrain.
When this repeated impact is too high or poorly managed—like running too much, too fast, over time the consistent strain on tissues like muscles, tendons, and joints can exceed their capacity to recover, leading to discomfort, pain, and ultimately injury.
The risk of injury increases significantly when the load placed on your body repeatedly exceeds your personal load tolerance. Your load tolerance represents your body’s capacity to handle and adapt to withstand and adapt to these higher loads, whether through running, strength training, or other activities.
By understanding and respecting your load tolerance, you can better manage load intensity and progression, allowing your body to adapt safely and reduce the likelihood of injury. Regularly monitoring your load and ensuring gradual increases are key strategies to staying within safe limits and building resilience over time.
Common types of RRIs include
- Patellofemoral Pain Syndrome (Runner’s Knee): Pain around or behind the kneecap
- Medial Tibial Stress Syndrome (Shin Splints): Pain along the inner edge of the shinbone
- Achilles Tendinitis/Tendinopathy: Pain or stiffness in the Achilles tendon
- Plantar Fasciitis: Pain and stiffness in the arch of the foot, particularly in the heel
- Stress Fractures: Tiny cracks in bones typically in the tibia (shinbone) or metatarsals (foot)
Preventing these injuries is key to enjoying running and achieving long-term fitness goals.
Do exercise-based programs prevent running injuries? Insights from research.
Recent studies found no clear evidence that exercise-based prevention programs significantly reduce the risk of stress fractures and other running-related injuries (RRIs) compared to running alone. Interestingly, some of these studies suggest that runners who adhere more strictly to the program and whose exercise routines are monitored more vigilantly tend to experience fewer injuries. This leads to the hypothesis that the level of compliance to the program and the degree of supervision could potentially influence the outcomes of such studies, thereby bringing some nuance to the statement.
The effectiveness of exercise-based programs depends on specific factors
- Threshold of intensity
Only loads that exceed a physiological threshold will stimulate bone and tissue adaptation. Low-intensity training, while beneficial for overall health, is insufficient for improving load tolerance. For example, strength training with heavier weights or plyometric exercises involving explosive movements provides the high-intensity stimuli required for significant changes in bone density & tendon resilience.
- Variety in exercise types enhances adaptation
Repeated exposure to the same type of stress can limit adaptation. Studies that observed favorable results for injury outcomes used training programs with varied exercises and loading patterns including strength, agility, balance, core, plyometrics, & bodyweight exercises. This includes a combination of eccentric and concentric movements or different jumping techniques. However, the most effective types of exercises that could potentially contribute to a significant reduction in injuries amongst long-distance runners are yet to be determined.
- Adaptation takes time & requires consistency
Studies show that training programs need to be frequent (multiple times a week) and consistent (last for at least six months) to elicit meaningful changes in bone mass or load tolerance. Interruptions or irregular training reduce the cumulative effects needed for adaptation. This interplay between repetitive load, recovery, and adaptation is key to staying injury-free and maintaining consistent training. However, the optimal frequency of these exercise sessions remains a topic of discussion and further research.
- Supervised programs are more effective
Research highlights that supervised programs are significantly more effective than unsupervised programs in reducing running-related injuries (RRIs). Coaches or healthcare professionals ensure:
- Proper technique reducing the risk of injury during training
- Gradual progression to avoid overloading the body too quickly preventing overuse injuries
- Accountability for consistent adherence to the program
Exercise modalities for injury prevention explained
Strength training
Strength training builds muscle and enhances joint stability, reducing the strain on your body during runs.
Key Benefits: Strengthens muscles, joints, and connective tissues & improves running efficiency.
Best Practices: Choose exercises like single-leg heel raises, squats, lunges, hip thrusts, and deadlifts using moderate to heavy weights. Incorporate at least one rest day between sessions.
Plyometric training
Plyometric exercises (e.g., jump squats, and box jumps) involve explosive movements that enhance bone density and strengthen tendons.
Caution: Introduce gradually to avoid excessive stress on joints & tendons, particularly for beginners or if you're injury-prone.
Balance and proprioception training
Strengthens smaller stabilizing muscles often neglected in other exercises and helps to improve coordination and stability, reducing the risk of falls or missteps.
Caution: To avoid unnecessary strain, start with simple exercises and progress gradually as your balance improves.
Extra tips for staying injury-free
1. Break the 10% rule for gradual progression
The traditional 10% rule, which advises against increasing your weekly running distance or duration by more than 10%, has its shortcomings. While it aims to minimize the risk of injury, it doesn't account for the total load your body experiences during running. Factors like changes in speed, running surface, or running style can cause your actual load to rise much more than expected.
For example, even with a modest 10% increase in running volume, variations in these factors could lead to a 20% or higher increase in the actual load on your body. This can significantly elevate the risk of overuse injuries.
With tools like the OnTracx sensor, you can track these critical load metrics in real time, allowing you to tailor your training to your body’s capacity and reduce the risk of injury.
2. Optimizing your running style, footwear, and terrain for injury prevention
As explained in the previous point, the mechanical load your body experiences during running isn’t just about how far you go — it’s primarily influenced by your speed, as well as your running style, footwear, and terrain. By understanding and optimizing these factors with tools like OnTracx, you can reduce the load on each step, make informed decisions about your training, and prevent overuse injuries for a smoother, safer running experience.
Interventions to reduce the load on your body during running may include:
- Running style
Your running style plays a crucial role in managing the impact forces on your body, but its effects are highly individual. While adjustments such as increasing step frequency can result in a decrease in load for one runner, but an increase in another. Tools like OnTracx offer real-time feedback on your unique running mechanics & exposed impact forces, empowering you to make immediate, personalized adjustments that optimize your load progression.
- Footwear
The right shoes can make a significant difference, but there is no single type of shoe that works best for everyone. Footwear choices are highly personalized and depend on your unique foot type, running style, and terrain. While more cushioned shoes can reduce impact forces for some runners, they may increase the mechanical load for others by altering running mechanics or encouraging heavier landings. Regularly replacing worn-out shoes is essential to maintain proper cushioning and support. OnTracx can help analyze how different shoes impact your mechanical load, guiding you to choose the most suitable option for your individual training needs.
- Terrain
The surface you run on influences the mechanical load on your body, but the effects are highly individual, varying based on factors like running style and footwear. While hard surfaces like pavement often generate higher impact forces, softer terrains such as grass or trails might reduce repetitive strain for some runners. However, for others, these softer surfaces can increase mechanical load by requiring greater muscle activation to maintain stability, particularly if their running style or footwear isn’t well-suited to the terrain.
This variability underscores the importance of a personalized approach. Tools like OnTracx can help you monitor how different surfaces impact your body, providing actionable insights to guide smarter, individualized choices in your training. By optimizing terrain selection alongside other factors like speed, cadence, and footwear, you can reduce injury risk, enhance performance, and create a more enjoyable running experience tailored to your unique needs
3. Prioritize recovery & incorporate rest days
Rest days are critical for allowing your body to repair and adapt. Use recovery tools like foam rollers and prioritize sleep and nutrition to optimize muscle recovery and overall performance.
4. Monitor your body
Pay attention to discomfort or fatigue. Persistent pain may signal the need for rest, slower training progression, or medical advice.
Takeaway and future directions
In conclusion, the effectiveness of exercise programs for injury prevention amongst long-distance runners remains a topic of ongoing research and debate & addresses the need for more well-designed studies with larger sample sizes. For now, there is no clear scientific consensus on the effectiveness of exercise programs in reducing the risk of stress fractures and other running-related injuries (RRIs) compared to running alone.
Factors such as program compliance, level of supervision, diversity of exercises, and frequency of exercise sessions could play significant roles in determining the effectiveness of such programs.
Remember, consistency is key because irregular or interrupted training disrupts this gradual process. Supervised programs excel in fostering this consistency by providing structured guidance, ensuring proper technique, gradual progression, and accountability. If in-person supervision is not feasible, leverage tools like real-time feedback, virtual coaching, or interactive instructional materials.
However, exercise programs can make your body stronger over time, helping to increase your load tolerance, they don't help much with the main cause of running injuries — sudden increases in training load. Most injuries happen because your body is pushed too hard, too fast, without enough time to adjust. This is where OnTracx stands out.
This award-winning, science-backed wearable is the ultimate tool for runners to monitor injury risk, stay within safe progression zones, and confidently train towards their next big goal. It shows how factors like speed, running surface, running style, and footwear affect the load on your muscles, bones, and tendons.
By addressing the root cause—poor load progression—OnTracx offers a more practical and dynamic approach to injury prevention than standalone strength exercise training programs.
