Rethinking Injury Prevention: Latest Meta-Analysis Casts Doubt On The Necessity of Strength Training

Evaluating the effectiveness of exercise-based injury prevention in endurance running.

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For many of us, running is more than just a sport; it’s a crucial component of our physical and mental well-being. Running offers a unique escape, a way to declutter the mind, elevate mood, increase cardiovascular health, and instil a sense of achievement.

Yet, a runner’s path is not without its hurdles. Injuries, ranging from muscle strains to stress fractures, frequently disrupt many runners’ training regimens and overall health.

Overuse injuries, which generally require lengthy healing times, are a common cause of frustration among runners. They can disrupt training, cause pre-race withdrawals, and, in some cases, cause some to give up running altogether.

Statistically speaking, about half of all runners each year find themselves injured.1van Mechelen, W. (1992). Running Injuries. Sports Medicine14(5), 320–335. https://doi.org/10.2165/00007256-199214050-00004. This staggering number begs the question, how do we avoid getting injured?

A runner doing strength training with dumbells and another runner with an injured knee on a purple background.
Credit: Marathon Handbook Staff

Traditional strength training has been a widely prescribed exercise-based intervention for decades and is often considered an effective evidence-based intervention.

Put simply, stronger muscles can better withstand the repetitive stress of running, reducing the likelihood of overuse injuries.

Previous studies on the effectiveness of exercise interventions in reducing running-related injuries (RRIs) have become somewhat outdated.

They often focus on multi-sport participation and draw data from overuse injuries in different sports, where the physiological stressors are different.

However, last week, a review published in Sports Medicine asked the question, “Do Exercise-Based Prevention Programs Reduce Injury in Endurance Runners?2Wu, H., Brooke-Wavell, K., Fong, D.T.P. et al. Do Exercise-Based Prevention Programs Reduce Injury in Endurance Runners? A Systematic Review and Meta-Analysis. Sports Med (2024). https://doi.org/10.1007/s40279-024-01993-7

Han Wu and colleagues analyzed nine select research papers, focusing on 1,904 runners. The team applied strict criteria to choose these studies, ensuring the results were relevant and reliable.

What they found may surprise you. Contrary to popular belief, the study’s analysis revealed that, in general, exercise-based interventions did not significantly reduce the risk or rate of running-related injuries (RRIs).

A runner holding their shin.

This revelation invites a deeper reflection on how exercise interventions are perceived in the context of injury prevention for runners.

It suggests that merely adding strength training or other exercises to a runner’s routine, without considering factors like specificity, progressive overload, and individual runner needs, might not be as effective in preventing injuries as previously thought.

That takes us to their second observation, the important impact of supervision on the effectiveness of exercise interventions. When the analysis focused solely on supervised exercise programs, there was a significant reduction in injury risk.

This underscores the importance of professional guidance in ensuring correct technique, tailoring exercises to individual needs, and perhaps most crucially, ensuring adherence to the training program.

Finally, the meta-analysis noted that most of the studies reviewed were classified as having a high overall risk of bias.

This aspect is critical as it implies that while the data collected was comprehensive, the study designs’ inherent limitations could affect the findings’ overall reliability.

For example, in some studies, people knew which treatment group they were in, which could lead to placebo effects or special treatment, skewing the results.

Many of these studies also relied on runners claiming injury rather than getting a diagnosis. Plus, there were issues with people dropping out or not sticking to the program.

In addition, many studies didn’t follow up with participants long enough to see if the interventions worked over time. All these issues highlight the need for better-designed studies in this field to get clearer answers.

Key Takeaways:

  • No Clear Evidence That Strength Training Alone Reduces RRIs: Strength training, on its own, has not been definitively shown to decrease running-related injuries, challenging the common belief in its protective role.
  • Supervised Strength Training is More Effective: The study highlights that strength training under supervision significantly reduces the risk of running-related injuries, underscoring the importance of professional guidance.
  • Call for Better-Designed Research: There is a need for more rigorously designed studies in this area, as current research often suffers from poor design and high bias risk.

What Makes Supervision So Effective?

Exercise intervention only protected against overuse injury in supervised participants who complied with the program.

Over the years of working with runners at my clinic, I have seen a highly effective adoption of a well-structured, progressive strength and conditioning program.

The contradiction between the effectiveness of supervised and non-supervised strength training highlights several key aspects of running training.

Firstly, it underscores the complexity of injury prevention in running, where the repetitive nature of the activity and individual variability in response to training play significant roles.

Secondly, it speaks to the importance of expertise in designing and implementing training programs. Strength training, while beneficial, is not a straightforward solution; it requires careful consideration of numerous variables that a professional coach or trainer is equipped to manage.

A coach supervising a client lifting weights.

Non-supervised strength training falls short of significantly reducing RRIs because of its:

  • Lack of personalization in generic programs that fail to cater to individual runners’ needs and injury histories.
  • Inconsistent intensity and progression, with runners pushing too hard or not enough.
  • Incorrect exercise execution without professional guidance leads to potential injuries.
  • Reduced motivation and adherence without accountability.

In contrast, supervised strength training shows a marked improvement in effectiveness. A coach can ensure exercises are performed correctly, significantly reducing the risk of injury.

They provide customized programs tailored to each runner’s unique needs, strengths, and weaknesses, crucial for addressing specific biomechanical and physiological demands.

Supervised training ensures appropriate progression in exercise and, most importantly, adherence.

As the study suggests, the presence of supervision significantly enhances the effectiveness of the exercises in preventing running-related injuries.

What Is The Most Common Reason Runners Get Injured?

Overuse injuries.

These injuries don’t arise from a single misstep or fall but are the cumulative result of repetitive stress without adequate recovery.

Without a structured plan, it is easy to get caught up in the excitement and increase running mileage, intensity, and frequency quickly. This enthusiasm, while commendable, overlooks a critical aspect of training: the body’s need for adaptation.

When you run, you subject your body to physical stress. This stress is not inherently bad; it’s the stimulus that leads to improved endurance and strength.

However, this stimulus must be balanced with sufficient rest and recovery. When stress outweighs recovery for a prolonged period, it often leads to overuse injuries.

Muscles, tendons, and bones strengthen when given time to recover after being stressed.

This process is adaptation – the body’s response to gradually increased load. Without proper adaptation, continuous stress leads to breakdown and inflammation rather than strengthening.

This can lead to injuries such as shin splints, stress fractures, or tendonitis.

A runner holding their knee.

The key is balancing enthusiasm with a well-thought-out training plan that respects the body’s limits and needs for gradual progression.

By adhering to the principles of progressive overload, monitoring bodily responses, and allowing adequate time for rest and recovery, runners can significantly reduce the risk of overuse injuries.

A patient, measured approach will lead to more sustainable, enjoyable, and injury-free running in the long term.

Here are a couple of pointers to keep in mind:

  1. Start Slow: If you’re new to running or returning after a break, begin with low mileage and intensity.
  2. Increase Volume Gradually: A common guideline is the ‘10% rule‘, which suggests not increasing weekly mileage by more than 10% from the previous week. While not a one-size-fits-all rule, it’s a good starting point.
  3. Mix Intensities: Include a variety of running intensities in your routine. Some days should be easy, others more challenging, and some can involve interval training. This variety helps overall conditioning and reduces the risk of overuse.
  4. Monitor Your Body’s Response: Pay attention to how your body feels. Muscle soreness is normal, but persistent pain might be a sign of overuse.
  5. Rest and Recovery: Incorporate rest days into your training schedule. These are as important as your running days. Additionally, ensure you’re getting adequate sleep, as this is when most recovery and adaptation occur.
A coach with a client at the gym.

So, What next?

The reivew offers us a new perspective on injury prevention in endurance running, indicating that strength training alone doesn’t significantly decrease the risk of injuries, challenging a widely held belief among runners and coaches.

Don’t cancel your gym membership just yet.

The study highlighted the substantial benefits of supervised strength training.

Despite the study’s findings that strength training may not yet be proven to significantly reduce running-related injuries, it’s important to remember that it has been proven to positively impact overall running performance.

It enhances endurance, increases speed, and improves running economy, all of which are crucial for runners.

Furthermore, strength training is just one piece of the injury prevention puzzle. Factors such as training volume, recovery, nutrition, and even psychological aspects like stress and sleep quality contribute significantly to injury risk and prevention.

Looking ahead, this study paves the way for future research that delves deeper into the dynamics of strength training. It’s a call to action for the scientific community to design more robust methodologies to gain clearer insights into injury prevention strategies.

References

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Ben is a qualified Personal Trainer and Sports Massage Therapist with a particular interest in running performance and injury. He has spent the last 9 years working with runners at his clinic in Brighton. Ben is a keen runner and avid cyclist. Evenly splitting his time between trail running, road biking, and MTB.

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