The Monday Shakeout: Strength Training to Prevent Injury
By Nathan Brown
In our latest Monday Shakeout, Nathan explores a new study about strength training and running. The Monday Shakeout is our weekly series which lets us go a bit further into subjects we have been looking to discuss a little bit more about. Have an idea for a Monday Shakeout? Share it with us by emailing doctorsofrunning@gmail.com
For many, remaining healthy and avoiding injury is priority number one during any training cycle or when simply running recreationally. Unfortunately, the statistics about running injury prevalence are unfavorable, as up to 79% of runners get injured yearly. Many look for a silver bullet when it comes to injury prevention, but ultimately it comes down to a holistic approach to avoid having your running interrupted by an unwelcome injury. This means dialing in proper training habits, nutrition, hydration, and overall life stress management. Intuitively, many believed that strength training and building tissue capacity would be another way to prevent injury, but studies looking at runners had not been conducted to confirm or refute this. Until now. Finally, a research group was able to look for a link between strength training and the incidence of injury. The goal today is to examine this new study and decipher some major takeaways for us as runners.
What was the study?
The study included 433 recreational runners (203 female, 220 male) that were divided into two groups. The intervention group performed general strength training and foam-rolling exercises twice weekly for 18 weeks, while the control group maintained their regular training habits. The runners in the intervention group were given a detailed exercise routine and were required to report weekly running volume and whether they were experiencing any running-related pain. The control group also reported their running volume and any pain, but did not have a strengthening program to report participation in.
The researchers defined an injury as "a running-related musculoskeletal pain in the lower limbs or back that causes a restriction of running (distance, speed, duration, or training) in more than 66% of all training sessions in 2 consecutive weeks or in more than 50% of all training sessions in four consecutive weeks, or that requires the runner to consult a physician or other health professional." I appreciate this definition overall because it encompasses multiple ways that runners experience injury and is consistent with different types of tissue irritation. I believe that an injury is something that either limits the progression of your running toward your goal or leads to degradation of running fitness. Therefore missing one day due to a "niggle" wouldn't be a running injury, and this study was sensitive to that reality.
What was the exercise routine?
The strengthening program was developed by looking at previous literature that documented correlations between weakness or movement impairments and people who sustained more injuries than their counterparts. Here were the exercises:
- Single Leg Squat
- Forward Lunges
- Side Steps with Elastic Band
- Supine Abduction with Elastic Band
- Side-Plank
- Diagonal Lifts and Foot Supination with Elastic Band
- Foam-Rolling of the Upper Leg (hamstring, quadriceps, gluteal and abductor muscles)
- Foam-Rolling of the Lower Leg (plantar fascia, calf and shin muscles)
What were the results?
This is where things start to get interesting. When looking at the control group vs. the overall intervention group, there was no difference in the proportion of injury-free runners between the groups. But before we say that strengthening isn't worth the work, we need to look a little deeper. Once the researchers split the intervention group (aka the ones who got the exercise routine) into low-, intermediate-, and high-compliance groups, differences started to appear between these groups and the control group.
Runners who were highly compliant with their exercise program had an 85% lower risk of sustaining a running-related injury compared to the control group. So what does it mean to be compliant? Well, runners who participated in at least 32 of the recommended 36 sessions were considered highly compliant and fell into this lower-risk category. They also found that the highly compliant group took on average 55 days longer to sustain an injury compared to the control group.
So what does this mean?
First, this is great news. What we have assumed for a long time is showing to be true: consistent strength training likely helps improve tissue resilience to handle the demands of running and can significantly decrease the risk of running-related injury (remember, 85% decrease in injury risk!!).
However, to achieve these benefits, you must be consistent and compliant with the program. And this may be the bigger issue. Sure, those who were able to be compliant with the program found these benefits, but that was only 28.5% of people within the intervention group. This means that 163 runners in the intervention group were given the key to an 85% injury reduction risk, but they weren't able to turn the key and walk through the door. As runners, we must consider how to set up ourselves for sustainable performance of a strengthening routine, because even a good effort where we miss more than 2 sessions per month may take you out of the category of runners who can reduce injury with a program like this one.
I also think it is important to consider the training habits of the runners included in this study. On average, the runners in both groups ran ~20.5km (12.7 miles) per week, with the highest average mileage being 32.9km (20.4 miles) per week. They did not report whether any of the runners were training for a specific event or changing their running distance or intensity throughout the 18 weeks. Therefore, this program may be appropriate for recreational runners trying to maintain consistent running without training for a new race or working on improving running economy or performance. However, we do not know if this program would work for someone going through a marathon training block or someone with a significantly higher weekly running volume.
Regardless, the results of this study are very encouraging to runners who want to implement strengthening to help decrease the incidence of injury and to achieve their goal of remaining healthy. From this study, it seems that a consistent routine of two times per week that targets the major muscle groups addressed in this study is a great place to start on your journey toward injury-free running. The trick is making sure that you find a way to stay motivated and consistent month to month. Get those bands and weights out!
References
Desai, P., Jungmalm, J., Börjesson, M., Karlsson, J., & Grau, S. (2023). Effectiveness of an 18‐week general strength and foam‐rolling intervention on running‐related injuries in recreational runners. Scandinavian Journal of Medicine & Science in Sports, 33(5), 766-775.
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