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Hip and core exercise programme prevents running-related overuse injuries in adult novice recreational runners: a three-arm randomised controlled trial (Run RCT)

PainSci » bibliography » Leppänen et al 2024
updated
Tags: prevention, running, IT band pain, good news, counter-intuitive, plantar fasciitis, exercise, self-treatment, treatment, knee, leg, limbs, pain problems, overuse injury, injury, tendinosis, foot

Two pages on PainSci cite Leppänen 2024: 1. Does Hip Strengthening Work for IT Band Syndrome? 2. STUDY: Hip and core strength can prevent running injuries 

PainSci notes on Leppänen 2024:

Leppänen et al. studied 245 novice runners in Finland for several months in 2021 and 2022, doing twice weekly group runs and training sessions, from May to October each year. The science sorting hat was used to put them into three test groups:

  1. Hip and core exercise.
  2. Ankle and foot exercise.
  3. Static stretching for a control. (Because it’s considered useless for prevention, LOL.)

Training sessions were led by physiotherapists and consisted of “common physiotherapy exercises,” bog standard stuff, nothing fancy, but certainly a decent general workout for the hips and core (details). Participants did an extra weekly session or two on their own, tracked by a gadget, and filled out weekly surveys. Everyone did general warm-ups before runs, plus their specific program.

The researchers tallied up every kind of lower extremity injury that happened, and also filed them into categories like overuse (runner’s knee), acute (ankle sprains), and severe (losing more than week of running).

The risk of any kind of injury was reduced by about a third in the hip and core group compared to the stretchers. Results were a little better for overuse injuries, and better still for more severe injuries.

(The foot group was identical to the control group for overuse injuries, but had a crazy 3.6× higher rate of acute injuries. We could have a whole conversation just about that! What the hell, foot folks?!)

The most important finding of our study was a 39% lower prevalence of all injuries and 52% lower prevalence of substantial overuse injuries in novice runners performing hip and core-focused programme compared with group performing static stretching before running.

Mic drop? If this result is right, it seriously challenges my own bias against the value of “core strength.” But there are a lot more details, and they are good details. I’ve read the whole thing carefully and suspiciously, and no problems jumped out at me. I could “nitpick,” and there are acknowledged limitations — there always are — but basically this seems like a solid experiment. The authors acknowledge that “the evidence is still very limited” for exercise-based injury prevention in novice runners. And that is clearly what they are trying to fix. One of the authors, Dr. Benno Nigg, is a particularly trusted source for me. I cannot easily dismiss this result.

But here are some reasons for a little skepticism …

  1. Just one study! Even a perfect trial can give us the wrong answer by fluke alone. It could be an outlier, and it’s easy to imagine it looking that way next to future experiments.
  2. A 50% drop in run-stopping injuries is good but not great from every perspective. Some people won’t think it’s worth adding a lot of exercise to their exercise. “You mean I have to run and do a lot of leg lifts and crunches… to make it somewhat safer?”
  3. Just because core/hip strength did quite well here doesn’t endorse them for other goals, like preventing or treating back pain.

Nevertheless, if this is replicated, I will eat my humble pie. Nom nom nom. I pinkie swear.

original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

OBJECTIVE: This study aims to investigate the efficacy of two exercise interventions in reducing lower extremity (LE) injuries in novice recreational runners.

METHODS: Novice runners (245 female, 80 male) were randomised into hip and core (n=108), ankle and foot (n=111) or control (n=106) groups. Interventions were completed before running and included exercise programmes focusing on either (1) hip and core or (2) ankle and foot muscles. The control group performed static stretching exercises. All groups were supervised by a physiotherapist and performed the same running programme. Injuries and running exposure were registered using weekly questionnaires during the 24-week study. Primary outcome was running-related LE injury.

RESULTS: The incidence of LE injuries was lower in the hip and core group compared with the control group (HR 0.66; 95% CI 0.45 to 0.97). The average weekly prevalence of overuse injuries was 39% lower (prevalence rate ratio, PRR 0.61, 95% CI 0.39 to 0.96), and the prevalence of substantial overuse injuries was 52% lower (PRR 0.48, 95% CI 0.27 to 0.90) in the hip and core group compared with the control group. No significant difference was observed between the ankle and foot group and control group in the prevalence of overuse injuries. A higher incidence of acute injuries was observed in the ankle and foot group compared with the control group (HR 3.60, 95% CI 1.20 to 10.86).

CONCLUSION: A physiotherapist-guided hip and core-focused exercise programme was effective in preventing LE injuries in novice recreational runners. The ankle and foot programme did not reduce LE injuries and did not protect against acute LE injuries when compared with static stretching.

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