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STUDY: Hip and core strength can prevent running injuries

 •  • by Paul Ingraham
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It’s amazing how little we know about preventing running injuries. Still.

As of 2024, the most recent scientific review of running injury prevention is thirteen years old. It was a garbage-in-garbage-out review of “very weak” trials … telling us little.

A new study by Leppänen et al. gives us a refreshing change, but it directly challenges one of my strongest biases: I don’t think hip strength is important for runners! (I think strength is important for runners, just not the hip/core particularly.) I won’t be changing my mind based on evidence from one study, no matter how cromulent it seems … but it does seem good. They begin by acknowledging 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.

And its conclusion is clear: Paul was wrong.

I hate it! I love it! Bring it on.

Photo of a male runner with shin splints, jogging away from the camera in a brightly sunlit empty garage.

How to prevent common running injuries has been one of the great mysteries of sports medicine — possibly now solved?

The study design: core vs. foot vs. stretch

I believe that the importance of core strength has been overstated for decades. Hip strength for runners is a closely related idea, based on even less evidence, and I have a whole article that heaps scorn on it. The burden of proof was always on fans of core/hip strengthening, it has never been met, and the whole line of thinking has major problems.

title Hip and core exercise programme prevents running-related overuse injuries in adult novice recreational runners: a three-arm randomised controlled trial (Run RCT)
journal British Journal of Sports Medicine
Volume 58, Number 13, Jun 2024, 722–732
authors Mari Leppänen, Janne Viiala, Piia Kaikkonen, Kari Tokola, Tommi Vasankari, Benno M Nigg, Tron Krosshaug, Penny Werthner, Jari Parkkari, and Kati Pasanen
links publisher • PubMedPainSci bibliography

To try to answer this question properly, 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).

Screenshot of the abstract for Leppanen et al. with several phrases highlighted, most notably “A physiotherapist-guided hip and core-focused exercise programme was effective.”

The startling results

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 study is right, then I have been wrong about this for many years.

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.

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.

PainSci Member Login » Submit your email to unlock member content. If you can’t remember/access your registration email, please contact me. ~ Paul Ingraham, PainSci Publisher