Foot Core Training to Prevent Running-Related Injuries: A Survival Analysis of a Single-Blind, Randomized Controlled Trial

Abstract

Background: Running-related injuries (RRIs) are a pervasive menace that can interrupt or end the participation of recreational runners in this healthy physical activity. To date, no satisfactory treatment has been developed to prevent RRIs. Purpose: To investigate the efficacy of a novel foot core strengthening protocol based on a ground-up approach to reduce the incidence of RRIs in recreational long-distance runners over the course of a 1-year follow-up. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: The participants, 118 runners, were assessed at baseline and randomly allocated to either an intervention group (n = 57) or a control group (n = 61). The intervention group received an 8-week training course focused on the foot-ankle muscles, followed by remotely supervised training thereafter. Assessments consisted of 3 separate biomechanical evaluations of foot strength and foot posture and a weekly report on each participant’s running distance, pace, and injury incidence over 12 months. Results: The control group participants were 2.42 times (95% CI, 1.98-3.62) more likely to experience an RRI within the 12-month study period than participants in the intervention group ( P = .035). Time to injury was significantly correlated with Foot Posture Index ( P = .031; r = 0.41) and foot strength gain ( P = .044; r = 0.45) scores. This foot exercise program showed evidence of effective RRI risk reduction in recreational runners at 4 to 8 months of training. Conclusion: Recreational runners randomized to the new foot core strengthening protocol had a 2.42-fold lower rate of RRIs compared with the control group. Further studies are recommended to better understand the underlying biomechanical mechanisms of injury, types of injuries, and subgroups of runners who might benefit maximally. Registration: NCT02306148 (ClinicalTrials.gov identifier).

Subgroups of Foot-Ankle Movement Patterns Can Influence the Responsiveness to a Foot-Core Exercise Program: A Hierarchical Cluster Analysis

“…For example, lower limb kinematics during locomotor tasks have been shown to be related to the responsiveness to exercise-based treatment in individuals with knee osteoarthritis ( Kobsar et al, 2015 ) and patellofemoral pain ( Watari et al, 2016 ). Seeing that the intervention protocol in this study was effective in reducing the incidence of running-related injuries ( Taddei et al, 2020a ), the results of this study can help understanding how individual variations of baseline motor behaviors can influence the response to these exercises and this approach can help guiding treatment strategies that are more individual-centered, taking into account their initial mechanical patterns. Future studies should investigate whether the identified movement patterns could be influencing the protective effects against running-related injuries that this exercise program has presented, by stratifying the experimental groups based on kinematic patterns.…”

“…Moreover, during running, wherein the motor behavior is more dynamic, the function of the FA is even more important, with evidence of its influence on running-related injury prevention. Taddei et al (2020a) showed that a foot-core exercise intervention program in middle and long-distance recreational runners resulted in 2.4 times lower injury incidence when compared to a control group in a 12 months period.…”

Neuromuscular training and sport injury prevention in different types of sports—What we know and what we do not know?

“…Another recently published RCT revealed that a novel foot-core muscle strengthening program was effective in prevention of running-related injuries in recreational runners. 6 Runners randomized to the foot-core strengthening group had 2.4-fold lower rate of running-related injuries within one-year study period than runners in the control group. Nevertheless, there are still many unexplored areas in the field of sport injury prevention.…”

“…NMT and other sport injury prevention strategies can reduce the number of injuries, but only if they are properly used by athletes. Another recently published RCT revealed that a novel foot‐core muscle strengthening program was effective in prevention of running‐related injuries in recreational runners 6 . Runners randomized to the foot‐core strengthening group had 2.4‐fold lower rate of running‐related injuries within one‐year study period than runners in the control group.…”

Adolescent Running Biomechanics - Implications for Injury Prevention and Rehabilitation

“…Such studies have not been conducted in youth runners, so the effectiveness of these programs remains unknown. Among adult runners, prevention programs emphasizing general lower extremity strength training have not reduced injury incidence (Toresdahl et al, 2020), though a program focused on foot muscle strengthening led to a 2.4-fold lower injury rate (Taddei et al, 2020).…”