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Does "too much too soon" really cause injury?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by NewsBot, Dec 31, 2007.

  1. NewsBot

    NewsBot The Admin that posts the news.


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    No Effect of a Graded Training Program on the Number of Running-Related Injuries in Novice Runners
    A Randomized Controlled Trial

    Ida Buist, Steef W. Bredeweg, Willem van Mechelen, Koen A. P. M. Lemmink, Gert-Jan Pepping and Ron L. Diercks
    The American Journal of Sports Medicine 36:33-39 (2008)
  2. I don't understand. How do you successfully compare injury rates between two training types when one is 8 weeks long and another is 13 weeks long? In addition, what is a "standard training program"? Does that mean you have the participants in the study run 21 miles one day a week or have them run 3 miles, 7 days a week??
  3. Steve_Pribut

    Steve_Pribut Member


    You are correct, there is no good way to compare an 8 week vs. 13 group running program. This is another poorly conceived and executed study. This one though conforms to criteria which gives it the highest ranking within Evidence Based Medicine standards, an inexplicable paradox.

    The authors were apparently stunned to learn that if you ran for more than a 50% longer time period than those you were being measured against, you might risk more injury.

    The details:

    Both studies had a gradual build up, not a random number of minutes run per week. The entire program was not spelled out but included both a 5 minute walking warm up, 3 days per week of running, and some walking added in. The 10% increase group ran for 13 weeks, while the standard group ran only for 8 weeks. The culmination was a 4 mile race/run.

    There were differences in the groups. The Gradual Increase group had a small but significantly higher BMI. An attenmpt to lessen the risk of BMI in the different groups was attempted using "Cox proportional hazards regression analysis". The standard group had significantly more drop outs that were not included in the study. No data was recorded or available for them. The number of failures to be included was literally more than twice as high in the "standard group": 11.9% vs. 5.3 or 32:14. If those drop outs were included as "injured" the results would have been radically different. The runners in the standard group included a higher number of experienced runners 55% vs. 50% in addition to being lighter, they were also more likely to be fit.

    Another attempt to make up for the differences in the number of weeks run was the use of "survival curves" or Kaplan-Meier Curves. The survival time of those in the gradual training group was 212 vs. 167 in the standard group. This was not deemed statistially significant.

    When the authors discovered that their "hypothesis" was not panning out they did further evaluation and noted the obvious. Those in the gradual increase running in running group had a lower RRI/1000 hours of running. It did not reach statistical significance with these study numbers however although it seemed to be about one injury away from statistical significance. The authors noted that their study was much too small to measure this very important and even superior parameter.

    During the 4 weeks in which the gradual program continued to run and the standard did not, there were 13 injuries in the gradual group. During the initial 8 weeks of each groups training there were 48 Injuries in the Standard group vs. 41 in the Gradual.

    Also note that the "standard group" had one drop back in distance, while the gradual group did not and invariably increased their time and distance each week.

    It is unfortunate that this study did not have a large enough sample size to measure RRI/1000 hours run, but at least the authors note that. Other authors will take less a small sample size and want a tidal change in the treatment of a condidition such as Achilles tendinopathy and come up with a protocol for treatment that through at least 4 stubborn iterations you are encouraged to continue a painful eccentric exercise program in spite of abject failure.


    Stephen Pribut, DPM
    Clinical Assistant Professor of Surgery
    George Washington University School of Medicine

    Private Practice:
    Suite 702
    2141 K Street, NW
    Washington, DC 20037


    email: dr.pribut@gmail.com

  4. Steve:

    Good to see you joining along on Podiatry Arena. Your comments will always be welcome and appreciated on this podiatric academic forum.

    I agree with your analysis of this study. I am surprised it was published, from what I read of the paper. In addition to your analysis, the runners only ran 3 days a week, which would tend to diminish the injury frequency compared to 5-7 days per week of training. I think that this type of study should be done, but the next time with a little more care in making certain that the study is set up to allow more useful comparison of one training protocol versus another.

    Hope all is well and Happy 2008!
  5. Steve_Pribut

    Steve_Pribut Member

    Thanks, Kevin.

    I look forward to reading & learning.

    There are many good and thoughtful people here!

    Happy holidays to all!

  6. admin

    admin Administrator Staff Member

    The full protocol of the methodology of this study has been published on BiomedCentral
  7. NewsBot

    NewsBot The Admin that posts the news.

    A description of training characteristics and its association with previous musculoskeletal injuries in recreational runners: a cross-sectional study.
    Hespanhol Junior LC, Costa LO, Carvalho AC, Lopes AD.
    Rev Bras Fisioter. 2012 Feb;16(1):46-53.
  8. NewsBot

    NewsBot The Admin that posts the news.

    Excessive Progression in Weekly Running Distance and Risk of Running-related Injuries: An Association Modified by Type of Injury
    Authors: Rasmus Oestergaard Nielsen, PT, MHSc, Erik Thorlund Parner, PhD, Ellen Aagaard Nohr, PhD, Henrik Sørensen, PhD, Martin Lind, PhD, Sten Rasmussen, MD
    J Orthop Sports Phys Ther, Epub 25 August 2014. doi:10.2519/jospt.2014.5164

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