Hip and core exercise programme prevents running-related overuse injuries in adult novice runners

Key points

1. 01Hip and core training cut overall lower extremity injury incidence by 34% (HR 0.66, 95% CI 0.45-0.97) versus static stretching
2. 02Overuse injury prevalence was 39% lower (PRR 0.61) and substantial overuse injury prevalence was 52% lower (PRR 0.48) in the hip and core group
3. 03The ankle and foot programme did not reduce overuse injuries and was associated with a 3.6-fold higher acute injury incidence versus controls (HR 3.60, 95% CI 1.20-10.86)
4. 04Programme was low-cost, required minimal equipment, and was completed in 20-35 minutes before each run session
5. 05Efficacy was tested under ideal conditions with physiotherapist supervision; real-world effectiveness without supervision is not yet established

How it was conducted

Design

Three-arm randomised controlled trial over 24 weeks (2021-2022), Tampere, Finland

Participants

325 adult novice recreational runners (mean age ~40 years, ~75% female) who started the intervention phase

Groups

Hip and Core (n=108) vs Ankle and Foot (n=111) vs control - static stretching (n=106)

Intervention

Eight exercises performed before each run session, supervised by physiotherapists, 2 sessions per week; 24-week programme

Primary outcome

Running-related all-complaint lower extremity injury (all-complaint definition, not requiring time-loss)

Injury registration

Weekly OSTRC-H2 health surveys with phone interview follow-up for all reported injuries

What they found

• Hip and Core group: 75 LE injuries (17.2 per 1,000 h, 95% CI 13.6-21.4); control group: 94 injuries (24.8 per 1,000 h, 95% CI 20.2-30.3); HR 0.66 (95% CI 0.45-0.97, P=0.034)
• Ankle and Foot group: 114 LE injuries (26.6 per 1,000 h, 95% CI 22.0-31.8) vs control; HR 1.06 (95% CI 0.74-1.50, P=0.759) - no significant difference
• Average weekly prevalence of overuse injuries: Hip and Core 9.2%, Ankle and Foot 12.0%, control 15.5%; PRR Hip and Core vs control 0.61 (95% CI 0.39-0.96, P=0.032)
• Average weekly prevalence of substantial overuse injuries: Hip and Core 3.3%, Ankle and Foot 5.0%, control 7.7%; PRR Hip and Core vs control 0.48 (95% CI 0.27-0.90, P=0.021)
• Ankle and Foot group: acute LE injury incidence 5.37 per 1,000 h vs control 1.06 per 1,000 h; HR 3.60 (95% CI 1.20-10.86, P=0.023)
• Acute time-loss LE injury incidence in Ankle and Foot group: HR 6.10 vs control (95% CI 1.38-27.07, P=0.017)
• Hip and Core group showed lower overuse injuries at thigh (PRR 0.21, 95% CI 0.05-0.92, P=0.039) and foot (PRR 0.31, 95% CI 0.11-0.83, P=0.020)
• Time-loss injury incidence: HR 0.65 (95% CI 0.42-0.99, P=0.044) in favour of Hip and Core vs control
• Average weekly adherence: Hip and Core 89%, Ankle and Foot 88%, control 87%

Limitations

• Blinding of participants and physiotherapists was not possible given the nature of the interventions
• Study tested efficacy under ideal supervised conditions and real-world effectiveness without physiotherapist guidance is unknown
• Sample was predominantly female (75%); sex-stratified results were not possible due to low male numbers, limiting generalisability
• Secondary analyses on acute injuries and specific body parts were likely underpowered and should be considered preliminary

Why it matters

For patients

Novice runners who add a short hip and core strengthening routine before each run are significantly less likely to develop overuse injuries over a 6-month running programme.

For clinicians

Prescribing a supervised hip and core programme as a warm-up for novice runners is supported by this RCT; an ankle and foot-only programme is not recommended before speed work and may increase acute muscle injury risk.

For readers

This is the first RCT comparing top-down (hip and core) and bottom-up (ankle and foot) injury prevention approaches in novice runners, providing clear directional evidence for programme design.