The dogma of running injuries: perceptions of adolescent and adult runners

Key points

1. 01This was an online survey of beliefs, not a study of what actually causes injuries.
2. 02Of all the factors teenage runners believed mattered, only a history of previous injury is moderately supported by current evidence.
3. 03Teenagers were more likely than adults to think more footwear cushioning and stretching protect against injury.
4. 04Teenagers were less likely than adults to think overtraining and being strong affect injury risk.
5. 05Teenagers more often answered I don't know, especially for biomechanics questions.

How it was conducted

Design

Cross-sectional study using an open online survey (Qualtrics), Oct 26 to Dec 10, 2021

Participants

302 adolescent runners (164 female, 138 male; age 16.0 +/- 1.4 y, range 12-19) and 357 adult runners (197 women, 160 men; age 40.7 +/- 11.8 y, range 20-77)

Measure

93-question 6-point Likert survey on whether training habits, footwear, biomechanics, strength, stretching, and nutrition change injury risk

Threshold

A factor was counted as perceived risk or protective if >=75% of adolescents said it increases or decreases risk

Analysis

Fisher exact test with false discovery rate adjustment, 95% CIs for the difference in proportions, and Cohen h effect sizes (medium and large counted as meaningful)

What they found

• Of 939 surveys initiated, 659 were completed (completion rate 70.2%).
• Top perceived risk factors among adolescents: poor bone health 93.1%, tight muscles 92.7%, hard landing 85.0%, low-calcium diet 83.5%, narrow steps 83.3%, previous injury 83.1%, hard surfaces 76.9%, footwear with >500 miles (800 km) 76.2%, eating fewer calories than burned 75.2%.
• Top perceived protective factors among adolescents: dynamic stretching before running 90.4%, static stretching after running 85.0%, strong legs 81.4%, off days 81.5%, strong core 79.2%, cross-training 77.2%, more cushioned footwear 76.5%.
• More adolescents than adults saw lifting heavy weights for few reps as a risk factor (difference 21.2%, 95% CI 12.6% to 29.7%, h = 0.48) and as protective only 31.2% less (difference -31.2%, 95% CI -38.6% to -24.1%, h = 0.64).
• Far fewer adolescents than adults saw running with long strides as a risk factor (difference -39.2%, 95% CI -46.3% to -32.1%, h = 0.82) and fewer saw low cadence as a risk factor (difference -25.5%, 95% CI -32.7% to -18.2%, h = 0.57).
• More adolescents than adults saw static stretching before running as protective (difference 33.0%, 95% CI 25.7% to 40.2%, h = 0.67) and more cushioned footwear as protective (difference 20.0%, 95% CI 12.9% to 26.9%, h = 0.43).
• 62.9% of adolescents perceived being overweight to increase injury risk, while 58.9% perceived being skinny to not influence risk.

Limitations

• This measured beliefs, not actual injury causes, so it cannot say which factors truly raise or lower risk.
• Adolescents often answered I don't know, and the authors could not tell if they misunderstood the question or genuinely did not know.
• It was a convenience sample recruited via email and social media with snowball sampling, with no view or participation rate and no removal of possible duplicate entries.
• Few studies have prospectively tested injury risk factors in adolescent runners, so it is unclear whether any of these perceptions are correct.

Why it matters

For patients

Common runner beliefs like more cushioning or pre-run stretching preventing injury are mostly unproven, so choose shoes for comfort and do not assume these habits protect you.

For clinicians

Injury-prevention education should be tailored separately for teen and adult runners, emphasizing footwear cushioning, running surfaces, and stretching myths for adolescents.

For readers

Many widely held 'rules' about avoiding running injuries are not backed by evidence, and the only factor here with moderate support is having a previous injury.