Interventions for preventing lower limb soft-tissue injuries in runners

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Abstract
Overuse musculoskeletal injuries occur frequently in runners. Suggestions for prevention have focused on stretching exercises, modifying training schedules and the use of protective devices such as braces and insoles. To date, no systematic analysis of the literature on the effectiveness of these strategies in the prevention of overuse injuries has been published. The objective of the review was to evaluate the evidence from randomised controlled trials on the prevention of lower limb soft-tissue running injuries. An electronic database search included The Cochrane Musculoskeletal Injuries Group specialised register (date of last search October 2000), The Cochrane Controlled Trials Register (The Cochrane Library, Issue 3, 1999), MEDLINE (from 1966), EMBASE (from 1980), SPORT Discus (1975-2000), HERACLES (1975-2000), ATLANTES (1980-1996), BIOSIS, CINAHL, SCISEARCH, Current Contents, Index To Theses and Dissertation Abstracts. Date of last search for these databses: May 2000. Any randomised or quasi-randomised trials evaluating interventions to prevent lower limb soft-tissue running injuries. All trials fulfilling the selection criteria were assessed by two reviewers independently. Data were also extracted independently by the two reviewers using a pre-derived data extraction form. Exploratory analyses, including pooling of results from groups of trials of similar designs were undertaken, using a fixed effects model. Results were reported as relative risks (RR) with 95 per cent confidence intervals (95% CI). Twelve trials with 8,806 participants were included. In one trial, a single control group was matched to three different included intervention groups. The effectiveness of stretching exercises (5 trials, 1944 participants in the intervention groups, 3159 controls), and of insoles and footwear modification (5 trials, 903 participants in the intervention groups, 3006 controls) in the prevention of lower extremity soft tissue injuries associated with running is unknown. Reducing the distance, frequency and duration of running may be effective in the prevention of lower extremity soft tissue injuries associated with running (3 trials, 514 participants in intervention groups, 1663 controls). Wearing a knee brace with a patellar support ring may be effective in the prevention of running-associated anterior knee pain (1 trial, 27 participants in the intervention group, 33 controls). This review provides some evidence for the effectiveness of the modification of training schedules, but there is insufficient evidence to determine the effectiveness of stretching exercises for major lower limb muscle groups in reducing lower limb soft-tissue running injuries. More studies are required to confirm that knee braces may prevent knee pain, to clarify the role of stretching, and to quantify optimal training loads. Generalisability of the results may be limited by the intensive nature of military training (the context for most of the studies) and the inclusion of only small numbers of women.