The Science of Injury Prevention


with Dr. Reed Ferber, Ph.D. CAT(C)

I’m always happy to see injury prevention research being published, and I thought I’d synthesize some of the more recent findings into practical tips for you.

A recent systematic review and meta-analysis was performed to figure out the best injury prevention strategies. Twenty-five different research studies were selected, which  resulted in the analysis of 26,610 athletes who sustained 3464 injuries. A surprising discovery in the data was that stretching did not show any protective effect, regardless of whether the stretching was performed before or after exercise. On the other hand, strength training was protective and reduced sports injuries by about one-third. These authors went further and suggested that overuse injuries, such as those experienced by runners, could be reduced by almost half if a regular strength training program was combined with some type of cross-training.

Victor Freitas / Unsplash

In another study, a research group in Luxembourg examined if rotating one’s running shoes could decrease injury risk. This was a 22-week study where they followed 264 recreational runners. Overall, 33% of the runners sustained an injury, which is what you would expect based on past research.
Interestingly, they found that they had two sub-groups of runners with respect to the number of shoes they used: 116 runners ran 91% of their mileage in same shoe and overall had an average of 1.3 pairs during the 22-week training program. The other group consisted of 148 runners who ran 58% of their mileage in the same shoe but had an average of 3.6 pairs and rotated through these shoes each week. This second group of multi-shoe runners actually had a 39% lower risk of injury as compared to those who had only 1.3 pairs of shoes over the course of training. So, the take-home message here is that
rotating multiple pairs of shoes can help to reduce your injury risk.

These authors also reported that cross-training resulted in a 25% reduced risk of injury. In other words, runners who spend more time in other sports, but still maintain their weekly mileage over fewer running days, will have a decreased risk of injuries. This finding is consistent with the first systematic review and meta-analysis study I discussed and strongly suggests that you should make cross-training—especially strength training—part of your weekly workout schedule.

The examples described above demonstrate that rotating shoes and participating in cross-training activities are strategies that can lead to increased variability in the loads being applied to your body. I’ll discuss this concept more in my next article and discuss some of our variability research.

Finally, several studies have been published recently that all point to the fact that if you have recently recovered from a previous running-related injury, the risk of sustaining another injury increases by 72%. As such, it is critical that the root cause of the injury be determined, especially if treatment has focused simply on reducing the pain. We know from our research that determining the root cause of an injury is a very complex problem, but the evidence shows that having multiple pairs of shoes, improving muscular strength and engaging in cross- training activities are important aspects of an injury prevention program.



Dr. Reed Ferber is the director of the Running Injury Clinic, a world leader in running-related research and 3D gait analysis technology. For more information, visit

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