Cross Fertilising Injury Prevention (IP) and the British Journal of Sports Medicine (BJSM)

The British Journal of Sports Medicine (BJSM) Volume 48, Issue 5 includes several papers relating to joint stability and its relationship to musculoskeletal injury. Verrelst et al. show that hip and thorax joint stability, as measured by range of motion, can contribute to the development of tibial (shin) pain in female physical education students. Gehring et al. demonstrate that mechanical ankle instability is related to the mechanism behind ankle sprains in “close-to-injury” scenarios in a lab-based study.

But it is two papers that highlight the multidimensional nature of risk factors associated with running injuries that particularly caught my eye – especially for their discussions of footwear.

One paper (by Theisen et al.) involved a double-blind randomised controlled trial of 247 runners allocated to either wearing shows with either a soft or a hard midsole. Although, it has been argued previously that runners, especially those with pronated feet, should wear shoes with more stability around the midsole to prevent injuries, this study found no difference in running related injury risk in the two groups over 5 months. The study did find that runners with higher body mass index, a previous injury history and a higher mean running session intensity were more at risk of injury. In contrast, runners who had been a regular runner over the previous 12 months and those who participated in other sports were protected from injury risk.

So if the type of shoe makes no difference, do you even need to wear running shoes?

A review of barefoot running, including its association with injury risk, by Tam et al. , is timely given much popular media attention given to the supposed benefits of this form of running. Unfortunately, for the proponents of barefoot running, the authors conclude that not enough research has been undertaken to date to confirm whether barefoot running is an effective injury prevention strategy. Whilst they argue that there are some benefits to barefoot running, these are likely to be experienced only by runners who have acquired technique adaptations to allow them to run this way properly. For other runners, barefoot running might exacerbate other factors associated with running injury such as poor technique, kinetic and kinetic factors associated with the biomechanics of running, etc.

Taken together, these papers highlight, once again, that the cause of sports injuries – particularly those of a musculoskeletal and/or overuse nature, – is highly multifactorial. Injury prevention for sports such as running will require the development of new strategies that are holistic and consider the modification or control of several risk factors at once. Given this complexity, the implementation of individual preventive measures is unlikely to be beneficial if they are do not consider the broader set of causal mechanisms that could influence injury risk – whether they be internal to the runner (e.g. injury history or personal biomechanics) or external to them (such as environmental, training load factors).

Caroline Finch is an injury prevention researcher and Head of the Australian Centre for Research into Injury in Sport and its Prevention (ACRISP) within the Federation University Australia located in Ballarat, Victoria, Australia. She specialises in two areas: (1) sports injury surveillance and research methodologies and (2) implementation and dissemination science applications for sports injury prevention. She is the Senior Associate Editor for Implementation & Dissemination for the British Journal of Sports Medicine and the Statistical Editor for Injury Prevention; both journals are published by the BMJ Group. Caroline can be followed on Twitter @CarolineFinch.