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Hi, it is Tom here from Running Physio. Today I want to talk to you about the topic of strength training and whether it might reduce the risk of running injury. We know there's lots of benefits for runners from strength training. There's evidence from systematic reviews that strength training can improve running economy to make us more efficient as runners, and as a result, improve performance as well, which is potentially a win-win for runners.

There's also research in other areas, other sports suggesting that strength training might reduce injury risk, but the evidence in running so far has not been particularly good quality and hasn't tended to show that strength training reduces risk of injury.

However, we have a new paper that's just been published by Desai et al that I wanted to dive into for you, and I've included the link to that. The authors very kindly made that open access, so I would check that out to find out more information about the study. And also in this video, I'm gonna talk at the end about a really simple program you could use with runners to help them build strength in a small amount of time. I've also put a link to our running resource page in the title where you'll find videos on shin pain and iliotibial band syndrome all free that you can check out.

So, let's talk about this study from Desai et al just published in 2023. They took a large group of runners, about 433 altogether, and then they divided them into an intervention group and a control group.

The intervention group did both strength training and foam rolling. And they did that twice a week for 18 weeks, and the control group continued with their normal training. Let's have a look at what this strength training actually involved then. Now this didn't take too long. It was roughly 19 minutes, twice a week. And it included a number of exercises designed to strengthen some of the key muscles involved in running. So, we've got single leg squats and lunges, which are gonna strengthen particularly the quads, side-steps with resistance band which is gonna work the glutes, supine abduction, also with resistance band for the glutes.

That one, when you look into the information on studies is essentially lying on your back with the knees bent and the feet on the bed and pushing their knees apart against band. They also included side plank, which we know is pretty good for working glute med, diagonal lifts, also known as bird dog, which is a kind of four-point kneeling and foot supination with resistance band.

If you want to check out the actual exercises, have a look at the study and its supplementary materials. Got pictures of those.

That was their strength training intervention, and I chatted to the authors of the study, they've been very helpful actually. It was a simple program and it wasn't progressed over the 18 weeks from what they told me.

So, simple selection of exercises there, and they combine that with foam rolling. Now, this took a little bit less time, about 11 minutes, again, twice a week, rolling the hamstrings and the quads, the glutes and abductors, the plantar fascia and foot, the calf and shin muscles. All together, this intervention took around about half an hour to do twice a week.

So, relatively small program. Now, we come to the results. The results are quite interesting. The main comparison between the control group and the intervention group, they did not find a significant difference in injuries. And this is what we've seen in previous studies, although previous studies have had some limitations to be totally honest. However, when they drilled down into the results a little bit further, they looked at the compliance and they looked to see if those people that were diligent with the exercises actually did them, they got different results. Let's have a look at the results then.

Recreational runners who were highly compliant with the intervention were 85% less likely to develop a running injury and took an average of 57 days longer to sustain a running injury compared with control. So, it does seem, perhaps not surprisingly, if you actually do the exercises, they might reduce your risk of running injury.

We don't know, though, whether these have worked by building strength because strength wasn't measured and studied in this trial from what I can find out. So, we don't actually know why this group that actually did the exercises had reduced running injury risk. There may be other factors in there. What we do know though, is that the compliance with it wasn't particularly great.

This highly compliant group were less than 30% of the total people. 28.5% of them were highly compliant. Out of the 36 exercise sessions, so 18 twice a week, they will have done at least 32. So, they've done pretty well there. However, nearly 44% had low compliance and actually completed less than half of the recommended training sessions.

And this is one of the big problems that we find when we are testing any intervention that requires the patient to be really diligent with it, particularly around strength training, is that when you look at the results, if a large proportion of the people in the intervention group haven't actually done what they were asked to do, in this case, nearly half have done less than half of the actual training, it's not that surprising that when you compare the two groups, the control group and the intervention group, you don't see a significant difference. So, it does seem, in this study, it's suggesting that if you do the exercises, you may get the benefits in terms of reduced running injury risk.

And the author say it's a relatively straightforward program done twice a week. Although over an 18-week period, I would wonder if that might influence the compliance with it as well.

Now, being devil's advocate here, we could have changed the title for this and ask, “Does foam rolling reduce running injury risk?”; because we don't necessarily know. Is it the strength training here or the foam rolling that's had an effect? Is it both together? We don't really know that necessarily. There's question marks around it and we would need further study to actually back this up, but we are starting to see one or two bits of research coming out.

There's some evidence around foot training that was able to reduce running injury risk. So, we are seeing one or two studies showing that perhaps some strength training might not only improve running economy and performance, but it does have the potential to reduce running injury risk. Although as ever we do need more high-quality research to look into this.

Now, I said I would talk through a potential program that you could try with runners. With this program that they've used in the study takes about half an hour. They've got a selection of a number of different things for people to do. There is some evidence that training for as little as 13 minutes, three times a week can improve strength and endurance.

So, I would wonder, perhaps if we would get better compliance with the exercises if we were to go with a shorter program and better results if that program was progressed in terms of weight, which I don't believe this one was.

An alternative might be that you work with a runner, you identify where they're perhaps weaker and particularly we're interested in those big muscles that manage big loads in running like the calf, quads, glutes, and hamstring. And maybe you put together a little circuit of three exercises that are loaded up so they're challenging. And that can often be done in as little as 15 minutes. Let's say for example, you wanted to target the hamstrings, the quads, and the calf. You might get the person to start with a single leg deadlift in the circuit, perhaps loaded up, so they're finding around about 8 to 12 reps challenging. Then, next in the circuit, go onto squats again, loaded, so it's challenging for them to work the quads and then go on to calf raises again with loads, so it's challenging for them to do it.

Then come back to the start of the circuit for those dead lifts again, and work through that circuit maybe three times. Now, if it's loaded up enough, you're likely to get strength change, and it's not gonna take much more than about 15 minutes, two or three times a week. Now, we have this word, “compliance” coming out. It's not my favorite word when it comes to exercises and doing exercises. It suggests that the person's gotta do as they're told. That's not really what this is about. Ideally, we very much involve the person in the exercise selection, in problem solving to help it get done. We can see in the study, less than 30% of people have actually followed the program through.

We want to try and work with each individual and identify on that individual basis. What are the barriers for you getting this exercise program done? What's gonna get in the way? What are the things that are gonna help you? Personally, I think that simple stuff like time of day makes a difference.

Once I get to the end of my day and the little ones in bed and all the jobs are done around the house, I find I want to relax then. The idea that going then to do more exercises and things at that time of day won't work. So, for me, I'd want it earlier on in the day, get it done, and then move on with the rest of the day.

You've gotta think about the kit that people have as well, using things that they've got easy access to at home will work well because they don't have that extra time of getting to a gym or going somewhere else for it. So, it's about problem solving a little bit, working with the person.

It's not about them being compliant, it's about them being involved and motivated to do those exercises because they've chosen them, because they know they're gonna be beneficial. And then highlighting those benefits.

This can actually help you to run faster. It may reduce your running injury risk. Strength training's got a whole host of different benefits, so that might help get people on board and sticking with the program.

Interesting research. Do check out that study. They've made it open access. Look at the supplementary material as well if you want to find a bit more about the exercises and the foam rolling and things involved there. Let me know if you've got any comments or questions about the study and what you think.

Do you think strength training is gonna reduce running injury risk? Might there be some downsides? We do often have to weigh up the fatiguing effects of strength work, so perhaps it might not be ideal for those people when they're reaching their peak mileage to be trying to squeeze in two or three strength sessions a week as well.

So, we do need to bear that in mind. Let me know your thoughts, and I'll look forward to speaking to you again very soon. Thanks for listening. Bye for now.