{"id":26053,"date":"2025-09-22T12:00:43","date_gmt":"2025-09-22T10:00:43","guid":{"rendered":"https:\/\/www.physiotutors.com\/?post_type=research&p=26053"},"modified":"2025-10-06T19:23:50","modified_gmt":"2025-10-06T17:23:50","slug":"running-injury-prevention","status":"publish","type":"research","link":"https:\/\/www.physiotutors.com\/research\/running-injury-prevention\/","title":{"rendered":"Running Injury Prevention: How Training Load and Single-Session Spikes Impact Injury Risk"},"featured_media":26063,"template":"","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":""},"featured-tag":[],"tracking_tag":[2204,2199],"class_list":["post-26053","research","type-research","status-publish","has-post-thumbnail","hentry","tracking_tag-exercise","tracking_tag-sports-rtp"],"acf":{"free_access":"unfree","app_link":"https:\/\/app.physiotutors.com\/research-reviews\/running-injury-prevention","sections":[{"acf_fc_layout":"page-header-small","background":{"background_image":26054,"background_image_alt_text":""},"heading":"Running Injury Prevention: How Training Load and Single-Session Spikes Impact Injury Risk","subheading":"Schuster Brandt Frandsen et al., (2025)","benefits":[{"benefit":"This longitudinal exploratory study examined session-to-session increases in running distance and their impact on injury incidence in long-distance runners."},{"benefit":"It found that increases of more than 10% from one session to the next significantly raised the risk of overuse injuries."},{"benefit":"These results suggest that session-to-session monitoring may be more reliable for developing effective running injury prevention strategies than the traditionally used ACWR."}]},{"acf_fc_layout":"content","background_color":"none","content_alignment":"left","content_editor":"

Introduction<\/h2>\r\nRunning remains one of the most accessible and widely practiced forms of physical activity worldwide. Despite advances in monitoring technology, including the widespread use of GPS wearables to track training load, the incidence of running-related injuries has not declined. Injury continues to be the primary factor leading individuals to discontinue running, underlining the importance of understanding the mechanisms underlying these conditions.<\/span>\r\n\r\nTraditionally, training load has been assessed within a weekly framework, most commonly using the Acute:Chronic Workload Ratio (ACWR), which is calculated by comparing the training load from the most recent week with the average weekly load from the preceding month. Traditional workload models may not capture the most effective<\/span> running injury prevention strategies<\/span> assuming that excessive increases in load across one week predispose athletes to overuse injuries. However, emerging evidence suggests that the period of vulnerability in running may be considerably shorter. Specifically, abrupt increases in running distance within a single session appear to play a critical role in injury development.<\/span>\r\n\r\nThis explorative study introduces a potential paradigm shift: moving from a weekly to a single-session model for understanding training load and injury risk in runners. Such a framework may provide physiotherapists with more precise tools for <\/span>running injury prevention <\/span>guiding load management and rehabilitation in clinical practice.\u00a0<\/span>\r\n

Methods\u00a0<\/span><\/h2>\r\nThis longitudinal exploratory study used data from the Garmin-RUNSAFE Running Health study with an 18-month follow-up period (July 2019 to January 2021). Enrollment took place between July and December 2019. The study was reported in accordance with the STROBE guidelines for observational studies, and the statistical analysis, interpretation, and reporting were verified using the CHAMP checklist.<\/span>\r\n\r\nRunners were recruited through Garmin newsletters, European running clubs, and magazines. Those who consented and completed enrollment questionnaires were considered for inclusion.<\/span>\r\n\r\nInclusion criteria:<\/b>\r\n
    \r\n \t
  1. Use of a Garmin GPS device with data uploaded via the Garmin Connect app.<\/span><\/li>\r\n \t
  2. Willingness to complete weekly questionnaires on injury status and anatomical location.<\/span><\/li>\r\n<\/ol>\r\nExclusion criteria:<\/b>\r\n
      \r\n \t
    1. Presence of a musculoskeletal problem at baseline.<\/span><\/li>\r\n \t
    2. Failure to complete baseline or weekly questionnaires.<\/span><\/li>\r\n \t
    3. No recorded running activity.<\/span><\/li>\r\n \t
    4. Reporting an injury during follow-up without specifying whether it was traumatic or repetitive in origin.<\/span><\/li>\r\n \t
    5. More than 10 days between a self-reported injury and the last recorded running session.<\/span><\/li>\r\n \t
    6. Only performing running sessions below or above the predefined distances (inferior to 500m or superior to 100km).<\/span><\/li>\r\n<\/ol>\r\n[caption id=\"attachment_26055\" align=\"alignnone\" width=\"411\"]\"running From: Schuster Brandt Frandsen J et al., Br J Sports Med (2025)[\/caption]\r\n\r\nProcedure\u00a0<\/strong>\r\n\r\nBaseline questionnaires collected demographic data (age, sex, height, weight), running experience, and history of previous injuries. Weekly questionnaires captured injury status and anatomical location of problems. Running activity data, including distance per session, was automatically recorded using Garmin GPS-enabled devices and transferred via the Garmin Connect app. Through an API-based system (Health API), these data were securely transmitted to Aarhus University servers and the RUNSAFE research group.<\/span>\r\n\r\nExposure<\/b>\r\n\r\nThe study measured exposure primarily as the ratio between the distance of a given running session and the longest session completed in the preceding 30 days. This ratio reflected how much a runner exceeded or fell short of their previous maximum. For example, running 12 km after a prior maximum of 8 km equalled a ratio of 1.5 (a 50% increase).<\/span>\r\n\r\nTo better capture injury risk, relative changes were classified as follows:<\/span>\r\n
        \r\n \t
      1. Regression or \u226410% increase<\/b> (reference)<\/span><\/li>\r\n \t
      2. Small spike<\/b> (>10\u201330% increase)<\/span><\/li>\r\n \t
      3. Moderate spike<\/b> (>30\u2013100% increase<\/span><\/li>\r\n \t
      4. Large spike<\/b> (>100% increase, i.e., doubling distance)<\/span><\/li>\r\n \t
      5. Not possible (NP)<\/b> \u2013 if no prior reference session existed<\/span><\/li>\r\n<\/ol>\r\nIn addition to single-session changes, traditional workload measures were also calculated:<\/span>\r\n