REF-1367 · Fredette et al., 2022 · Journal of Athletic Training · Paper · PubMed · Free full text

Does ramping up my running too fast cause injury?

Not shown: across 36 prospective studies of 23,047 runners, distance, intensity and recent increases did not consistently predict injury, and a 10% rule did not prevent it (A-).

Main caveat: Observational evidence. 33 of 36 studies are cohorts; associations only, with mostly self-reported or prescribed training (GPS-based data in 5 studies).
fairly strong evidenceMeasured on non-athletes to highly trained athletes

Fredette, Roy, Perreault, Dupuis, Napier and Esculier pooled the prospective evidence on how often runners are injured and whether injury follows training distance, duration, frequency or intensity, or recent changes in them. They included 36 studies (33 prospective cohorts, 3 randomised trials) with 23,047 runners.

Overall 6,043 runners (26.2%) had a running-related injury: 14.9% of novice, 26.1% of recreational and 62.6% of competitive runners, with follow-up from 1 to 60 months; the knee, foot and ankle, and lower leg were most often injured. For each training parameter the evidence conflicted.

For weekly distance, 8 studies suggested more distance meant more injuries, 4 that it protected, 7 found no link and 1 was mixed; similar splits held for duration, frequency and intensity.

On recent changes in training, 11 studies: five associated a recent increase in running distance with more injuries (two of them only as non-significant trends, P = .07 and P = .06), five found no association — including a randomised trial in which a 10% weekly progression had no preventive effect against faster progression (odds ratio 0.8, 95% CI 0.6-1.3) — and one study of 261 runners found more injuries with a 20-60% weekly increase only in the first 3 weeks, not later and not above 60%.

The authors conclude that current evidence does not consistently link running injuries with specific training parameters or recent changes in them, that the popular 10% rule is not justified, and that no specific recommendations on training parameters or progressions can be issued; they put the conflict down to inconsistent injury definitions, little objective load data and the many individual factors that were not measured.

Our reading: this is the base's second systematic review against "quick load rises cause running injuries" (with REF-565, which found very limited evidence in 4 studies), and so the con side of the contested injury link in PHYS-38. It does not show that load changes are safe; it shows that, measured as these studies measured them, they do not consistently predict injury.

Protocol

Design: systematic review registered in PROSPERO (CRD42018112913), reported to PRISMA 2009.
Search: MEDLINE/Ovid, CINAHL, Embase and SPORTDiscus from inception to 7 July 2020, with research librarians; reference lists hand-searched (9 additional articles).
Inclusion: English or French; humans running (novice, recreational, competitive or mixed, as defined by the authors of each study); any running programme; prospective cohort or randomised design; data on running-related injury and training parameters or changes in them. Systematic reviews, conference abstracts and grey literature excluded; no age or sex limit.
Screening and appraisal: two blinded reviewers screened; two raters checked full texts and appraised quality with QualSyst (14 items; high quality >80%, good 65-80%, moderate 50-64.9%, low <50%); third reviewer for disagreements; preconsensus interrater ICC 0.97 (95% CI 0.95-0.99).
Synthesis: qualitative, with levels of evidence adapted from the Cochrane Collaboration (strong, moderate, limited, very limited, conflicting) using imprecision, risk of bias, indirectness and inconsistency; injury incidence as weighted averages. No meta-analysis (heterogeneity of injury definitions, runner categories and follow-up).
Sample: n = 36 studies, 23,047 runners (44% women), aged 17 years and older.
Funding and interests: no funding or competing-interest statement appears in the PubMed Central text. The corresponding author lists The Running Clinic (Lac Beauport, Quebec) and MoveMed Physiotherapy (Kelowna) among his affiliations; one author lists the Canadian Armed Forces.

Key Results

ItemResult
Studies and runners36 (33 prospective cohorts, 3 RCTs); 23,047 runners, 44% women
Qualityscores 27.3% to 96.2%, median 86.4%; 22 high, 5 good, 5 moderate, 4 low quality
Injured6,043 (26.2%); novice 14.9%, recreational 26.1%, competitive 62.6%, mixed levels 27.6%
Injury definitiononly 14 of 36 studies close to the 2015 consensus definition
Weekly distance (20 studies)conflicting: 8 more injuries with more distance (e.g. >30 km/wk HR 3.28, 95% CI 1.23-8.75), 4 protective, 7 no association, 1 mixed
Duration (12), frequency (10), intensity (14)conflicting in each
Recent changes in training (11 studies)conflicting: 5 for an association with a recent rise in distance, 5 none, 1 mixed

The 11 studies on recent changes, as the review reports them:

FindingStudies
Injured novices had a larger distance progression in the week before injury (86% difference, 95% CI 12.9%-159.9%, P = .026); their average weekly increase was 31.6% vs 22.1% (P = .07)1 high-quality study, 58 novices
Progressing weekly distance by >30% vs <10%: more "distance-based injuries" (HR 1.59, 95% CI 0.96-2.66, P = .07), no difference in overall injuries1 high-quality study, 873 novices
Higher injury risk with a rise in distance between marathon-preparation phases1 moderate-quality study, 73 novices
Larger differences between regular and high-mileage weeks: trend to more injuries (P = .06)1 good-quality study, 97 university runners
Injured runners often raised weekly distance by >30% and even >50% in the 4 weeks before injury1 moderate-quality study, 76 runners
No link of week-to-week changes in frequency or duration with injury1 high-quality study
A 10% average weekly increase had no preventive effect vs >10% (OR 0.8, 95% CI 0.6-1.3)1 RCT, novices
Similar injury incidence with progression by intensity or by distance (mean weekly volume increase only 3.25%)1 RCT, 447 recreational runners
No difference after raising distance by 103% or intensity by 152% over 4 weeks1 low-quality study, 17 runners
Acute-to-chronic workload ratio not associated with injury1 good-quality study, 23 competitive runners
More injuries with a 20-60% weekly increase vs <20%, at 3 weeks only (not at 7 or 14 weeks); >60% not more1 high-quality study, 261 runners

A number that does not add up: the abstract gives the lower leg as 24.4% of all injuries, the same figure as the foot and ankle; the Results give 20.9%.

Mechanisms

Authors' interpretation: running injuries come when repetitive stress exceeds a tissue's tolerance, so training load matters in principle; but load as these studies measured it (mostly prescribed or self-reported distance, rarely intensity or GPS data) and in isolation from individual factors (biomechanics, previous adaptation, sleep, stress, hormones, recovery) cannot show it.Runners differ in what load they tolerate — "a 10% increase for a novice runner who runs 10 km per week is likely much safer than for a competitive runner who runs 150 km per week".
Inference: a mechanism can be real and still not show up as a consistent group-level association when exposure is measured crudely and injuries are defined differently; the review's null-to-conflicting result weakens the claim that quick load rises are a proven cause, without disproving it.
Inference: none of the outcomes is tendon-specific, so this review bears on the muscle-tendon "clocks" idea only through running injuries as a whole.

Practical Application

Does ramping up my running too fast cause injury? Not shown: across 36 prospective studies of 23,047 runners, distance, intensity and recent increases did not consistently predict injury, and a 10% rule did not prevent it (A-).
What it is good for as a source: the con side of the "quick load rise causes overuse injury" claim, from a registered systematic review: conflicting evidence for every training parameter and for recent changes, and no support for a fixed 10% weekly rule.
What it does not show: that load changes are harmless. Several higher-quality studies found more injuries after large rises in distance (some only as trends) while others, two randomised trials among them, found none, and the authors attribute the conflict to poor measurement and definitions, not to an absence of effect.
How a principle should cite it: "a systematic review of 36 prospective studies found no consistent link between running injuries and training parameters or recent changes in them (Fredette 2022)".
What it means for training: Not from this paper; the base's own practice: progress gradually and by the slowest tissue, without trusting a fixed weekly percentage (SYNTH-29, SYNTH-75); watch spikes more than levels, and treat pain that worsens through a run as a reason to stop (SYNTH-73).

Limitations

Observational evidence. 33 of 36 studies are cohorts; associations only, with mostly self-reported or prescribed training (GPS-based data in 5 studies).
Heterogeneity. Injury definitions (only 14 of 36 close to the consensus), runner categories and follow-up (1 to 60 months) differ, which ruled out a meta-analysis.
Vote counting. "Conflicting" is reached by counting studies for, against and null, which weighs a trend at P = .07 like a clear result and a study of 17 runners like one of 873.
All lower-limb running injuries together; no tendon-specific analysis, no cycling.
Search to July 2020. Later cohorts are not included.
Interests: no funding or competing-interest statement in the text read; the affiliations are given above.
How this entry was checked and changed
Why this level

a registered systematic review of 36 prospective studies with dual screening and appraisal (interrater ICC 0.97); held below A because nearly all the evidence is observational cohorts, heterogeneity in injury definitions and follow-up prevented any meta-analysis, and the synthesis counts studies for and against

Full text (checked 2026-10-28)
A total of 36 articles that involved 23 047 runners were included; 6043 runners (26.2%) sustained an RRI (incidence range = 8.8%–91.3%) (full text)
Of the 36 included studies, 33 were prospective cohort studies and 3 were RCTs; 22 were classified as high quality, 5 as good, 5 as moderate and 4 as low quality, with an ICC of 0.97 (full text)
We found conflicting evidence about the association between RRIs and specific changes in training parameters based on 11 studies (full text)
An RCT revealed that a 10% average increase in weekly running distance had no preventive effect against RRIs in novice runners compared with a progression >10% (OR = 0.8, 95% CI = 0.6, 1.3) (full text)
Those progressing weekly distance by >30% seemed more vulnerable to distance-based injuries than those who progressed <10% (HR = 1.59, 95% CI = 0.96, 2.66), with no association between overall injury incidence and distance progression (full text)
Current evidence does not consistently link RRIs with specific training parameters or recent changes in training parameters; the popular 10% rule for increasing weekly distance is not justified (full text)
Only 5 studies (14%) of the 36 included collected global positioning system–based data (full text)