Does a strength routine before runs prevent injury for a new runner?
One kind did: in 325 novices, supervised hip-and-core work cut injuries by about a third vs stretching (HR 0.66); ankle-and-foot work did not.
Main caveat: Self-reported injuries, no diagnosis. All-complaint injuries came from a weekly questionnaire developed for competitive athletes and not validated in…
Leppänen and colleagues tested two "top-down" and "bottom-up" ideas of running-injury prevention in adult novice recreational runners in Tampere, Finland, over two seasons (May to October 2021 and 2022). 370 volunteers were randomised and 325 who started were analysed: hip and core (n = 108), ankle and foot (n = 111) or a static-stretching control (n = 106); 245 were women and the mean age was about 40.
Every group followed the same progressive running plan, met twice a week in physiotherapist-led groups and, after a 5-minute warm-up, did its own eight exercises (20-35 min; strengthening and neuromuscular control with resistance bands for the two programmes, static stretching for the control) before the outdoor run; one or two home sessions a week were advised.
Weekly questionnaires recorded every running-related complaint.
Against stretching, hip-and-core work lowered the hazard of a first running-related lower-limb complaint (HR 0.66, 95% CI 0.45-0.97) and of a first time-loss injury (HR 0.65, 0.42-0.99), and the average weekly prevalence of overuse injuries was 9.2% against 15.5% in the stretching group (PRR 0.61, 0.39-0.96), of substantial overuse injuries 3.3% against 7.7% (PRR 0.48, 0.27-0.90).
The ankle-and-foot programme showed no evidence of a difference for any injury (HR 1.06, 0.74-1.50) or for overuse (PRR 0.83, 0.55-1.25), and had more acute injuries — mostly thigh and calf muscle strains during intervals or hills — than stretching (23 vs 4; HR 3.60, 1.20-10.86).
Adherence (average weekly share of participants doing at least two sessions: 87-89%) and running exposure did not differ between groups, so the contrast between the two exercise arms is one of content, not of attention.
Our reading: the first large supervised prevention trial in runners, and a programme-specific result — "do a strength routine" is not what it shows; a particular supervised hip-and-core routine helped novices, and the foot-and-ankle routine did not, unlike an earlier small trial in experienced runners pooled in REF-1244.
Protocol
Design: three-arm randomised controlled trial (Run RCT) over two years, CONSORT, registered in ISRCTN (ISRCTN47734782) before the intervention; approved by the Regional Ethics Committee of the Expert Responsibility area of Tampere University Hospital (R20042). The planning assumed 15 training-group clusters (5 per arm).
Who (Table 1): adult novice recreational runners recruited through newspapers, web pages and social media in January 2021 and January 2022: aged 18-55, long-distance running as the main exercise, under two years of weekly running, at most 20 km a week, able to run 3 km or 20 min, no time-loss injury in the previous 3 months, no lower-limb surgery in 6 months, no fracture of the spine, pelvis or legs in the past year.Group means: age 39.9, 40.6 and 39.9 y; women 82 (75.9%), 85 (76.6%) and 78 (73.6%); BMI 25.4-25.5; running experience 9.3, 9.1 and 8.2 months; 4.6, 5.0 and 5.2 km a week; a lower-limb complaint in the past 12 months in 25.9%, 33.3% and 30.2%.
Flow: n = 386 assessed eligible, 16 excluded, n = 370 randomised (124 hip and core, 122 ankle and foot, 124 control); 45 withdrew before the intervention began; n = 325 analysed as randomised from the time they took part (108, 111, 106).
Randomisation and blinding: computer-generated, stratified by sex and age (<45 or ≥45 years) by a statistician with no other role; acquaintances were randomised together to avoid contamination. Participants and group physiotherapists were not blinded, but were told neither the content of the other arms nor that one arm was a control; the physiotherapist collecting injury data and the statistician were blinded.
Sessions: each started with the same 5-minute indoor warm-up with running drills, then the arm's eight exercises (20-35 min): strengthening and neuromuscular control for the hip and core muscles (the Discussion names lunges and planks among them), strengthening and neuromuscular control for the ankle and foot muscles (isometric and resistance-band exercises the authors describe as unfamiliar to participants), or eight static stretches.Resistance bands came in four levels; band exercises "were instructed to feel heavy" and were done with good quality until fatigue; each exercise had graded variations set by the physiotherapist. The exercise lists are in Figure 1 and Supplementary Table 1, which were not read.
Dose: two supervised group sessions a week, with one or two more at home advised (minimum two, maximum four intervention sessions a week); missed group sessions were done at home with provided bands, minibands and written instructions; a 5-week mid-summer break was unsupervised (three to four sessions a week on their own). Three physiotherapists each led one arm throughout both years after shared workshops.
Running plan (all arms): two organised outdoor sessions a week (30-75 min) plus one or two voluntary ones, from an endurance coach and exercise physiologist; running, brisk and Nordic walking, hills, intervals and drills; weekly volume rose by about 30 min per 6-week period. Two group technique sessions in June and August; no advice on foot strike or footwear.
Injury recording: a weekly Sunday health survey in a mobile app (AthleteMonitoring) with the OSTRC-H2 questionnaire, plus follow-up questions on location, type, recurrence and time loss; every reported injury was checked in a phone interview by a blinded study physiotherapist on a structured form.
Outcomes: primary — a running-related all-complaint lower-limb injury, defined as any physical complaint (pain, ache, instability, stiffness or other) from running, irrespective of medical attention or time loss.Secondary — overuse injuries (gradual onset), substantial overuse injuries (moderate or severe training modification, moderate to major effect on performance, or inability to participate), acute injuries (a single identifiable event), acute time-loss injuries and injuries by body part. Muscle soreness, injuries outside running and contact injuries were excluded.
Analysis: Cox proportional hazards on time to first injury for all and for acute injuries; generalised linear mixed models (binomial, log link, week as repeated measure) for weekly prevalence of overuse injuries; intention to treat among starters, no imputation; not adjusted for clusters, because participants could change subgroup; adjusting for previous lower-limb injury did not change the results, so unadjusted results are shown.Sample size: 321 runners for 81% power to detect a halving from 0.4 to 0.2 injuries per runner per season, allowing 30% attrition.
Funding and interests: funded by the Ministry of Education and Culture, Finland, and by the State funding for university-level health research, Tampere University Hospital, Wellbeing services county of Pirkanmaa (Project No. 9AB055); "The funders had no role in planning, execution, or reporting of the study." Competing interests: "No competing interests to declare." No device maker, federation or data platform is named as a funder; the injury app (AthleteMonitoring, Canada) is named only as the recording tool.
Key Results
Arms against the static-stretching control (Results, Tables 2 and 3; injuries per 1,000 h of running; prevalence = average weekly share of respondents with the complaint):
| Outcome | Hip & Core (n = 108) | Ankle & Foot (n = 111) | Control, stretching (n = 106) | Hip & Core vs control | Ankle & Foot vs control |
|---|---|---|---|---|---|
| All lower-limb injuries (primary) | 75; 17.2 per 1,000 h (13.6-21.4) | 114; 26.6 (22.0-31.8) | 94; 24.8 (20.2-30.3) | HR 0.66 (0.45-0.97), P = 0.034 | HR 1.06 (0.74-1.50), P = 0.759 |
| Time-loss lower-limb injuries | — | — | — | HR 0.65 (0.42-0.99), P = 0.044 | HR 1.05 (0.72-1.54), P = 0.800 |
| Runners with at least one overuse episode | 45 (42%) | 65 (59%) | 57 (54%) | — | — |
| Weekly prevalence of overuse injuries | 9.2% (7.9-10.5) | 12.0% (10.6-13.6) | 15.5% (13.8-17.4) | PRR 0.61 (0.39-0.96), P = 0.032 | PRR 0.83 (0.55-1.25), P = 0.372 |
| Runners with at least one substantial overuse episode | 30 (28%) | 37 (33%) | 34 (32%) | — | — |
| Weekly prevalence of substantial overuse injuries | 3.3% (2.6-4.1) | 5.0% (4.1-6.0) | 7.7% (6.6-9.0) | PRR 0.48 (0.27-0.90), P = 0.021 | PRR 0.69 (0.40-1.19), P = 0.181 |
| Acute lower-limb injuries | 11; 2.52 (1.32-4.38) | 23; 5.37 (3.48-7.92) | 4; 1.06 (0.34-2.55) | HR 2.08 (0.64-6.75), P = 0.224 | HR 3.60 (1.20-10.86), P = 0.023 |
| Runners with at least one acute injury | 9 (8%) | 15 (14%) | 4 (4%) | — | — |
| Acute time-loss injuries | 10; 2.29 (1.16-4.08) | 21; 4.90 (3.11-7.36) | 2; 0.53 (0.09-1.75) | HR 4.10 (0.89-18.98), P = 0.071 | HR 6.10 (1.38-27.07), P = 0.017 |
Bold rows are the results named in the abstract; bold ratios are significant (P < 0.05).
Overuse injuries by body part, Hip & Core vs control (Table 2): thigh PRR 0.21 (0.05-0.92) and foot PRR 0.31 (0.11-0.83) lower; hip/groin 0.21 (0.04-1.27), knee 0.84 (0.35-1.99), lower leg (tibia, fibula, calf, Achilles) 0.84 (0.38-1.87) and ankle 0.95 (0.22-4.13) — no evidence of a difference. Ankle & Foot vs control: no body part differed.
What was injured: 310 running-related injuries, 283 (91%) in the lower limb; 245 (87%) of these overuse and 38 (13%) acute. 95% of acute injuries were at the hip/groin, thigh or calf, nearly all muscle strains and cramps during running intervals or uphill/downhill running.
Exposure and adherence: 12 441 h of running, no difference between groups; 4 873, 4 811 and 4 261 intervention sessions (2.0, 1.9 and 1.9 a week); average weekly adherence (at least two sessions that week) 89%, 88% and 87% — below the advised three to four sessions a week, similar in all arms. Response to the weekly survey 94.7% (6 736 reports).
Harms during the programme sessions: three minor acute injuries during hip-and-core training (two thigh muscle injuries and one gluteal pain, no time loss); none during ankle-and-foot training; two during stretching (a patellar dislocation with 30 days' time loss and a neck strain).
Sensitivity: in week 1 overuse prevalence already differed slightly (4.0% in both exercise arms vs 7.3% in the control, P=0.52); dropping the first two weeks, or the runners injured in week 1, did not change the Hip & Core result.
A number that does not add up: Table 2 gives Hip & Core overuse thigh prevalence as "0.2 (0.8–0.5)", an interval that does not contain its own estimate — a typo in the accepted manuscript.
Mechanisms
Measured: hip-and-core work lowered overuse complaints, mainly at the thigh and foot, and lowered time-loss injuries; it did not lower acute injuries (HR 2.08, interval 0.64-6.75). Ankle-and-foot work changed no overuse outcome; its excess acute injuries were thigh and calf muscle injuries, while acute foot and ankle injuries did not differ from the control.
Authors' interpretation: the top-down idea — stronger hip and core muscles reduce lower-limb joint motion and external moments in running — fits the overuse result; the ankle-and-foot programme may have been too light for the loads of running, its unfamiliar exercises may have been done at lower intensity than planned early on, and ankle work alone may not prepare the large leg muscles for the high-speed running where the strains happened.They read the low acute-injury count in the stretching group as consistent with stretching possibly protecting against muscle strains — "preliminary rather than conclusive".
Inference: supervision, session frequency and adherence were similar in all three arms (the two exercise arms spent more hours on their programme than the stretching control; Supplementary Table 3, not read), so the difference between hip-and-core and ankle-and-foot work is one of content, not of attention or of doing something before running.The primary hazard ratio is for a first complaint of any kind; the larger relative effects are in the weekly prevalence measures, which count persisting and recurring overuse complaints, so the programme seems to have shortened or prevented ongoing problems more than it delayed the first niggle.
Practical Application
Does a strength routine before runs prevent injury for a new runner? One kind did: in 325 novices, supervised hip-and-core work cut injuries by about a third vs stretching (HR 0.66); ankle-and-foot work did not.
What was done: eight hip-and-core strength and control exercises (lunges and planks among them, with resistance bands to "feel heavy" until fatigue) for 20-35 min before running, twice a week under a physiotherapist, with one or two home sessions advised, for 24 weeks; in adult novices, three quarters of them women (A, one RCT, accepted manuscript). The full exercise list is in the paper's supplement, not in this entry.
Not an ankle-and-foot routine on its own before fast running: the authors suggest that pre-run ankle-and-foot training without other leg strength or stretching work is not advisable, especially before sessions with sprints, because acute muscle injuries were more frequent (HR 3.60, 1.20-10.86; a secondary outcome with 23 vs 4 injuries).A small foot-strengthening trial in experienced runners pointed the other way (REF-1244, where it is one of nine pooled trials), so the foot result is population- and programme-specific.
Where it changes the base: SYNTH-44 lists as a gap "No trial of heavy strength training against injury in runners, and no large supervised one", and SYNTH-75 lists "Heavy strength training, and a large supervised programme, as injury prevention in new runners".This trial answers the second half for adult novice runners, mostly women: a large supervised programme lowered injuries — one specific programme, while the second supervised programme in the same trial did not. "Heavy strength training" stays untested: bands and body weight are not heavy lifting.The pooled null for mostly light, unsupervised routines (REF-1244, A-) still stands beside it; this trial post-dates that review's search.
What it is good for / what it does not show: good for telling a new runner that a supervised hip-and-core routine has randomised evidence for fewer overuse complaints, and that not every strength routine helps.It does not show that the routine works done alone at home, in experienced or competitive runners, in men specifically, with heavy weights, or against no exercise at all (the control stretched, under the same supervision); and it does not show which of the eight exercises matters.
Not from this paper; the base's own practice: SYNTH-44 advises "Strength work rather than stretching, but do not promise fewer running injuries" for an athlete who wants the gym to cut injury risk. With this trial the assistant can say that one supervised hip-and-core programme lowered overuse injuries in novices, without promising it for the athlete in front of it.
Limitations
Self-reported injuries, no diagnosis. All-complaint injuries came from a weekly questionnaire developed for competitive athletes and not validated in recreational runners (the authors' limitation); questions on performance and modified training may have been hard for non-competitive runners. A blinded physiotherapist checked each report by phone.
Not blinded. Participants and the group physiotherapists knew the programme; the authors tried to standardise all running advice at group level and believe the physiotherapist effect was small and similar across arms, but cannot rule it out.
Efficacy, not effectiveness. The programme was supervised by physiotherapists twice a week; whether runners on their own get the same result is untested (the authors call for that trial).
One trial, close to the line. The primary interval reaches 0.97; secondary analyses of acute injuries and of body parts were not powered and are preliminary (the authors' limitation). Clustering by training group, assumed in the power calculation, was not adjusted for in the analyses, which may make the intervals narrower than they should be; acquaintances were randomised together, which may bias reporting.
Who. Adult novices, three quarters women, mean age about 40, low starting volume; too few men for a separate analysis; the authors say the results cannot be generalised to other cohorts or to more experienced runners.
Analysed set. 45 of 370 randomised withdrew before the intervention began and were not analysed; the analysis is intention to treat among those who started.
Version. Read from the accepted manuscript; the typeset paper may differ in details (Table 2 holds at least one typo, see Key Results). Supplementary tables (exercises, injuries by sex, exposure) not read.
Funding and interests: Finnish Ministry of Education and Culture and state funding for university-level health research (Tampere University Hospital, Wellbeing services county of Pirkanmaa); funders had no role; no competing interests declared. No device maker, federation or data platform funded the trial.
How this entry was checked and changed
Why this level
a pre-registered RCT with more than 100 participants (rubric A), read from the full text: the accepted manuscript (final draft) self-archived in the University of Jyväskylä repository, whose numbers may differ from the typeset BJSM version in places. It carries what one trial can: participants and physiotherapists were not blinded, injuries were self-reported weekly on a questionnaire not validated in recreational runners (each one checked by a blinded physiotherapist by phone), the primary effect's interval reaches 0.97, the analyses were not adjusted for the training-group clusters the power calculation assumed, and the acute-injury and body-part results are secondary and, by the authors' account, underpowered
Full text (checked 2026-10-28)
Novice runners (245 female, 80 male) were randomised into Hip & Core (n=108), Ankle & Foot (n=111), or control (n=106) groups (full text)
Hip & Core vs control: all lower-limb injuries HR 0.66; 95% CI 0.45–0.97, P=0.034; Ankle & Foot HR 1.06; 95% CI 0.74–1.50, P=0.759 (full text)
Average weekly prevalence of overuse injuries 9.2% (Hip & Core), 12.0% (Ankle & Foot) and 15.5% (control); PRR 0.61; 95% CI 0.39–0.96 and PRR 0.83; 95% CI 0.55–1.25 (full text)
Substantial overuse injuries 3.3%, 5.0% and 7.7%; Hip & Core PRR 0.48; 95% CI 0.27–0.90; Ankle & Foot PRR 0.69; 95% CI 0.40–1.19 (full text)
Acute lower-limb injuries 2.52, 5.37 and 1.06 per 1000 hours; Ankle & Foot vs control HR 3.60, 95% CI 1.20–10.86; Hip & Core vs control HR 2.08, 95% CI 0.64–6.75 (full text)
Average weekly adherence was 89% in the Hip & Core group, 88% in the Ankle & Foot group, and 87% in the control group (full text)
Funded by the Ministry of Education and Culture, Finland, and State funding for university-level health research, Project No. 9AB055; No competing interests to declare (full text)