Carl R. Darnall Army Medical Center - Health Library

Very Little Evidence Available for Prevention of Lower Leg Injuries in Runners

Running has grown in popularity as a way to get in shape that requires no gym membership or intensive skill training. As running increases in popularity so does participation in triathlons, road races, and marathons. These challenges have many people lacing up their sneakers and hitting the road or treadmill a little too hard at times. Pushing too hard or just the basic wear and tear of running can cause nagging injuries. Taking care of injuries and resting from activity that caused the injury is important, although somewhat frustrating for someone in training for a big race. Prevention is the ideal approach but it is not clear what the best prevention steps are.

Analysts from the Cochrane Database assessed outcomes of several studies that reviewed injury prevention in runners. The review, published in Cochrane databases, found little evidence to support or refute current options to reduce lower limb injuries in runners.

About the Study ^

A systematic review is a collection of similar trials that increases the reliability of results by creating a large pool of participants. This review included 25 randomized trials with 30,252 participants. Participants included military recruits in 19 trials, prisoners in two trials, referees in one trial, and runners from the general population in three trials. The trials compared approaches for prevention of lower leg injuries including exercises, modification of training, use of foot or knee orthotics, and footwear and sock choices.


Stretching and other preventative exercises were not found to be effective in reducing lower leg injuries in eight trials.

Modifications of Training

  • One study found that reducing training time in prisoners from 45 minutes to 15-30 minutes was associated with decreased lower leg injuries.
  • A second trial found lower injury rates with training 1-3 days per week compared to five days per week in prisoners.
  • Another trial did not show that gradually increasing training in new runners prevented injuries. A different trial performed in military recruits actually showed increased risk of shin pain in the group that had a longer build-up in training intensity.

Conclusions came from single studies limiting reliability. Two trials found that decreased frequency or duration of running may decrease injury but the trials were of poor quality and were done in prisoners so the results may not apply to runners in general.

Foot or Knee Orthotics

Knee braces were found to reduce pain in the front of the knee in two trials. Only one out of five trials looking at shoe insoles found a benefit from wearing them. No trials showed that customized foot orthotics were more effective than off-the-shelf orthotics.

Footwear Choice

Running shoes suited for individual foot shape were not found to be more effective than standard running shoes at decreasing rate of lower leg injury.

How Does This Affect You? ^

Most approaches were only evaluated by few trials, often only one trial. In addition, many of the trials were also considered to be low quality, decreasing their reliability. As a result, these conclusions are considered very weak, and no firm conclusions could be drawn from this review.

This review shows that there is a lack of enough information to make firm recommendations on what to use and what not to use to prevent injuries in runners. There is enough information, however, to make you think twice before purchasing specialized and often expensive devices. The strongest evidence was for common sense recommendations. Decreasing duration and frequency of running will decrease chance of lower leg injuries. Overuse injuries are common with any repeated activity. You may want to consider decreasing the number of days you run and adding other activities to your routine (cross training). This will help you reach your fitness goals but give your body a break from running rigors.


American College of Sports Medicine


Yeung SS, Yeung EW, Gillespie LD. Interventions for preventing lower limb soft-tissue running injuries. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD001256.

Last reviewed September 2011 by Brian P. Randall, MD