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Back in 2013 I had a nasty case of Proximal Hamstring Tendinopathy (PHT). I was the fittest I’ve ever been so it was really frustrating to have to take a break from running. At the time I wondered what could have prevented this.
Overdoing the hill training was the likely cause, but as I was pushing hard for a marathon PB I would have welcomed some exercise options to help reduce my risk of injury.
To date, the evidence behind strength training for running injury prevention hasn’t been very conclusive, but new research from Mari Leppänen and colleagues just published in BJSM has some encouraging results (Leppänen et al. 2024).
They utilised 8 exercises which could be progressed over 4 levels of difficulty:
- Front plank
- Side plank
- Pelvic lift (bridge)
- Band squat/ band walks
- Banded hip flexion
- Lunge
- Side lunges
- Deadlift
This was compared to foot and ankle exercises and static stretches.
The programme was completed 2 to 4 times per week. It was designed to be challenging, “The strength exercises were instructed to feel heavy and to be performed until fatigue, but with good quality”.
Two of the rehab sessions per week were supervised by physiotherapists and tended to be before running. All groups performed the same running programme to help reduce the effect of different training loads on running injuries.
Here’s a summary of their findings:
What about the foot and ankle strengthening?
The results weren’t as positive here and they actually faired worse than the control group in some areas. A possible reason for this is that the foot and ankle exercises may not have had sufficient load to prepare for the demands of running. For example, calf work was very low level and it doesn’t appear that any additional load was added to the heel raises.
Did the stretching in the control group help?
The authors commented on this,
“We observed a notably low number of acute thigh and calf injuries in the stretching group supporting the previous findings of possible beneficial effect of stretching on the risk of muscle injuries”
It didn’t seem to have an impact on reducing overuse injuries which are far more common in runners.
Important Considerations
The strength exercises were performed before running training which may not be ideal as it can cause fatigue. There were 8 exercises in total which took 20 to 35 minutes to do. A shorter programme may be more realistic, particularly for those with a high ‘life load’!
So did the hip and core exercises actually prevent injury?
Running injury prevalence was 39% lower in the hip and core group compared to the control group so yes, they may have helped prevent some running injuries.
However, there were a number of interventions in this study including a structured warm-up, training advice and suggestions on running technique. Also, it doesn’t appear that strength was measured during the study so we’re not able to conclude that getting stronger is what reduced injury prevalence. Despite this, these are positive findings that hopefully can be built upon with future research.
Clinical implications
The evidence isn’t conclusive in this area but I think there are several priorities to consider with injury prevention in runners:
- Training load management
- Improving recovery (both physical and psychological)
- Strength and conditioning
- Diet and nutrition
The art to it comes in working closely with an athlete to know what is the priority for them at that particular time.
For more on running injury management and prevention check out Running Repairs Online. It’s currently open for enrolment with 18 great modules to explore.
When I consider my PHT I think what would have been most likely to prevent it would have been better load management and recovery. My symptoms began immediately after a large spike in hill training which can increase the load on the hamstring tendon.
I was hitting peak mileage for the marathon which is a difficult time to integrate strength work without creating excessive fatigue. However, some targeted strength work earlier in the season and maintained at a lower frequency during the marathon training might have helped keep me on track!
