Strategies to prevent and manage running-related knee injuries: a systematic review of randomised controlled trials

James L N Alexander; Adam G Culvenor; Richard R T Johnston; Allison M Ezzat; Christian J Barton

doi:10.1136/bjsports-2022-105553

Strategies to prevent and manage running-related knee injuries: a systematic review of randomised controlled trials

Br J Sports Med. 2022 Nov;56(22):1307-1319. doi: 10.1136/bjsports-2022-105553. Epub 2022 Sep 23.

Authors

James L N Alexander^{1

2}, Adam G Culvenor¹, Richard R T Johnston¹, Allison M Ezzat^{1

3}, Christian J Barton^{4

5}

Affiliations

¹ La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.
² Evado Studios, Nelson Bay, New South Wales, Australia.
³ Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
⁴ La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia christian@completesportscare.com.au.
⁵ Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.

PMID: 36150753
DOI: 10.1136/bjsports-2022-105553

Abstract

Objective: To evaluate the effectiveness of interventions to prevent and manage knee injuries in runners.

Design: Systematic review and meta-analysis.

Data sources: MEDLINE, EMBASE, CINAHL, Web of Science and SPORTDiscus up to May 2022.

Eligibility criteria for selecting studies: Randomised controlled trials (RCTs) with a primary aim of evaluating the effectiveness of intervention(s) to prevent or manage running-related knee injury.

Results: Thirty RCTs (18 prevention, 12 management) analysed multiple interventions in novice and recreational running populations. Low-certainty evidence (one trial, 320 participants) indicated that running technique retraining (to land softer) reduced the risk of knee injury compared with control treadmill running (risk ratio (RR) 0.32, 95% CI 0.16 to 0.63). Very low-certainty to low-certainty evidence from 17 other prevention trials (participant range: 24 -3287) indicated that various footwear options, multicomponent exercise therapy, graduated running programmes and online and in person injury prevention education programmes did not influence knee injury risk (RR range: 0.55-1.06). In runners with patellofemoral pain, very low-certainty to low-certainty evidence indicated that running technique retraining strategies, medial-wedged foot orthoses, multicomponent exercise therapy and osteopathic manipulation can reduce knee pain in the short-term (standardised mean difference range: -4.96 to -0.90).

Conclusion: There is low-certainty evidence that running technique retraining to land softer may reduce knee injury risk by two-thirds. Very low-certainty to low-certainty evidence suggests that running-related patellofemoral pain may be effectively managed through a variety of active (eg, running technique retraining, multicomponent exercise therapy) and passive interventions (eg, foot orthoses, osteopathic manipulation).

Prospero registration number: CRD42020150630.

Keywords: Exercise Therapy; Knee injuries; Preventive Medicine; Running; Sporting injuries.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Exercise Therapy
Humans
Knee Injuries* / prevention & control
Knee Joint
Patellofemoral Pain Syndrome* / therapy
Randomized Controlled Trials as Topic
Running* / injuries