Introduction
In Western countries, a large group of people participate in running and this number is still increasing.1–4 In 2014, running was the second most popular sport (12% of the population) in the Netherlands.3 In addition, a large number of these runners participate in recreational running events.2 5 6 Most participants in recreational running events are 30–55 years old (72%) and perform the sport individually or in a running group (68%).5
Health benefits associated with running include personal well-being, aerobic fitness, metabolic fitness, body mass, resting heart rate, VO2max, triglycerides and High-density lipoprotein cholesterol, cardiovascular function, running performance and adiposity.7–9 However, the risk of sustaining a running injury is high, especially for novice runners. In 2014, 6.1 running injuries per 1000 hours were reported in the Netherlands.10 Runners presented the highest injury incidence, followed by soccer and martial arts (both 4.3 per 1000 hours).11 More recent analyses reported an incidence per 1000 running hours of 17.8 (95% CI 16.7 to 19.1) for novice runners, 7.7 (95% CI 6.9 to 8.7) for recreational runners,12 a pooled injury proportion of 26.4% (95% CI 14.2 to 43.7) for novice runners and 28.0% (95% CI 23.1 to 33.5) in recreational runners.13
Injury history,14–17 training characteristics, such as a greater training distance14 16 18 and less running experience,19 20 are common reported risk factors for general, lower extremity and specific running-related injuries (eg, knee injuries), in novice and recreational runners. There is less evidence in literature on novice and recreational runners that sex (male),19 21 longer training duration and use of speed training,22 lower weekly training volume23 24 and lower weekly session frequency23 are risk factors for general and lower extremity or back injuries.
Participants in recreational running events often use a running application (app) on a smartphone or a sport watch.25 26 Using an app or a sport watch could be associated to the occurrence of injuries. It is unclear if the use of these technologies may increase or decrease the risk of injuries. On the one hand, these technologies may support and motivate the athlete before, during and after running.25 On the other hand, these tools often do not provide tailored coaching and/or could push runners to increase their running volume insensible, potentially resulting in injuries. Based on a retrospective study among experienced and novice runners, there was no relationship between the use of a smartphone app and risk of general running-related injuries.27 To our knowledge, no prospective study has investigated the association between the use of running apps or sport watches and running injuries.
In current literature on risk factors for running-related injuries, studies have included specific types of runners, like novice and recreational runners who participated in a recreational event (Parkrun or 4 mile event),19 21 a broad group of recreational runners,22 23 trail runners28 and short, moderate and long distance event runners.16 Nevertheless, these studies did not focus on one cohort of runners who participate in a short and middle distance recreational running event. To investigate risk factors for running injuries among participants in a recreational running event, the Dam tot Damloop, a prospective study was designed. The Dam tot Damloop is one of the largest recreational running events in the Netherlands, with 65 000 participants each year. These runners can choose between a 8 km (Nightrun, 15 000 participants) and 16 km run (50 000 participants). A large variation of recreational and novice runners participate in this running event,25 which provides the possibility to study risk factors in a broad group of recreational event runners.
The aim of this study was to determine (1) the injury incidence in recreational event runners in preparation for the Dam tot Damloop and (2) whether injury history, anthropometrics, training characteristics, event distance, main sport and use of technology were risk factors for injuries among participants in a recreational running event.