Lower limb soft-tissue injuries are common in runners. Most running-related injuries are overuse injuries and the causes of these injuries are often multifactorial. Prevention strategies attempt to target modifiable risk factors. We included 25 trials with 30,252 participants in this review. Only three of the trials recruited runners from the general population, and one recruited soccer referees. Nineteen trials involved service personnel (Army, Marines, Naval personnel etc) undertaking basic training which includes intensive periods of running, along with other activities. Two trials were conducted in prisons.
The included trials tested four categories of interventions: exercises, modification of training schedules, use of orthoses, and footwear and socks.
In the following results, where there is "no evidence" that an intervention worked, the results were compatible with either a reduction or an increase in the number of soft-tissue injuries.
There is no evidence that improving physical attributes by exercises (stretching or conditioning exercises) reduces lower limb soft-tissue injuries.
With regards to the modification of training schedules, there is no evidence that a longer training programme with a gradual increase in the amount of running is more effective than a shorter training programme for preventing injuries in novice runners training for a four-mile recreational run. Having a longer build-up in training intensity may even result in an increase in sore shins in people undergoing military training. There is limited evidence from two poor quality trials conducted in prisons for the effectiveness of decreased frequency or duration of running but these results may not apply to runners in general, or military recruits.
Knee braces may reduce the frequency of anterior knee pain. Custom-made biomechanical insoles may be more effective than no insoles for reducing shin splints (medial tibial stress syndrome) in military recruits. There is no evidence to support the use of shoe insoles for the reduction of other lower limb soft-tissue injuries, whether they are individually prescribed to suit foot shape or off-the-shelf.
There is no evidence that running shoes prescribed to suit individual foot shape are better than standard running shoes for preventing injuries in military recruits.
Overall, the evidence for the effectiveness of interventions to reduce lower-limb pain and injury after intensive running is very weak. More trials, designed, conducted and reported to contemporary standards, would be required to confirm these findings, especially in recreational or competitive runners, rather than military recruits.