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Research project


To examine the effect of a multifactorial, online injury prevention programme on the number of running-related injuries (RRIs) in recreational runners.

What we do

About our project

A research team, led by Dr. Marienke van Middelkoop (associate professor) and Dr. Robert-Jan de Vos (sports physician) and coordinated by Dr. Tryntsje Fokkema (PhD student) at Erasmus MC, completed a randomized clinical trial on the effectiveness of an injury prevention program in recreational runners.

This large project took more than 2 years to complete, and was funded by the Netherlands Organization for Health Research and Development (ZonMW).

Running is a sport that is frequently practiced and is growing in popularity. In the Netherlands, about 2 million people performed running regularly in 2014, which is about 12.5% of the Dutch population. Regular running has many positive effects on both physical and mental health and is an efficient way to improve physical fitness. A main drawback, however, is the high number of musculoskeletal injuries among runners. The injury proportions in runners vary between 3% and 85%.

Only a previous injury is a consistent and frequently identified risk factor for RRIs, which emphasizes the need for primary injury prevention measures in runners. So far, only a few randomised controlled trials (RCTs) have investigated the effects of injury prevention measures in runners. None of these RCTs showed effectiveness of a program. This may be related to the fact that these RCTs targeted only one risk factor for RRIs, while the cause of RRIs seems to be multifactorial. 

The aim of this study was to examine the effect of a multifactorial, online injury prevention program on the number of RRIs in recreational runners.

Methods of our project

Potential participants of the INSPIRE trial were runners who registered for one of three large running events in the Netherlands in 2017. These running events included the NN City Pier City The Hague (5, 10 and 21.1 km), NN Marathon Rotterdam (10.55 and 42.195 km) and the LadiesRun Rotterdam (5, 7.5 and 10 km). During the online registration for the running events, the runners were asked if they were willing to participate in the INSPIRE trial.

The included runners were randomised into the intervention group or control group. Participants in the intervention group were given access to the online injury prevention programme, which consisted of information on evidence-based risk factors and advices to reduce the injury risk. Participants in the control group followed their regular preparation for the running event. The primary outcome measure was the number of self-reported RRIs in the time frame between registration for a running event and 1 month after the running event. 


This trial included 2378 recreational runners (1252 men; mean [SD] age 41.2 [11.9] years), of which 1196 were allocated to the intervention group and 1182 to the control group. Of the participants in the intervention group 37.5% (95% CI 34.8 to 40.4) sustained a new RRI during follow-up, compared with 36.7% (95% CI 34.0 to 39.6) in the control group. Univariate logistic regression analysis showed no significant difference between the intervention and control group (OR 1.08; 95% CI 0.90 to 1.30). Furthermore, the prevention programme seemed to have a negative impact on the occurrence of new RRIs in the subgroup of runners with no injuries in the 12 months preceding the trial (OR 1.30; 95% CI 0.99 to 1.70). 

A multifactorial, online injury prevention programme did not decrease the total number of RRIs in recreational runners. We hypothesise that this may be related to the way the information on injury prevention was presented to the runners. Perhaps runners need more personalised information or more directed practical information on injury prevention. Furthermore, it may be related to the heterogeneity in the study population, especially in runners with a history of previous injuries.

Funds & Grants

This research received a grant from the Netherlands Organization for Health Research and Development (ZonMW).


Golazo Sports, Rotterdam, the Netherlands.

Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, Massachusetts, USA.


The results of this Randomized Clinical Trial have been published in the highly rated British Journal of Sports Medicine – and available as open access – click the link to read the full paper: https://bjsm.bmj.com/content/53/23/1479.long

Our team

T. Fokkema 
J.M. van Ochten
I.S. Davis
P.J.E. Bindels
J.A.N. Verhaar
S.M.A. Bierma-Zeinstra
R.J. de Vos
M. van Middelkoop