The quality of evidence is downgraded by various limitations in study quality and byinconsistency (variability in results across studies, heterogeneity in interventions and outcomes).
A Cochrane review [Abstract] 1 included 25 studies with a total of 30 252 subjects. Participants were military recruits (19 trials), runners from the general population (3 trials), soccer referees (1 trial), and prisoners (2 trials). The interventions fell into four main preventive strategies: exercises, modification of training schedules, use of orthoses, and footwear and socks.
Stretching did not reduce lower limb soft-tissue injuries (risk ratio [RR] 0.85, 95% confidence interval [95% CI] 0.65 to 1.12; 6 trials, n = 5 130). There was no evidence to support a training regimen of conditioning exercises to improve strength, flexibility and coordination (RR 1.20, 95% CI 0.77 to 1.87; 1 trial, n = 1 020). A longer, more gradual increase in training did not reduce injuries in novice runners (RR 1.02, 95% CI 0.72 to 1.45; 1 trial, n = 486). There was some evidence that additional training resulted in a significant increase in the number of naval recruits with shin splints (medial tibial stress syndrome; RR 2.02, 95% CI 1.11 to 3.70; 1 trial, n = 1 670). There was limited evidence that injuries were less frequent in prisoners when running duration (RR 0.41, 95% CI 0.21 to 0.79; 1 trial, n = 69) or frequency (RR 0.19, 95% CI 0.06 to 0.66; 1 trial, n = 58) were reduced.Patellofemoral braces appear to be effective for preventing anterior knee pain (RR 0.41, 95% CI 0.24 to 0.67; 2 trials, n = 227).Custom-made biomechanical insoles may be more effective than no insoles for reducing shin splints in military recruits (RR 0.24, 95% CI 0.08 to 0.69; 1 trial, n = 146).Wearing running shoes based on foot shape, rather than standard running shoes, did not significantly reduce the rate of running injuries in military recruits (Rate Ratio 1.03, 95% CI 0.93 to 1.14; 2 trials, n = 5 795).
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