‘Volume’ based injuries vs ‘Pace’ based injuries

The cause of overuse injury in runners is multifactorial and training related issues are commonly cited as a factor. This review investigated some of those issues and proposed an interesting hypothesis:

Rasmus Oestergaard Nielsen, MHSc, Ellen Aagaard Nohr, PhD, Sten Rasmussen, MD, and Henrik Sørensen,
Int J Sports Phys Ther. 2013 April; 8(2): 172–179.
Background and Purpose:
Many researchers acknowledge the importance of “training errors” as the main cause of running‐related injuries. The purpose of this clinical commentary is to present a theoretical framework for the assumption that some running‐related injuries among rear‐foot strikers develop due to rapidly changing running volume, while others develop due to rapidly changing running pace.
Description of Topic with Related Evidence:
Evidence from clinical and experimental studies is presented to support the assertion that rapid change in running volume may lead to the development of patellofemoral pain syndrome, iliotibial band syndrome, and patellar tendinopathy, while change in running pace may be associated with the development of achilles tendinopathy, gastrocnemius injuries, and plantar fasciitis.
Discussion/Relation to Clinical Practice:
If this assertion is correct, bias may be prevented in future studies by categorizing injuries into volume or pacing injuries. However, more work is needed to provide further evidence in support of this approach. Future investigations of the link between training patterns and injury development should be designed as large‐scale prospective studies using objective methods to quantify training patterns.

The authors did a literature search on papers related to running injuries and ‘running volume‘ (ie average weekly distance run) and ‘running pace‘ (ie pace of workout). They looked at risk factors reported for the injuries to see what injuries could be classified into which category.

As a result of the review, they were able to classify the following injuries into either the volume or pace classifications:

Volume Related:
Patellofemoral pain syndrome
Iliotibial band syndrome
Patellar tendinopathy
Pace Related:
Achilles tendinopathy
Gastrocnemius injuries
Plantar fasciitis


This covered about half the injuries that they investigated. The other half of the injuries could not be classified into one of the two categories.

There are a number of assumptions that do underpin the way they classified the injuries into the two groups and more work is needed on the validity of those assumptions. There is also probably an issue with the strength of the evidence that is used to classify some of them. Neither of these detract from the idea or concept and it certainly warrants further consideration.

This does now highlight the importance of pace and volume in epidemiological studies of running injuries and the need to accurately quantify that data.

As always, I go where the evidence takes me until convinced otherwise.

Nielsen RO, Nohr EA, Rasmussen S, & Sørensen H (2013). Classifying running-related injuries based upon etiology, with emphasis on volume and pace. International journal of sports physical therapy, 8 (2), 172-9 PMID: 23593555

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