Co-creation of injury prevention measures for competitive adolescent distance runners: knowledge, behavior, and needs of athletes and coaches enrolled on England Athletics’ Youth Talent Programme

Figures & data

Table 1. Characteristics of competitive adolescent distance runners and distance running coaches.

Characteristics	Distance runners (n = 39)	Distance running coaches (n = 29)
Sex
Female	24 (62%)	6 (21%)
Male	15 (38%)	23 (79%)
Chronological age, years (SD)	17.1 (0.5)	–
Training age, years (SD)	3.4 (1.1)	–
YTP cohort
2019/2021	7 (18%)	5 (17%)
2020/2022	32 (82%)	23 (79%)
Both	–	1 (3%)
Main event
800 m	10 (27%)	–
1500 m	11 (28%)	–
3000 m	11 (28%)	–
5000 m	4 (10%)	–
Steeplechase	3 (8%)	–
Level of sport specialization^a
High	24 (62%)	–
Moderate	13 (33%)	–
Low	2 (5%)	–
Years of coaching experience
1–5 years	–	6 (21%)
6–10 years	–	12 (41%)
11–15 years	–	5 (17%)
>15 years	–	6 (21%)
Number of athletes in training group
1–10 athletes	–	10 (35%)
11–20 athletes	–	10 (35%)
>20 athletes	–	9 (31%)
Number of coached training sessions per week^b
1–2 sessions	–	8 (27%)
3–4 sessions	–	19 (66%)
>4 sessions	–	2 (7%)

n: number; SD: standard deviation; YTP: Youth Talent Programme.

Data are presented as n and %, unless otherwise stated. Due to rounding, not all numbers add up to stated n.

^a Level of sport specialization was calculated according to participant responses to three binary (yes/no) questions related to: (1) whether distance running was their main sport; (2) if they had quit other sports to focus on distance running; and (3) if they train/participate in distance running for more than 8 months a year – aligned to work of Jayanthi et al..

^b Response was related to the number of coached training sessions per week before COVID-19 pandemic.

Table 2. Questions and responses about the current knowledge and behavior of distance runners and coaches in relation to RRI prevention.

Survey question	All (n = 68)	Distance runners (n = 39)	Coaches (n = 29)	Chi-square
How big is the risk of sustaining a RRI to adolescent distance runners? [K]				0.003
High	20 (29%)	6 (15%)	14 (48%)
Moderate	42 (62%)	27 (69%)	15 (52%)
Low	6 (9%)	6 (15%)	0 (0%)
How important do you think it is to try to prevent RRI? [K]				0.304
Very important	61 (88%)	34 (87%)	27 (93%)
Important	4 (6%)	2 (5%)	2 (7%)
Moderately important	3 (4%)	3 (8%)	0 (0%)
Somewhat important	0 (0%)	0 (0%)	0 (0%)
Not important	0 (0%)	0 (0%)	0 (0%)
How would you rate your current knowledge about RRI prevention? [K]				0.046
Excellent	6 (9%)	1 (3%)	5 (17%)
Good	38 (56%)	20 (51%)	18 (62%)
Average	22 (32%)	16 (41%)	6 (21%)
Poor	2 (3%)	2 (5%)	0 (0%)
Very poor	0 (0%)	0 (0%)	0 (0%)
In a normal week, do you currently do anything to try and prevent RRI? [B]				0.427
Yes	61 (90%)	34 (87%)	27 (93%)
No	0 (0%)	0 (0%)	0 (0%)
Sometimes	7 (10%)	5 (13%)	2 (7%)
Don’t know	0 (0%)	0 (0%)	0 (0%)
Have you previously received advice about implementing RRI prevention measures? [B]				0.001
Yes	51 (75%)	35 (90%)	16 (55%)
No	17 (25%)	4 (10%)	13 (45%)
Don’t know	0 (0%)	0 (0%)	0 (0%)

n: number; RRI: running-related injury; [K]: a question related to current knowledge; [B]: a question related to current behavior.

Data are presented as n and %. Due to rounding, not all numbers add up to stated N. The location of any observed differences is explained in ‘Results’ section.

Figure 1. Current understanding of the most common causes of running-related injury for distance runners and coaches. The different causes of running-related injury are shown in order from most (top) to least (bottom) commonly selected by all participants. ‘Other’ causes of running-related injury included: (1) inconsistent training, (2) inappropriate footwear, (3) muscle imbalances, and (4) poor nutrition. Please note that all percentages were rounded. *Chi-squared <0.05.

Figure 2. Types of running-related injuries that distance runners and coaches currently know adolescent distance runners are exposed to (A) and believe are important to prevent (B). In (A), types of running-related injuries are shown in order from ‘most’ (left) to ‘least’ (right) commonly selected by all participants. To enable comparison, this ordering is maintained in (B). ‘Other’ types of running-related injuries included: (1) lower back, (2) spine, (3) bone stress, and (4) all injuries. Note that all percentages were rounded. *Chi-squared <0.05.

Table 3. Types of RRI prevention measures implemented by distance runners and coaches, including weekly frequency.

	Athletes (n = 39)			Coaches (n = 29)
Type of RRI prevention measures	None	1–2 times per week	>2 times per week	None	1–2 times per week	>2 times per week
Use of warm-up	3 (8%)	2 (5%)	34 (87%)	1 (3%)	8 (28%)	20 (71%)
Use of cool-down	3 (8%)	2 (5%)	34 (87%)	3 (10%)	7 (24%)	19 (66%)
Balance and coordination training	14 (36%)	20 (51%)	5 (13%)	6 (21%)	16 (55%)	7 (24%)
Flexibility training	12 (31%)	16 (41%)	11 (28%)	5 (17%)	18 (62%)	6 (20%)
Strength training	3 (8%)	22 (56%)	14 (36%)	6 (21%)	21 (72%)	2 (7%)
Circuit training	7 (18%)	19 (49%)	13 (33%)	5 (17%)	22 (76%)	2 (7%)
Stretching pre-run	7 (18%)	3 (8%)	29 (75%)	14 (48%)	6 (21%)	9 (31%)
Stretching post-run	9 (23%)	2 (5%)	28 (73%)	9 (31%)	5 (17%)	15 (52%)
Running-specific drills	4 (10%)	8 (21%)	27 (69%)	2 (7%)	13 (45%)	14 (48%)
Use of a specific prevention protocol	28 (72%)	6 (15%)	5 (13%)	17 (59%)	7 (24%)	5 (17%)

n: number; RRI: running-related injury.

Data are presented as n and %. Due to rounding, not all numbers add up to stated N.

Figure 3. How distance runners and coaches currently feel about injury prevention measures (A) and think about if developing context-specific injury prevention measures is an important initiative (B). Both (A) and (B) are shown in order from ‘most’ (left) to ‘least’ (right) supportive Likert scale response. Note that all percentages were rounded.

Table 4. Questions and responses from distance runners and coaches about their delivery preferences for RRI prevention measures.

Survey question	All (n = 68)	Distance runners (n = 39)	Coaches (n = 29)	Chi-squared
How would you/your athletes like to receive information about RRI prevention measures?^a
Via a qualified athletics coach	45 (66%)	22 (56%)	23 (79%)	0.048
Via email	30 (44%)	20 (51%)	10 (35%)	0.168
Via England Athletics’ website	29 (43%)	17 (44%)	12 (41%)	0.885
Via a workshop/seminar series	27 (40%)	11 (28%)	16 (55%)	0.025
Via tailored video content	26 (38%)	13 (33%)	13 (45%)	0.335
Via specific (tailored) website	23 (34%)	11 (28%)	12 (41%)	0.256
Via tailored social media posts	22 (32%)	10 (26%)	12 (41%)	0.170
Via a smart phone application	22 (32%)	12 (31%)	10 (35%)	0.105
Via own athletics club website	12 (18%)	4 (10%)	8 (28%)	0.064
Via a series of infographics	10 (15%)	5 (13%)	5 (17%)	0.611
No preference	6 (9%)	3 (8%)	3 (10%)	0.703
Who would you/your athletes like to be delivered information about RRI prevention measures from?^a
Strength and conditioning coach	49 (72%)	25 (64%)	24 (83%)	0.090
Athletics coach	42 (62%)	21 (54%)	21 (72%)	0.119
Physiotherapist/physician	41 (60%)	22 (56%)	19 (66%)	0.448
Professional athlete	32 (47%)	16 (41%)	16 (55%)	0.248
No preference	11 (16%)	9 (23%)	2 (7%)	0.073
Where would you/your athletes like to complete RRI prevention measures?				<0.001
At home	37 (54%)	29 (74%)	8 (28%)
At local athletics club	22 (32%)	10 (26%)	12 (41%)
At school, academy, or college	0 (0%)	0 (0%)	0 (0%)
Otherb	1 (2%)	0 (0%)	1 (3%)
Don’t know	8 (12%)	0 (0%)	8 (28%)
When would you/your athletes like to include RRI prevention measures into a training schedule?				0.041
As part of a training session	30 (44%)	14 (36%)	16 (55%)
At a different time to training	35 (52%)	25 (64%)	10 (35%)
Otherc	2 (3%)	0 (0%)	2 (7%)
Don’t know	1 (2%)	0 (0%)	1 (3%)

n: number; RRI: running-related injury.

Data are presented as n and %. Due to rounding, not all numbers add up to stated N. The location of any observed differences is explained in ‘Results’ section.

^a Participants were able to respond ‘yes’ or ‘no’ (binary choice) to each of the options presented as part of these survey questions. Options are listed according to overall (i.e., ‘All’) preference.

^b Other included ‘at the gym.’

^c Other included a combination of ‘as part of a running training session’ and ‘at a different time to training.’

Data availability statement

Data are available upon reasonable request. Please contact the corresponding author to arrange access to study data.