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Approximately 1% of Americans run on an average day, nearly twice as many as those who golf or cycle.1 Running is an excellent form of exercise; even at a slow pace, it is matched in metabolic equivalents only by vigorous swimming or cycling.2,3 However, injuries are common among runners (Table 1).4 A systematic review showed a one-year injury rate of 27% in novice runners, 32% in long distance runners, and 52% in marathon runners.5 The lower prevalence for novice runners seems to be secondary to less running time. Another systematic review found that novice runners were injured twice as often as recreational runners.6
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | References |
|---|---|---|
| Eccentric exercises are primary therapy for patellar and Achilles tendinopathies. | A | 11, 12, 14, 15 |
| Exercise therapy for patellofemoral pain should consist of core and leg strengthening as well as leg flexibility exercises. | A | 23 |
| Exercise therapy for iliotibial band syndrome should consist of hip abductor strengthening and hamstring and iliotibial band stretching. | B | 29 |
| Functional bracing while running should be continued for six to 12 months after an ankle sprain to improve stability and prevent recurrence. | A | 37 |
| Foot orthoses are beneficial for plantar fasciopathy (plantar fasciitis). There is no evidence that custom orthoses are superior to commercially available products. | A | 46, 47 |
| Eccentric exercises should be considered for treatment of hamstring tendinopathy. | C | 18, 54 |
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.
BEST PRACTICES IN ORTHOPEDICS
Recommendations from the Choosing Wisely Campaign
| Recommendation | Sponsoring organization |
|---|---|
| Do not routinely order radiography for diagnosis of plantar fasciitis/heel pain in employees who stand or walk at work. | American College of Occupational and Environmental Medicine |
| Avoid ordering knee magnetic resonance imaging for a patient with anterior knee pain without mechanical symptoms or effusion unless the patient has not improved following completion of an appropriate functional rehabilitation program. | American Medical Society for Sports Medicine |
| Do not perform surgery for plantar fasciitis before trying six months of nonoperative care. | American Orthopaedic Foot and Ankle Society |
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