路跑風潮
隨著跑步的人口增加，跑者據在一起討論的事情不外乎是比賽、成績、配備、運動傷害。在台灣當跑者有著運動傷害時，往往先試著按摩忍痛繼續練習，當疼痛影響到走路時才開始就醫。而台灣醫學對於運動醫學卻相當得漠視，但隨著近年來運動人口的增加，開始有逐漸改善的情況。跑者的型態也開始從just finish，逐漸轉變成追求成績，傳統的練法跟科學化訓練都有不少支持者，但不變的是受傷的比例還是一樣的居高不下。Garmin、Nike、美津濃等廠商都有在辦馬拉松訓練營，有著專業的教練，比一般跑者更多的資源，但是受傷的人數絲毫沒有減少的狀況。每個訓練營不同的教練有不同的說法，但證據或許更能客觀的描述受傷這件事情。
常見的運動傷害及成因
跑者常見的運動傷害包含：足底筋膜炎、骼脛束摩擦綜合症、髕骨股骨症候群、脛前疼痛、疲勞性骨折、各種肌群拉傷等等。多數的運動傷害並不需要開刀治療，發生運動傷害的比例落在20-80%，隨著跑者的年資增加，產生運動傷害的比率有下降的趨勢。根據一個將近3000個跑者的研究，運動傷害容易發生在男性、一週跑6天以上、週跑量超過30mile的跑者身上。除了少數的研究把受傷的特定原因單獨挑出來，大多數的研究認為受傷是多方原因造成的。少數特定原因包含之前有受傷的病史、沒有完整的復健治療、沒有找到受傷的原因、過高的跑量、肥胖等。各種多重加重因素包含個人的身體素質及外在的配備和訓練方式。
個人身體上的狀況常常被認為是導致受傷的原因，像是Ｏ型腿、 高足公低足弓等等，但是研究發現，這都找不到跟受傷明顯的關聯。但是如果肢體上有所不平衡（如長短腿），確實有可能會造成受傷。
性別在不同研究上有不同的發現，但總歸一句無法用性別來當作受傷的風險因子。年紀被認為是跑步受傷的原因，跟一般人想的不一樣，越年輕受傷的機會是增加的，當超過40歲後風險反而降低，但是這可能是當跑者在40歲以前受傷就會退出跑場，不再被列入統計，40歲以上的這些跑者反而是選擇性偏誤後剩下的一群。
當個人的身體似乎不是造成受傷的主因後，接著就要探討訓練的方式。當週跑量超過65公里後，被認為會增加受傷的機會，一些書上都會提到的，週跑量不要一週增加超過10%，要不然可能會增加受傷的風險，但在一些對於剛剛從是跑步訓練的跑者的研究上，發現這樣的法則得不到證據的支持（有經驗的跑者？），但是還是建議逐漸增加跑量而非突然大量增加跑量。
突然改變訓練的量跟方式，也是造成受傷的原因之一。而定期從事間歇跑被認為是可以預防膝蓋受傷。拉筋暖身被一般跑者是為避免受傷的一個重要儀式，但是找不到支持這樣做法的證據，但這可能牽涉到實驗設計的困難，拉筋暖身的方式太多樣化，無法好好設計怎樣的暖身是否可以避免受傷。
足測、跑鞋能降低受傷風險?
近幾年很流行的足測，廠商針對個人的腳型，跑步姿態去選購合適的跑鞋，結果許多臨床實驗發現這並無法降低受傷的風險。至於多久應該要換鞋呢，一般市售的跑鞋約在400-800公里的跑量後就會喪失一半以上的吸震能力，因此建議500-800公里就應該要把跑鞋給替換掉。
shoe drop(鞋跟到鞋底的落差，一般競速鞋大多為低落差6mm左右，強調高避震性的跑鞋通常超過10mm)，再給跑者穿上0，6，10mm shoe drop的鞋後，發現10mm的組別，受傷風險明顯降低（Nike vaporfly 4%，adidas adios的競速鞋款剛好都是10mm)。
赤足或是極度薄底跑鞋（陸王？vibram)研究的樣本數量還是太少，但是初步認為使用這樣的穿著方式，會使步幅減少、中足或前足著地，初步認為可能可以降低受傷的風險。
延伸閱讀
Anatomy for Runners 跑者解剖學 (一)
Anatomy for Runners 跑者解剖學 (二)
參考文獻
1. Fields KB, Sykes JC, Walker KM, Jackson JC. Prevention of running injuries. Curr Sports Med Rep 2010; 9:176.
2. van Gent RN, Siem D, van Middelkoop M, et al. Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. Br J Sports Med 2007; 41:469.
3. Wen DY. Risk factors for overuse injuries in runners. Curr Sports Med Rep 2007; 6:307.
4. Taunton JE, Ryan MB, Clement DB, et al. A retrospective case-control analysis of 2002 running injuries. Br J Sports Med 2002; 36:95.
5. Junior LC, Carvalho AC, Costa LO, Lopes AD. The prevalence of musculoskeletal injuries in runners: a systematic review. Br J Sports Med 2011; 45:351.
6. McKean KA, Manson NA, Stanish WD. Musculoskeletal injury in the masters runners. Clin J Sport Med 2006; 16:149.
7. Wright AA, Taylor JB, Ford KR, et al. Risk factors associated with lower extremity stress fractures in runners: a systematic review with meta-analysis. Br J Sports Med 2015; 49:1517.
8. Bovens AM, Janssen GM, Vermeer HG, et al. Occurrence of running injuries in adults following a supervised training program. Int J Sports Med 1989; 10 Suppl 3:S186.
9. Theisen D, Malisoux L, Genin J, et al. Influence of midsole hardness of standard cushioned shoes on running-related injury risk. Br J Sports Med 2014; 48:371.
10. Vincent HK, Vincent KR. Considerations for initiating and progressing running programs in obese individuals. PM R 2013; 5:513.
11. Reinking MF, Hayes AM. Intrinsic factors associated with exercise-related leg pain in collegiate cross-country runners. Clin J Sport Med 2006; 16:10.
12. Reinking MF, Austin TM, Hayes AM. Exercise-related leg pain in collegiate cross-country athletes: extrinsic and intrinsic risk factors. J Orthop Sports Phys Ther 2007; 37:670.
13. Cowan DN, Jones BH, Robinson JR. Foot morphologic characteristics and risk of exercise-related injury. Arch Fam Med 1993; 2:773.
14. Taunton JE, Ryan MB, Clement DB, et al. A prospective study of running injuries: the Vancouver Sun Run "In Training" clinics. Br J Sports Med 2003; 37:239.
15. Buist I, Bredeweg SW, Lemmink KA, et al. Predictors of running-related injuries in novice runners enrolled in a systematic training program: a prospective cohort study. Am J Sports Med 2010; 38:273.
16. Rauh MJ, Margherita AJ, Rice SG, et al. High school cross country running injuries: a longitudinal study. Clin J Sport Med 2000; 10:110.
17. Nigg BM, Baltich J, Hoerzer S, Enders H. Running shoes and running injuries: mythbusting and a proposal for two new paradigms: 'preferred movement path' and 'comfort filter'. Br J Sports Med 2015; 49:1290.
18. Ryan M, MacLean C, Taunton JE. A review of anthropometric, biomechanical, neuromuscular and training related factors associated with injury in runners. Int J Sports Med 2006; 7:120.
19. Buist I, Bredeweg SW, van Mechelen W, et al. No effect of a graded training program on the number of running-related injuries in novice runners: a randomized controlled trial. Am J Sports Med 2008; 36:33.
20. Van Middelkoop M, Kolkman J, Van Ochten J, et al. Risk factors for lower extremity injuries among male marathon runners. Scand J Med Sci Sports 2008; 18:691.
21. Thacker SB, Gilchrist J, Stroup DF, Kimsey CD Jr. The impact of stretching on sports injury risk: a systematic review of the literature. Med Sci Sports Exerc 2004; 36:371.
22. Yeung SS, Yeung EW, Gillespie LD. Interventions for preventing lower limb soft-tissue running injuries. Cochrane Database Syst Rev 2011; :CD001256.
23. van Mechelen W, Hlobil H, Kemper HC, et al. Prevention of running injuries by warm-up, cool-down, and stretching exercises. Am J Sports Med 1993; 21:711.
24. Reinschmidt C, Nigg BM. Current issues in the design of running and court shoes. Sportverletz Sportschaden 2000; 14:71.
25. Nigg, Benno. Biomechanics of Sports Shoes, University of Calgary, 2011.
26. Knapik JJ, Trone DW, Swedler DI, et al. Injury reduction effectiveness of assigning running shoes based on plantar shape in Marine Corps basic training. Am J Sports Med 2010; 38:1759.
27. Knapik JJ, Brosch LC, Venuto M, et al. Effect on injuries of assigning shoes based on foot shape in air force basic training. Am J Prev Med 2010; 38:S197.
28. Richards CE, Magin PJ, Callister R. Is your prescription of distance running shoes evidence-based? Br J Sports Med 2009; 43:159.
29. Wegener C, Burns J, Penkala S. Effect of neutral-cushioned running shoes on plantar pressure loading and comfort in athletes with cavus feet: a crossover randomized controlled trial. Am J Sports Med 2008; 36:2139.
30. Malisoux L, Chambon N, Delattre N, et al. Injury risk in runners using standard or motion control shoes: a randomised controlled trial with participant and assessor blinding. Br J Sports Med 2016; 50:481.
31. Cook SD, Kester MA, Brunet ME. Shock absorption characteristics of running shoes. Am J Sports Med 1985; 13:248.
32. Malisoux L, Chambon N, Urhausen A, Theisen D. Influence of the Heel-to-Toe Drop of Standard Cushioned Running Shoes on Injury Risk in Leisure-Time Runners: A Randomized Controlled Trial With 6-Month Follow-up. Am J Sports Med 2016; 44:2933.
