Running-related injuries can take a toll on your pocket as well as your body. We look at a Dutch study examining the economic burden of RRIs


There is no denying the popularity of running. For example, one 2008 study estimated that about 6% of the population of England runs at least once a week. A measure of this popularity is the rise of organised running programmes which aim to increase the participation of novice, non-elite runners and to prevent, or reduce, running related injuries (RRIs), which are proportionally higher among inexperienced runners.

Despite physical activity being associated with reduced mortality and disability, RRIs remain a potential downside of running, with possible outcomes including acute injury, chronic injury and even time off work. But what is the economic burden associated with RRIs?

This question was addressed by the authors of a Dutch study that investigated the ‘Health and economic burden of running-related injuries in runners training for an event: A prospective cohort study.’ The study took place following running clinics set up at the Tilburg Ten Miles (TTM) running events in Tilburg, the Netherlands, in 2014 53 runners (22 male, 31 female) participated in supervised training sessions lasting 1.5 hours from April 2014 to September 2014, and also undertook unsupervised training sessions.

Runners completed online, in-depth questionnaires, which included providing details of RRIs, healthcare usage and time off work. There was an 18-week follow-up period.

The results showed that:

  • The cumulative hours of running exposure were 1,215 (1,138 hours training, 77 hours racing) from a total of 1,204 running sessions.
  • Each participant attended an average of two sessions per week.
  • 32 participants reported 41 RRIs.
  • The most commonly reported RRIs were Achilles tendon injury and knee pain, and a total of 35 overuse injuries (85.4%) was reported by 29 participants.

As far as the economic burden was concerned:

  • There were 38 physio consultations, five medical specialist consultations and four GP consultations
  • There were 13 missing days from paid work.
  • A total cost of £4,058 (based on €1 = 73p) was calculated for 32 RRIs reported by 25 participants during the 18 week follow-up period, with £2,704 due to indirect costs, such as absenteeism from work, and £1,304 due to direct costs such as healthcare consultations.
  • The mean cost per RRI was £127.
  • Overall and direct costs were significantly higher for males than females.

Writing in the Scandinavian Journal of Medicine & Science in Sports, the authors note that theirs is the first report of the direct and indirect costs of RRIs among runners in an organised training programme. It is clear that the health benefits conferred by running, both on individuals and society, outweigh the economic burden of RRIs. However, the researchers point out that given the high popularity of running events and the high number of runners participating in organised training programmes, “Absolute societal costs of RRIs on the short term can be considered a matter of concern for public health; costs that can be prevented by implementing preventive advices [sic] and programs.”

The fact that the indirect costs of RRIs through absenteeism were two-fold higher than the direct costs of seeking treatment supports the findings of other studies of the costs of sports injuries in other populations. It appears that the main contributor to the economic burden resulting from RRIs is not directly accessing healthcare professionals for treatment; rather it is lost productivity which delivers the main impact on society.

The results of this study represent a significant public health challenge, and one way that it might be usefully addressed would be to focus more resources on ways and means to prevent the development of RRIs – perhaps through running education programmes – among inexperienced runners, many of whom are males.