From awareness to action: behavioral change is associated with functional gains and injury reduction in elite runners-a prospective observational study.

Background: Running-related injuries (RRIs) are a major concern among long-distance athletes. Although body awareness is important for injury prevention, the interplay between awareness, behavioral changes, and functional outcomes has not been fully examined. Objective: To investigate how body awareness and behavioral changes, measured through the Koji Awareness (KA) self-screening system, are associated with injury incidence and functional recovery across a competitive season. Methods: Eighty male collegiate runners from a single collegiate team participated in this study, and 63 runners completed the KA test before and after the season. The incidence of injury was tracked over 6 months. Participants were categorized into groups based on retrospective post-season self-report questionnaires assessing awareness and implementation of behavioral changes. Group differences in KA scores and injury incidence were analyzed using the Fisher's exact test, Student's Results: Among the 63 included athletes, 88.9% reported increased awareness, and 65.1% reported behavioral changes. Awareness alone was not significantly associated with the incidence of RRIs (Not-awareness group: 0%, Awareness group: 12.5%, Conclusion: Although awareness alone was not significantly associated with injury incidence, it was linked to improved function and a greater likelihood of behavioral change. Given the observational design, self-reported measures, and the small number of injury events, these findings should be interpreted cautiously. Nevertheless, when body awareness is accompanied by active behavior modification, it may be relevant to injury-related outcomes. The KA screening test may serve not only as a functional assessment tool but also as a potential framework for self-regulation and resilience in performance.