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Incidence, risk factors and prevention of running related injuries in long-distance running: a systematic review Injury, location and type
Abstract and Figures
Until today, no systematic review exists on the epidemiology, etiology and prevention of tunning related injuries, in which a distinction is made between each running level. The purpose of this study was to perform a systematic review using three electronic databases. Data were pooled to become overall injury incidences and injury localizations. Injury incidence varies between 0.1 % and 2.6% (p<0.05). Most common injuries sustained by long-distance runners were found to be Achillestendinopathy, lliotibial Friction Syndrome (ITBS) and Medial Tibial Stress Syndrome (MTSS). Most common risk factors are age, running history and injury history. The only significant measure for runners was the use of orthoses in the prevention of MTSS and stress fracturés. Most of thé suggested preventing strategies in running lack convincing evidence of (non) randomized clinical trials or have hot yet been investigated. Therefore, suggestions for prevention and future research were made.
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... Previous studies, including systematic reviews, have largely focused on the epidemiology of road running-related injury (RRI) outcomes [5,10,[14][15][16][17][18]. The application of these results to trail running seems problematic due to the nature of trail running that requires a specific endurance effort affected by large elevation gains/losses, environmental conditions, altitude, distance covered, and uneven surfaces [19]. ...
... The lower leg as injury site was reported among four studies [21,24,36,37]. The ankle was noted as a common injury site among trail runners [8,18,21,41]. Scheer and Murray [21] reported the ankle as the second most commonly injured site, with acute ankle inversion sprains accounting for 83.3% of ankle injuries. Similar results were found by Vernillo et al. (28.6%) and González-Lázaro et al. (32%) who reported the ankle as the most commonly injured site among trail runners that participate in mountainous terrains [8,41]. ...
... Race participation studies Abrasions, lacerations and skin wounds occurred in five studies [8,18,19,21,31] while blisters and chafing were reported in three studies [18,21,31]. Two of the studies reported exclusively on dermatological injuries [35,36], with 100% of participants in the Graham et al. [36] study having blisters and abrasions. ...
Background
Trail running (TR) is characterised by uneven varying running surfaces, with large elevation gains/losses. Therefore, the injury and illness profiles of TR may differ compared to road running. Limited information is available on injury and illness among trail runners (TRs) to help develop interventions towards injury prevention.
Objective
Systematically review data on TR injury and illness.
Design
Systematic review.
Setting
MEDLINE Ovid, PubMed, Scopus, SportsDiscus, CINAHL, Health Source: Nursing/Academic, Health Source: Consumer Ed. and Cochrane were searched from inception to February 2019. Methodological quality was assessed using an adapted Downs and Black assessment tool.
Patients (or Participants)
N/A (systematic review abstract).
Interventions (or Assessment of Risk Factors)
Studies were included if they investigated injury and/or illness among TRs participating in training/racing and full-text available in English/French. Studies were excluded on biomarkers of injury/illness in the absence of participants reporting injury/illness, or if no clear evidence was found of investigating TR.
Main Outcome Measurements
TR injury (incidence, prevalence, anatomical site, tissue type, specific diagnosis, severity) and illness (incidence, prevalence, symptoms, specific diagnosis, body system, severity).
Results
Fourteen studies with 3094 participants were included. Six studies investigated injuries and illnesses, 3 studies investigated only injuries and 5 studies only illnesses. Twelve studies investigated race-related injury and/or illness and 2 studies included training-related injuries. Different study designs, injury and illness definitions, race distances, and surfaces, made pooling of results difficult. The foot, knee, ankle and thigh are the most common anatomical sites of TR injury, with lacerations/abrasions, blisters, muscle strains, cramping and ankle sprains most commonly diagnosed. TR illness involved the gastrointestinal tract (GIT), metabolic and cardiovascular body systems. Symptoms of nausea and vomiting related to GIT distress and dehydration are commonly reported.
Conclusions
Injury and illness are common among TRs participating in TR races. Limited evidence is available on training-related injury and illness in TR specific.
... The predominant injury region was the knee (30%). Iliotibial band syndrome, Achilles tendonitis and tibial stress syndrome were among the most common injuries reported by endurance runners (Tonoli et al. [7] ). Mbarak et al . ...
... Ellapen et al. dealt with 200 half marathon runners and classified an 'injury' as an incident that caused more than 24 hours of time lost, thus explaining the variation between the two studies. According to Tonoli et al. [7] experienced runners tend to incur fewer injuries because there is the development of an innate ability to recognise the onset of an injury thus preventing its severity compared to novice runners. This concurs with the result in Table 1 that the majority of the endurance runners (n=84; 50%) had professional running experience of between one to three years. ...
... Large amounts of high-intensity running, rapid increase in training mileage and/or variation of running surfaces seen among the runners could possibly be an injury risk for ankle injuries, specifically if running on a hard surface. [8] These findings were slightly higher than those of Tonoli et al. [7] who found the prevalence rate of ankle injury among marathoners to be 25%. However, the ankle injury prevalence in this study was much higher than the 17 % prevalence rate reported by Small and Relph [5] among multiday marathoners. ...
Background: Injuries related to endurance running have attracted attention as the sport has become more competitive, and as athletes seek to improve their performance. Consequently, endurance runners are increasingly becoming more susceptible to lower extremity running injuries. Objectives: The aim of this study was to establish the prevalence of running-related injuries among professional endurance runners in the Rift Valley, Kenya. Methods: We used a cross-sectional survey design targeting professional endurance runners who had participated in both local and international running competitions. The sample size consisted of 209 respondents selected through stratified and simple random sampling techniques, of which 167 participated in the study. A self-administered questionnaire was used to collect data on the prevalence of injuries among the endurance runners. The data were analysed using descriptive statistics. Results: The prevalence of running injuries was 63% (n=106). The prevalence among males (n=64; 69%) was higher in comparison with that of females (n=42; 57%). The posterior thigh was the most common site for injuries among the athletes (n=87; 52%), followed by the lower back (n=78; 47%) and ankle (n=63; 38%). Conclusion: The prevalence of running-related injuries was high among professional Kenyan endurance runners compared to other populations. These findings therefore form the basis of future research to explore the mechanisms behind the injuries and the feasibility of targeted injury prevention programmes.
... Previous studies, including systematic reviews, have largely focused on the epidemiology of road running-related injury (RRI) outcomes [5,10,[14][15][16][17][18]. The application of these results to trail running seems problematic due to the nature of trail running that requires a specific endurance effort affected by large elevation gains/losses, environmental conditions, altitude, distance covered, and uneven surfaces [19]. ...
... The lower leg as injury site was reported among four studies [21,24,36,37]. The ankle was noted as a common injury site among trail runners [8,18,21,41]. Scheer and Murray [21] reported the ankle as the second most commonly injured site, with acute ankle inversion sprains accounting for 83.3% of ankle injuries. Similar results were found by Vernillo et al. (28.6%) and González-Lázaro et al. (32%) who reported the ankle as the most commonly injured site among trail runners that participate in mountainous terrains [8,41]. ...
... Race participation studies Abrasions, lacerations and skin wounds occurred in five studies [8,18,19,21,31] while blisters and chafing were reported in three studies [18,21,31]. Two of the studies reported exclusively on dermatological injuries [35,36], with 100% of participants in the Graham et al. [36] study having blisters and abrasions. ...
Background
Trail running is characterised by large elevation gains/losses and uneven varying running surfaces. Limited information is available on injury and illness among trail runners to help guide injury and illness prevention strategies.Objective
The primary aim of this review was to describe the epidemiology of injury and illness among trail runners.Methods
Eight electronic databases were systematically searched (MEDLINE Ovid, PubMed, Scopus, SportsDiscus, CINAHL, Health Source: Nursing/Academic, Health Source: Consumer Ed., and Cochrane) from inception to November 2020. The search was conducted according to the PRISMA statement and the study was registered on PROSPERO international prospective register of systematic reviews (CRD42019135933). Full-text English and French studies that investigated injury and/or illness among trail runners participating in training/racing were included. The main outcome measurements included: trail running injury (incidence, prevalence, anatomical site, tissue type, pathology-type/specific diagnosis, severity), and illness (incidence, prevalence, symptoms, specific diagnosis, organ system, severity). The methodological quality of the included studies was assessed using an adapted Downs and Black assessment tool.ResultsSixteen studies with 8644 participants were included. Thirteen studies investigated race-related injury and/or illness and three studies included training-related injuries. The overall incidence range was 1.6–4285.0 injuries per 1000 h of running and 65.0–6676.6 illnesses per 1000 h of running. The foot was the most common anatomical site of trail running injury followed by the knee, lower leg, thigh, and ankle. Skin lacerations/abrasions were the most common injury diagnoses followed by skin blisters, muscle strains, muscle cramping, and ligament sprains. The most common trail running illnesses reported related to the gastro-intestinal tract (GIT), followed by the metabolic, and cardiovascular systems. Symptoms of nausea and vomiting related to GIT distress and dehydration were commonly reported.Conclusion
Current trail running literature consists mainly of injury and illness outcomes specifically in relation to single-day race participation events. Limited evidence is available on training-related injury and illness in trail running. Our review showed that injury and illness are common among trail runners, but certain studies included in this review only focused on dermatological injuries (e.g. large number of feet blisters) and GIT symptoms. Specific areas for future research were identified that could improve the management of trail running injury and illness.
... Chronic, non-healing tendon injuries frequently require surgical treatment, and despite recent advancements in orthopedic surgery, many common tendon repair techniques yield less than optimal results [3][4][5]. Moreover, healed tendons tend to form scar tissue with different mechanical properties than healthy tendons and are prone to reinjury. ...
... Acute injuries involve a sudden external disruption of originally healthy tendon. Although such injuries often heal with acceptable recovery of function, the preinjury state is rarely fully restored after healing [5,32]. Tendon ruptures may also occur spontaneously during daily living activities, but in these cases, those are attributable to underlying accumulated tissue damage associated with degenerative tissue remodeling processes. ...
The tendon is a highly aligned connective tissue that transmits force from muscle to bone. Each year, more than 32 million tendon injuries have been reported, in fact, tendinopathies represent at least 50% of all sports injuries, and their incidence rates have increased in recent decades due to the aging population. Current clinical grafts used in tendon treatment are subject to several restrictions and there is a significant demand for alternative engineered tissue. For this reason, innovative strategies need to be explored. Tendon replacement and regeneration are complex since scaffolds need to guarantee an adequate hierarchical structured morphology and mechanical properties to stand the load. Moreover, to guide cell proliferation and growth, scaffolds should provide a fibrous network that mimics the collagen arrangement of the extracellular matrix in the tendons. This review focuses on tendon repair and regeneration. Particular attention has been devoted to the innovative approaches in tissue engineering. Advanced manufacturing techniques, such as electrospinning, soft lithography, and three-dimensional (3D) printing, have been described. Furthermore, biological augmentation has been considered, as an emerging strategy with great therapeutic potential.
... Wearable devices allow running monitoring, but applications for assessing training loads, biomechanics, return-to-running programs, and gait rehabilitation are still debated [41]. Lack of orientation for the development of activity, physical characteristics and overuse can lead to harmful patterns with biomechanical changes during running practice [42]. There are still questions to be answered to confirm the reliability of the devices, such as the type of circuits, location, activity execution speed, capture frequency, among others [43]. ...
It is accepted that running must be rehabilitated at low speeds, and for this it is necessary to objectively evaluate used devices.
This study aimed to know the reliability of an inertial motion sensor at low speeds career. Materials: IMU Runscribe plus 3 was
used in a test-retest in healthy subjects in which % CV, SEM, ICC y Bland Altman plots were evaluated at speeds of 5 and 8 km/h.
Results: Kinetic variables (Shock, impact and Braking) and Kinematics (Pronation excution and Pronation velocity) presented greater
reliability at 8 km/h . Conclusion: It is possible to use this device to reeducate running at a low speeds.
... Specifically, subtalar pronation promotes internal rotation of the tibia through joint coupling with the foot, which in turn was thought to place greater stress at the tibiofemoral and/or patellofemoral joints (Hintermann and Nigg, 1998). Since most of the injuries in recreational runners were-and still are-at the knee (van Gent et al., 2007;Tonoli et al., 2010), using footwear to prevent increased knee joint stress was a logical method to reduce knee pain and injury Liao et al., 2018). ...
Many runners seek health professional advice regarding footwear recommendations to reduce injury risk. Unfortunately, many clinicians, as well as runners, have ideas about how to select running footwear that are not scientifically supported. This is likely because much of the research on running footwear has not been highly accessible outside of the technical footwear research circle. Therefore, the purpose of this narrative review is to update clinical readers on the state of the science for assessing runners and recommending running footwear that facilitate the goals of the runner. We begin with a review of basic footwear construction and the features thought to influence biomechanics relevant to the running medicine practitioner. Subsequently, we review the four main paradigms that have driven footwear design and recommendation with respect to injury risk reduction: Pronation Control, Impact Force Modification, Habitual Joint (Motion) Path, and Comfort Filter. We find that evidence in support of any paradigm is generally limited. In the absence of a clearly supported paradigm, we propose that in general clinicians should recommend footwear that is lightweight, comfortable, and has minimal pronation control technology. We further encourage clinicians to arm themselves with the basic understanding of the known effects of specific footwear features on biomechanics in order to better recommend footwear on a patient-by-patient basis.
... One advantage is that the risk of injury for the participant is lower. For example, novice runners have the highest proportion of injury in comparison with more experienced runners [87][88][89]. Additionally, trained participants may provide more consistent data as they require fewer familiarisation sessions prior to testing to decrease possible learning effects and to achieve a higher level of reproducibility [90]. ...
Background
Carbohydrates are an important fuel for optimal exercise performance during moderate- and high-intensity exercise; however, carbohydrate ingestion during high-intensity exercise may cause gastrointestinal upset. A carbohydrate oral rinse is an alternative method to improve exercise performance in moderate- to high-intensity exercise with a duration of 30–75 min. This is the first systematic review and meta-analysis to comprehensively examine the isolated effect of maltodextrin-based rinsing on exercise performance.
Objective
The objective of this review was to establish the effect of a maltodextrin-based carbohydrate oral rinse on exercise performance across various modes of exercise. Furthermore, a secondary objective was to determine the effects of moderators [(1) participant characteristics; (2) oral rinse protocols; (3) exercise protocol (i.e. cycling, running etc.) and (4) fasting] on exercise performance while using a maltodextrin-based, carbohydrate oral rinse.
Methods
Five databases (MEDLINE, PsycINFO, Embase, SPORTDiscus and Global Health) were systematically searched for articles up to March 2021 and screened using Covidence (a systematic review management tool). A random effects robust meta-analysis and subgroup analyses were performed using Stata Statistical Software: Release 16.
Results
Thirty-five articles met the inclusion criteria and were included in the systematic review; 34 of these articles were included in the meta-analysis. When using a conventional meta-analytic approach, overall, a carbohydrate oral rinse improved exercise performance in comparison with a placebo (SMD = 0.15, 95% CI 0.04, 0.27; p = 0.01). Furthermore, when implementing an adjusted, conservative, random effects meta-regression model using robust variance estimation, overall, compared with placebo, a carbohydrate oral rinse demonstrated evidence of improving exercise performance with a small effect size (SMD = 0.17, 95% CI − 0.01, 0.34; p = 0.051).
Conclusion
This systematic review and meta-analysis demonstrates that a maltodextrin-based carbohydrate oral rinse can improve exercise performance. When comparing the two meta-analytic approaches, although non-significant, the more robust, adjusted, random effects meta-regression model demonstrated some evidence of a maltodextrin-based carbohydrate oral rinse improving exercise performance overall.
... A review on injury rates in long distance runners, for instance, established that novice runners have a higher injury rate (2.56 injuries/1000 hours; 95% CI 2.55 to 2.60) than recreational runners (2.06 injuries/1000 hours; 95% CI 1.70 to 1.90), who, in turn, have a higher injury rate than competitive runners (1.55 injuries/1000 hours; 95% CI 1.54 to 1.56). 7 Similar differences have been found for children 8 and soccer. 9 With the contemporary focus on physical activity promotion, 1 2 more physical activity and sport participants can be expected, and, thus, the number of novice participants will logically increase. ...
Objectives
To evaluate whether in fitness-related activities and recreational running over time, there is an increase in the number of novice sports athletes and whether these novice athletes have an increased injury rate compared with their experienced counterparts.
Methods
Data were collected from a large population-based retrospective cross-sectional study, ‘Injuries and Physical Activity in the Netherlands’ (IPAN). Athletes aged ≥18 years were included. We used descriptive statistics to describe the characteristics of athletes and their injuries. The number of athletes and injuries were calculated for each year and, where applicable, for each sport separately. The injury incidence rate was expressed as the number of injuries per 1000 hours of exposure. Logistic regression analyses were performed with non-extrapolated data to analyse the differences in injury risk for novice and experienced athletes included in this study, separate for fitness-related activities and running.
Results
Over the 5 years, 9209 fitness athletes reported 370 fitness-related injuries, 5426 runners reported 537 running-related injuries. Weighted data showed that, in 2010–2014, the inflow of novice fitness athletes slightly decreased, whereas the inflow of novice runners slightly increased. In each year, injury risk was higher in novice athletes compared with experienced athletes for both fitness-related activities and running. The injury incidence rates in running are much higher than in fitness-related activities.
Conclusions
Over the years 2010–2014, the absolute number of novice athletes in fitness-related activities and running together increased. Although most injuries occurred in experienced athletes, injury risk was higher in novice athletes in both sports.
... Of all populations, novice runners experience a high rate of injury. Novice runner's injury rate was higher compared to recreational, competitive, or marathon runners [11]. It is important to focus on injury prevention among novice runners. ...
Purpose. Examining and understanding the biomechanics of novice runners and experienced runners can further improve our knowledge within the field of running mechanics and running injuries. The purpose of this study was to classify the differences in lower limb biomechanics during a 3.3 m/s running task among both experienced runners and novice runners. Method. Twenty-four participants (12 experienced runners and 12 novice runners) ran at 3.3 m/s across a force plate; kinematics and kinetics data were collected by the Vicon motion system and Kistler force plate. Group comparisons were made using an independent samples -test to identify differences in the impact peak, loading rate, contact time, ankle, knee, and hip joint kinematics and kinetics during the stance phase. Results. No significant differences were observed between novice and experienced runners for both ankle and knee joint kinetics except that the ankle joint plantar flexion torque was significantly greater in the novice runners. However, the plantar flexion, dorsiflexion, range of motion (ROM), plantar flexion torque, and max angular velocity of ankle joint significantly increased in novice runners than inexperienced runners. Additionally, the flexion angle and range of motion of the hip joint were observed to be larger in the novice runners. Moreover, the maximum extension torque and the maximum extension power in the hip joint were significantly increased in the experienced runners. There were no significant differences in the first peak, contact time, and average vertical loading rate. Novice runners showed a larger vertical instantaneous loading rate than experienced runners. Conclusion. These preliminary findings indicate that novice runners are prone to running injuries in comparison to experienced runners. Novice runners showed larger kinematics and kinetic parameters in the joint of the ankle and hip. Novice runners should enhance muscle strength in the hip and choose scientific training methods.
1. Introduction
Running is one of the most popular recreational physical activities in the world. Regular running helps prevent the incidence of chronic diseases, such as cardiovascular disease and obesity [1, 2]. Because of easy accessibility, many people prefer participating in long-distance running which can increase cardiopulmonary function and relieve psychological stress [3]. Unfortunately, excessive running can trigger running-related injuries and musculoskeletal injuries to develop [4, 5]. Running injuries are mainly lower limb injuries, primarily knee joint injuries, especially in the front of the knee (such as patellofemoral joint pain) [6–8]. Other common injuries include strains of the tibia, Achilles tendon, gastrocnemius, foot, and thigh muscles [4].
A previous study has shown that the risks of overuse running injury were increased from 20% to 70% in recreational and competitive distance runners [9]. Videbæk et al. have demonstrated the incidence of injury per 1000 hours of running, in which the rate of injury was 17.8% of novice runners compared to recreational runners (7.7%) and ultramarathon runners (7.2%) [10]. Of all populations, novice runners experience a high rate of injury. Novice runner’s injury rate was higher compared to recreational, competitive, or marathon runners [11]. It is important to focus on injury prevention among novice runners. Nevertheless, there are few research recommendations for novice runners who desire to begin running training. There are many reasons which can cause running injuries, such as error training, the difference in running surface, different running habits, and running shoes [12, 13]. Although scientific researchers and clinical staff have been working hard to help runners reduce running-related injuries, the incidence of injuries has remained high for many years [14].
Epidemiological studies have found that overuse injuries were associated with kinematic variables of lower limb joints: the increased hip interrotation and hip adduction [13, 15]. Novacheck also found that the increased eversion angle velocity and ankle eversion angle might trigger the development of overuse injuries (Sallis et al., 1992). Running-related injuries were associated with ground reaction force, specifically increased vertical loading rate and vertical instantaneous loading rate, and the first peak caused the tibial stress fractures [16].
Running-related injuries especially in the knee joint have the characteristics of the frequent occurrence in people without running experience [17, 18]. Psychological fear of running-related injuries makes it difficult for nonrunning habit groups to form running habits [19], which hinders the widespread development of running.
Thus, several studies show a biomechanical difference between novice and experienced runners. Schmitz et al. found that there were no significant differences in impact peak, loading rate, peak nonsagittal hip kinematics, or strength among the novice runners and competitive runners. However, novice runners showed larger peak hip internal rotation and a decrease in trunk side-plank endurance [20]. When novice runners and competitive runners ran in a state of fatigue, novice runners showed larger hip abduction and peak trunk lean during midswing [21]. Van Mechelen proposed that about 50% to 75% of sports injuries may be due to overuse injuries caused by the repeated repetition of the same action. Factors related to running injuries include a history of previous sports injuries, a lack of running experience, participation in running competitions, and running long distances per week [22]. Moreover, the effect of running experience on the kinematics and kinetic energy of the lower limb remains unclear. Thus, the purpose of this study was to determine the effect of running experienced on lower limb biomechanical changes during the stance phase at 3.3 m/s among both experienced runners and novice runners. The hypotheses were that the novice runners’ group would show higher changes in kinematics and kinetics when compared with experienced runners.
2. Methods
2.1. Participants
Two populations were recruited using flyers around the society and university: experienced runners and novice runners. The experienced runners consisted of 12 males that had been running at least 20 miles per week and the running experience was more than 5 years. The novice runner consisted of 12 males who ran 2 or 5 miles per week. A novice runner was defined as an individual having no former experience in running and never taken part in a running competition. All information about the 24 endurance runners is given in Table 1. Only subjects having the target foot length of US size 9 (±0.5) and self-reported as right leg dominant (defined as the preferred kicking leg) were included. Exclusion criteria consisted of any spinal or lower extremity surgery or any knee ligament or cartilage pathology in the past year. For this test, all the participants were rearfoot strikers (RFS) [23]. Written informed consent was obtained from the subjects, and the testing procedures were approved by Ningbo University.
Characteristic
Experienced
Novice
Age (years)
Weight (kg)
Height (cm)
BMI (kg/m²)
Running experience (years)
Background:
Lower-limb running injuries are common. Running shoes have been proposed as one means of reducing injury risk. However, there is uncertainty as to how effective running shoes are for the prevention of injury. It is also unclear how the effects of different characteristics of running shoes prevent injury.
Objectives:
To assess the effects (benefits and harms) of running shoes for preventing lower-limb running injuries in adult runners.
Search methods:
We searched the following databases: CENTRAL, MEDLINE, Embase, AMED, CINAHL Plus and SPORTDiscus plus trial registers WHO ICTRP and ClinicalTrials.gov. We also searched additional sources for published and unpublished trials. The date of the search was June 2021.
Selection criteria:
We included randomised controlled trials (RCTs) and quasi-RCTs involving runners or military personnel in basic training that either compared a) a running shoe with a non-running shoe; b) different types of running shoes (minimalist, neutral/cushioned, motion control, stability, soft midsole, hard midsole); or c) footwear recommended and selected on foot posture versus footwear not recommended and not selected on foot posture for preventing lower-limb running injuries. Our primary outcomes were number of people sustaining a lower-limb running injury and number of lower-limb running injuries. Our secondary outcomes were number of runners who failed to return to running or their previous level of running, runner satisfaction with footwear, adverse events other than musculoskeletal injuries, and number of runners requiring hospital admission or surgery, or both, for musculoskeletal injury or adverse event.
Data collection and analysis:
Two review authors independently assessed study eligibility and performed data extraction and risk of bias assessment. The certainty of the included evidence was assessed using GRADE methodology.
Main results:
We included 12 trials in the analysis which included a total of 11,240 participants, in trials that lasted from 6 to 26 weeks and were carried out in North America, Europe, Australia and South Africa. Most of the evidence was low or very low certainty as it was not possible to blind runners to their allocated running shoe, there was variation in the definition of an injury and characteristics of footwear, and there were too few studies for most comparisons. We did not find any trials that compared running shoes with non-running shoes. Neutral/cushioned versus minimalist (5 studies, 766 participants) Neutral/cushioned shoes may make little or no difference to the number of runners sustaining a lower-limb running injuries when compared with minimalist shoes (low-certainty evidence) (risk ratio (RR) 0.77, 95% confidence interval (CI) 0.59 to 1.01). One trial reported that 67% and 92% of runners were satisfied with their neutral/cushioned or minimalist running shoes, respectively (RR 0.73, 95% CI 0.47 to 1.12). Another trial reported mean satisfaction scores ranged from 4.0 to 4.3 in the neutral/ cushioned group and 3.6 to 3.9 in the minimalist running shoe group out of a total of 5. Hence neutral/cushioned running shoes may make little or no difference to runner satisfaction with footwear (low-certainty evidence). Motion control versus neutral / cushioned (2 studies, 421 participants) It is uncertain whether or not motion control shoes reduce the number of runners sustaining a lower-limb running injuries when compared with neutral / cushioned shoes because the quality of the evidence has been assessed as very low certainty (RR 0.92, 95% CI 0.30 to 2.81). Soft midsole versus hard midsole (2 studies, 1095 participants) Soft midsole shoes may make little or no difference to the number of runners sustaining a lower-limb running injuries when compared with hard midsole shoes (low-certainty of evidence) (RR 0.82, 95% CI 0.61 to 1.10). Stability versus neutral / cushioned (1 study, 57 participants) It is uncertain whether or not stability shoes reduce the number of runners sustaining a lower-limb running injuries when compared with neutral/cushioned shoes because the quality of the evidence has been assessed as very low certainty (RR 0.49, 95% CI 0.18 to 1.31). Motion control versus stability (1 study, 56 participants) It is uncertain whether or not motion control shoes reduce the number of runners sustaining a lower-limb running injuries when compared with stability shoes because the quality of the evidence has been assessed as very low certainty (RR 3.47, 95% CI 1.43 to 8.40). Running shoes prescribed and selected on foot posture (3 studies, 7203 participants) There was no evidence that running shoes prescribed based on static foot posture reduced the number of injuries compared with those who received a shoe not prescribed based on foot posture in military recruits (Rate Ratio 1.03, 95% CI 0.94 to 1.13). Subgroup analysis confirmed these findings were consistent between males and females. Therefore, prescribing running shoes and selecting on foot posture probably makes little or no difference to lower-limb running injuries (moderate-certainty evidence). Data were not available for all other review outcomes.
Authors' conclusions:
Most evidence demonstrates no reduction in lower-limb running injuries in adults when comparing different types of running shoes. Overall, the certainty of the evidence determining whether different types of running shoes influence running injury rates was very low to low, and as such we are uncertain as to the true effects of different types of running shoes upon injury rates. There is no evidence that prescribing footwear based on foot type reduces running-related lower-limb injures in adults. The evidence for this comparison was rated as moderate and as such we can have more certainty when interpreting these findings. However, all three trials included in this comparison used military populations and as such the findings may differ in recreational runners. Future researchers should develop a consensus definition of running shoe design to help standardise classification. The definition of a running injury should also be used consistently and confirmed via health practitioners. More researchers should consider a RCT design to increase the evidence in this area. Lastly, future work should look to explore the influence of different types or running shoes upon injury rates in specific subgroups.
The present study evaluated the association among sex, sport, and injured body region of sport injuries. The subjects were 329 men and 127 women, ranging in age from 17 to 28 years, attending classes in the departments of Physical Training and Sport of Atatürk University (Erzurum, Erzincan, and Ağri in Turkey). There were no differences between men and women in percentages of injuries. The difference among various sports in the percentages of injured athletes was statistically significant. Running had the lowest percentage of injuries and basketball had the highest percentage. The most frequently injured body regions were the foot and the ankle in basketball, volleyball, soccer, and running, but in wrestling, the knee. These findings suggest that injury rates are associated with the sport rather than sex of player, and the most frequently injured body regions are the lower extremities. Therefore, the muscles of lower extremity should be strengthened to avoid injuries.
Running is a popular form of recreational exercise. Beside the positive effects of running on health and fitness, the risk of a running related injury has to be considered. The incidence of injuries in runners is high and varies from 30-79%. However, few intervention studies on prevention of running related injuries have been performed and none of these studies involved novice runners.
GRONORUN (Groningen Novice Running) is a two armed randomized controlled trial, comparing the effects of two different training programs for novice runners on the incidence of running related injuries. Participants are novice runners, who want to train for a four mile running event. The control group will train according a standard 8 week training program. The intervention group will use a more gradual, 13 week training program which is based on "the ten percent training rule". During the thirteen week follow up participants register information on running and RRI's in an internet based running log. The primary outcome measure is RRI. An injury is defined as a musculoskeletal ailment of the lower extremity or back, causing a restriction of running for at least one week.
The GRONORUN trial is the first randomized controlled trial to study a preventive intervention in novice runners. Many different training programs for novice runners are offered, but none are evidence based.
In recent years, ergonomics practices have increasingly relied upon the knowledge derived from epidemiological studies. In this regard, there is limited research devoted to the exclusive evaluation of the methodological qualities of ergonomics epidemiological studies. The aim of this study was to develop and test a general purpose 'epidemiological appraisal instrument' (EAI) for evaluating the methodological quality of existing or new ergonomic epidemiological studies using a critical appraisal system rooted in epidemiological principles. A pilot EAI version was developed and tested by a team of epidemiologists/physicians/biostatisticians, with the team leader being both epidemiologist and ergonomist. The pilot version was further tested with regard to other raters with/without a background in epidemiology, biostatistics and ergonomics. A revised version was evaluated for criterion validity and reliability. An assessor with a basic background in epidemiology and biostatistics would be able to correctly respond on four out of five questions, provided that subject matter expertise is obtained on specific items. This may improve with the article's quality. Training may have an effect upon assessors with virtually no background in epidemiology/biostatistics, but with a background in ergonomics. In this latter case, the inter-rater degree of agreement is largely above 90% and assessors can resolve their differences in a subsequent round. The EAI proved to be a valid and reliable appraisal instrument that may be used in various applications, such as systematic reviews and meta-analyses.
Dynamic and flow-through flux chambers are convenient tools for field measurements of gas or VOC emission flux from solid surfaces in the field. This study was undertaken to collect on site and quantify the emissions of volatile organic compounds (VOCs) released from athletic running tracks. Three typical types of tracks, one synthetic rubber and two tracks (types I and II) consisting mainly of polyurethane, were studied. They were all installed with adhesives and backings, both of which contributed significant amount of VOCs. VOCs released from the track surface were collected with a flux chamber and subsequently analyzed by a gas chromatograph/mass spectrometer (GC/MS). Also, for each track and at each selected time the emission flux and mass emission were measured on site under outdoor conditions over a period of 40 min. GC/MS analyses show that the VOCs emitted include 2-methyl furan, butanal, methyl ethyl ketone, benzene, heptane, methyl isobutyl ketone, toluene+octane, hexanal, nonane+ethylbenzene, xylenes+styrene, propyl benzene, decane, 1,3,5-trimethyl benzene, 1,2,4-trimethyl benzene, 1,2,3-trimethyl benzene and undecane. Of these, hexanal was the common and principal compound for all three types of tracks. 2-Methyl furan and methyl isobutyl ketone were the characteristic compounds for the synthetic rubber and the type II of polyurethane tracks, respectively. In the field studies, no unique compounds were found in the type I of polyurethane tracks. For each of these three types of tracks the total-VOCs emission flux was correlated to the track age and track surface temperature. The results of multiple regression analysis showed good correlation. The type II polyurethane track had the highest decay rate, while the synthetic rubber track had the lowest decay rate. Two years after the track installation, the VOC concentrations measured at 1.5 m above the track, the breathing height of school children, were not significantly higher than the background levels.
In a prospective study of stress fractures the hypothesis that training with custom made biomechanical shoe orthoses could lessen the incidence of stress fractures in infantry recruits was tested. Recruits were assigned randomly to groups and given soft biomechanical orthoses or semirigid biomechanical orthoses and compared with a control group that did not train in biomechanical orthoses. All recruits wore infantry boots with soles designed like those of basketball shoes. Recruits were examined biweekly during 14 weeks of basic training. The incidence of stress fractures was 15.7% for the recruits with the semirigid biomechanical orthoses, 10.7% for the recruits with the soft biomechanical orthoses, and 27% for the control group. The soft biomechanical orthoses were tolerated better by the recruits than were the semirigid devices. Among trainees at high risk for stress fractures, prophylactic use of custom made biomechanical orthoses may be warranted.
The purpose of this intervention study was to prove that increasing flexibility of the hamstring musculotendinous unit would decrease the number of lower extremity overuse injuries that occur in military infantry basic trainees. Two different companies going through basic training at the same time were used. Hamstring flexibility was checked at the beginning and at the end of the 13-week infantry basic training course. The control company (N = 148) proceeded through normal basic training. The intervention company (N = 150) followed the same program but added three hamstring stretching sessions to their already scheduled fitness program. All subsequent lower extremity overuse injuries were recorded through the troop medical clinic. Hamstring flexibility increased significantly in the intervention group compared with the control group. The number of injuries was also significantly lower in the intervention group. Forty-three injuries occurred in the control group for an incidence rate of 29.1%, compared with 25 injuries in the intervention group for an incidence rate of 16.7%. Thus, in this study, the number of lower extremity overuse injuries was significantly lower infantry basic trainees with increased hamstring flexibility.
This study investigated the effect of muscle stretching during warm-up on the risk of exercise-related injury.
1538 male army recruits were randomly allocated to stretch or control groups. During the ensuing 12 wk of training, both groups performed active warm-up exercises before physical training sessions. In addition, the stretch group performed one 20-s static stretch under supervision for each of six major leg muscle groups during every warm-up. The control group did not stretch.
333 lower-limb injuries were recorded during the training period, including 214 soft-tissue injuries. There were 158 injuries in the stretch group and 175 in the control group. There was no significant effect of preexercise stretching on all-injuries risk (hazard ratio [HR] = 0.95, 95% CI 0.77-1.18), soft-tissue injury risk (HR = 0.83, 95% CI 0.63-1.09), or bone injury risk (HR = 1.22, 95% CI 0.86-1.76). Fitness (20-m progressive shuttle run test score), age, and enlistment date all significantly predicted injury risk (P < 0.01 for each), but height, weight, and body mass index did not.
A typical muscle stretching protocol performed during preexercise warm-ups does not produce clinically meaningful reductions in risk of exercise-related injury in army recruits. Fitness may be an important, modifiable risk factor.
This study investigated effects of ankle dorsiflexion range and pre-exercise calf muscle stretching on relative risk of selected injuries in 1093 male Army recruits undertaking 12 weeks of intensive training. Prior to training, ankle dorsiflexion range was measured and recruits were allocated to stretch and control groups using a quasi-random procedure. The stretch group stretched calf muscles under supervision prior to all intense exercise. The control group stretched upper limb muscles instead. Forty-eight injuries were recorded. Survival analysis indicated that ankle dorsiflexion range was a strong predictor of injury (p = 0.03). Definitive evidence of an effect of stretching on injury risk was not found (p = 0.76), but the sample size may have been insufficient to detect such an effect.
To review the published and unpublished evidence regarding risk factors associated with shin splints, assess the effectiveness of prevention strategies, and offer evidence-based recommendations to coaches, athletes, and researchers.
We searched electronic data bases without language restriction, identified citations from reference sections of research papers retrieved, contacted experts in the field, and searched the Cochrane Collaboration. Of the 199 citations identified, we emphasized results of the four reports that compared methods to prevent shin splints. We assessed the methodologic quality of these reports by using a standardized instrument.
The use of shock-absorbent insoles, foam heel pads, heel cord stretching, alternative footwear, as well as graduated running programs among military recruits have undergone assessment in controlled trials. There is no strong support for any of these interventions, and each of the four controlled trials is limited methodologically. Median quality scores in these four studies ranged from 29 to 47, and serious flaws in study design, control of bias, and statistical methods were identified.
Our review yielded little objective evidence to support widespread use of any existing interventions to prevent shin splints. The most encouraging evidence for effective prevention of shin splints involves the use of shock-absorbing insoles. However, serious flaws in study design and implementation constrain the work in this field thus far. A rigorously implemented research program is critically needed to address this common sports medicine problem.
Shock-absorbing and biomechanic shoe orthoses are frequently used in the prevention and treatment of back and lower extremity problems. One review concludes that the former is clinically effective in relation to prevention, whereas the latter has been tested in only 1 randomized clinical trial, concluding that stress fractures could be prevented.
To investigate if biomechanic shoe orthoses can prevent problems in the back and lower extremities and if reducing the number of days off-duty because of back or lower extremity problems is possible.
Prospective, randomized, controlled intervention trial.
One female and 145 male military conscripts (aged 18 to 24 years), representing 25% of all new conscripts in a Danish regiment.
Health data were collected by questionnaires at initiation of the study and 3 months later. Custom-made biomechanic shoe orthoses to be worn in military boots were provided to all in the study group during the 3-month intervention period. No intervention was provided for the control group. Differences between the 2 groups were tested with the chi-square test, and statistical significance was accepted at P <.05. Risk ratio (RR), risk difference (ARR), numbers needed to prevent (NNP), and cost per successfully prevented case were calculated.
Outcome variables included self-reported back and/or lower extremity problems; specific problems in the back or knees or shin splints, Achilles tendonitis, sprained ankle, or other problems in the lower extremity; number of subjects with at least 1 day off-duty because of back or lower extremity problems and total number of days off-duty within the first 3 months of military service because of back or lower extremity problems.
Results were significantly better in an actual-use analysis in the intervention group for total number of subjects with back or lower extremity problems (RR 0.7, ARR 19%, NNP 5, cost 98 US dollars); number of subjects with shin splints (RR 0.2, ARR 19%, NNP 5, cost 101 US dollars); number of off-duty days because of back or lower extremity problems (RR 0.6, ARR < 1%, NNP 200, cost 3750 US dollars). In an intention-to-treat analysis, a significant difference was found for only number of subjects with shin splints (RR 0.3, ARR 18%, NNP 6 cost 105 US dollars), whereas a worst-case analysis revealed no significant differences between the study groups.
This study shows that it may be possible to prevent certain musculoskeletal problems in the back or lower extremities among military conscripts by using custom-made biomechanic shoe orthoses. However, because care-seeking for lower extremity problems is rare, using this method of prevention in military conscripts would be too costly. We also noted that the choice of statistical approach determined the outcome.