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Multifactorial Determinants of Running Injury Locations in 550 Injured Recreational Runners
Abstract
Purpose: Despite the health benefits of running, the prevalence of running injuries (RRI) remains high. The underlying risk factors between these injuries are still not well understood. Therefore, the aim of this study was to compare biomechanical, anthropometric and demographic injury risk factors between different locations in injured recreational runners.
Methods: In this retrospective case-control analysis, 550 injured runners (49.6% female) with a medically diagnosed RRI were included. All runners had undergone an instrumented treadmill analysis to determine habitual footstrike pattern, vertical instantaneous load rate, peak vertical ground reaction force (vGRF) and cadence. Injuries were classified by location according to a recent consensus statement. A logistic regression model was used to determine the association between the biomechanical parameters and RRI locations. As injuries can be associated with age, sex and BMI, these variables were also entered into the logistic regression.
Results: Strike pattern and peak vGRF were the only biomechanical variable distinguishing an injury from the group of injuries. A midfoot strike differentiated Achilles tendon injuries (OR 2.27; 90%CI 1.17 to 4.41) and a forefoot strike distinguished posterior lower leg injuries (OR 2.59; 90%CI 1.50 to 4.47) from the rest of the injured group. Peak vGRF was weakly associated with hip injuries (OR 1.14; 90%CI 1.05 to 1.24). Female sex was associated with injuries to the lower leg (OR 2.65; 90%CI 1.45 to 4.87) and hip/groin (OR 2.22; 90%CI 1.43 to 3.45). Male sex was associated with Achilles tendon injuries (OR 1.923: 90%CI 1.094 to 3.378).
Conclusion: Sex, foot strike pattern and vGRF were the only factors that distinguished specific injury locations from the remaining injury locations.
... 27 Conversely, results from studies by Azevedo et al 25 and Bramah et al 24 suggested the opposite, that runners with AT injury had a more extended knee during the stance phase. 24,25 A retrospective study by Hollander et al 31 indicated that a midfoot foot strike pattern was associated with AT RRI. 31 However, as these are all crosssectional, retrospective studies, it is not clear whether the difference in the biomechanics of the ankle and knee are the cause or the consequence of the injury. Only one prospective study has shown that a more extended knee during the midstance phase was associated with an AT injury. ...
... 24,25 A retrospective study by Hollander et al 31 indicated that a midfoot foot strike pattern was associated with AT RRI. 31 However, as these are all crosssectional, retrospective studies, it is not clear whether the difference in the biomechanics of the ankle and knee are the cause or the consequence of the injury. Only one prospective study has shown that a more extended knee during the midstance phase was associated with an AT injury. ...
... Several studies suggest and speculate that foot strike pattern may play a role in AT RRI. 18,19,31 This may be because AT load, stress, and impulse are significantly higher in nonrearfoot runners compared to rearfoot runners. [17][18][19] A recent retrospective study by Hollander et al 31 indicated that midfoot foot strike pattern is associated with AT RRI. 31 However, based on this retrospective study, when the running biomechanics were measured after the AT RRI was diagnosed and the foot strike pattern was classified using video recording, we cannot deduce whether the foot strike pattern is a consequence or cause of the AT RRI. ...
There are relatively few running studies that have attempted to prospectively identify biomechanical risk factors associated with Achilles tendon (AT) injuries. Therefore, the aim was to prospectively determine potential running biomechanical risk factors associated with the development of AT injuries in recreational, healthy runners. At study entry, 108 participants completed a set of questionnaires. They underwent an analysis of their running biomechanics at self-selected running speed. The incidence of AT running-related injuries (RRI) was assessed after 1-year using a weekly questionnaire standardized for RRI. Potential biomechanical risk factors for the development of AT RRI injury were identified using multivariable logistic regression. Of the 103 participants, 25% of the sample (15 males and 11 females) reported an AT RRI on the right lower limb during the 1-year evaluation period. A more flexed knee at initial contact (odds ratio = 1.146, P = .034) and at the midstance phase (odds ratio = 1.143, P = .037) were significant predictors for developing AT RRI. The results suggested that a 1-degree increase in knee flexion at initial contact and midstance was associated with a 15% increase in the risk of an AT RRI, thus causing a limitation of training or a stoppage of running in runners.
... Greater average vertical loading rates have been linked to RRIs including stress fractures (Zadpoor & Nikooyan, 2011), plantar fasciitis (Johnson et al., 2020), and patellofemoral pain syndrome (Johnson et al., 2020). Running using a NRFS pattern places a greater demand on the gastrocnemius muscle (Yong et al., 2020), increasing risk of RRIs at the posterior lower leg (Hollander et al., 2021). However, there is only weak evidence of a link between foot strike pattern and RRI (Burke et al., 2021). ...
... In a recent systematic review by Anderson et al., limited evidence indicated that runners using a NRFS pattern retrospectively had fewer overuse injuries; however, prospective studies are lacking (Anderson et al., 2020). Foot strike pattern may be more important when considering a specific injury location (Hollander et al., 2021). RFS runners have demonstrated more negative work at the knee (Goss & Gross, 2013) and have been observed to have almost six times greater risk for developing knee pain compared to NRFS runners . ...
... RFS runners have demonstrated more negative work at the knee (Goss & Gross, 2013) and have been observed to have almost six times greater risk for developing knee pain compared to NRFS runners . Calf injuries and Achilles injuries have been observed to be more than twice as likely in injured runners using a habitual NRFS pattern (Hollander et al., 2021). In the current study, the limited number of injuries per body region and limited number of injured NRFS runners (n = 8) restricts our ability to observe if there is an association between habitual foot strike pattern and specific body region injury risk. ...
The purpose of this study was to determine if running biomechanical variables measured by wearable technology were prospectively associated with running injuries in Active Duty Soldiers. A total of 171 Soldiers wore a shoe pod that collected data on running foot strike pattern, step rate, step length and contact time for 6 weeks. Running-related injuries were determined by medical record review 12 months post-study enrollment. Differences in running biomechanics between injured and non-injured runners were compared using independent t-tests or ANCOVA for continuous variables and chi-square analyses for the association of categorical variables. Kaplan-Meier survival curves were used to estimate the time to a running-related injury. Risk factors were carried forward to estimate hazard ratios using Cox proportional hazard regression models. Forty-one participants (24%) sustained a running-related injury. Injured participants had a lower step rate than non-injured participants, but step rate did not have a significant effect on time to injury. Participants with the longest contact time were at a 2.25 times greater risk for a running-related injury; they were also relatively slower, heavier, and older. Concomitant with known demographic risk factors for injury, contact time may be an additional indicator of a running-related injury risk in Active Duty Soldiers.
... 10 RFS describes initial contact with the heel or posterior aspect of the foot, FFS involves contact with anterior aspects of the foot, and MFS involves simultaneous contact of both the posterior and the anterior parts. 1 Some studies 57,66 have also combined MFS and FFS patterns, grouping them together as non-RFS. Studies that have reported FSP classifications have used visual analysis of sagittal plane video recordings, 11,21,32,61,66 categorization of continuous measures (foot and ankle contact angles and strike index [SI]), 14,15,18,45,48,53 or self-reporting methods. 25 Continuous measures of FST have been derived from 3 assessment techniques: (1) measuring the foot contact angle (FCA), (2) measuring the ankle flexion angle (AFA) at contact, and (3) calculating the center of pressure during impact relative to foot length (SI). ...
... 21 One study 53 25 In contrast, 7 studies 14,15,18,37,45,48,53 examined FST on 2 continuous scales: (1) initial ground contact angles (FCA, AFA) via 3D motion analysis 14,15,18,53 and (2) location of initial point of contact relative to foot length (SI) using pressure-sensitive insoles 45 and force plate analysis. 37,48 There were also differences in testing conditions, with 3 studies 18,37,48 analyzing running on an overground surface within a laboratory; 6, on a treadmill 14,15,32,45,53,61 ; and 2, on an outdoor runway. 21,66 One study analyzed running on both an outdoor track and a treadmill, 11 reporting identical FSP categorization across surfaces. ...
... 25 There was also variation in the number 11 the FSP at which the participant ran the majority of his or her miles was used in the FSP classification of that runner. Of the 10 studies analyzing self-selected speeds, § § 6 studies 14,15,18,21,32,45 reported the actual test speed, which ranged between 2.1 and 3.0 m/s. Regarding the evidence of a relationship between FST and RRIs, there was very low evidence to confidently say that a relationship existed (Table 1). ...
Background
It has been suggested that foot strike technique (FST) at initial contact is related to running-related injuries (RRIs).
Purpose
To explore the relationship between FST and RRIs.
Study Design
Systematic review; Level of evidence, 3.
Methods
A systematic electronic search was performed using MEDLINE, PubMed, SPORTDiscus, Scopus, and Web of Science databases. Included were studies published in the English language that explored the relationship between FST and RRIs between January 1960 and November 2020. Results were extracted and collated. The Grading of Recommendations, Assessment, Development and Evaluation approach was applied to synthesize the quality of evidence.
Results
We reviewed 13 studies exploring the relationship between FST and RRIs. Of these, 6 studies reported FST categorically (foot strike pattern [FSP]), and 7 reported continuous measures (foot contact angle, ankle flexion angle, and strike index). Three of the 6 studies looking at categorical FSP found rearfoot strikers have a significantly greater retrospective injury rate than do non– rearfoot strikers, with 1 other study noting a greater risk associated with midfoot and forefoot strike. Regarding the continuous measures of FST, only 1 of the 7 studies reported a significant relationship with RRIs.
Conclusion
There was low evidence to suggest a relationship between FST (or its subcategories of categorical FSP and continuous measures) and RRIs. While two-thirds of the categorical studies found a relationship between FSP and RRIs, these studies were very low quality, with limitations such as retrospective study design, low participant numbers, and poor FSP assessment methods. More large-scale prospective studies are required.
... Agreement between 2D Visual-and 3D Motion Capture-based Assessment of Foot Strike Pattern A previous study that classified foot strike patterns into three types by the visual method indicated that MFS runners had a higher prevalence of Achilles tendon injury and FFS runners had a higher prevalence of posterior lower leg injuries. 25 The force applied around the ankle joints, such as the Achilles tendon and triceps surae, has been reported to be higher for NRFS runners, including both FFS and MFS, 8,9 and this might increase the risk for both Achilles tendon and lower leg injury. In the present study, foot strike patterns were classified into three types by visual method with 125 fps high-speed movies. ...
... In the present study, foot strike patterns were classified into three types by visual method with 125 fps high-speed movies. 25 However, categorizing foot strike patterns into three types may have lacked reliability, and it is important to note that a previous study might not have accurately distinguished between FFS and MFS. Consequently, caution is warranted when applying the results of studies that classify foot strike patterns into three types, particularly in observational studies and training scenarios. ...
Background
Foot strike patterns during running are typically categorized into two types: non-rearfoot strike (NRFS) and rearfoot strike (RFS), or as three distinct types: forefoot strike (FFS), midfoot strike (MFS), and RFS, based on which part of the foot lands first. Various methods, including two-dimensional (2D) visual-based methods and three-dimensional (3D) motion capture-based methods utilizing parameters such as the strike index (SI) or strike angle (SA), have been employed to assess these patterns. However, the consistency between the results obtained from each method remains debatable.
Hypothesis/Purpose
The purpose of this study was to examine the agreement for assessing foot strike patterns into two (NRFS and RFS) or three types (FFS, MFS, and RFS) between 2D visual- and 3D motion capture-based methods. The authors hypothesized that using two description types (NRFS and RFS) would have high inter-method reliability; however, using three description types (FFS, MFS and RFS) would have lower inter-method reliability because of the difficulty in distinguishing between FFS and MFS.
Study design
Controlled Laboratory Study
Methods
Overall, 162 foot strikes from four healthy runners with various foot strike patterns were analyzed. Running kinematics and kinetics were recorded using a 3D motion capture system with a force platform. Each foot strike was filmed at 240 fps from the sagittal perspective. The visual, SI, and SA methods were used, and the kappa values for each method were calculated.
Results
An assessment of the two types of foot strike: NRFS and RFS, revealed almost perfect kappa values (κ = 0.89–0.95) among the visual, SI, and SA methods. In contrast, an assessment of the three types: FFS, MFS, and RFS, revealed relatively low kappa values (κ = 0.58–0.71). Kappa values within the NRFS category, which includes MFS and FFS, ranged from fair to slight (κ = 0.08–0.33).
Conclusion
Previous laboratory findings that categorized foot strike patterns into two distinct types may be applied in observational studies, clinical practice, and training situations.
Level of evidence
Level 2
... Runners were classified as rearfoot strikers if they landed on the heel first [32]. A short warmup (slow run of 2 to 3 min) was provided followed by instructions for each runner to increase speed to reach a self-selected running speed, described as a comfortable training pace for an easy training run [15,33]. After reaching the self-selected speed, 10 consecutive foot strikes were collected for analysis. ...
... Ground reaction force data were filtered at a cut-off frequency of 50 Hz using a low pass, fourth-order Butterworth filter. A custom program written in MATLAB (MathWorks, Natick, Massachusetts USA) was used to process data as reported previously [15,32,33]. The point of interest (POI) was defined as the first point above 75% of a subject's body weight (BW) with a vertical GRF slope less than 15 BW/s. ...
Background
Patellofemoral pain (PFP) is among the most common injuries in runners. While multiple risk factors for patellofemoral pain have been investigated, the interactions of variables contributing to this condition have not been explored. This study aimed to classify runners with patellofemoral pain using a combination of factors including biomechanical, anthropometric, and demographic factors through a Classification and Regression Tree analysis.
Results
Thirty-eight runners with PFP and 38 healthy controls (CON) were selected with mean (standard deviation) age 33 (16) years old and body mass index 22.3 (2.6) kg/m². Each ran at self-selected speed, but no between-group difference was identified (PFP = 2.54 (0.2) m/s x CON = 2.55 (0.1) m/s, P = .660). Runners with patellofemoral pain had different patterns of interactions involving braking ground reaction force impulse, contact time, vertical average loading rate, and age. The classification and regression tree model classified 84.2% of runners with patellofemoral pain, and 78.9% of healthy controls. The prevalence ratios ranged from 0.06 (95% confidence interval: 0.02–0.23) to 9.86 (95% confidence interval: 1.16–83.34). The strongest model identified runners with patellofemoral pain as having higher braking ground reaction force impulse, lower contact times, higher vertical average loading rate, and older age. The receiver operating characteristic curve demonstrated high accuracy at 0.83 (95% confidence interval: 0.74–0.93; standard error: 0.04; P < .001).
Conclusions
The classification and regression tree model identified an influence of multiple factors associated with patellofemoral pain in runners. Future studies may clarify whether addressing modifiable biomechanical factors may address this form of injury.
... Since running injuries are predominantly attributable to overuse [1,15], the combined analysis of bone and muscle status, biomechanics and the individual running technique represent an important approach to identify risk factors for these injuries. In this context, for example, vitamin D, bone density and microarchitecture [16,17], ground reaction forces, load rates, foot strike, and cadence are discussed as important parameters [8,[16][17][18][19][20][21]. Current research in the field of sports injuries indicates that a shift in thinking from single risk factors to individual injury patterns that are dynamically influenced by a variety of mediators is necessary [22]. ...
... Previous systematic reviews indicate that there is some evidence for increased risk due to a greater peak hip adduction [8,58,59] and a reduced peak rearfoot eversion in female runners [58]. In a retrospective casecontrol study, strike patterns and peak vertical ground reaction force were characterized as biomechanical characteristics for some injuries [21]. However, the current literature highlights the need for further research to identify biomechanical factors and their interaction as risk factors in running. ...
Background
Running is a very popular sport among both recreational and competitive athletes. However, participating in running is associated with a comparably high risk of sustaining an exercise-related injury. Due to the often multifactorial and individual reasons for running injuries, a shift in thinking is required to account for the dynamic process of the various risk factors. Therefore, a machine learning approach will be used to comprehensively analyze biomechanical, biological, and loading parameters in order to identify risk factors and to detect risk patterns in runners.
Methods
The prospective longitudinal cohort study will include competitive adult athletes, running at least 20 km per week and being free of injuries three months before the start of the study. At baseline and the end of the study period, subjective questionnaires (demographics, injury history, sports participation, menstruation, medication, psychology), biomechanical measures (e.g., stride length, cadence, kinematics, kinetics, tibial shock, and tibial acceleration) and a medical examination (BMI, laboratory: blood count, creatinine, calcium, phosphate, parathyroid hormone, vitamin D, osteocalcin, bone-specific alkaline phosphatase, DPD cross-links) will be performed. During the study period (one season), continuous data collection will be performed for biomechanical parameters, injuries, internal and external load. Statistical analysis of the data is performed using machine learning (ML) methods. For this purpose, the correlation of the collected data to possible injuries is automatically learned by an ML model and from this, a ranking of the risk factors can be determined with the help of sensitivity analysis methods.
Discussion
To achieve a comprehensive risk reduction of injuries in runners, a multifactorial and individual approach and analysis is necessary. Recently, the use of ML processes for the analysis of risk factors in sports was discussed and positive results have been published. This study will be the first prospective longitudinal cohort study in runners to investigate the association of biomechanical, bone health, and loading parameters as well as injuries via ML models. The results may help to predict the risk of sustaining an injury and give way for new analysis methods that may also be transferred to other sports.
Trial registration : DRKS00026904 (German Clinical Trial Register DKRS), date of registration 18.10.2021.
... Notably, early sport specialization in adolescent athletes is associated with increased sport-related injury risk, attributed in part to the homogeneity of movement patterns repetitively stressing the same immature tissues (Hamill et al., 2012;Post et al., 2017). Although associations between running biomechanics and overuse injuries have been widely studied in adults (Ceyssens et al., 2019;Hollander et al., 2021a), comparatively little research has targeted potential relationships between musculoskeletal injury and growth-related changes in biological age, body anthropometry, neuromuscular control, and running biomechanics in youth (Krabak et al., 2020). The aim of this perspective article was to provide a brief summary of the current epidemiology and etiology of RRI. ...
... Moreover, the results from several studies note that the biomechanical benefit of specific footstrike patterns are conflicting (Stearne et al., 2014;Dudley et al., 2017), which has been supported by recent prospective injury studies in adults (Warr et al., 2015;Kuhman et al., 2016;Messier et al., 2018;Anderson et al., 2019). Other evidence from studies on adult runners suggest that footstrike more likely affects the risk of specific injuries, rather than one footstrike pattern being more or less injurious than another (Hollander et al., 2021a). Further research encompassing the effect of footstrike pattern on adolescent running gait relating to injury is warranted. ...
Global participation in running continues to increase, especially amongst adolescents. Consequently, the number of running-related injuries (RRI) in adolescents is rising. Emerging evidence now suggests that overuse type injuries involving growing bone (e.g., bone stress injuries) and soft tissues (e.g., tendinopathies) predominate in adolescents that participate in running-related sports. Associations between running biomechanics and overuse injuries have been widely studied in adults, however, relatively little research has comparatively targeted running biomechanics in adolescents. Moreover, available literature on injury prevention and rehabilitation for adolescent runners is limited, and there is a tendency to generalize adult literature to adolescent populations despite pertinent considerations regarding growth-related changes unique to these athletes. This perspective article provides commentary and expert opinion surrounding the state of knowledge and future directions for research in adolescent running biomechanics, injury prevention and supplemental training.
... For injury prevention, risk factors need to be well understood [6]. Risk factors for running are manifold and consist of training load, biomechanical, anatomical and anthropometrical variables [7][8][9][10][11][12]. While some previous studies exclusively investigated either male [9,13] or female [14][15][16] runners, sex has been suggested to be a risk factor for specific injury patterns in running, as well as for overall injury risk [7,17,18]. ...
... While the amount of loading is the key factor in the etiology of Achilles tendinopathy, there are several intrinsic (age, stress, genes, biomechanics, body composition) and extrinsic factors (footwear) modulating the risk for this injury [83]. Recent studies found biomechanical (footstrike pattern, ankle dorsiflexion moments) and training-related parameters (changes in training, cold weather, footwear, use of compression socks, mileage) as possible risk factors [10,51,[84][85][86]. This summary of (possible) risk factors does not directly explain the increased probability for male runners to have an Achilles tendinopathy. ...
Background
Running is a popular sport with high injury rates. Although risk factors have intensively been investigated, synthesized knowledge about the differences in injury rates of female and male runners is scarce.
Objective
To systematically investigate the differences in injury rates and characteristics between female and male runners.
Methods
Database searches (PubMed, Web of Science, PEDro, SPORTDiscus) were conducted according to PRISMA guidelines using the keywords “running AND injur*”. Prospective studies reporting running related injury rates for both sexes were included. A random-effects meta-analysis was used to pool the risk ratios (RR) for the occurrence of injuries in female vs. male runners. Potential moderators (effect modifiers) were analysed using meta-regression.
Results
After removal of duplicates, 12,215 articles were screened. Thirty-eight studies were included and the OR of 31 could be pooled in the quantitative analysis. The overall injury rate was 20.8 (95% CI 19.9–21.7) injuries per 100 female runners and 20.4 (95% CI 19.7–21.1) injuries per 100 male runners. Meta-analysis revealed no differences between sexes for overall injuries reported per 100 runners (RR 0.99, 95% CI 0.90–1.10, n = 24) and per hours or athlete exposure (RR 0.94, 95% CI 0.69–1.27, n = 6). Female sex was associated with a more frequent occurrence of bone stress injury (RR (for males) 0.52, 95% CI 0.36–0.76, n = 5) while male runners had higher risk for Achilles tendinopathies (RR 1. 86, 95% CI 1.25–2.79, n = 2). Meta-regression showed an association between a higher injury risk and competition distances of 10 km and shorter in female runners (RR 1.08, 95% CI 1.00–1.69).
Conclusion
Differences between female and male runners in specific injury diagnoses should be considered in the development of individualised and sex-specific prevention and rehabilitation strategies to manage running-related injuries.
... Additionally, rearfoot strike recreational runners have demonstrated an almost 6 times greater relative risk of sustaining a knee injury compared to non-rearfoot strike runners (Morris et al., 2020). Non-rearfoot strike runners have demonstrated greater odds of calf injuries (Hollander et al., 2021), likely as a result of greater loading of the ankles during non-rearfoot strike running (Xu et al., 2021). ...
... Further, it is VStiff that has been shown to relate to specific running injuries in a previous study (Johnson, Tenforde, et al., 2020). In that study, the authors found that one of the strongest associations was with Achilles tendinopathy (Johnson, Tenforde, et al., 2020), an injury that has been reported to be more prevalent in male versus female runners (Hollander et al., 2021;Taunton et al., 2002). Therefore, our results may indicate that higher VStiff is an external loading factor that could predispose male trainees to specific injuries, such as Achilles tendinopathies, during military IET. ...
Lower extremity injuries are prevalent in military trainees, especially in female and older trainees. Modifiable factors that lead to higher injury risk in these subgroups are not clear. The purpose of this study was to identify whether external loading variables during military‐relevant tasks differ by age and sex in U.S. Army trainees. Data was collected on 915 trainees in the first week of Basic Combat Training. Participants performed running and ruck marching (walking with 18.1 kg pack) on a treadmill, as well as double‐/single‐leg drop landings. Variables included: vertical force loading rates, vertical stiffness, first peak vertical forces, peak vertical and resultant tibial accelerations. Comparisons were made between sexes and age groups (young, ≤19 years; middle, 20–24 years; older, ≥25 years). Significant main effects of sex were found, with females showing higher vertical loading rates during ruck marching, and peak tibial accelerations during running and ruck marching (p ≤ 0.03). Males showed higher vertical stiffness during running and peak vertical tibial accelerations during drop landings (p < 0.01). A main effect of age was found for vertical loading rates during running (p = 0.03), however no significant pairwise differences were found between age groups. These findings suggest that higher external loading may contribute to higher overall injury rates in female trainees. Further, higher stiffness during running may contribute to specific injuries, such as Achilles Tendinopathy, that are more prevalent in males. The lack of differences between age groups suggests that other factors contribute more to higher injury rates in older trainees.
... The aetiology of running-related injuries is complex and multifactorial (Hollander et al., 2021;Winter et al., 2020). Numerous studies have reported an association between vertical impact loading and running-related injuries, including tibial stress fractures (Milner et al., 2006) and patellofemoral pain (Ahmadi & Yalfani, 2022). ...
This study investigated the relationships between inertial measurement unit (IMU) acceleration at multiple body locations and 3D motion capture impact landing measures in runners. Thirty healthy runners ran on an instrumented treadmill at five running speeds (9–17 km/h) during 3D motion capture. Axial and resultant acceleration were collected from IMUs at the distal and proximal tibia, distal femur and sacrum. Relationships between peak acceleration from each IMU location and patellofemoral joint (PFJ) peak force and loading rate, impact peak and instantaneous vertical loading rate (IVLR) were investigated using linear mixed models. Acceleration was positively related to IVLR at all lower limb locations (p < 0.01). Models predicted a 1.9–3.2 g peak acceleration change at the tibia and distal femur, corresponding with a 10% IVLR change. Impact peak was positively related to acceleration at the distal femur only (p < 0.01). PFJ peak force was positively related to acceleration at the distal (p = 0.03) and proximal tibia (p = 0.03). PFJ loading rate was positively related to the tibia and femur acceleration in males only (p < 0.01). These findings suggest multiple IMU lower limb locations are viable for measuring peak acceleration during running as a meaningful indicator of IVLR.
... However, it is also important to note that some previous studies failed to identify impact loading as a predictor of runningrelated injury (Kliethermes et al., 2021;Schmida et al., 2022). Given the fact that running-related injury is multifactorial in nature (Hollander et al., 2021), future work should investigate the prospective injury risk between trail and road runners in relation to VALR, VILR and FSA. ...
... However, a number of studies that have investigated footfall patterns and running economy are not unified in their opinion of which footfall pattern during running is the most economical (Hamill & Gruber, 2017;Melcher et al., 2017). From an injury prevention perspective, a retrospective study by Hollander et al. (2021) suggested that a midfoot footfall pattern is associated with AT running injuries. This can be explained by the higher AT loading, stress, and impulse in runners with a forefoot strike pattern compared to runners using a rearfoot strike pattern (Gruber et al., 2011;Rice & Patel, 2017). ...
The main purpose of this study was to investigate the relationship among Achilles tendon (AT) dimensions, ankle joint stiffness, and footfall patterns in recreational rearfoot and non-rearfoot runners. Based on the foot strike index, a total of 107 runners were divided into rearfoot (47 females/40 males) and non-rearfoot runners (14 females/6 males). All participants had theirs AT dimensions (AT length, AT thickness, and AT moment arm) measured using a combination of ultrasound and motion capture systems. In addition, all performed running trials measured at self-selected speed in laboratory-neutral shoes. A partial correlation coefficient was used for correlations between the selected variables. The results revealed a significant relationship between ankle joint stiffness and level of footfall pattern in rearfoot (r = 0.232, p = 0.032) and non-rearfoot runners (r = -0.811, p < 0.001). The results also suggest a relationship between AT thickness and foot strike index (r = -0.486) in non-rearfoot runners. Runners whose footfall pattern is closer to the heel have greater ankle joint stiffness. Non-rearfoot runners whose footfall pattern is closer to the toe have a thinner AT. Non-rearfoot runners with thicker AT had greater ankle joint stiffness.
... An additional finding of interest (although not significant in the adjusted analysis) was that non-rearfoot strike runners were more likely to have sustained a prospective injury than rearfoot strike runners, a finding that is similar to the results of Hollander et al. [109] and Dingenen et al. [110]. A non-rearfoot strike pattern is thought to invoke greater loading on the plantarflexor muscles and Achilles tendon [50,111,112], which aligns well with the calf and Achilles tendon being the most commonly injured sites in the present study. ...
Background
Running-related injuries (RRIs) are a prevalent issue for runners, with several factors proposed to be causative. The majority of studies to date are limited by retrospective study design, small sample sizes and seem to focus on individual risk factors in isolation. This study aims to investigate the multifactorial contribution of risk factors to prospective RRIs.
Methods
Recreational runners (n = 258) participated in the study, where injury history and training practices, impact acceleration, and running kinematics were assessed at a baseline testing session. Prospective injuries were tracked for one year. Univariate and multivariate Cox regression was performed in the analysis.
Results
A total of 51% of runners sustained a prospective injury, with the calf most commonly affected. Univariate analysis found previous history of injury < 1 year ago, training for a marathon, frequent changing of shoes (every 0–3 months), and running technique (non-rearfoot strike pattern, less knee valgus, greater knee rotation) to be significantly associated with injury. The multivariate analysis revealed previous injury, training for a marathon, less knee valgus, and greater thorax drop to the contralateral side to be risk factors for injury.
Conclusion
This study found several factors to be potentially causative of injury. With the omission of previous injury history, the risk factors (footwear, marathon training and running kinematics) identified in this study may be easily modifiable, and therefore could inform injury prevention strategies. This is the first study to find foot strike pattern and trunk kinematics to relate to prospective injury.
... The literature still discusses that women and men demonstrate different magnitudes of muscle strength, synchronization and variability during running, which can result in different types of injuries in the lower limbs [15]. Studies show a predominance of injuries to the Achilles tendon in men [16], this being the fifth most frequent lesion in our study, and patellofemoral dysfunction in women [17]. ...
Objective: To analyze the epidemiological profile of lower limb pathologies in road runners assessed in a Brazilian private orthopedics and physical therapy service. Method: Retrospective analysis of 197 medical records of runners undergoing a running assessment in an Orthopedics and Physical Therapy clinic in Campinas, state of São Paulo, Brazil, in 2017 and 2018.
... A custom program, written in MATLAB (MathWorks, Natick, Massachusetts, USA), was used to process these data. Detailed information about data processing has been published elsewhere [22,28,29]. First, a point of interest (POI) was defined as the first point above 75% of a subject's body weight (BW), with a vertical ground reaction force slope less than 15 BW/s. ...
Iliotibial band syndrome (ITBS) is a common running related injury. While previous studies have evaluated the relationship between biomechanical variables and ITBS, most have found limited evidence, particularly with measures related to ground reaction force (GRF). The purpose of this study was to use a classification and regression tree (CART) analysis to determine whether the combination of GRF measures would be strongly associated in runners with ITBS. A cross-sectional study was performed at an outpatient center focused on running injuries. A convenience sample of 52 runners with ITBS, assessed between September 2012 and July 2022, were evaluated for eligibility, from which, 30 rearfoot strike runners with ITBS and no secondary running-related injuries were selected. Injured runners were matched to 30 healthy controls from a normative database. Each ran on an instrumented treadmill at a self-selected speed. GRF variables were calculated, including peak GRFs, loading rates, and impulses. CART analysis was performed to identify interactions between GRF data and runners with ITBS. An ROC curve was executed, to determine the accuracy of the model. Posterior GRF impulse (PGRFI), anterior GRF (AGRFI), peak anterior GRF (PAGRF), and vertical stiffness at initial loading (VSIL) all emerged as variables associated with ITBS in the CART analysis. The model was able to correctly identify 25 (83.3%) runners with ITBS and 25 (83.3%) controls. The area under the ROC curve (accuracy) was 0.87 (95% CI, 0.77-0.96; SE, 0.04; p < 0.001). In conclusion, interactions between GRF variables were associated with ITBS in runners. The best classification included interactions between PGRFI, AGRFI, AGRFP, and VSIL, using specific cutoff values. Loading rates were not independently associated with ITBS.
... More than 40 million people participate in running each year in the U.S [1]. Recreational runners vary widely in demography, experience and running technique [2]. While running confers numerous health benefits on physical and psychological well-being, between 20% to 80% of runners may be managing a musculoskeletal injury at any given time [3,4]. ...
This prospective cohort study examined the impact of high anxiety levels on psychological state and gait performance during recovery in runners with lower body injuries. Recreational runners diagnosed with lower body injuries who had reduced running volume (N = 41) were stratified into groups using State Trait Anxiety Inventory (STAI) scores: high anxiety (H-Anx; STAI ≥40 points) and low anxiety (L-Anx; STAI <40 points). Runners were followed through rehabilitation to return-to-run using monthly surveys. Main outcome measures included kinesiophobia (Tampa Scale of Kinesiophobia, TSK-11), Positive and Negative Affect Schedule (PANAS; Positive and negative scores), Lower Extremity Function Scale (LEFS), running recovery (University of Wisconsin Running Injury and Recovery Index [UWRI]) and CDC Healthy Days modules for general health, days of anxiety/tension, disrupted sleep and work/usual activities. Running biomechanics were assessed at baseline and the final visit using 3D motion capture and a force-plated treadmill. The time to return-to-running for was 5.0±3.1 and 7.9±4.1 months for L-Anx and H-Anx, respectively and participants who withdrew (n = 15) did so at 7.7±6.2 months. L-Anx maintained low anxiety and H-Anx reduced anxiety from baseline to final visit (STAI = 31.5 to 28.4 points, 50.4 to 37.8 points, respectively), whereas the withdrawn runners remained clinically anxious at their final survey (41.5 to 40.3 points; p < .05). Group by time interactions were found for PANAS positive, LEFS UWRI, general health scores, and days feeling worry, tension and anxiety (all p < .05). Final running performance in L-Anx compared to H-Anx was most improved with cadence (8.6% vs 3.5%; p = .044), impact loading rate [-1.9% vs +8.9%] and lower body stiffness [+14.1% vs +3.2%; all p < .05). High anxiety may identify runners who will experience a longer recovery process, health-related functional disruptions, and less optimization of gait biomechanics during rehabilitation after a lower extremity injury.
... 44 In addition, other biomechanical and anthropometric factors such as foot strike pattern and peak vertical ground reaction force may be determinants of the injury location and should be taken into consideration when indicating and choosing the type of orthosis. 45 Thus, for the implementation and use of orthoses in clinical practice, it is important to also take into consideration the characteristics of the population, and anatomical and biomechanical factors. ...
Context:
A variety of approaches have been proposed to prevent lower limb injuries in runners. However, the evidence for the effectiveness of interventions to reduce lower limb pain and injury after intensive running is very weak.
Objective:
The authors performed a systematic review to investigate the effects of foot orthoses on pain and the prevention of lower limb injuries in runners.
Evidence acquisition:
The authors searched the MEDLINE/PubMed, Physiotherapy Evidence Database, Scielo, and Cochrane Central (from inception to February 2022) databases for randomized controlled trials that evaluated the effects of foot orthoses in runners. The authors then calculated mean differences and 95% confidence intervals from these trials. Heterogeneity was assessed using the I2 test. Furthermore, the authors compared the criteria between runners with foot orthoses and ones with no intervention (control group).
Evidence synthesis:
Twelve studies (5321 runners) met our review criteria. The control and the foot orthoses group sustained 721 (37%) and 238 (24%) injuries, respectively. Compared with the control group, the use of foot orthoses resulted in a significant reduction in lower limb injury risk (risk ratio = 0.6; 95% confidence interval, 0.5-0.7; P = .00001, I2 = 54%; 7 studies, N = 2983: moderate-quality evidence). Moreover, the foot orthoses group corresponded to a 40% reduction in the risk of developing lower limb injuries.
Conclusions:
The use of foot orthoses may help reduce the incidence of lower limb injuries and pain in runners.
... 33 The footstrike pattern does not appear to change injury prevalence but may modify injury location in response to their respective joint stresses. Hollander et al. 34 described that running with a MFS has twice the odds of sustaining an injury to Achilles tendon than injured runners using a FFS or a RFS. They also describe that runners with a FFS sustain 2.6 times more calf injuries than the MFS or RFS ones. ...
Purpose
To date, the relationship between footstrike pattern and performance, as well as with injury incidence in endurance running remains unclear. For these reasons, it is currently not recommended to modify footstrike pattern in an uninjured long-distance runner. The purpose of this study was to analyse whether athletic coaches apply these current scientific recommendations with their endurance runners on the field.
Methods
A Delphi method study was used to develop an online survey that was administered to French-speaking athletic coaches in Belgium. The survey comprised three sections: 1) coaches’ profile, 2) coaches’ perception of footstrike patterns, 3) practices pertaining to footstrike patterns.
Results
One hundred and fourteen respondents completed the entire questionnaire. Ninety-six (84%) athletic coaches reported modifying the footstrike pattern of their endurance runners. They reported that they modify their runners’ rearfoot and forefoot strike more often than a midfoot strike (P < 0.0001) to prevent injury (83%) and to improve performance (66%). According to them, midfoot strike is considered as the best landing pattern for endurance performance (47%) and injury prevention (36%) whereas rearfoot strike is considered as the worst (respectively, 50% and 52%).
Summary and conclusion
This study highlights the disparities between scientific recommendations and athletic coaches’ field practices for modifying footstrike patterns in endurance runners. Contrary to current scientific literature recommendations, a large proportion of coaches modify the natural footstrike pattern of their endurance runners towards a midfoot strike pattern to improve performance and prevent injury.
... • Running-related injuries (RRI) are prevalent among recreational runners (1). Injury prevention and self-management programmes can help runners continue running. ...
A survey study mapping recreational runners views on running injury prevention and management, the ways in which they prevent and manage injury, their use of digital technologies in monitoring running and preventing/managing injuries and what runners would want to see in a digital intervention aimed at helping runners prevent and manage injuries.
... For longer distances and outside of competitions, the rearfoot strike is the most prevalent [21,22]. Regarding injuries, a recent study from a biomechanics laboratory showed an association of Achilles tendon and posterior calf injuries with particular foot strike patterns (midfoot strike and Achilles tendon; forefoot strike and posterior calf injuries) [23]. Therefore, the implication of foot strike pattern is widely debated regarding performance [20] and injury occurrence [24] without any consensus on whether one-foot strike pattern is better than another [25,26]. ...
The purpose of this chapter is to describe the interdisciplinary field of biomechanics and its importance in the evaluation of running. We will shortly describe the basic principles and origins of this scientific field and go into further details of new technical innovations. Then, a comprehensive overview of laboratory and field-based biomechanical analyses will be discussed in the light of implication for injury aetiology and prevention. Finally, we will end with a discussion on new research areas and implications for future research.
... Aging itself has been cited as an RRI risk factor, 10,38 with older athletes showing higher risk for lower limb RRIs, 8 and its inclusion in our prediction model supports this body of evidence in the literature. Older runners present alterations in muscle-tendon unit properties, with tendon stiffness and decreased muscle strength, which do not seem to be counteracted by musculoskeletal gains resulting from endurancerunning practice. ...
Background:
Running carries the risk of several types of running-related injuries (RRIs), especially in the lower limbs. The variety of risk factors and the lack of strong evidence for several of these injury risks hinder the ability to draw assertive conclusions about them, hampering the implementation of effective preventive strategies. Because the etiology of RRIs seems to be multifactorial, the presence of RRI risk factors might influence the outcome of therapeutic strategies in different ways. Thus, further investigations on how risk and protective factors influence the incidence and prevention of RRIs should be conducted.
Purpose:
To investigate the predictive effect of well-known risk factors and 1 protective factor-foot-core training-on the incidence of lower limb RRIs in recreational runners.
Study design:
Cohort study; Level of evidence, 2.
Methods:
Middle- and long-distance recreational runners (N = 118) were assessed at baseline and randomly allocated to either an intervention group (n = 57) or a control group (n = 61). The intervention group underwent an 8-week (3 times/wk) foot-core training program. Participants were followed for a year after baseline assessment for the occurrence of RRIs. Logistic regression with backward elimination of variables was used to develop a model for prediction of RRI in recreational runners. Candidate predictor variables included age, sex, body mass index, years of running practice, number of races, training volume, training frequency, previous RRI, and the foot-core exercise training.
Results:
The final logistic regression model included 3 variables. As previously shown, the foot-core exercise program is a protective factor for RRIs (odds ratio, 0.40; 95% CI, 0.15-0.98). In addition, older age (odds ratio, 1.07; 95% CI, 1.00-1.14) and higher training volume (odds ratio, 1.02; 95% CI, 1.00-1.03) were risk factors for RRIs.
Conclusion:
The foot-core training was identified as a protective effect against lower limb RRI, which can be negatively influenced by older age and higher weekly training volume. The predictive model showed that RRIs should be considered a multivariate entity owing to the interaction among several factors.
Registration:
NCT02306148 (ClinicalTrials.gov identifier).
... However, musculoskeletal injuries are common among runners (Bueno et al., 2018;Saragiotto et al., 2014). These injuries can be related to intrinsic factors (sex, age, experience) and extrinsic factors (such as place of training, type of race, and professional monitoring), which may lead to a reduction in the practice of running (Benca et al., 2020;Hino et al., 2009;Hollander et al., 2021). In some cases, injuries require a lengthy recovery period and are often reported as the reason for giving up the physical activity (Bueno et al., 2018;Hespanhol Junior et al., 2012;. ...
Problem statement: The street running practice has grown substantially in the last decades. Some musculoskeletal injuries from this running can cause prolonged periods of absence from this activity. Aim: To estimate the occurrence of running-related injuries and to analyze their association with sociodemographic characteristics, training variables, and characteristics of the primary type of competition in adult street runners from Curitiba, Brazil. Material and methods: A observational and cross-sectional design study was conducted in 2017. The 195 participants (60.5% male) were recreational street runners, intentionally selected among clients of four running consultancy companies or approached after a race competition. Injury occurrence was self-reported and measured with a dichotomous answer to the question: In the last six months, have you suffered any type of injury to your lower limbs as a result of running? The independent variables included sociodemographic characteristics (sex, age group, body mass, height, Body Mass Index), training variables (weekly frequency, volume, place, professional monitoring), and characteristics of the primary type of competition (main running types, distance, and years of practice). Data were analyzed using a multivariate Poisson regression in SPSS 26.0. Results: The prevalence of injury was 16.9% and was positively associated only with five or more years of run practices (PR: 2.11; 95% CI: 1.07-4.17; p = 0.032). The most injured site was the leg (49%), while the least common was the thigh (3%). Tibial periostitis (47%) and muscle strain (3%) were the most and least reported types of injury, respectively. Conclusion: These results may help professionals develop preventive injury strategies with adequate exercise and periodization to preserve long-time street runners' health.
... However, musculoskeletal injuries are common among runners (Bueno et al., 2018;Saragiotto et al., 2014). These injuries can be related to intrinsic factors (sex, age, experience) and extrinsic factors (such as place of training, type of race, and professional monitoring), which may lead to a reduction in the practice of running (Benca et al., 2020;Hino et al., 2009;Hollander et al., 2021). In some cases, injuries require a lengthy recovery period and are often reported as the reason for giving up the physical activity (Bueno et al., 2018;Hespanhol Junior et al., 2012;. ...
Problem statement: The street running practice has grown substantially in the last decades. Some musculoskeletal injuries from this running can cause prolonged periods of absence from this activity. Aim: To estimate the occurrence of running-related injuries and to analyze their association with sociodemographic characteristics, training variables, and characteristics of the primary type of competition in adult street runners from Curitiba, Brazil. Material and methods: A observational and cross-sectional design study was conducted in 2017. The 195 participants (60.5% male) were recreational street runners, intentionally selected among clients of four running consultancy companies or approached after a race competition. Injury occurrence was self-reported and measured with a dichotomous answer to the question: In the last six months, have you suffered any type of injury to your lower limbs as a result of running? The independent variables included sociodemographic characteristics (sex, age group, body mass, height, Body Mass Index), training variables (weekly frequency, volume, place, professional monitoring), and characteristics of the primary type of competition (main running types, distance, and years of practice). Data were analyzed using a multivariate Poisson regression in SPSS 26.0. Results: The prevalence of injury was 16.9% and was positively associated only with five or more years of run practices (PR: 2.11; 95% CI: 1.07-4.17; p = 0.032). The most injured site was the leg (49%), while the least common was the thigh (3%). Tibial periostitis (47%) and muscle strain (3%) were the most and least reported types of injury, respectively. Conclusion: These results may help professionals develop preventive injury strategies with adequate exercise and periodization to preserve long-time street runners' health.
Background
Female sex is a significant determinant of anterior cruciate ligament (ACL) injury. It is not understood if sex is a key determinant of other sports-related injuries.
Objective
The aim of this systematic review was to identify where differences in injury profiles are most apparent between the sexes in all sports across the six-tiered participant classification framework.
Methods
This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the 'implementing PRISMA in Exercise, Rehabilitation, Sport medicine and SporTs science’(PERSiST) guidance. The databases PubMed, CINAHL, Web of Science, SPORTDiscus, Medline, Scopus, Cochrane Library and EBSCO were searched from database inception to 24 April 2023. Longitudinal, prospective and retrospective cohort studies and cross-sectional and descriptive epidemiology studies that used standard injury data collection were included. Studies were excluded if injuries were not medically diagnosed and if injuries were not reported and/or analysed by sex. Two reviewers independently extracted data and assessed study quality using the Downs and Black checklist.
Results
Overall, 180 studies were included (8 tier-5, 40 tier-4, 98 tier-3, 30 tier-2, 5 tier-1 studies; one study included data in two tiers). Of those, 174 studies were of moderate quality and six studies were of limited quality. In sex-comparable sports, there was moderate evidence that female athletes had greater risk of knee injury (relative risk (RR) 2.7; 95% CI 1.4–5.5), foot/ankle injuries (RR 1.25; 95% CI 1.17–1.34), bone stress injury (RR 3.4; 95% CI 2.1–5.4) and concussion (RR 8.46; 95% CI 1.04–68.77) than male athletes. Male athletes were at increased risk of hip/groin injuries (RR 2.26; 95% CI 1.31–3.88) and hamstring injuries (RR 2.4; 95% CI 1.8–3.2) compared with females, particularly in dynamic sports. Male athletes were 1.8 (1.37–2.7) to 2.8 (2.45–3.24) times more likely to sustain acute fractures than female athletes, with the highest risk in competition.
Discussion
Most studies in all cohorts were of moderate quality (mean/range of scores tier-5: 17 ± 2.2 [14–20], tier-4: 16.9 ± 1.9 [11–21], tier-3: 16.9 ± 1.5 [11–20], tier-2: 16.3 ± 2.2 [11–20], tier-1 studies: 15.6 ± 1.3 [14–17] out of 28 on the Downs and Black checklist), with only six studies of limited quality. Female athletes’ propensity for bone stress injuries highlights opportunities to reinforce development of optimal bone health during adolescence and to outline the effects of energy availability. Earlier strength development and exposure to neuromuscular training programmes and modification of skill development in female athletes may be effective strategies for reducing lower limb injury risk. Key components of neuromuscular training programmes could be beneficial for reducing hip/groin and hamstring injury risk in male athletes. There may be a need for sex-specific prevention and return-to-sport protocols for sports-related concussion in female athletes.
Conclusions
Female sex was a key determinant of sports-related injuries beyond ACL injury including foot/ankle injury, bone stress injury and sports-related concussion. Male sex was a key determinant of hip/groin, hamstring injury and upper limb injury.
Trial Registry
PROSPERO registration number: CRD42017058806 (last updated on 7th June 2023).
This paper examines the relationship between long-distance runners’ foot strike patterns (Rearfoot Strike [RFS] and Non Rearfoot Strike [NRFS]) and various aspects such as injuries, performance, and biomechanics. While running has established itself as a popular activity with cardiovascular, respiratory, and psychological benefits, it carries a significant risk of injuries. It was found that most runners adopt an RFS pattern, which tends to increase with distance covered and the use of cushioned footwear. Although some studies suggest a relationship between certain foot strike patterns and specific injuries, there is insufficient evidence to recommend changes in foot strike patterns for injury prevention. Elite runners tend to use an NRFS pattern more than amateurs, but the relationship between foot strike patterns, performance, and biomechanical variables is complex and varies indivually. It concludes that health professionals and coaches should consider these variations when advising runners on training techniques and strategies, prevention, treatment, and rehabilitation of injuries.
Background
Plantar heel pain (PHP), or plantar fasciopathy, is a common condition in active and sedentary populations, contributing to short- and long-term reductions in quality of life. The condition's aetiology and pathophysiology are the subjects of a significant body of research. However, much of this research has been conducted with sedentary participants, and comparatively little research exists in a population of highly-trained athletes focused on performance outcomes. Models for PHP and proposed mechanisms, such as high body mass index or systemic disease, are mostly absent from an athletic population. Even less is known about the origins of pain in PHP. Pain is believed to be a complex multifactorial process and may be experienced differently by sedentary and highly active populations, particularly endurance athletes. Consequently, conservative through to surgical treatment for athletes is informed by literature for a different population, potentially hindering treatment outcomes.
Aims
The aim of this review, therefore, is to summarise what is known about PHP in athletic populations and propose potential directions for future research.
Methods
Embase, PubMed, and Scopus using MeSH search terms for PHP and competitive sport and common synonyms.
Discussion
Two explanatory models for PHP were found. These primarily propose mechanical factors for PHP. It remains unclear how gait, body composition, and psychological factors may differ in an athletic population with and without PHP. Therefore, research in these three area is needed to inform clinical and training interventions for this population.
Objectives
Hip/groin running-related injuries (RRI) are relatively uncommon. It is unclear if runners of either sex are disproportionately affected. Our objective was to systematically review differences in hip/groin RRIs between males and females.
Data Sources
A structured and comprehensive search of four medical literature databases was performed (PubMed, Embase, Ovid Medline, and CINAHL). Terms searched were: risk, epidemiology, hip injury, groin injury, overuse injury, running, sprinting, and track and field.
Study Selection
Studies reporting sex-specific data on hip/groin RRIs in adult runners were included. Data was extracted and reviewed independently by two authors.
Study Appraisal and Data Synthesis
Sex-specific injury rates, risk factors, and return to sport (RTS) following hip/groin RRI were extracted. Risk of bias was assessed using the Joanna-Briggs Institute Critical Appraisal Tool.
Results
10 studies with 7,353 total runners were included: 2,315 (47%) males and 2,559 (53%) females. The mean age of included runners was 37.3 ± 8.9 years and mean weekly running distance was 10.4 ± 8.4 km. Hip/groin injuries comprised 10.1% (491/4,874) of total RRIs, including 6.3% of RRIs sustained by males and 11.0% by females. Three studies reported significantly higher rates of hip/groin RRIs in female runners. One study reported significantly higher rates of gluteus medius and adductor RRIs for females and males, respectively. One study identified female sex as an independent risk factor for hip/groin RRIs. Three studies reported on RTS after hip/groin RRIs: the pooled RTS rate was 81.4% (57/70) at 1 to 368 days after injury.
Limitations
Data was pooled when possible; however, there was considerable clinical, methodological, and statistical heterogeneity across studies.
Conclusions
Hip/groin RRIs comprise a greater percentage of total injuries among injured female runners relative to males. Females may be at a higher risk for sustaining hip/groin RRIs, though more research on risk factors and RTS is needed.
Local dynamic running stability is the ability of a dynamic system to compensate for small perturbations during running. While the immediate effects of footwear on running biomechanics are frequently investigated, no research has studied the long-term effects of barefoot vs. shod running on local dynamic running stability. In this randomized single-blinded controlled trial, young adults novice to barefoot running were randomly allocated to a barefoot or a cushioned footwear running group. Over an 8-week-period, both groups performed a weekly 15-min treadmill running intervention in the allocated condition at 70% of their VO 2 max velocity. During each session, an inertial measurement unit on the tibia recorded kinematic data (angular velocity) which was used to determine the short-time largest Lyapunov exponents as a measure of local dynamic running stability. One hundred running gait cycles at the beginning, middle, and end of each running session were analysed using one mixed linear multilevel random intercept model. Of the 41 included participants (48.8% females), 37 completed the study (drop-out = 9.7%). Participants in the barefoot running group exhibited lower running stability than in the shod running group ( p = 0.037) with no changes during the intervention period ( p = 0.997). Within a single session, running stability decreased over the course of the 15-min run ( p = 0.012) without differences between both groups ( p = 0.060). Changing from shod to barefoot running reduces running stability not only in the acute phase but also in the longer term. While running stability is a relatively new concept, it enables further insight into the biomechanical influence of footwear.
The footstrike pattern of an athlete is understood as the way the foot touches the ground. Over the years, several definitions and techniques to classify and quantify footstrike patterns have been described. Therefore, this narrative review summarizes the existing classifications of footstrike patterns, gives suggestions for further use of these classifications, and provides a summary of the relationship between footstrike patterns and the occurrence of overuse injuries.
Footstrike patterns are classified by using nominal (e.g. forefoot strike, midfoot strike, rearfoot strike) or continuous variables (e.g. footstrike angle). Possible assessments include visual, video-based, 3D-biomechanical, force plate-based or inertial measurement unit-based analysis.
Scientists, coaches, and clinicians can choose between different methods to analyze footstrike patterns in runners. All approaches to classify footstrike patterns have advantages and limitations. In certain situations, it might be beneficial to combine these methods. Despite great efforts in analyzing footstrike patterns, relationships between footstrike patterns and running-related injuries are mostly unclear at present. Based on the current literature, causal links to overuse injuries, recommendations to change running technique, and other simplifications solely based on the footstrike pattern must be considered critically.
Background
Running is a popular form of physical activity with many health benefits. However, the incidence and prevalence of running-related injuries (RRIs) is high. Biomechanical factors may be related to the development of RRIs.
Objective
This systematic review synthesizes biomechanical risk factors related to the development of RRIs in non-injured runners.
Methods
PubMed, Web of Science, CINAHL, Embase, and SPORTDiscus were searched in July 2018 for original peer-reviewed prospective studies evaluating potential biomechanical factors associated with the development of RRIs. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Two reviewers independently assessed articles for inclusion and methodological quality. Due to methodological heterogeneity across studies, a narrative synthesis of findings was conducted, rather than a meta-analysis.
Results
Sixteen studies, including 13 of high quality and three of moderate quality, were included. A large number of biomechanical variables were evaluated, producing inconsistent evidence overall. Limited evidence indicated greater peak hip adduction in female runners developing patellofemoral pain and iliotibial band syndrome, but not for a mixed-sex population of cross-country runners sustaining an RRI. The relationship between vertical loading rate and RRIs was inconsistent. Other kinematic, kinetic and spatiotemporal factors were only studied to a limited extent.
Conclusions
Current prospective evidence relating biomechanical variables to RRI risk is sparse and inconsistent, with findings largely dependent on the population and injuries being studied. Future research is needed to confirm these biomechanical risk factors and determine whether modification of these variables may assist in running injury prevention and management.
Purpose
The purpose of the present study was to describe the incidence proportion of different types of running-related injuries (RRI) among recreational runners and to determine their time to recovery.
Methods
A sub-analysis of the injured runners included in the 839-person, 24-week randomized trial named Run Clever. During follow-up, the participants reported levels of pain in different anatomical areas on a weekly basis. In case injured, runners attended a clinical examination at a physiotherapist, who provided a diagnosis, e.g., medial tibial stress syndrome (MTSS), Achilles tendinopathy (AT), patellofemoral pain (PFP), iliotibial band syndrome (ITBS) and plantar fasciopathy (PF). The diagnose-specific injury proportions (IP) and 95% confidence intervals (CI) were calculated using descriptive statistics. The time to recovery was defined as the time from the first registration of pain until total pain relief in the same anatomical area. It was reported as medians and interquartile range (IQR) if possible.
Results
A total of 140 runners were injured at least once leading to a 24-week cumulative injury proportion of 32% [95% CI: 26%; 37%]. The diagnoses with the highest incidence proportion were MTSS (IP = 16% [95% CI: 9.3%; 22.9%], AT (IP = 8.9% [95% CI: 3.6%; 14.2%], PFP (IP = 8% [95% CI: 3.0%; 13.1%]. The median time to recovery for all types of injuries was 56 days (IQR = 70 days). Diagnose-specific time-to-recoveries included 70 days (IQR = 89 days) for MTSS, 56 days (IQR = 165 days) for AT, 49 days (IQR = 63 days) for PFP.
Conclusion
The most common running injuries among recreational runners were MTSS followed by AT, PFP, ITBS and PF. In total, 77 injured participants recovered their RRI and the median time to recovery for all types of injuries was 56 days and MTSS was the diagnosis with the longest median time to recovery, 70 days.
Objectives:
To determine the proportion of participants of a running program for novice runners that discontinued running and investigate the main reasons to discontinue and characteristics associated with discontinuation.
Design:
Prospective cohort study.
Methods:
The study included 774 participants of Start to Run, a 6-week running program for novice runners. Before the start of the program, participants filled-in a baseline questionnaire to collect information on demographics, physical activity and perceived health. The 26-weeks follow-up questionnaire was used to obtain information on the continuation of running (yes/no) and main reasons for discontinuation. To determine predictors for discontinuation of running, multivariable logistic regression was performed.
Results:
Within 26 weeks after the start of the 6-week running program, 29.5% of the novice runners (n=225) had stopped running. The main reason for discontinuation was a running-related injury (n=108, 48%). Being female (OR 1.74; 95% CI 1.13-2.68), being unsure about the continuation of running after the program (OR 2.06; 95% CI 1.31-3.24) and (almost) no alcohol use (OR 1.62; 95%CI 1.11-2.37) were associated with a higher chance of discontinuation of running. Previous running experience less than one year previously (OR 0.46; 95% CI 0.26-0.83) and a higher score on the RAND-36 subscale physical functioning (OR 0.98; 95% CI 0.96-0.99) were associated with a lower chance of discontinuation.
Conclusions:
In this group of novice runners, almost one-third stopped running within six months. A running-related injury was the main reason to stop running. Women with a low perceived physical functioning and without running experience were prone to discontinue running.
Objectives: While the health benefits of running are legitimately advocated, participation in running can also lead to health problems. There is a high range of reported prevalence rates especially of running-related overuse injuries in high-level athletes and during competition. Little consensus exists for acute injuries and illnesses especially in recreational runners. Therefore, the aim of this study was to record the prevalence of health problems in recreational long-distance runners preparing for an event.
Methods: Recreational runners aged 18–65 years who were registered 13 weeks prior to a half-marathon running event were invited to take part in this study. Participants were prospectively monitored weekly over 13 weeks by applying a standardised surveillance system for injuries and illnesses (Oslo Sports Trauma Research Center questionnaire). From this, prevalence and severity of acute and overuse injuries, as well as illnesses, were calculated.
Results: We received 3213 fully answered questionnaires from 327 participants (40.7% female, 40.9±11.7 years of age, 31.5±21.1 km weekly mileage, 8.3±7.8 years of running experience). At any point in time over the preparation phase, 37.3% of the participants had health problems. Overuse injuries were the major burden (18%). They were followed by illnesses (14.1%) and acute injuries (7.9%). The median weekly severity score was 56.5 (IQR 37.0–58.0).
Conclusion: The high prevalence of health problems in our cohort suggests that future efforts are needed to further specify the underlying mechanism and develop adequate prevention strategies for recreational runners.
Effects of early and permanent footwear use are not well understood. The aim of this study was to investigate the effects of habituation to footwear on foot strike patterns of children and adolescents. Healthy habitually barefoot and shod participants (aged 6–18 years) from South Africa (n = 288) and Germany (n = 390) performed multiple 20-m jogging and running trials with and without shoes. Each foot strike was captured using a high-speed camera to determine a rearfoot or non-rearfoot strike. The probability of a rearfoot strike in both cohorts and each age was analyzed by using a mixed-effects logistic regression adjusted for possible confounders. Habitually barefoot children showed a higher probability of using rearfoot strikes than habitually shod children (p < 0.001). The probability was age-dependent and decreased in habitually barefoot children with age (OR(barefoot-jogging) = 0.82, 95 % CI, 0.71 to 0.96, p = 0.014; OR(barefoot-running = 0.58), 95 % CI, 0.50 to 0.67, p < 0.001 and OR(shod-running) = 0.68, 95 % CI, 0.59 to 0.79, p < 0.001). In habitually shod children, the probability increased significantly for shod jogging (OR = 1.19, 95 % CI, 1.05 to 1.35, p = 0.006). To conclude, foot strike patterns of children are inuenced by habituation to footwear. Younger habitually barefoot children show higher rates of rearfoot strikes for shod and barefoot running, and it converges in later adolescence.
Increased incidence of stress fracture has been reported for amenorrheic runners, while some studies have reported decreased spinal bone mass in amenorrheic runners. Based on results from these studies, one tends to associate decreased spinal bone mass with an increased risk of stress fracture. The present study compared regional bone mass and external loads during running between six female runners reporting a history of stress fracture (seven tibial and three femoral neck) and eight female runners with no history of stress fracture. Dual photon absorptiometry measures indicated significantly greater spinal (L2-L4) and femoral neck bone mineral density in stress fracture subjects (p<0.05) but no differences between groups for tibial bone density. Normalized forces recorded from Kistler force plates indicated significantly greater vertical propulsive, maximal medial, lateral, and posterior forces for stress fracture subjects during running (p<0.05).
The purpose of this study was to identify biomechanical and anthropometric variables that contribute to overuse injuries in runner. The comparisons were made between a group of runners who had sustained at least one overuse running injury and a group of runners who had been injury free throughout their running careers. Groups were well matched in important training variables. Synchronized kinetic and rearfoot kinematic variables of both feet were collected by filming subjects running over a force platform at a speed of 4 m.s-1. The injury-free group demonstrated significantly greater posterior thigh (hamstring) flexibility, as measured by a standard sit and reach test. This was the only anthropometric variable in which the groups differed. Within each group, there were no significant differences between left and right foot landing for any biomechanical variable. Biomechanical variables that demonstrated significantly lower values for the injury free group were the vertical force impact peak and the maximal vertical loading rate, with the maximal rate of rearfoot pronation and the touchdown supination angle showing a trend toward being greater in the injury free group. These results suggest that runners who have developed stride patterns that incorporate relatively low levels of impact forces, and a moderately rapid rate of pronation are at a reduced risk of incurring overuse running injuries.
(HERACLES) Identification des variables biomecaniques et anthropometriques intervenant dans l'etiologie des lesions de fatigue des membres inferieurs chez les coureurs de fond.
Understanding the demographics of patellofemoral pain is important to determine the best practices in diagnosis and treatment of this difficult pathology. The occurrence of patellofemoral pain has been reported from isolated sports medicine clinics and from within the military, but its incidence has never been examined in the general population within the United States.
The purpose of this study was to examine the reported occurrence of patellofemoral pain for those individuals seeking medical care and to compare that to all other pathologies that result in anterior knee pain, such as tendinopathies, patella subluxation, osteoarthritis, or meniscal and bursal conditions. Occurrence rates were examined across sex, age and region within a large healthcare provider database that contains over 30 million individuals.
Data were queried with the PearlDiver Patient Record Database, a national database containing orthopedic patient records. Two common International Classification of Disease, Ninth Revision (ICD-9) codes for patellofemoral pain (717.7 - Patella Chondromalacia and 719.46 - Pain in joint, lower leg) were utilized and were searched from the years 2007-2011. The top twenty additional ICD-9 codes that were concurrently coded with 717.7 and 719.46 were removed from the data. Chi-squared and Mantel-Haenszel tests were utilized to identify statistically significant differences in the diagnosis of patellofemoral pain between sex, age, and year.
During this five-year period, there were 2,188,753 individuals diagnosed with patellofemoral pain. The diagnosis was more common in females compared to males with 1,211,665 and 977,088 cases respectfully (p<0.001). Statistically significant differences between ages was found, with 50-59 year olds having the most cases with 578,854, p<0.001. And, during the five-year examination period, there was a steady increase between 2007-2011, p<0.01.
Patellofemoral pain was diagnosed between 1.5% and 7.3% of all patients seeking medical care within the United States. Females experienced patellofemoral pain more often than males and there was a steady increase of cases in the United States during the 2007-2011 examination period. The diagnosis of patellofemoral pain increased with age and the 50-59 year old age group had the most cases.
2b.
Possible benefits of barefoot running have been widely discussed in recent years. Uncertainty exists about which footwear strategy adequately simulates barefoot running kinematics. The objective of this study was to investigate the effects of athletic footwear with different minimalist strategies on running kinematics. Thirty-five distance runners (22 males, 13 females, 27.9 ± 6.2 years, 179.2 ± 8.4 cm, 73.4 ± 12.1 kg, 24.9 ± 10.9 km.week-1) performed a treadmill protocol at three running velocities (2.22, 2.78 and 3.33 m.s-1) using four footwear conditions: barefoot, uncushioned minimalist shoes, cushioned minimalist shoes, and standard running shoes. 3D kinematic analysis was performed to determine ankle and knee angles at initial foot-ground contact, rate of rear-foot strikes, stride frequency and step length. Ankle angle at foot strike, step length and stride frequency were significantly influenced by footwear conditions (p<0.001) at all running velocities. Posthoc pairwise comparisons showed significant differences (p<0.001) between running barefoot and all shod situations as well as between the uncushioned minimalistic shoe and both cushioned shoe conditions. The rate of rear-foot strikes was lowest during barefoot running (58.6% at 3.33 m.s-1), followed by running with uncushioned minimalist shoes (62.9%), cushioned minimalist (88.6%) and standard shoes (94.3%). Aside from showing the influence of shod conditions on running kinematics, this study helps to elucidate differences between footwear marked as minimalist shoes and their ability to mimic barefoot running adequately. These findings have implications on the use of footwear applied in future research debating the topic of barefoot or minimalist shoe running.
No systematic review has identified the incidence of running-related injuries per 1000 h of running in different types of runners.
The purpose of the present review was to systematically search the literature for the incidence of running-related injuries per 1000 h of running in different types of runners, and to include the data in meta-analyses.
A search of the PubMed, Scopus, SPORTDiscus, PEDro and Web of Science databases was conducted.
Titles, abstracts, and full-text articles were screened by two blinded reviewers to identify prospective cohort studies and randomized controlled trials reporting the incidence of running-related injuries in novice runners, recreational runners, ultra-marathon runners, and track and field athletes.
Data were extracted from all studies and comprised for further analysis. An adapted scale was applied to assess the risk of bias.
After screening 815 abstracts, 13 original articles were included in the main analysis. Running-related injuries per 1000 h of running ranged from a minimum of 2.5 in a study of long-distance track and field athletes to a maximum of 33.0 in a study of novice runners. The meta-analyses revealed a weighted injury incidence of 17.8 (95 % confidence interval [CI] 16.7-19.1) in novice runners and 7.7 (95 % CI 6.9-8.7) in recreational runners.
Heterogeneity in definitions of injury, definition of type of runner, and outcome measures in the included full-text articles challenged comparison across studies.
Novice runners seem to face a significantly greater risk of injury per 1000 h of running than recreational runners.
Study design:
Delphi study.
Objective:
To reach a consensus definition of running-related injury in recreational runners through a modified Delphi approach.
Background:
Many studies have suggested the need for a standardized definition of running-related injury to provide uniformity to injury surveillance in running.
Methods:
We invited 112 researchers from running-related injury studies identified in a previous systematic review to classify words and terms frequently used in definitions of running-related injury in an online form during 3 rounds of study. In the last round, participants were asked to approve or disapprove the consensus definition. We considered an agreement level of at least 75% to be a consensus.
Results:
Thirty-eight participants agreed to participate in the study. The response rates were 94.7% (n = 36) for the first round, 83.3% (n = 30) for the second round, and 86.7% (n = 26) for the third round. A consensus definition of running-related injury was reached, with 80% of participants approving the following: "Running-related (training or competition) musculoskeletal pain in the lower limbs that causes a restriction on or stoppage of running (distance, speed, duration, or training) for at least 7 days or 3 consecutive scheduled training sessions, or that requires the runner to consult a physician or other health professional."
Conclusion:
The proposed standardized definition of running-related injury could assist in standardizing the definitions used in sport science research and facilitate between-study comparisons. Future studies testing the validity of the proposed consensus definition, as well as its accurate translation to other languages, are also needed.
Despite several studies that have been conducted on running injuries, the risk factors for running-related injuries are still not clear in the literature.
The aim of this study was to systematically review prospective cohort studies that investigated the risk factors for running injuries in general.
We conducted electronic searches without restriction of language on EMBASE (1980 to Dec 2012), PUBMED (1946 to Dec 2012), CINAHL (1988 to Dec 2012) SPORTDiscus (1977 to Dec 2012), Latin American and Caribbean Centre on Health Sciences Information (1985 to Dec 2012) and Scientific Electronic Library Online (1998 to Dec 2012) databases, using subject headings, synonyms, relevant terms and variant spellings for each database.
Only prospective cohort studies investigating the risk factors for running-related musculoskeletal injuries were included in this review. Two independent reviewers screened each article and, if they did not reach a consensus, a third reviewer decided whether or not the article should be included.
Year of publication, type of runners, sample size, definition of running-related musculoskeletal injury, baseline characteristics, reported risk factors and the statistical measurement of risk or protection association were extracted from the articles. A scale adapted by the authors evaluated the risk of bias of the articles.
A total of 11 articles were considered eligible in this systematic review. A total of 4,671 pooled participants were analysed and 60 different predictive factors were investigated. The main risk factor reported was previous injury (last 12 months), reported in 5 of the 8 studies that investigated previous injuries as a risk factor. Only one article met the criteria for random selection of the sample and only six articles included a follow-up of 6 months or more. There was no association between gender and running injuries in most of the studies.
It is possible that eligible articles for this review were published in journals that were not indexed in any of the searched databases. We found a great heterogeneity of statistical methods between studies, which prevented us from performing a meta-analysis.
The main risk factor identified in this review was previous injury in the last 12 months, although many risk factors had been investigated in the literature. Relatively few prospective studies were identified in this review, reducing the overall ability to detect risk factors. This highlights the need for more, well designed prospective studies in order to fully appreciate the risk factors associated with running.
Movement towards sport safety in Athletics through the introduction of preventive strategies requires consensus on definitions and methods for reporting epidemiological data in the various populations of athletes.
To define health-related incidents (injuries and illnesses) that should be recorded in epidemiological studies in Athletics, and the criteria for recording their nature, cause and severity, as well as standards for data collection and analysis procedures.
A 1-day meeting of 14 experts from eight countries representing a range of Athletics stakeholders and sport science researchers was facilitated. Definitions of injuries and illnesses, study design and data collection for epidemiological studies in Athletics were discussed during the meeting. Two members of the group produced a draft statement after this meeting, and distributed to the group members for their input. A revision was prepared, and the procedure was repeated to finalise the consensus statement.
Definitions of injuries and illnesses and categories for recording of their nature, cause and severity were provided. Essential baseline information was listed. Guidelines on the recording of exposure data during competition and training and the calculation of prevalence and incidences were given. Finally, methodological guidance for consistent recording and reporting on injury and illness in athletics was described.
This consensus statement provides definitions and methodological guidance for epidemiological studies in Athletics. Consistent use of the definitions and methodological guidance would lead to more reliable and comparable evidence.
Objective
To determine the distribution of the foot strike patterns among recreational shod runners and to compare the personal and training characteristics between runners with different foot strike patterns.
Design
Cross-sectional study
Setting
Areas of running practice in São Paulo, Brazil.
Participants
514 recreational shod runners older than 18 years and free of injury.
Outcomes measures
Foot strike patterns were evaluated with a high-speed camera (250 Hz) and photocells to assess the running speed of participants. Personal and training characteristics were collected through a questionnaire.
Results
The inter-rater reliability of the visual foot strike pattern classification method was 96.7% and intra-rater reliability was 98.9%. 95.1% (n= 489) of the participants were rearfoot strikers, 4.1% (n= 21) were midfoot strikers, and four runners (0.8%) were forefoot strikers. There were no significant differences between strike patterns for personal and training characteristics.
Conclusion
This is the first study to demonstrate that almost all recreational shod runners were rearfoot strikers. The visual method of evaluation seems to be a reliable and feasible option to classify foot strike pattern.
Despite anecdotal evidence linking overpronation to the onset of Achilles tendinopathy (AT), there is little conclusive evidence of a particular movement pattern of the lower extremity associated with this injury. Therefore, the objective of the present study was to observe differences in the kinematic profiles of healthy runners (CON) and runners with mid-portion Achilles tendinopathy (ATG).
In this cross-sectional analysis, 48 male height and weight matched subjects were invited to participate: 27 with mid-portion Achilles tendon pain and 21 asymptomatic controls. Subjects underwent lower extremity clinical examination, then ran barefoot for 10-trials at a self-selected pace. A 3D motion capture system analysed tri-plane kinematic data for the lower extremity.
The ATG displayed significantly greater sub-talar joint eversion displacement during mid-stance of the running gait (13 +/- 3 degrees vs. 11 +/- 3 degrees; p = 0.04). Trends were observed such that the ATG showed lower peak dorsiflexion velocity (300 +/- 39 degrees/s vs. 330 +/- 59 degrees/s; p = 0.08) and greater overall frontal plane ankle joint range of motion (45 degrees +/- 7 vs. 41 degrees +/- 7; p = 0.09).
We found an increase in eversion displacement of the sub-talar joint in runners with Achilles mid-portion tendinopathy. Based on the findings from this study, there is evidence that devices used to control sub-talar eversion may be warranted in patients with Achilles mid-portion tendinopathy who demonstrate over-pronation during mid-stance of the running gait.
We performed a Monte Carlo study to evaluate the effect of the number of events per variable (EPV) analyzed in logistic regression analysis. The simulations were based on data from a cardiac trial of 673 patients in which 252 deaths occurred and seven variables were cogent predictors of mortality; the number of events per predictive variable was (252/7 =) 36 for the full sample. For the simulations, at values of EPV = 2, 5, 10, 15, 20, and 25, we randomly generated 500 samples of the 673 patients, chosen with replacement, according to a logistic model derived from the full sample. Simulation results for the regression coefficients for each variable in each group of 500 samples were compared for bias, precision, and significance testing against the results of the model fitted to the original sample. For EPV values of 10 or greater, no major problems occurred. For EPV values less than 10, however, the regression coefficients were biased in both positive and negative directions; the large sample variance estimates from the logistic model both overestimated and underestimated the sample variance of the regression coefficients; the 90% confidence limits about the estimated values did not have proper coverage; the Wald statistic was conservative under the null hypothesis; and paradoxical associations (significance in the wrong direction) were increased. Although other factors (such as the total number of events, or sample size) may influence the validity of the logistic model, our findings indicate that low EPV can lead to major problems.
To provide an extensive and up to date database for specific running related injuries, across the sexes, as seen at a primary care sports medicine facility, and to assess the relative risk for individual injuries based on investigation of selected risk factors.
Patient data were recorded by doctors at the Allan McGavin Sports Medicine Centre over a two year period. They included assessment of anthropometric, training, and biomechanical information. A model was constructed (with odds ratios and their 95% confidence intervals) of possible contributing factors using a dependent variable of runners with a specific injury and comparing them with a control group of runners who experienced a different injury. Variables included in the model were: height, weight, body mass index, age, activity history, weekly activity, history of injury, and calibre of runner.
Most of the study group were women (54%). Some injuries occurred with a significantly higher frequency in one sex. Being less than 34 years old was reported as a risk factor across the sexes for patellofemoral pain syndrome, and in men for iliotibial band friction syndrome, patellar tendinopathy, and tibial stress syndrome. Being active for less than 8.5 years was positively associated with injury in both sexes for tibial stress syndrome; and women with a body mass index less than 21 kg/m(2) were at a significantly higher risk for tibial stress fractures and spinal injuries. Patellofemoral pain syndrome was the most common injury, followed by iliotibial band friction syndrome, plantar fasciitis, meniscal injuries of the knee, and tibial stress syndrome.
Although various risk factors were shown to be positively associated with a risk for, or protection from, specific injuries, future research should include a non-injured control group and a more precise measure of weekly running distance and running experience to validate these results.
Prospective cohort.
To determine (1) the cumulative seasonal incidence and overall injury rate of medial tibial stress syndrome (MTSS) and (2) risk factors for MTSS with a primary focus on the relationship between navicular drop values and MTSS in high school cross-country runners.
MTSS is a common injury among runners. However, few studies have reported the injury rate and risk factors for MTSS among adolescent runners.
Data collected included measurement of bilateral navicular drop and foot length, and a baseline questionnaire regarding the runner's height, body mass, previous running injury, running experience, and orthotic or tape use. Runners were followed during the season to determine athletic exposures (AEs) and occurrence of MTSS.
The overall injury rate for MTSS was 2.8/1000 AEs. Although not statistically different, girls had a higher rate (4.3/1000 AEs) than boys (1.7/1000 AEs) (P = .11). Logistic regression modeling indicated that only gender and body mass index (BMI) were significantly associated with the occurrence of MTSS. However, when controlled for orthotic use, only BMI was associated with risk of MTSS. No significant associations were found between MTSS and navicular drop or foot length.
Our findings suggest that navicular drop may not be an appropriate measure to identify runners who may develop MTSS during a cross-country season; thus, additional studies are needed to identify appropriate preseason screening tools.
The purpose of this study was to present a systematic overview of published reports on the incidence and associated potential risk factors of lower extremity running injuries in long distance runners. An electronic database search was conducted using the PubMed-Medline database. Two observers independently assessed the quality of the studies and a best evidence synthesis was used to summarise the results. The incidence of lower extremity running injuries ranged from 19.4% to 79.3%. The predominant site of these injuries was the knee. There was strong evidence that a long training distance per week in male runners and a history of previous injuries were risk factors for injuries, and that an increase in training distance per week was a protective factor for knee injuries.
Background:
The loadrate of the vertical ground reaction force at impact has been associated with a variety of running injuries. Peak tibial shocks occur during the early stance phase and has been shown to be correlated to the loadrates in healthy runners using a rearfoot strike pattern. As a result, tibial accelerometry has been used as a surrogate for loadrates. However, these correlations have not been assessed in injured runners nor in runners with differing footstrike patterns.
Objective:
To examine the relationship between tibial acceleration and loadrates in injured runners who are habitual rearfoot (RFS), midfoot (MFS), and forefoot (FFS) strikers. Tibial acceleration was expected to be positively associated with loadrates across all footstrike patterns.
Design:
Cross-sectional cohort.
Setting:
Academic medical center with biomechanics laboratory.
Participants:
One hundred sixty-nine injured runners (age 38.7 ± 13.1 years, 127 RFS, 17 MFS, 25 FFS).
Methods:
Each participant completed a biomechanical assessment for injury including evaluation on a force treadmill with a triaxial accelerometer fastened by a Velcro strap to the distal medial tibia. Peak vertical and resultant tibial acceleration (VTA, RTA) were measured from the accelerometer. Vertical average and instantaneous loadrates (VALR, VILR) and the resultant instantaneous loadrate (RILR) were determined from the force data.
Main outcome measurements:
The relationship between tibial acceleration and loadrates measured using Pearson's correlation coefficient (r).
Results:
Loadrates were each associated with VTA (r = 0.66-0.82, P < .001) and RTA (r = 0.41-0.68, P < .05) across all footstrike groups with the exception of association of VILR to RTA in the FFS group. The strength in correlations was lowest between RTA and loadrates for the FFS runners (r = 0.41-0.47, P < .05).
Conclusion:
Vertical tibial acceleration is the stronger surrogate for loadrates in injured runners across differing footstrike patterns.
The capacity of foot-strike running patterns to influence the functional properties of the Achilles tendon is controversial. This study used transmission-mode ultrasound to investigate the influence of habitual running foot-strike pattern on Achilles tendon properties during barefoot walking and running. Fifteen runners with rearfoot (RFS) and 10 with a forefoot (FFS) foot-strike running pattern had ultrasound transmission velocity measured in the right Achilles tendon during barefoot walking (≈1.1 ms⁻¹) and running (≈2.0 ms⁻¹). Temporospatial gait parameters, ankle kinematics and vertical ground reaction force were simultaneously recorded. Statistical comparisons between foot-strike patterns were made using repeated measure ANOVAs. FFS was characterised by a significantly shorter stance duration (−4%), greater ankle dorsiflexion (+2°), and higher peak vertical ground reaction force (+20% bodyweight) than RFS running (P < .05). Both groups adopted a RFS pattern during walking, with only the relative timing of peak dorsiflexion (3%), ground reaction force (1–2%) and peak vertical force loading rates (22–23%) differing between groups (P < .05). Peak ultrasound transmission velocity in the Achilles tendon was significantly higher in FFS during walking (≈100 ms⁻¹) and running (≈130 ms⁻¹) than RFS (P < .05). Functional Achilles tendon properties differ with habitual footfall patterns in recreational runners.
Purpose:
Foot strike patterns (FSP) influence landing mechanics, with rearfoot strike (RFS) runners exhibiting higher impact loading than forefoot strike (FFS) runners. The few studies that included midfoot strike (MFS) runners have typically grouped them together with FFS. In addition, most running studies have been conducted in laboratories. Advances in wearable technology now allow the measurement of runners' mechanics in their natural environment. The purpose of this study was to examine the relationship between FSP and impacts across a marathon race.
Methods:
A total of 222 healthy runners (119 males, 103 females; age, 44.1 ± 10.8 yr) running a marathon race were included. A treadmill assessment was undertaken to determine FSP. An ankle-mounted accelerometer recorded tibial shock (TS) over the course of the marathon. TS was compared between RFS, MFS, and FFS. Correlations between speed and impacts were examined between FSP. TS was also compared at the 10- and 40-km race points.
Results:
RFS and MFS runners exhibited similar TS (12.24g ± 3.59g vs 11.82g ± 2.68g, P = 0.46) that was significantly higher (P < 0.001 and P < 0.01, respectively) than FFS runners (9.88g ± 2.51g). In addition, TS increased with speed for both RFS (r = 0.54, P = 0.01) and MFS (r = 0.42, P = 0.02) runners, but not FFS (r = 0.05, P = 0.83). Finally, both speed (P < 0.001) and TS (P < 0.001) were reduced between the 10- and the 40-km race points. However, when normalized for speed, TS was not different (P = 0.84).
Conclusions:
RFS and MFS exhibit higher TS than FFS. In addition, RFS and MFS increase TS with speed, whereas FFS do not. These results suggest that the impact loading of MFS is more like RFS than FFS. Finally, TS, when normalized for speed, is similar between the beginning and the end of the race.
Running is associated with a higher risk of overuse injury than other forms of aerobic exercise such as walking, swimming and cycling. An accurate description of the proportion of running injuries per anatomical location and where possible, per specific pathology, for both genders is required. The aim of this review was to determine the proportion of lower limb running injuries by anatomical location and by specific pathology in male and female runners (≥800m - ≤ marathon). The preferred reporting items for systematic reviews and meta-analyses guidelines were followed for this review. A literature search was performed with no re-striction on publication year in Web of Science, Scopus, Sport-Discus, PubMed, and CINAHL up to July 2017. Retrospective, cross-sectional, prospective and randomised-controlled studies which surveyed injury data in runners were included. 36 studies were included to report the overall proportion of injury per ana-tomical location. The overall proportion of injury by specific pathology was reported from 11 studies. The knee (28%), ankle-foot (26%) and shank (16%) accounted for the highest proportion of injury in male and female runners, although the proportion of knee injury was greater in women (40% vs. 31%). Relative to women, men had a greater proportion of ankle-foot (26% vs. 19%) and shank (21% vs. 16%) injuries. Patellofemoral pain syndrome (PFPS; 17%), Achilles tendinopathy (AT; 10%) and medial tibial stress syndrome (MTS; 8%) accounted for the high-est proportion of specific pathologies recorded overall. There was insufficient data to sub-divide specific pathology between gen-ders. The predominate injury in female runners is to the knee. Male runners have a more even distribution of injury between the knee, shank and ankle-foot complex. There are several methodo-logical issues, which limit the interpretation of epidemiological data in running injury.
In the analysis of human walking, the assessment of local dynamic stability (LDS) has been widely used to determine gait stability. To extend the concepts of LDS to the analysis of running biomechanics, this study aimed to compare LDS during exhaustive running between competitive and recreational runners. Fifteen recreational and fifteen competitive runners performed an exhaustive 5000 m run. Inertial measurement units at foot, pelvis, and thorax were used to determine local dynamic running stability as quantified by the largest Lyapunov exponent. In addition, we measured running velocity, lactate levels, perceived exertion, and foot strike patterns. LDS at the start, mid, and end of a 5000 m run was compared between the two groups by a two-way repeated-measures analysis of variance (ANOVA). Local dynamic stability increased during the run (thorax, pelvis) in both recreational and competitive runners (PThorax = 0.006; PPelvis = 0.001). During the whole run, competitive runners showed a significantly higher LDS (P = 0.029) compared to recreational runners at the foot kinematics. In conclusion, exhaustive running can lead to improvements in LDS, indicating a higher local dynamic stability of the running technique with increasing exhaustion. Furthermore, LDS of the foot differs between the two groups at all measurement points. The results of this study show the value of determining LDS in athletes as it can give a better understanding into the biomechanics of running.
Objectives:
To investigate the incidence and type of running related injuries in novice and recreational UK runners, and identify factors associated with injury.
Design:
Retrospective cross-sectional study.
Methods:
Novice and recreational runners were recruited through UK parkrun to complete a web-based survey. 1145 respondents reported information on demographics, personal characteristics, and running training characteristics (training goal, novice runners' training plans, frequency of running, running experience, running terrain). Current and previous injuries were self-reported and questions from the Oslo Sports Trauma Centre Questionnaire for overuse injury were completed. Chi-squared tests and binomial logistic regression were performed.
Results:
570 runners had a current injury and 86% were continuing to run despite their injury causing pain, directly affecting their performance and causing a reduction of running volume. In the first year of running, runners using a self-devised training programme were more likely to be injured compared with using a structured programme such as Couch to 5K. Running experience of over 2 years was protective (OR 0.578-0.65). Males were 1.45 times more likely to be injured. Other factors associated with current injury were wearing orthotics (OR 1.88), and lack of previous injuries in the past 12 months (OR 1.44).
Conclusions:
More experienced runners have a lower rate of injury. A novice runner should use a recognised structured training programme. These results suggest that graduated loading is important for novice runners, and that load modification may be important whilst recovering from an injury, however full recovery from previous injury may prevent future injury.
Purpose:
To examine the relationships between habitual running cadence and vertical loadrates in healthy and injured runners using habitual footstrike patterns. As CAD increased, we expected vertical loadrates would decrease.
Methods:
Healthy runners (n=32, 25 male) and injured runners (n=93, 45 male) seeking treatment were analyzed. Footstrike classifications were heel at initial contact (RFS) or forefoot at initial contact (FFS). Runners were divided into 4 injury-status/footstrike pattern (FSP) subgroups: healthy-RFS (n=19), injured-RFS (n=70), healthy-FFS (n=13), and injured-FFS (n=23). VGRF and CAD were recorded as participants ran on an instrumented treadmill at self-selected speed (x =2.6m/s ±0.12). Healthy runners used lab footwear similar to their habitual footwear and injured runners used habitual footwear. The vertical average and instantaneous loadrates (VALR, VILR) of the VGRF of each runner's right leg were calculated and correlated with CAD for 4 injury status-FSP subgroups and for all runners combined.
Results:
There were no differences in CAD between all runners or any subgroup (p>0.05). VALR and VILR were significantly higher (p<0.01) in the injured-RFS group compared to all other subgroups. Injured-FFS and healthy-FFS had similar loadrates (p=1.0).
Conclusions:
We found no relationships between habitual running cadence and vertical loadrates. The highest loadrates were in injured-RFS runners and the lowest loadrates were in FFS runners, regardless of injury status. Future studies of gait retraining to increase CAD and reduce loadrates should follow runners long-term to examine this relationship once CAD has become habituated.
Background:
There is disagreement in the literature regarding whether the excessive excursion or velocity of rearfoot eversion is related to the development of 2 common running injuries: Achilles tendinopathy (AT) and medial tibial stress syndrome (MTSS). An alternative hypothesis suggests that the duration of rearfoot eversion may be an important factor. However, the duration of eversion has received relatively little attention in the biomechanics literature.
Hypothesis:
Runners with AT or MTSS will demonstrate a longer duration of eversion but not greater excursion or velocity of eversion compared with healthy controls.
Study design:
Controlled laboratory study.
Methods:
Forty-two runners participated in this study (13 with AT, 8 with MTSS, and 21 matched controls). Participants were evaluated for lower extremity alignment and flexibility, after which a 3-dimensional kinematic and kinetic running gait analysis was performed. Differences between the 2 injuries and between injured and control participants were evaluated for flexibility and alignment, rearfoot kinematics, and 3 ground-reaction force metrics. Binary logistic regression was used to evaluate which variables best predicted membership in the injured group.
Results:
Injured participants, compared with controls, demonstrated higher standing tibia varus angles (8.67° ± 1.79° vs 6.76° ± 1.75°, respectively; P = .002), reduced static dorsiflexion range of motion (6.14° ± 5.04° vs 11.19° ± 5.10°, respectively; P = .002), more rearfoot eversion at heel-off (-6.47° ± 5.58° vs 1.07° ± 2.26°, respectively; P < .001), and a longer duration of eversion (86.02% ± 15.65% stance vs 59.12% ± 16.50% stance, respectively; P < .001). There were no differences in the excursion or velocity of eversion. The logistic regression (χ2 = 20.84, P < .001) revealed that every 1% increase in the duration of eversion during the stance phase increased the odds of being in the injured group by 1.08 (95% CI, 1.023-1.141; P = .006).
Conclusion:
Compared with healthy controls, runners currently symptomatic with AT or MTSS have a longer duration of eversion but not greater excursion or velocity of eversion.
Clinical relevance:
Static measures of the tibia varus angle and dorsiflexion range of motion, along with dynamic measures of the duration of eversion, may be useful for identifying runners at risk of sustaining AT or MTSS.
Mounting evidence has firmly established that low levels of cardiorespiratory fitness (CRF) are associated with a high risk of cardiovascular disease, all-cause mortality, and mortality rates attributable to various cancers. A growing body of epidemiological and clinical evidence demonstrates not only that CRF is a potentially stronger predictor of mortality than established risk factors such as smoking, hypertension, high cholesterol, and type 2 diabetes mellitus, but that the addition of CRF to traditional risk factors significantly improves the reclassification of risk for adverse outcomes. The purpose of this statement is to review current knowledge related to the association between CRF and health outcomes, increase awareness of the added value of CRF to improve risk prediction, and suggest future directions in research. Although the statement is not intended to be a comprehensive review, critical references that address important advances in the field are highlighted. The underlying premise of this statement is that the addition of CRF for risk classification presents health professionals with unique opportunities to improve patient management and to encourage lifestyle-based strategies designed to reduce cardiovascular risk. These opportunities must be realized to optimize the prevention and treatment of cardiovascular disease and hence meet the American Heart Association's 2020 goals.
Context
Medial tibial stress syndrome (MTSS) is a common condition in active individuals and presents as diffuse pain along the posteromedial border of the tibia.
Objective
To use cross-sectional, case-control, and cohort studies to identify significant MTSS risk factors.
Data Sources
Bibliographic databases (PubMed, Scopus, CINAHL, SPORTDiscus, EMBASE, EBM Reviews, PEDRo), grey literature, electronic search of full text of journals, manual review of reference lists, and automatically executed PubMed MTSS searches were utilized. All searches were conducted between 2011 and 2015.
Study Selection
Inclusion criteria were determined a priori and included original research with participants’ pain diffuse, located in the posterior medial tibial region, and activity related.
Study Design
Systematic review with meta-analysis.
Level of evidence
Level 4.
Data Extraction
Titles and abstracts were reviewed to eliminate citations that did not meet the criteria for inclusion. Study characteristics identified a priori were extracted for data analysis. Statistical heterogeneity was examined using the I² index and Cochran Q test, and a random-effects model was used to calculate the meta-analysis when 2 or more studies examined a risk factor. Two authors independently assessed study quality.
Results
Eighty-three articles met the inclusion criteria, and 22 articles included risk factor data. Of the 27 risk factors that were in 2 or more studies, 5 risk factors showed a significant pooled effect and low statistical heterogeneity, including female sex (odds ratio [OR], 2.35; CI, 1.58-3.50), increased weight (standardized mean difference [SMD], 0.24; CI, 0.03-0.45), higher navicular drop (SMD, 0.44; CI, 0.21-0.67), previous running injury (OR, 2.18; CI, 1.00-4.72), and greater hip external rotation with the hip in flexion (SMD, 0.44; CI, 0.23-0.65). The remaining risk factors had a nonsignificant pooled effect or significant pooled effect with high statistical heterogeneity.
Conclusion
Female sex, increased weight, higher navicular drop, previous running injury, and greater hip external rotation with the hip in flexion are risk factors for the development of MTSS.
Purpose:
High school cross country runners have a high incidence of injury, particularly at the shin and knee. An increased step rate during running has been shown to reduce impact forces and loading of the lower extremity joints. The purpose of this prospective study was to examine step rate as a risk factor for injury occurrence.
Materials/methods:
Running step rates of 68 healthy high school cross country runners (47 females; 21 males; mean age 16.2±1.3 yrs) were assessed at a fixed speed (3.3±0.0 m/s) and self-selected speed (mean 3.8±0.5 m/s). Runners were prospectively followed during the interscholastic season to determine athletic exposures, occurrences of shin injury and anterior knee pain, and days lost to injury.
Results:
During the season, 19.1% of runners experienced a shin injury and 4.4% experienced anterior knee pain. Most injuries (63.6%) were classified as minor (1-7 days lost). At the fixed speed, runners in the lowest tertile of step rate (≤164 steps/min) were more likely (OR=6.67; 95% CI, 1.2-36.7; p=0.03) to experience a shin injury compared to runners in the highest tertile (≥174 steps/min). Similarly, for self-selected speed, runners in the lowest tertile (≤166 steps/min) (OR=5.85; 95% CI, 1.1-32.1; p<0.04) were more likely to experience a shin injury than runners in the highest tertile (≥178 steps/min). Anterior knee pain incidence was not significantly influenced by step rate.
Conclusion:
A lower running step rate was associated with a greater likelihood of shin injury at both self-selected and fixed running speeds. Future studies evaluating whether increasing running step rate reduces shin injury risk and time lost during a high-school cross country season should be considered.
Background Vertical ground reaction force (VGRF) parameters have been implicated as a cause of several running-related injuries. However, no systematic review has examined this relationship.
Aim We systematically reviewed evidence for a relation between VGRF parameters and specific running-related injuries.
Methods MEDLINE, Web of Science and EMBASE databases were searched. Two independent assessors screened the articles and rated the methodological quality. The 3 key VGRF parameters we measured were vertical loading rate, impact/passive peak (Fz1) and propulsive/active peak (Fz2). Standardised mean differences of these parameters were calculated using a random-effects model. Meta-regression was performed using injury type, study type and methodological quality as factors.
Results The search yielded 2016 citations and 18 met the inclusion criteria for the systematic review. The loading rate was higher in studies that included patients with a history of stress fractures and patients with all injury types, both compared with controls. Only studies that included patients with a history of symptoms at the time of kinetic data collection showed higher loading rates overall in cases than in controls. There were no differences between injured subjects and controls for the active and passive peaks of the VGRF.
Summary The loading rate is higher in respondents with a history of stress fractures than in respondents without running injuries. Owing to the absence of prospective studies on other injury types, it is not possible to draw definite conclusions regarding their relation with loading rate.
Background Running has been critical to human survival. Therefore, the high rate of injuries experienced by modern day runners is puzzling. Landing on the heel, as most modern day shod runners do, results in a distinct vertical impact force that has been shown to be associated with running-related injuries. However, these injury studies were retrospective in nature and do not establish cause and effect.
Objective To determine whether runners with high impacts are at greater risk for developing medically diagnosed injuries.
Methods 249 female runners underwent a gait analysis to measure vertical instantaneous loading rate, vertical average loading rate (VALR), vertical impact peak (VIP) and peak vertical force. Participants then recorded their mileage and any running-related injuries monthly in a web-based, database programme. Variables were first compared between the entire injured (INJ; n=144) and uninjured (n=105) groups. However, the focus of this study was on those injured runners seeking medical attention (n=103) and those who had never injured (n=21).
Results There were no differences between the entire group of injured and uninjured groups. However, all impact-related variables were higher in those with medically diagnosed injuries compared with those who had never been injured. (effect size (ES) 0.4–0.59). When VALR was >66.0 body weight (BW)/s, the odds of being DX_INJ were 2.72 (95% CI 1.0 to 7.4). Impact loading was associated with bony and soft-tissue injuries.
Conclusions Vertical average loading rate was lower in female runners classified as ‘never injured’ compared with those who had been injured and sought medical attention.
This retrospective study tests if runners who habitually forefoot strike have different rates of injury than runners who habitually rearfoot strike.
We measured the strike characteristics of middle- and long-distance runners from a collegiate cross-country team and quantified their history of injury, including the incidence and rate of specific injuries, the severity of each injury, and the rate of mild, moderate, and severe injuries per mile run.
Of the 52 runners studied, 36 (69%) primarily used a rearfoot strike and 16 (31%) primarily used a forefoot strike. Approximately 74% of runners experienced a moderate or severe injury each year, but those who habitually rearfoot strike had approximately twice the rate of repetitive stress injuries than individuals who habitually forefoot strike. Traumatic injury rates were not significantly different between the two groups. A generalized linear model showed that strike type, sex, race distance, and average miles per week each correlate significantly (P < 0.01) with repetitive injury rates.
Competitive cross-country runners on a college team incur high injury rates, but runners who habitually rearfoot strike have significantly higher rates of repetitive stress injury than those who mostly forefoot strike. This study does not test the causal bases for this general difference. One hypothesis, which requires further research, is that the absence of a marked impact peak in the ground reaction force during a forefoot strike compared with a rearfoot strike may contribute to lower rates of injuries in habitual forefoot strikers.
lower-limb stress fracture is one of the most common types of running injuries. There have been several studies focusing on the association between stress fractures and biomechanical factors. In the current study, the ground reaction force and loading rate are examined. There is disagreement in the literature about whether the history of stress fractures is associated with ground reaction forces (either higher or lower than control), or with loading rates.
a systematic review of the literature was conducted on the relationship between the history of tibial and/or metatarsal stress fracture and the magnitude of the ground reaction force and loading rate. Fixed-effect meta-analysis techniques were applied to determine whether or not the ground reaction force and/or loading rate are different between the stress fracture and control groups.
thirteen articles were identified through a systematic search of the literature. About 54% of these articles reported significantly different vertical ground reaction force and/or loading rate between the stress fracture and control groups. Other studies (~46%) did not observe any significant difference between the two groups. Meta-analysis results showed no significant differences between the ground reaction force of the lower-limb stress fracture and control groups (P>0.05). However, significant differences were observed for the average and instantaneous vertical loading rates (P<0.05).
the currently available data does not support the hypothesis that there is a significant difference between the ground reaction force of subjects experiencing lower-limb stress fracture and control groups. Instead, the vertical loading rate was found to be significantly different between the two groups.
To compare selected structural and biomechanical factors between female runners with a history of plantar fasciitis and healthy control subjects.
Cross-sectional.
University of Delaware Motion Analysis Laboratory, Newark, Delaware; and University of Massachusetts Biomechanics Laboratory, Amherst, Massachusetts.
Twenty-five female runners with a history of plantar fasciitis were recruited for this study. A group of 25 age- and mileage-matched runners with no history of plantar fasciitis served as control subjects.
The independent variable was whether or not subjects had a history of plantar fasciitis.
Subjects ran overground while kinematic and kinetic data were recorded using a motion capture system and force plate. Rearfoot kinematic variables of interest included peak dorsiflexion, peak eversion, time to peak eversion along with eversion excursion. Vertical ground reaction force variables included impact peak and the maximum instantaneous load rate. Structural measures were taken for calcaneal valgus and arch index during standing and passive ankle dorsiflexion range of motion.
A significantly greater maximum instantaneous load rate was found in the plantar fasciitis group along with an increased ankle dorsiflexion range of motion compared with the control group. The plantar fasciitis group had a lower arch index compared with control subjects, but calcaneal valgus was similar between groups. No differences in rearfoot kinematics were found between groups.
These data indicate that a history of plantar fasciitis in runners may be associated with greater vertical ground reaction force load rates and a lower medial longitudinal arch of the foot.
The aim of this study is to describe the prevalence and incidence of lower extremity injuries occurring before and during the Rotterdam marathon, and to evaluate the impact of the injuries. A cohort study was compiled of recreational male participants in the 2005 Rotterdam marathon. Demographic data and information on previous injuries were obtained from participants using a baseline questionnaire. Information on injuries sustained shortly before or during the marathon was obtained from a post-race questionnaire. Seven hundred and twenty-five (48.3%) participants returned the baseline questionnaire. The 1-year prevalence of running injuries was 54.8%. In the post-race questionnaire, 15.6% of all respondents reported at least one new lower extremity injury in the month preceding the Rotterdam marathon. The incidence of lower extremity injuries occurring during the marathon was 18.2%; most of these injuries occurred in the calf, knee and thigh. Immediately after the marathon the median score of pain intensity at rest was 2 points vs 4.5 points during physical exercise. Hence we can conclude that running injuries are very common among recreational male marathon runners. However, the pain severity and consequences for work and daily activities seem to be relatively low 1 week after the marathon.
What are the main risk factors for running-related injuries
- B T Saragiotto
- T P Yamato
- Hespanhol Junior
- L C Rainbow
- M J Davis
- I S Lopes
Saragiotto BT, Yamato TP, Hespanhol Junior LC, Rainbow MJ,
Davis IS, Lopes AD. What are the main risk factors for running-related
injuries? Sports Med. 2014;44(8):1153-63.
Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review