Running-related injuries in middle school cross-country runners: Prevalence and characteristics of common injuries

Do we underestimate the frequency of ankle sprains in running? A systematic review and meta-analysis

OBJECTIVE

To provide a systematic review and meta-analysis of the proportion of ankle sprains in running practices.

DESIGN

Systematic review and meta-analysis.

MAIN OUTCOME MEASURES

We calculated the weighted summary proportion and conducted meta-analyses for runners, considering levels (elite/recreational) and disciplines (distance, track, cross-country, trail, and orienteering).

RESULTS

32 studies were included in the systematic review and 19 were included in the meta-analysis with a level of quality ranging from poor to good. Proportion of ankle sprains in runners was 13.69% (95%CI = 7.40-21.54; I2 = 98.58%) in global, 12.20% (95%CI = 5.24-21.53; I2 = 89.31%) in elite, 19.40% (95%CI = 10.05-30.90; I2 = 99.09%) in recreational, 8.51% (95%CI = 4.22-14.12; I2 = 96.15%) in distance, 67.42% (95%CI = 0.50-82.85; I2 = 99.36%) in track, 27.07% (95%CI = 12.48-44.81; I2 = 97.97%) in cross-country, and 25.70% (95%CI = 19.87-32.14; I2 = 0.00) in orienteering.

CONCLUSIONS

Running practice results in significant proportion rate of ankle sprains. Recreational runners exhibit higher proportion than elite. Running disciplines, especially track, cross-country, and orienteering, influence reported ankle sprain rates, surpassing those of distance runners.

Injury and Treatment Characteristics of Middle School-Aged Patients Under the Care of Athletic Trainers From 2010 to 2022: A Report From the Athletic Training Practice-Based Research Network

CONTEXT

Exploring sports-related musculoskeletal injuries and treatment characteristics in middle school sports may help inform patient care decisions such as appropriate medical coverage.

OBJECTIVE

To describe injury and treatment characteristics of middle school-aged athletes receiving care from athletic trainers within the Athletic Training Practice-Based Research Network (AT-PBRN).

DESIGN

Descriptive study.

SETTING

Middle school.

PATIENT OR OTHER PARTICIPANTS

Middle school-aged athletes (n = 1011; male = 503, female = 506, 2 declined to answer) with sports-related musculoskeletal injuries.

MAIN OUTCOME MEASURES

Electronic patient records were analyzed from the AT-PBRN from 59 athletic trainers across 14 states between 2010 and 2022. Summary statistics (frequency, percentages, median, and interquartile ranges [IQR]) were used to describe injury (age at injury, sex, sport, body part, and diagnosis) and treatment characteristics (type of treatment, number of visits, and number of procedures per visit).

RESULTS

Football (17.7%, n = 179), basketball (17.6%, n = 178), and soccer (14.9%, n = 151) reported the highest number of injuries. The ankle (17.2%, n = 174), knee (16.5%, n = 167), and head (14.1%, n = 143) were the most common injury locations. Concussion (13.0%, n = 131), ankle strain/sprain (12.4%, n = 125), and thigh/hip/groin sprain/strain (11.1%, n = 112) were the most reported diagnoses. Therapeutic exercise or activities (27.6%, n = 1068), athletic trainer evaluation or re-evaluation (24.7%, n = 957), and hot/cold packs (19.8%, n = 766) were the most common services, with a median of 2 visits (IQR = 1 to 4) and 2 procedures (IQR = 1 to 2) per visit.

CONCLUSIONS

Football, basketball, and soccer reported the most musculoskeletal injuries for middle school-aged athletes. Concussions were the most frequent diagnosis, followed by ankle sprains/strains. Our findings are similar to prior investigations at the high school and collegiate levels. Treatments at the middle school level were also similar to those that have been previously reported at the high school level with therapeutic exercise/activity, athletic trainer evaluation or re-evaluation, and hot/cold packs being the most common treatments. This information may be useful for informing patient care decisions at the middle-school level.

A systematic review, meta-analysis, and meta-regression of the prevalence of self-reported disordered eating and associated factors among athletes worldwide

BACKGROUND

The purpose of this meta-analysis was to provide a pooled prevalence estimate of self-reported disordered eating (SRDE) in athletes based on the available literature, and to identify risk factors for their occurrence.

METHODS

Across ten academic databases, an electronic search was conducted from inception to 7th January 2024. The proportion of athletes scoring at or above predetermined cutoffs on validated self-reporting screening measures was used to identify disordered eating (DE). Subgroup analysis per country, per culture, and per research measure were also conducted. Age, body mass index (BMI), and sex were considered as associated/correlated factors.

RESULTS

The mean prevalence of SRDE among 70,957 athletes in 177 studies (132 publications) was 19.23% (17.04%; 21.62%), I2 = 97.4%, τ2 = 0.8990, Cochran's Q p value = 0. Australia had the highest percentage of SRDE athletes with a mean of 57.1% (36.0%-75.8%), while Iceland had the lowest, with a mean of 4.9% (1.2%-17.7%). The SRDE prevalence in Eastern countries was higher than in Western countries with 29.1% versus 18.5%. Anaerobic sports had almost double the prevalence of SRDE 37.9% (27.0%-50.2%) compared to aerobic sports 19.6% (15.2%-25%). Gymnastics sports had the highest SRDE prevalence rate, with 41.5% (30.4%-53.6%) while outdoor sports showed the lowest at 15.4% (11.6%-20.2%). Among various tools used to assess SRDE, the three-factor eating questionnaire yielded the highest SRDE rate 73.0% (60.1%-82.8%). Meta-regression analyses showed that female sex, older age, and higher BMI (all p < 0.01) are associated with higher prevalence rates of SRDE.

CONCLUSION

The outcome of this review suggests that factors specific to the sport affect eating behaviors throughout an athlete's life. As a result, one in five athletes run the risk of developing an eating disorder. Culture-specific and sport-specific diagnostic tools need to be developed and increased attention paid to nutritional deficiencies in athletes.

Overuse Injuries, Overtraining, and Burnout in Young Athletes

Sports participation can have tremendous physical and mental health benefits for children. Properly implemented progressive training programs can yield a broad range of beneficial physiologic adaptations, but imbalances of training load and recovery can have important negative consequences. Overuse injuries, for example, can result from repetitive stress without sufficient recovery that leads to accumulated musculoskeletal damage. In addition, extended periods of increased training loads that exceed the intervening recovery can have systemic consequences such as overtraining syndrome, which results in decreased performance, increased injury and illness risk, and derangement of endocrine, neurologic, cardiovascular, and psychological systems. Burnout represents one of the primary reasons for attrition in youth sports. Broadly defined as physical or mental exhaustion and a reduced sense of accomplishment that leads to devaluation of sport, burnout represents a direct threat to the goal of lifelong physical activity and the wide-ranging health benefits that it provides. This clinical report is intended to provide pediatricians with information regarding the risk factors, diagnosis, management, and prevention of these conditions to assist in the identification of at-risk children, the treatment of young athletes, and the guidance of families in the promotion of safe and healthy sport participation.

Body Weight Satisfaction, Comments, Nutrition and Injury Risk in 489 Adolescent Elite Athletes

Exposure to critical body weight comments in youth athletes could lead to decreased self-esteem, affect body image, and increase the risk of eating disorders and cause depressive symptoms. The aim was to explore differences between sex, body mass index, sports type, with regards to body weight satisfaction, exposure to critical body weight comments from their coach and nutrition status in adolescent elite athletes. A questionnaire about body weight, critical body weight comments and nutrition was distributed to 489 adolescent elite athletes and injury prevalence was monitored across 20 weeks. The results showed that almost one in four athletes (n=116, 24%) was not satisfied with their weight and 12% (n=59) had received critical body weight comments from their coach. Of the athletes who were unsatisfied with their body weight (n=116), 47% wanted to lose weight (n=55). A significant (p<0.05) higher proportion of ice hockey players and swimmers used nutritional supplements, were unsatisfied with their body weight, and were more exposed to critical body weight comments compared to athletes from other sports. Adolescent elite athletes as young as 15-16 years old are exposed to critical body weight comments from their coach and experience challenges with body weight satisfaction that is partly dependent on the sport-specific context.

Knee function and quality of life in adolescent soccer players with Osgood Shlatter disease history: a preliminary study

The aim of the study was to assess psycho-physical deficits among young athletes with history of Osgood Shlatter Disease (OSD-H) compared to adolescents without history of knee pain (Control group). Eighteen participants were recruited from a group of 80 young (U14-U17) male soccer players. Medical records, and Knee Osteoarthritis Outcome Score (KOOS) were performed from both groups. The tests were conducted to assess the anthropometric characteristics, knee and ankle range of motion (Ely's and Weight Bearing Lunge tests), and muscle power of the lower limbs (Leg Press, Single Leg Countermovement Jump, and Single Leg Hop for Distance). Results showed that overall patient-relevant outcomes following OSD (87%) were significantly lower than in the Control group (95%) (p < 0.05). Scores of the KOOS subscales revealed that Quality of Life and Function, Sports and recreational activities were significantly lower in the OSD-H group (p < 0.05). Although, there were no differences in subscale scores for Pain, Symptoms and Daily Activities. There were, also no difference between groups in range of motion angles and muscle power of the lower limbs values. The preliminary results support existing knowledge indicate that OSD may have a long-term influence on function, sports and recreational participation, and quality of life on young athletes.

The impact of the menstrual cycle on orthopaedic sports injuries in female athletes

There is a disparity in sport-related injuries between sexes, with females sustaining non-contact musculoskeletal injuries at a higher rate. Anterior cruciate ligament ruptures are between two and eight times more common than in males, and females also have a higher incidence of ankle sprains, patellofemoral pain, and bone stress injuries. The sequelae of such injuries can be devastating to an athlete, resulting in time out of sport, surgery, and the early onset of osteoarthritis. It is important to identify the causes of this disparity and introduce prevention programmes to reduce the incidence of these injuries. A natural difference reflects the effect of reproductive hormones in females, which have receptors in certain musculoskeletal tissues. Relaxin increases ligamentous laxity. Oestrogen decreases the synthesis of collagen and progesterone does the opposite. Insufficient diet and intensive training can lead to menstrual irregularities, which are common in female athletes and result in injury, whereas oral contraception may have a protective effect against certain injuries. It is important for coaches, physiotherapists, nutritionists, doctors, and athletes to be aware of these issues and to implement preventive measures. This annotation explores the relationship between the menstrual cycle and orthopaedic sports injuries in pre-menopausal females, and proposes recommendations to mitigate the risk of sustaining these injuries.

Anxiety state impact on recovery of runners with lower extremity injuries

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.

Prevalence and factors associated with bone stress injury in middle school runners

BACKGROUND

Bone stress injury (BSI) in youth runners is clinically important during times of skeletal growth and is not well studied.

OBJECTIVE

To evaluate the prevalence, anatomical distribution, and factors associated with running-related BSI in boy and girl middle school runners.

DESIGN

Retrospective cross-sectional study.

SETTING

Online survey distributed to middle school runners.

METHODS

Survey evaluated BSI history, age, grade, height, weight, eating behaviors, menstrual function, exercise training, and other health characteristics.

MAIN OUTCOME MEASUREMENTS

Prevalence and characteristics associated with history of BSI, stratified by cortical-rich (eg, tibia) and trabecular-rich (pelvis and femoral neck) locations.

PARTICIPANTS

2107 runners (n = 1250 boys, n = 857 girls), age 13.2 ± 0.9 years.

RESULTS

One hundred five (4.7%) runners reported a history of 132 BSIs, with higher prevalence in girls than boys (6.7% vs 3.8%, p = .004). The most common location was the tibia (n = 51). Most trabecular-rich BSIs (n = 16, 94% total) were sustained by girls (pelvis: n = 6; femoral neck: n = 6; sacrum: n = 4). In girls, consuming <3 daily meals (odds ratio [OR] = 18.5, 95% confidence interval [CI] = 7.3, 47.4), eating disorder (9.8, 95% CI = 2.0, 47.0), family history of osteoporosis (OR = 6.9, 95% CI = 2.6, 18.0), and age (OR = 1.6, 95% CI = 1.0, 2.6) were associated with BSI. In boys, family history of osteoporosis (OR = 3.2, 95% CI = 1.2, 8.4), prior non-BSI fracture (OR = 3.2, 95% CI = 1.6, 6.7), and running mileage (OR = 1.1, 95% CI = 1.0, 1.1) were associated with BSI. Participating in soccer or basketball ≥2 years was associated with lower odds of BSI for both sexes.

CONCLUSION

Whereas family history of osteoporosis and prior fracture (non-BSI) were most strongly related to BSI in the youth runners, behaviors contributing to an energy deficit, such as eating disorder and consuming <3 meals daily, also emerged as independent factors associated with BSI. Although cross-sectional design limits determining causality, our findings suggest promoting optimal skeletal health through nutrition and participation in other sports including soccer and basketball may address factors associated with BSI in this population.

Biomechanical running gait assessments across prevalent adolescent musculoskeletal injuries

BACKGROUND

While there is substantial information available regarding expected biomechanical adaptations associated with adult running-related injuries, less is known about adolescent gait profiles that may influence injury development.

RESEARCH QUESTIONS

Which biomechanical profiles are associated with prevalent musculoskeletal lower extremity injuries among adolescent runners, and how do these profiles compare across injury types and body regions?

METHODS

We conducted a cross-sectional study of 149 injured adolescents (110 F; 39 M) seen at a hospital-affiliated injured runner's clinic between the years 2016-2021. Biomechanical data were obtained from 2-dimensional video analyses and an instrumented treadmill system. Multivariate analyses of variance covarying for gender and body mass index were used to compare continuous biomechanical measures, and Chi-square analyses were used to compare categorical biomechanical variables across injury types and body regions. Spearman's rho correlation analyses were conducted to assess the relationship of significant outcomes.

RESULTS

Patients with bony injuries had significantly higher maximum vertical ground reaction forces (bony: 1.87 body weight [BW] vs. soft tissue: 1.79BW, p = 0.05), and a higher proportion of runners with contralateral pelvic drop at midstance (χ² =5.3, p = 0.02). Maximum vertical ground reaction forces and pelvic drop were significantly yet weakly correlated (ρ = 0.20, p = 0.01). Foot strike patterns differed across injured body regions, with a higher proportion of hip and knee injury patients presenting with forefoot strike patterns (χ² =22.0, p = 0.01).

SIGNIFICANCE

These biomechanical factors may represent risk factors for injuries sustained by young runners. Clinicians may consider assessing these gait adaptations when treating injured adolescent patients.

Osgood-Schlatter Disease: Appearance, Diagnosis and Treatment: A Narrative Review

Osgood-Schlatter disease is the most common osteochondritis of the lower limb in sport-practicing children and adolescents. Its manifestation usually coincides with the appearance of the secondary ossification center of the tibia and is linked to the practice of sports with an explosive component. In the present study, a review of the factors related to its appearance, diagnosis and treatment was carried out. Its appearance seems to be multifactorial and related to multiple morphological, functional, mechanical and environmental factors. Given all the above, risk factor reduction and prevention seem the most logical strategies to effectively prevent the appearance of the condition. In addition, it is essential to create prevention programs that can be objectively assessed and would allow to stop the progress of the pathology, particularly in those sports where high forces are generated on the insertion zone of the patellar tendon at sensitive ages. More studies are needed to clarify which type of treatment is the most appropriate—specific exercises or the usual care treatment.

Adolescent Running Biomechanics - Implications for Injury Prevention and Rehabilitation

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.