Perception of Health Problems Among Competitive Runners: A Qualitative Study of Cognitive Appraisals and Behavioral Responses

'The right advice': a qualitative study examining enablers and barriers to recreational running and beliefs about knee health following knee surgery

OBJECTIVES

To examine the experiences, knowledge and beliefs of recreational runners with a history of knee surgery regarding (i) enablers and barriers to running participation, (ii) the association of running and knee joint health, and (iii) perceived benefits and motivations for running.

METHODS

17 runners (≥3 times/week, ≥10 km/week) with a history of knee surgery (7±7 years post-surgery, 9 women, age 36±8 years) participated in one-on-one semi-structured interviews. Interviews were recorded, transcribed verbatim and analysed using reflexive thematic analysis. Trustworthiness was built by following established qualitative research guidelines and by participant validation of findings in the final analysis stages.

RESULTS

We identified 9 themes (5 subthemes) for aim (i); 3 themes (10 subthemes) for aim (ii); and 2 themes (4 subthemes) for aim (iii). Positive health professional support including education, exercise rehabilitation and a tailored return-to-run plan enabled participants to return to running following surgery. Effective load management either independently or with coach assistance, and consistent strength training were considered key to maintaining participation. Barriers to running following surgery included unhelpful health professional encounters, persistent knee symptoms and muscle weakness, new running-related injuries, anxiety and fear about reinjury, and difficulty finding time. Participants had varying beliefs about running and knee joint health, although most believed that running benefited long-term knee health. Improved mental health and social connection were the most common motivators to run.

CONCLUSION

Our qualitative findings may inform strategies to support adults to commence, or return to, and maintain running participation following knee surgery.

The Running Injury Continuum: A qualitative examination of recreational runners' description and management of injury

INTRODUCTION

A critical step in understanding and preventing running-related injuries (RRIs) is appropriately defining RRIs. Current definitions of RRIs may not represent the full process of injury development, failing to capture lower levels of injury that many athletes continue to train through. Understanding runners' description and management of the injury development process may allow for a more appropriate examination of all levels of injury. This study aimed to examine recreational runners' description and management of the injury development process.

METHODS

A qualitative focus group study was undertaken. Seven semi-structured focus groups with male (n = 13) and female (n = 18) recreational runners took place. Focus groups were audio and video recorded, and transcribed verbatim. Transcripts were reflexively thematically analysed. A critical friend approach was taken to data coding. Multiple methods of trustworthiness were executed.

RESULTS

Runners describe injury on a nine-level continuum, ranging from injury-free to career-ending injury. There are lower and higher levels of injury. Each level of injury is described across four categories of descriptors; physical description, outcome (effect on running and daily life), psychological description, and management.

CONCLUSION

The Running Injury Continuum is a tool that can be used for injury surveillance (for healthcare professionals and researchers) and for research investigating RRI risk factors. Healthcare professionals, researchers and coaches must ensure they monitor the development of all levels of RRIs, across all categories of descriptors. Runners need to be educated regarding appropriate self-management strategies for lower level injuries, with access to evidence-based information being a critical management tool.

Youth athletes at Swedish sports high schools with an athletics specialism emphasise environmental support for injury risk management: a focus group study

In this study, we examined knowledge and understanding of sport-related injuries among youth athletics (track and field) athletes and assessed their needs in managing any health problems. Qualitative data were collected via 12 focus groups with youth athletes (16-19 years) studying at Swedish sports high schools with an athletics specialism. All focus group discussions were audiorecorded and transcribed before being analysed using a thematic analysis approach. Four researchers independently reviewed the transcripts, generated codes and developed themes. Three overarching themes related to the athletes' knowledge and understanding of sport-related injury were developed: (1) awareness of injuries, (2) perception of injuries, and (3) factors contributing to injuries. The youth athletes were typically uncertain about how to acknowledge a sport-related injury. They expressed that knowledge about injuries was obtained in part by reflecting on the lived experiences of their peers. It was also demonstrated that there appears to be a 'culture of acceptance' regarding injury occurrence. In contrast, causes of injuries were viewed as dependent on multiple factors (eg, lack of context-specific knowledge about training practices). Regarding athletes' needs in managing injuries, an additional three themes were developed: (1) creating functioning elite sports environments, (2) application of knowledge and (3) fostering athletes. An apparent lack of structure and organisation related to the school environment was identified as an important issue to review to create opportunities for sustainable athletic development. The study identified areas that can be improved in Swedish sports high schools with an athletic specialism and could be applied in other youth sports contexts. The results of this study guide school stakeholders, alongside the sport governing bodies who have the mandate to influence activities in youth sports contexts, whereby special attention should be directed towards improving the social environment for youth athletes.

Injury acknowledgement by reduction of sports load in world-leading athletics (track and field) athletes varies with their musculoskeletal health literacy and the socioeconomic environment

Objective

Although injury burden prompts elite athletics (track and field) athletes to engage in injury management, little is known about their health literacy. We investigated musculoskeletal (MS) health literacy in world-leading athletics athletes and associations with prechampionship injury acknowledgement by reduction of training load in different socioeconomic environments.

Methods

Adult and youth athletics athletes (n=1785) preparing for World Championships were invited to complete the Literacy in Musculoskeletal Problems instrument and report acknowledgement of injury by reduction in training load during prechampionship tapering. Their socioeconomic standing was estimated through the Human Development Index of their home country. Demographic differences were examined using χ2tests and determinants of injury acknowledgement assessed using logistic regression.

Results

Complete data were obtained from 780 athletes (43.7%) with 26% demonstrating sufficient MS health literacy, higher in adult (41%) than youth (13%) athletes (p<0.001). Adult athletes at the uppermost socioeconomic level showed higher MS health literacy than athletes at lower socioeconomic levels (p<0.001). At the uppermost socioeconomic level, adult athletes with sufficient MS health literacy had increased likelihood of acknowledging an injury by reduction in training load compared with peers demonstrating insufficient MS health literacy (OR=2.45; 95% CI 1.33–4.53). Athletes at middle socioeconomic levels with sufficient MS health literacy had decreased likelihood for acknowledging an injury during tapering (OR=0.29; 95% CI 0.11–0.78).

Conclusions

The prevalence of sufficient MS health literacy in world-leading athletics athletes is low. Associations between MS health literacy and injury acknowledgement in these athletes vary with the resourcefulness of the socioeconomic environment, implying that health literacy and resources for medical and performance support should be ascertained concurrently.

Psychosocial Risk Factors for Overuse Injuries in Competitive Athletes: A Mixed-Studies Systematic Review

Background

While the psychosocial risk factors for traumatic injuries have been comprehensively investigated, less is known about psychosocial factors predisposing athletes to overuse injuries.

Objective

The aim of this review was to systematically identify studies and synthesise data that examined psychosocial risk factors for overuse injuries in athletes.

Design

Systematic review.

Data Sources

MEDLINE, Web of Science and PsycINFO databases, supplemented by hand searching of journals and reference lists.

Eligibility Criteria for Selecting Studies

Quantitative and qualitative studies involving competitive athletes, published prior to July 2021, and reporting the relationship between psychosocial variables and overuse injury as an outcome were reviewed. This was limited to academic peer-reviewed journals in Swedish, English, German, Spanish and French. An assessment of the risk of bias was performed using modified versions of the RoBANS and SBU Quality Assessment Scale for Qualitative Studies.

Results

Nine quantitative and five qualitative studies evaluating 1061 athletes and 27 psychosocial factors were included for review. Intra-personal factors, inter-personal factors and sociocultural factors were found to be related to the risk of overuse injury when synthesised and reported according to a narrative synthesis approach. Importantly, these psychosocial factors, and the potential mechanisms describing how they might contribute to overuse injury development, appeared to be different compared with those already known for traumatic injuries.

Conclusions

There is preliminary evidence that overuse injuries are likely to partially result from complex interactions between psychosocial factors. Coaches and supporting staff are encouraged to acknowledge the similarities and differences between traumatic and overuse injury aetiology.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40279-021-01597-5.

'I JUST WANT TO RUN': how recreational runners perceive and deal with injuries

Running injuries impact the health gains achieved through running and are linked to drop-out from this otherwise healthy activity. The need for effective prevention is apparent, however, implementation of preventive measures implies a change in runners’ behaviour. This exploratory qualitative study aimed to explore Dutch recreational runners’ perception on injuries, injury occurrence and prevention. An interpretative paradigm underpins this study. We conducted 12 individual semistructured interviews with male (n=6) and female runners (n=6). Through a constant comparative data analysis, we developed a conceptual model to illustrate the final product of the analysis and represent the main themes’ connection. We present a framework that describes the pathway from load to injury and the self-regulatory process controlling this pathway. Runners mentioned that pain is not necessarily an injury, and they usually continue running. Once complaints become unmanageable and limit the runner’s ability to participate, an injury was perceived. Based on our outcomes, we recommend that preventive strategies focus on the self-regulation by which runners manage their complaints and injuries—providing information, advice and programmes that support the runner to make well-informed, effective decisions.

Health complaints and heat stress prevention strategies during taper as predictors of peaked athletic performance at the 2015 World Athletics Championship in hot conditions

OBJECTIVES

To investigate whether self-reported health complaints and choice of heat stress prevention strategies during the taper predicted peaking at an athletics championship in hot conditions.

DESIGN

Cohort study.

METHODS

Data on health and heat stress prevention were collected before the 2015 World Athletics Championship in Beijing, China. Peaking was defined using the athlete's pre-competition ranking and final competition rank. Baseline and endpoint data were fitted into multiple logic regression models.

RESULTS

Two hundred forty-five (29%) of 841 eligible athletes participated. Both sprint/power (Odds ratio (OR) 0.33 (95% Confidence interval (CI) 0.11 to 0.94), P=0.038) and endurance/combined events (OR 0.38 (95% CI 0.14 to 1.00), P=0.049) athletes having sustained concern-causing health complaints during the taper were less likely to peak. Endurance/combined events athletes who chose pre-cooling to mitigate heat stress were less likely to peak (OR 0.35 (95% CI 0.15 to 0.80), P=0.013), while sprint/power athletes reporting a sudden-onset injury complaint during the taper displayed increased peaking (OR 4.47 (95% CI 1.28 to 15.59), P=0.019).

CONCLUSIONS

Health complaints that caused the athlete concern during the taper were predictive of failure to peak at a major athletics competition. Sprint/power athletes who experienced an acute injury symptom during the taper appeared to benefit from rest. Pre-cooling strategies seem to require further validation during real-world endurance/combined events. It appears that athletics athletes' self-reported health should be monitored during the taper, concerns addressed, and heat stress prevention strategies individually tested before championships in hot conditions.

Perceptions of Overuse Injury Among Swedish Ultramarathon and Marathon Runners: Cross-Sectional Study Based on the Illness Perception Questionnaire Revised (IPQ-R)

Background

Long-distance runners’ understandings of overuse injuries are not well known which decreases the possibilities for prevention. The common sense model (CSM) outlines that runners’ perceptions of a health problem can be described using the categories identity, consequence, timeline, personal control, and cause. The aim of this study was to use the CSM to investigate perceptions of overuse injury among long-distance runners with different exercise loads.

Methods

The study used a cross-sectional design. An adapted version of the illness perception questionnaire revised (IPQ-R) derived from the CSM was used to investigate Swedish ultramarathon and marathon runners’ perceptions of overuse injuries. Cluster analysis was employed for categorizing runners into high and low exercise load categories. A Principal Component Analysis was thereafter used to group variables describing injury causes. Multiple logistic regression methods were finally applied using high exercise load as endpoint variable and CSM items representing perceptions of injury identity, consequence, timeline, personal control, and causes as explanatory variables.

Results

Complete data sets were collected from 165/443 (37.2%) runners. The symptoms most commonly associated with overuse injury were pain (80.1% of the runners), stiff muscles (54.1%), and stiff joints (42.0%). Overuse injury was perceived to be characterized by the possibility of personal control (stated by 78.7% of the runners), treatability (70.4%), and that the injury context was comprehensible (69.3%). The main injury causes highlighted were runner biomechanics (stated by 78.3%), the runner’s personality (72.4%), and running surface biomechanics (70.0%). Among men, a belief in that personality contributes to overuse injury increased the likelihood of belonging to the high exercise load category [Odds ratio (OR) 2.10 (95% Confidence interval (95% CI) 1.38–3.19); P = 0.001], while beliefs in that running biomechanics [OR 0.56 (95% CI 0.37–0.85); P = 0.006) and mileage (OR 0.72 (95% CI 0.54–0.96); P = 0.026] causes injury decreased the likelihood. In women, a strong perception that overuse injuries can be controlled by medical interventions decreased the likelihood of high exercise load [OR 0.68 (95% CI 0.52–0.89); P = 0.005].

Conclusion

This study indicates that recognition among long-distance runners of the association between own decisions in overuse injury causation is accentuated by increased exercise loads.

Letting the cat out of the bag: athletes, coaches and physiotherapists share their perspectives on injury prevention in elite sports

Objectives

To explore how sports injury prevention takes place in elite sport practice and to describe the perspectives of athletes, coaches and physiotherapists regarding the most critical factors that help prevent injury in the elite sports context.

Methods

Qualitative study. Semistructured interviews with 19 international level athletes, coaches and physiotherapists, from different Olympic sports. Interviews were transcribed verbatim and analysed using comparative data analysis based on Grounded Theory.

Results

The participants perceived injury risk as an inherent part of elite sports, because athletes try to enhance performance by pushing their limits. Participants described injury prevention as a learning process that changed over time, based on their sports experience and the injuries that they had sustained along their career. Communication among the athletes, coaches and physiotherapists was described as a key component of the injury prevention process. Study participants emphasised the relevance of teamwork and shared responsibility. Performance was presented as the core of the athlete’s daily practice, indicating that injury prevention can be a means to that end but is not a goal in itself for this community.

Conclusion

Participants perceive injury prevention as part of elite sports and thus embrace the need for injury prevention. Injury prevention strategies in elite sports were described as a learning process, following the dynamic nature of training for maximal performance. Performance is the participants’ main goal.

Preparticipation predictors for championship injury and illness: cohort study at the Beijing 2015 International Association of Athletics Federations World Championships

OBJECTIVES

To determine preparticipation predictors of injury and illness at a major Athletics championship.

METHODS

A cohort study design was used. Before the 2015 International Association of Athletics Federations World Championships in Athletics, all 207 registered national teams were approached about partaking in a study of preparticipation health; 50 teams accepted. The athletes (n=957) in the participating teams were invited to complete a preparticipation health questionnaire (PHQ). New injuries and illnesses that occurred at the championships were prospectively recorded. Logistic regression analyses were performed with simple and multiple models using any in-championship injury and in-championship illness as outcomes.

RESULTS

The PHQ was completed by 307 (32.1%) of the invited athletes; 116 athletes (38.3%) reported an injury symptom during the month before the championships, while 40 athletes (13%) reported an illness symptom. 20 (6.5%) of the participating athletes sustained a health problem during the championships. Endurance athletes were almost 10-fold more likely to sustain an in-championship illness than speed/power athletes (OR, 9.88; 95% CI 1.20 to 81.31; p=0.033). Participants reporting a preparticipation gradual-onset injury symptom were three times more likely (OR, 3.09; 95% CI 1.08 to 8.79; p=0.035) and those reporting an illness symptom causing anxiety were fivefold more likely (OR, 5.56; 95% CI 1.34 to 23.15; p=0.018) to sustain an in-championship injury.

SUMMARY AND CONCLUSIONS

Analyses of preparticipation predictors of injury and illness at a major Athletics championship suggest that endurance athletes require particular clinical attention. Preparticipation symptoms causing anxiety are interesting predictors for in-championship health problems.