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Gruber AH. The "impacts cause injury" hypothesis: Running in circles or making new strides? J Biomech 2023; 156:111694. [PMID: 37364393 DOI: 10.1016/j.jbiomech.2023.111694] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 06/15/2023] [Accepted: 06/18/2023] [Indexed: 06/28/2023]
Abstract
Some of the earliest biomechanics research focused on running and the ground reaction forces generated with each step. Research in running gait accelerated in the 1970's as the growing popularity in running increased attention to the musculoskeletal injuries sustained by runners. Despite decades of high-quality research, running remains the most common cause of exercise-related musculoskeletal injuries and rates of overuse running-related injuries (RRI) have not appreciably declined since the research began. One leading area of running gait research focuses on discrete variables derived from the vertical ground reaction force, such as the vertical loading rate. Across sub-disciplines of running gait research, vertical loading rate is often discussed as the primary and undisputed variable associated with RRI despite only low to moderate evidence that retrospectively or prospectively injured runners generate greater vertical loading rates than uninjured counterparts. The central thesis of this review is that relying on vertical loading rate is insufficient to establish causal mechanisms for RRI etiology. To present this argument, this review examines the history of the 'impacts cause injury' hypothesis, including a historical look at ground reaction forces in human running and the research from which this hypothesis was generated. Additionally, a synthesis of studies that have tested the hypothesis is provided and recommendations for future research are discussed. Although it is premature to reject or support the 'impacts cause injury' hypothesis, new knowledge of biomechanical risk factors for RRI will remain concealed until research departs from the current path or adopts new approaches to previous paradigms.
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Affiliation(s)
- Allison H Gruber
- The H.H. Morris Human Performance Laboratories, Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA.
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2
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Opara M, Kozinc Ž. Stretching and Releasing of Iliotibial Band Complex in Patients with Iliotibial Band Syndrome: A Narrative Review. J Funct Morphol Kinesiol 2023; 8:74. [PMID: 37367238 DOI: 10.3390/jfmk8020074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023] Open
Abstract
Iliotibial band syndrome (ITBS) is one of the most common overuse syndromes causing knee pain; it is especially prevalent in runners and also common in cyclists, rowers, and field athletes, with occasional cases occurring in non-athletes too. ITBS symptoms can negatively affect not only knee function, but also mental and physical aspects of health-related quality of life. Although various conservative treatment options have been investigated and discussed, there is still no consensus on a standard of care for ITBS. Moreover, the literature on the etiology and risk factors of ITBS, which could help in selecting appropriate treatment methods, is conflicting and inconclusive. The role of individual treatment modalities such as stretching and releasing techniques has not been extensively studied and remains unclear. In this article, we will critically review the available evidence for the benefits of ITB stretching and "release" methods in the treatment of ITBS. In addition to the direct evidence (clinical studies examining the effects of ITB stretching and other methods that purportedly stretch or "release" the ITB), we present several additional lines of reasoning that discuss the rationale for ITB stretching/releasing in terms of the etiology of ITBS, the mechanical properties and behavior of the ITB, and the risk factors for ITBS development. We conclude that the current literature provides some evidence for the inclusion of stretching or other "release" methods in the early rehabilitation of ITBS. Long-term interventions typically include ITB stretching; however, it remains unclear to what extent stretching within a multimodal treatment actually contributes to resolving the symptoms. At the same time, there is no direct evidence to suggest that stretching and "release" methods have any negative effects.
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Affiliation(s)
- Manca Opara
- Faculty of Health Sciences, University of Primorska, Polje 42, SI-6310 Izola, Slovenia
| | - Žiga Kozinc
- Faculty of Health Sciences, University of Primorska, Polje 42, SI-6310 Izola, Slovenia
- Andrej Marušič Institute, University of Primorska, Muzejski trg 2, SI-6000 Koper, Slovenia
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Skroce K, Bettega S, D’Emanuele S, Boccia G, Schena F, Tarperi C. Flat versus Simulated Mountain Trail Running: A Multidisciplinary Comparison in Well-Trained Runners. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5189. [PMID: 36982098 PMCID: PMC10049634 DOI: 10.3390/ijerph20065189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/06/2023] [Accepted: 03/10/2023] [Indexed: 06/18/2023]
Abstract
This paper compares cardiopulmonary and neuromuscular parameters across three running aerobic speeds in two conditions that differed from a treadmill's movement: flat condition (FC) and unpredictable roll variations similar to mountain trail running (URV). Twenty well-trained male runners (age 33 ± 8 years, body mass 70.3 ± 6.4 kg, height 1.77 ± 0.06 m, V˙O2max 63.8 ± 7.2 mL·kg-1·min-1) voluntarily participated in the study. Laboratory sessions consisted of a cardiopulmonary incremental ramp test (IRT) and two experimental protocols. Cardiopulmonary parameters, plasma lactate (BLa-), cadence, ground contact time (GT) and RPE values were assessed. We also recorded surface electromyographic (sEMG) signals from eight lower limb muscles, and we calculated, from the sEMG envelope, the amplitude and width of peak muscle activation for each step. Cardiopulmonary parameters were not significantly different between conditions (V˙O2: p = 0.104; BLa-: p = 0.214; HR: p = 0.788). The amplitude (p = 0.271) and width (p = 0.057) of sEMG activation peaks did not change between conditions. The variability of sEMG was significantly affected by conditions; indeed, the coefficient of variation in peak amplitude (p = 0.003) and peak width (p < 0.001) was higher in URV than in FC. Since the specific physical demands of running can differ between surfaces, coaches should resort to the use of non-traditional surfaces, emphasizing specific surface-related motor tasks that are normally observed in natural running environments. Seeing that the variability of muscle activations was affected, further studies are required to better understand the physiological effects induced by systematic surface-specific training and to define how variable-surface activities help injury prevention.
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Affiliation(s)
- Kristina Skroce
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, 37131 Verona, Italy
| | - Simone Bettega
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, 37131 Verona, Italy
| | - Samuel D’Emanuele
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, 37131 Verona, Italy
| | - Gennaro Boccia
- Department of Clinical and Biological Sciences, University of Turin, 10124 Turin, Italy
| | - Federico Schena
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, 37131 Verona, Italy
| | - Cantor Tarperi
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, 37131 Verona, Italy
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Foch E, Brindle RA, Pohl MB. Lower extremity kinematics during running and hip abductor strength in iliotibial band syndrome: A systematic review and meta-analysis. Gait Posture 2023; 101:73-81. [PMID: 36758425 DOI: 10.1016/j.gaitpost.2023.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 01/26/2023] [Accepted: 02/01/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Iliotibial band syndrome is a common overuse injury that is twice as likely to affect female runners compared to male runners. It is unclear if there is a consistent running pattern and strength profile exhibited by female and male runners with iliotibial band syndrome. RESEARCH QUESTION The purpose of this systematic review and meta-analysis was to determine if any differences existed in lower-extremity kinematics and hip strength between runners who retrospectively, currently, or prospectively had iliotibial band syndrome. METHODS Papers included must have reported three-dimensional kinematic running data and/or hip strength data that were statistically analyzed between runners that never developed iliotibial band syndrome and runners with iliotibial band syndrome. Meta-analysis was performed for each kinematic or strength variable reported in at least three studies. Female and male runners were analyzed separately and grouped into three cohorts (retrospective, current, prospective). RESULTS Seventeen articles were included in this systematic review. Data from 10 cross-sectional studies were included for meta-analysis. Female runners with current iliotibial band syndrome exhibited smaller peak hip internal rotation angles and lower isometric hip abductor strength compared to controls. SIGNIFICANCE Although limited biomechanical evidence exists, risk factors for ITBS are different between female and male runners and may vary according to injury status. Specifically, transverse plane hip motion and hip abductor strength weakness may be biomechanical risk factors in female runners with current iliotibial band syndrome only.
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Affiliation(s)
- Eric Foch
- Department of Health Sciences, Central Washington University, Ellensburg, WA, USA.
| | | | - Michael B Pohl
- Department of Exercise Science, University of Puget Sound, Tacoma, WA, USA
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Gupta P, Yadav D, Singh K, Bhattacharjee S. Iliotibial band friction syndrome: A common cause of lateral knee pain in long-distance runners. JOURNAL OF MARINE MEDICAL SOCIETY 2023. [DOI: 10.4103/jmms.jmms_49_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
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Matias AB, Watari R, Taddei UT, Caravaggi P, Inoue RS, Thibes RB, Suda EY, Vieira MF, Sacco ICN. Effects of Foot-Core Training on Foot-Ankle Kinematics and Running Kinetics in Runners: Secondary Outcomes From a Randomized Controlled Trial. Front Bioeng Biotechnol 2022; 10:890428. [PMID: 35497357 PMCID: PMC9046605 DOI: 10.3389/fbioe.2022.890428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 03/29/2022] [Indexed: 11/13/2022] Open
Abstract
This study investigated the effectiveness of an 8-week foot-core exercise training program on foot-ankle kinematics during running and also on running kinetics (impact loads), with particular interest in biomechanical outcomes considered risk factors for running-related injuries in recreational runners. A single-blind, randomized, controlled trial was conducted with 87 recreational runners randomly allocated to either the control (CG) or intervention (IG) group and assessed at baseline and after 8 weeks. The IG underwent foot-core training 3 times/week, while the CG followed a placebo lower-limb stretching protocol. The participants ran on a force-instrumented treadmill at a self-selected speed while foot-segment motion was captured simultaneously with kinetic measurements. After the intervention, there were statistically significant changed in foot biomechanics, such as: IG participants strike the ground with a more inverted calcaneus and a less dorsiflexed midfoot than those in the CG; at midstance, ran with a less plantarflexed and more adducted forefoot and a more abducted hallux; and at push-off, ran with a less dorsiflexed midfoot and a less adducted and more dorsiflexed hallux. The IG runners also had significantly decreased medial longitudinal arch excursion (p = 0.024) and increased rearfoot inversion (p = 0.037). The 8-week foot-core exercise program had no effect on impact (p = 0.129) and breaking forces (p = 0.934) or on vertical loading rate (p = 0.537), but it was positively effective in changing foot-ankle kinematic patterns.”
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Affiliation(s)
- Alessandra B. Matias
- Faculdade de Medicina, Physical Therapy, Speech and Occupational Therapy Department, Universidade de São Paulo, Sao Paulo, Brazil
| | - Ricky Watari
- Faculdade de Medicina, Physical Therapy, Speech and Occupational Therapy Department, Universidade de São Paulo, Sao Paulo, Brazil
| | - Ulisses T. Taddei
- Faculdade de Medicina, Physical Therapy, Speech and Occupational Therapy Department, Universidade de São Paulo, Sao Paulo, Brazil
| | - Paolo Caravaggi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Rafael S. Inoue
- Faculdade de Medicina, Physical Therapy, Speech and Occupational Therapy Department, Universidade de São Paulo, Sao Paulo, Brazil
| | - Raissa B. Thibes
- Center of Mathematics, Computing and Cognition, Universidade Federal do ABC, Santo André, Brazil
| | - Eneida Y. Suda
- Faculdade de Medicina, Physical Therapy, Speech and Occupational Therapy Department, Universidade de São Paulo, Sao Paulo, Brazil
| | - Marcus F. Vieira
- Bioengineering and Biomechanics Laboratory, Federal University of Goiás, Goiás, Brazil
| | - Isabel C. N. Sacco
- Faculdade de Medicina, Physical Therapy, Speech and Occupational Therapy Department, Universidade de São Paulo, Sao Paulo, Brazil
- *Correspondence: Isabel C. N. Sacco,
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Willwacher S, Kurz M, Robbin J, Thelen M, Hamill J, Kelly L, Mai P. Running-Related Biomechanical Risk Factors for Overuse Injuries in Distance Runners: A Systematic Review Considering Injury Specificity and the Potentials for Future Research. Sports Med 2022; 52:1863-1877. [PMID: 35247202 PMCID: PMC9325808 DOI: 10.1007/s40279-022-01666-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Running overuse injuries (ROIs) occur within a complex, partly injury-specific interplay between training loads and extrinsic and intrinsic risk factors. Biomechanical risk factors (BRFs) are related to the individual running style. While BRFs have been reviewed regarding general ROI risk, no systematic review has addressed BRFs for specific ROIs using a standardized methodology. OBJECTIVE To identify and evaluate the evidence for the most relevant BRFs for ROIs determined during running and to suggest future research directions. DESIGN Systematic review considering prospective and retrospective studies. (PROSPERO_ID: 236,832). DATA SOURCES PubMed. Connected Papers. The search was performed in February 2021. ELIGIBILITY CRITERIA English language. Studies on participants whose primary sport is running addressing the risk for the seven most common ROIs and at least one kinematic, kinetic (including pressure measurements), or electromyographic BRF. A BRF needed to be identified in at least one prospective or two independent retrospective studies. BRFs needed to be determined during running. RESULTS Sixty-six articles fulfilled our eligibility criteria. Levels of evidence for specific ROIs ranged from conflicting to moderate evidence. Running populations and methods applied varied considerably between studies. While some BRFs appeared for several ROIs, most BRFs were specific for a particular ROI. Most BRFs derived from lower-extremity joint kinematics and kinetics were located in the frontal and transverse planes of motion. Further, plantar pressure, vertical ground reaction force loading rate and free moment-related parameters were identified as kinetic BRFs. CONCLUSION This study offers a comprehensive overview of BRFs for the most common ROIs, which might serve as a starting point to develop ROI-specific risk profiles of individual runners. We identified limited evidence for most ROI-specific risk factors, highlighting the need for performing further high-quality studies in the future. However, consensus on data collection standards (including the quantification of workload and stress tolerance variables and the reporting of injuries) is warranted.
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Affiliation(s)
- Steffen Willwacher
- grid.440974.a0000 0001 2234 6983Department for Mechanical and Process Engineering, Offenburg University of Applied Sciences, Offenburg, Germany ,grid.27593.3a0000 0001 2244 5164Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Markus Kurz
- grid.29050.3e0000 0001 1530 0805Department of Quality Technology & Mechanical Engineering, Mid Sweden University, Östersund, Sweden
| | - Johanna Robbin
- grid.440974.a0000 0001 2234 6983Department for Mechanical and Process Engineering, Offenburg University of Applied Sciences, Offenburg, Germany ,grid.27593.3a0000 0001 2244 5164Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Matthias Thelen
- grid.27593.3a0000 0001 2244 5164Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Joseph Hamill
- grid.266683.f0000 0001 2166 5835Biomechanics Laboratory, University of Massachusetts, Amherst, MA USA
| | - Luke Kelly
- grid.1003.20000 0000 9320 7537School of Human Movement and Nutrition Sciences, University of Queensland, St. Lucia, QLD Australia
| | - Patrick Mai
- grid.440974.a0000 0001 2234 6983Department for Mechanical and Process Engineering, Offenburg University of Applied Sciences, Offenburg, Germany ,grid.27593.3a0000 0001 2244 5164Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
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Vincent HK, Brownstein M, Vincent KR. Injury Prevention, Safe Training Techniques, Rehabilitation, and Return to Sport in Trail Runners. Arthrosc Sports Med Rehabil 2022; 4:e151-e162. [PMID: 35141547 PMCID: PMC8811510 DOI: 10.1016/j.asmr.2021.09.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/22/2021] [Indexed: 12/31/2022] Open
Abstract
This current concept, narrative review provides the latest integrated evidence of the musculoskeletal injuries involved with trail running and therapeutic strategies to prevent injury and promote safe participation. Running activities that comprise any form of off-road running (trail running, orienteering, short-long distance, different terrain, and climate) are relevant to this review. Literature searches were conducted to 1) identify types and mechanisms of acute and chronic/overuse musculoskeletal injuries in trail runners, 2) injury prevention techniques most relevant to running trails, 3) safe methods of participation and rehabilitation timelines in the sport. The majority of acute and chronic trail running-related musculoskeletal injuries in trail running occur in the lower leg, primarily in the knee and ankle. More than 70% are due to overuse, and ankle sprains are the most common acute injury. Key mechanisms underlying injury and injury progression include inadequate neuromotor control-balance-coordination, running through fatigue, and abnormal kinematics on variable terrain. Complete kinetic chain prehabilitation programs consisting of dynamic flexibility, neuromotor strength and balance, and plyometrics exercise can foster stable, controlled movement on trails. Patient education about early musculoskeletal pain symptoms and training adjustment can help prevent injury from progressing to serious overuse injuries. Real-time adjustments to cadence, step length, and knee flexion on the trail may also mitigate impact-related risk for injury. After injury occurs, rehabilitation will involve similar exercise components, but it will also incorporate rest and active rest based on the type of injury. Multicomponent prehabilitation can help prevent musculoskeletal injuries in trail runners through movement control and fatigue resistance.
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Affiliation(s)
- Heather K Vincent
- Department of Physical Medicine and Rehabilitation, University of Florida College of Medicine, Gainesville, Florida, U.S.A
| | - Michael Brownstein
- Department of Physical Medicine and Rehabilitation, University of Florida College of Medicine, Gainesville, Florida, U.S.A
| | - Kevin R Vincent
- Department of Physical Medicine and Rehabilitation, University of Florida College of Medicine, Gainesville, Florida, U.S.A
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Aristizábal Pla G, Hollville E, Schütte K, Vanwanseele B. The Use of a Single Trunk-Mounted Accelerometer to Detect Changes in Center of Mass Motion Linked to Lower-Leg Overuse Injuries: A Prospective Study. SENSORS 2021; 21:s21217385. [PMID: 34770692 PMCID: PMC8588413 DOI: 10.3390/s21217385] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 11/27/2022]
Abstract
Movement dynamics during running was previously characterized using a trunk-mounted accelerometer, and were associated with a history of overuse injuries. However, it remains unknown if these measures are also linked to the development of overuse injuries. The aim of this study was therefore to determine how movement dynamics alter in response to fatigue, and the possible link with developing lower-leg overuse injuries during a six-month follow-up period. Two hundred and eight movement science university students completed a 12-min all-out run while wearing a trunk-mounted accelerometer. Dynamic stability, dynamic loading and spatiotemporal measures were extracted from the accelerometer. Participants sustaining an injury within the 6-month period demonstrated significantly higher RMS ratio values in the vertical direction and lower RMS ratio values in the anteroposterior direction, and lower impact acceleration values in the anteroposterior direction in an unfatigued state compared to the uninjured group. They also demonstrated an increase in dynamic loading in the horizontal plane during the run. In addition, with running fatigue both groups exhibited changes in dynamic stability and loading measures. These results show the potential of using a single trunk-mounted accelerometer to detect changes in movement dynamics that are linked to lower-leg overuse injuries.
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Affiliation(s)
- Gerard Aristizábal Pla
- Human Movements Biomechanics Research Group, Department of Movement Sciences, KU Leuven, 3001 Leuven, Belgium; (G.A.P.); (E.H.); (K.S.)
- Department of Kinesiology, UMASS Amherst Amherst, University of Massachusetts Integrative Locomotion Lab, Amherst, MA 01003, USA
| | - Enzo Hollville
- Human Movements Biomechanics Research Group, Department of Movement Sciences, KU Leuven, 3001 Leuven, Belgium; (G.A.P.); (E.H.); (K.S.)
| | - Kurt Schütte
- Human Movements Biomechanics Research Group, Department of Movement Sciences, KU Leuven, 3001 Leuven, Belgium; (G.A.P.); (E.H.); (K.S.)
| | - Benedicte Vanwanseele
- Human Movements Biomechanics Research Group, Department of Movement Sciences, KU Leuven, 3001 Leuven, Belgium; (G.A.P.); (E.H.); (K.S.)
- Correspondence:
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Mohseni MM, Filmalter SE, Taylor WC, Vadeboncoeur TF, Thomas CS. Factors Associated With Half- and Full-Marathon Race-Related Injuries: A 3-Year Review. Clin J Sport Med 2021; 31:e277-e286. [PMID: 31855590 DOI: 10.1097/jsm.0000000000000775] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 06/19/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To better evaluate the relationships between training, demographics, and injury, this study sought to define race-related injury risk factors for half- and full-marathon runners. DESIGN This 3-year, observational cross-sectional study included adults who participated in a half or full marathon. Prerace and 2-week postrace surveys collected data on demographics, training factors, and injuries. SETTING This study took place during a nationally recognized marathon affiliated with a local hospital. PARTICIPANTS Runners were recruited during the Expo in the days before the race. Postrace surveys were returned by 1043 half marathoners and 624 full marathoners (response rate, 83%). INTERVENTIONS This was an observational study; independent variables included demographic data and race year. MAIN OUTCOME MEASURE The primary outcome was race-related injury that occurred during the race or within 2 weeks after the race. RESULTS Race-related injuries were reported by 24% of half marathoners and 30% of full marathoners. For half and full marathoners, respectively, significant factors for injuries were previous injury, lower peak weekly training mileage, and lower weekly mileage before race training. Factors significant for only half-marathon injuries were younger age, female sex, shorter distance of longest training run, and no formal training program. Factors significant for only full-marathon injuries were higher body mass index, fewer days running per week, and fewer years of running experience. CONCLUSIONS Previous running injuries, undertraining, and inexperience increased race-related injury risk; women had higher risk than men. Decreased risk of injury was associated with training loads of greater than 23 miles/week for half marathoners and 40 miles/week for full marathoners.
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Jaén-Carrillo D, Roche-Seruendo LE, Felton L, Cartón-Llorente A, García-Pinillos F. Stiffness in Running: A Narrative Integrative Review. Strength Cond J 2021. [DOI: 10.1519/ssc.0000000000000593] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Johnson CD, Tenforde AS, Outerleys J, Reilly J, Davis IS. Impact-Related Ground Reaction Forces Are More Strongly Associated With Some Running Injuries Than Others. Am J Sports Med 2020; 48:3072-3080. [PMID: 32915664 DOI: 10.1177/0363546520950731] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Inconsistent associations have been reported for impact-related ground reaction force variables and running injuries when grouping all injuries together. However, previous work has shown more consistent associations when focusing on specific injuries. PURPOSE To compare ground reaction force variables between healthy and injured runners as a group and within specific common injuries. STUDY DESIGN Controlled laboratory study. METHODS A total of 125 runners presenting with patellofemoral pain, tibial bone stress injury, plantar fasciitis, Achilles tendinopathy, or iliotibial band syndrome and 65 healthy controls completed an instrumented treadmill assessment at a self-selected speed. Impact-related ground reaction force variables included vertical average (VALR) and instantaneous (VILR) load rates, posterior and medial/lateral instantaneous load rates, and vertical stiffness at initial loading (VSIL). Mean comparisons were made between the general and specific injury and control groups (α = .05). Cutoff thresholds were established and evaluated using several criteria. RESULTS VALR (+17.5%; P < .01), VILR (+15.8%; P < .01), and VSIL (+19.7%; P < .01) were significantly higher in the overall injured versus control groups. For individual injuries, VALR, VILR, and VSIL were significantly higher for patellofemoral pain (+23.4%-26.4%; P < .01) and plantar fasciitis (+17.5%-29.0%; P < .01), as well as VSIL for Achilles tendinopathy (+29.4%; P < .01). Cutoff thresholds showed better diagnostic criteria for individual versus grouped injuries. CONCLUSION Impact variables (VALR, VILR, and VSIL) were significantly higher when assessing the injured group as a whole. However, these findings were driven by specific injury groups, highlighting the importance of taking an injury-specific approach to biomechanical risk factors for running injury. CLINICAL RELEVANCE These results suggest that practitioners may want to address impact loading in their treatment of injured runners, especially in those with patellofemoral pain and plantar fasciitis.
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Affiliation(s)
- Caleb D Johnson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
| | - Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
| | - Jereme Outerleys
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
| | - Julia Reilly
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
| | - Irene S Davis
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
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Jiménez Díaz F, Gitto S, Sconfienza LM, Draghi F. Ultrasound of iliotibial band syndrome. J Ultrasound 2020; 23:379-385. [PMID: 32514741 DOI: 10.1007/s40477-020-00478-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/09/2020] [Indexed: 12/29/2022] Open
Abstract
Iliotibial band syndrome or friction syndrome is an overuse disorder of the lateral knee. It is commonly reported in athletes, such as runners and cyclists, and refers to pain related to physical activity. The diagnosis is based on clinical history and physical assessment. Imaging, including ultrasound, is mainly performed in recurrent or refractory cases. The purpose of this paper is to review the etiology, diagnosis, and therapy of iliotibial band syndrome with a focus on ultrasound imaging and ultrasound-guided treatment. Ultrasound findings include soft-tissue edematous swelling or discrete fluid collection, suggestive of bursitis, between the iliotibial band and the lateral femoral epicondyle. The thickening of the iliotibial band has been inconsistently reported. Treatment varies according to the disease phase and, in the acute phase, consists of rest, physical therapy, and anti-inflammatory medications. Ultrasound-guided local steroid injections are effective in relieving symptoms.
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Affiliation(s)
- Fernando Jiménez Díaz
- Sport Sciences Faculty, Castilla La Mancha University, Toledo, Spain
- San Antonio Catholic University (UCAM), Murcia, Spain
| | - Salvatore Gitto
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133, Milan, Italy.
| | - Luca Maria Sconfienza
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Ferdinando Draghi
- Istituto di Radiologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Effects of iliotibial band syndrome on pain sensitivity and gait kinematics in female runners: A preliminary study. Clin Biomech (Bristol, Avon) 2020; 76:105017. [PMID: 32388078 DOI: 10.1016/j.clinbiomech.2020.105017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 11/22/2019] [Accepted: 04/21/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Runners with iliotibial band syndrome display symptoms similar to chronic tendinopathy and distinct gait patterns compared to healthy controls. Although altered pain processing has been demonstrated in chronic tendinopathies, central pain processing and its relationship to motor control has not been measured in iliotibial band syndrome. The purpose of this study was to examine pain sensitivity, hip strength, and gait kinematics in runners with and without iliotibial band syndrome. METHODS Nine female runners with iliotibial band syndrome and eight healthy controls participated. Subjective pain was reported and pressure pain threshold measured at the bilateral foot, tibialis anterior, contralateral hand. Isometric hip strength was assessed. Three-dimensional joint angles were collected while running. Differences in pain and strength were determined using 1-way ANOVAs. Discrete hip and knee joint angles during stance phase were calculated and waveform analysis performed. FINDINGS Runners with iliotibial band syndrome exhibited bilaterally diminished pain at the foot (injured-limb: 1.54 (SD = 0.51); non-injured limb: 1.54 (SD = 0.55); control: 4.01 (SD = 2.30) kg, P < .001) and ipsilateral tibialis anterior (injured-limb: 2.33 (SD = 1.10); control: 6.13 (SD = 4.89) kg, P = .03). Hip strength was not different between groups. Runners with iliotibial band syndrome had greater hip adduction at touchdown, knee internal rotation during loading, and knee abduction and flexion at toe-off than controls. INTERPRETATION Runners with iliotibial band syndrome demonstrated expanded somatic pain sensitivity without hip strength differences, but concomitant with altered gait patterns. Bilateral pain symptoms and gait deviations exist in runners with iliotibial band syndrome even with unilateral symptoms, highlighting the importance of bilateral assessment.
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15
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Blagrove RC, Howe LP, Howatson G, Hayes PR. Strength and Conditioning for Adolescent Endurance Runners. Strength Cond J 2020. [DOI: 10.1519/ssc.0000000000000425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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16
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Everhart JS, Kirven JC, Higgins J, Hair A, Chaudhari AAMW, Flanigan DC. The relationship between lateral epicondyle morphology and iliotibial band friction syndrome: A matched case-control study. Knee 2019; 26:1198-1203. [PMID: 31439366 DOI: 10.1016/j.knee.2019.07.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 07/23/2019] [Accepted: 07/27/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Iliotibial band friction syndrome (ITBFS) is an overuse injury with pain at the level of the knee lateral epicondyle. We sought to determine whether there is greater knee lateral epicondyle prominence among patients with ITBFS versus matched controls. METHODS Seventy five patients with ITBFS and 75 age-, height-, and sex-matched controls (n = 150 total patients) with knee magnetic resonance imaging from 2015 to 2017 were included. All cases had a diagnosis of ITBFS and a lack of other identified lateral knee injuries on magnetic resonance imaging. Controls had medial knee pain with medial meniscus tear on MRI and no clinical evidence of ITBFS. Lateral knee epicondyle height in millimeters was measured. RESULTS Mean patient age was 39.1 years (SD 15.1), 57% were female, and mean height was 170.0 cm (SD 9.3) with no difference between cases and controls. Mean lateral epicondyle height for cases was 13.1 mm (SD 1.6) and for controls was 12.2 (SD 1.4) with a mean difference of 0.9 mm (95% CI 0.4-1.3 mm) between matched pairs (p < 0.001). Mean epicondyle height:condylar AP width ratio was 0.211 (SD 0.023) for cases and 0.198 (SD 0.020) for controls with a mean difference of 0.013 (95% CI 0.006-0.020) between matched pairs (p < 0.001). CONCLUSIONS There is a significant association between greater lateral epicondyle prominence and IT band friction syndrome, suggesting another anatomic risk factor for this multifactorial condition.
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Affiliation(s)
- Joshua S Everhart
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - James C Kirven
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - John Higgins
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Andrew Hair
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Ajit A M W Chaudhari
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - David C Flanigan
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America.
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Ahmad Z, Parkar A, Shepherd J, Rushton N. Revolving doors of tendinopathy: definition, pathogenesis and treatment. Postgrad Med J 2019; 96:94-101. [PMID: 31757873 DOI: 10.1136/postgradmedj-2019-136786] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 10/01/2019] [Accepted: 10/11/2019] [Indexed: 01/08/2023]
Abstract
The ultimate cure for the tendon pathology continues to elude current science. Despite great steps in technology, the causation and treatment is still not clear. The number of different theories and treatment modalities in the literature may confuse clinicians and patients. In this paper we outline the definitions, evolution of pathogenesis and treatment for tendinopathy. By highlighting these, the aim of this paper is to guide the practitioner in counselling and treating their patients.
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Affiliation(s)
- Zafar Ahmad
- Orthopaedic Research Unit, University of Cambridge, Cambridge, UK
| | - Asif Parkar
- Orthopaedics, Barking Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | | | - Neil Rushton
- Orthopaedic Research Unit, University of Cambridge, Cambridge, UK
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Acute Effects of Wedge Orthoses and Sex on Iliotibial Band Strain During Overground Running in Nonfatiguing Conditions. J Orthop Sports Phys Ther 2019; 49:743-750. [PMID: 31475615 DOI: 10.2519/jospt.2019.8837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Previous research has identified that iliotibial band (ITB) syndrome is more prevalent in females than in males. It has been theorized that high ITB strain rate is a primary etiological factor for developing ITB syndrome. Orthoses are commonly used to influence gait mechanics and may reduce ITB strain rate by influencing alterations in the kinematic chain. OBJECTIVES To identify how wedge orthoses and sex affect ITB strain and strain rate. METHODS Thirty asymptomatic participants (15 male, 15 female) ran with 7° lateral, 3° lateral, 0° (no wedge), 3° medial, and 7° medial wedges in this within-subject, repeated-measures study. Participants ran overground while data were collected with a motion-capture system and force platform. Iliotibial band strain and strain rate were estimated using a novel 6-degrees-of-freedom musculoskeletal model. A mixed-model multivariate analysis of covariance for between-subject comparison of sex and within-subject comparison of wedge was used. RESULTS There were no significant differences in ITB strain or strain rate between wedge conditions. Females had significantly higher ITB strain and strain rate compared to males. CONCLUSION Clinicians should be aware that medial wedges may not acutely alter ITB strain or strain rate. Females exhibited greater peak ITB strain and strain rate, potentially due to increased hip internal rotation compared to males. Further research is needed to investigate longitudinal effects of the wedges. J Orthop Sports Phys Ther 2019;49(10):743-750. Epub 31 Aug 2019. doi:10.2519/jospt.2019.8837.
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Biomechanical Risk Factors Associated with Running-Related Injuries: A Systematic Review. Sports Med 2019; 49:1095-1115. [DOI: 10.1007/s40279-019-01110-z] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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20
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Shen P, Mao D, Zhang C, Sun W, Song Q. Effects of running biomechanics on the occurrence of iliotibial band syndrome in male runners during an eight-week running programme-a prospective study. Sports Biomech 2019; 20:560-570. [PMID: 30973056 DOI: 10.1080/14763141.2019.1584235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Iliotibial band syndrome (ITBS) is a common injury that is related to running biomechanics. This study aimed to determine the gait characteristics that easily induce ITBS and explore the gait changes after the occurrence of ITBS. Thirty healthy male recreational runners participated in our study. Amongst them, 15 developed ITBS and comprised the ITBS group; the other 15 were healthy and comprised the control group. All participants underwent two gait trials, namely, before the first day of their running and after eight weeks, during which a force platform and a motion capture system collected biomechanical data. After running, the ITBS group exhibited greater anterior pelvic tilt and hip flexion angle than the control group. The ITBS group showed increased trunk inclination angle, whereas the control group demonstrated lower hip flexion, hip adduction angle and hip abductor moment than those at the beginning of running. Decreasing hip flexion, adduction angle and abductor moment may be a reasonable strategy to avoid the occurrence of ITBS. The occurrence of ITBS may be due to the lack of timely gait adjustment. Excessive trunk inclination and anterior pelvic tilt angle may be risks factor in the development of ITBS during running.
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Affiliation(s)
| | - Dewei Mao
- Shandong Sport University, Jinan, China
| | - Cui Zhang
- Shandong Institute of Sport Science, Jinan, China
| | - Wei Sun
- Shandong Institute of Sport Science, Jinan, China
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21
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Kinematic risk factors for lower limb tendinopathy in distance runners: A systematic review and meta-analysis. Gait Posture 2019; 69:13-24. [PMID: 30658311 DOI: 10.1016/j.gaitpost.2019.01.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/05/2018] [Accepted: 01/09/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Abnormal kinematics have been implicated as one of the major risk factors for lower limb tendinopathy (LLT). OBJECTIVE To systematically review evidence for kinematic risk factors for LLT in runners. METHODS Individual electronic searches in PubMed, EMBASE and Web of Science were conducted. Two reviewers screened studies to identify observational studies reporting kinematic risk factors in runners with LLT compared to healthy controls. The Down and Black appraisal scale was applied to assess quality. A meta-analysis was performed provided that at least two studies with similar methodology reported the same factor. RESULTS Twenty-eight studies were included: Achilles tendinopathy (AT) (9), iliotibial band syndrome (ITBS) (17), plantar fasciopathy (PF) (2), patellar tendinopathy (PT) (1), posterior tibial tendon dysfunction (PTTD) (1). Eighteen studies were rated high-quality and ten medium-quality. The meta-analyses revealed strong evidence of higher peak knee internal rotation, moderate evidence of lower peak rearfoot eversion and knee flexion at heel strike and greater peak hip adduction in runners with ITBS. Very limited evidence revealed higher peak ankle eversion in runners with PF and PTTD or higher peak hip adduction in PT. SIGNIFICANCE Peak rearfoot eversion was the only factor reported in all included LLTs; it is a significant factor in ITBS, PT and PTTD but not in AT and PF. More prospective studies are needed to accurately evaluate the role of kinematic risk factors as a cause of LLT. Taken together, addressing rearfoot kinematic and kinematic chain movements accompanied by peak eversion should be considered in the prevention and management of LLT.
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22
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Christopher SM, McCullough J, Snodgrass SJ, Cook C. Do alterations in muscle strength, flexibility, range of motion, and alignment predict lower extremity injury in runners: a systematic review. Arch Physiother 2019; 9:2. [PMID: 30805204 PMCID: PMC6373037 DOI: 10.1186/s40945-019-0054-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 01/20/2019] [Indexed: 12/29/2022] Open
Abstract
Background Injury is common in running and seen to impact up to 94% of recreational runners. Clinicians often use alterations from normal musculoskeletal clinical assessments to assess for risk of injury, but it is unclear if these assessments are associated with future injury. Objectives To identify alterations in muscle strength, flexibility, range of motion, and alignment that may predict lower extremity injury in runners. Methods Articles were selected following a comprehensive search of PubMed, Embase, CINAHL, and SPORTDiscus from database inception to May 2018. Included articles were prospective cohort studies, which specifically analyzed musculoskeletal impairments associated with future running-related injury. Two authors extracted study data, assessed the methodological quality of each study using the Critical Appraisal Tool and assessed the overall quality using the GRADE approach. Results Seven articles met the inclusion criteria. There was very low quality of evidence for the 7 identified clinical assessment alteration categories. Strong hip abductors were significantly associated with running-related injury in one study. Increased hip external-to-internal rotation strength and decreased hip internal range of motion were protective for running injury, each in one study. Decreased navicular drop in females had a protective effect for running-related injury in one study. Conclusions Due to very low quality of evidence for each assessment, confounders present within the studies, a limited number of studies, different measurement methods among studies, measurement variability within clinical assessments, inconsistent definitions of injury and runner, different statistical modeling, and study bias, caution is suggested in interpreting these results.
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Affiliation(s)
- Shefali M Christopher
- 1Department of physical therapy Education, Elon University, Elon, NC 27244 USA.,2School of Health Sciences, The University of Newcastle, Callaghan, Australia
| | | | - Suzanne J Snodgrass
- 2School of Health Sciences, The University of Newcastle, Callaghan, Australia
| | - Chad Cook
- 4Division of Physical Therapy, Duke University, 2200 W. Main Street, Durham, NC 27705 USA
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23
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Messier SP, Martin DF, Mihalko SL, Ip E, DeVita P, Cannon DW, Love M, Beringer D, Saldana S, Fellin RE, Seay JF. A 2-Year Prospective Cohort Study of Overuse Running Injuries: The Runners and Injury Longitudinal Study (TRAILS). Am J Sports Med 2018; 46:2211-2221. [PMID: 29791183 DOI: 10.1177/0363546518773755] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The National Center for Injury Prevention and Control, noting flaws in previous running injury research, called for more rigorous prospective designs and comprehensive analyses to define the origin of running injuries. PURPOSE To determine the risk factors that differentiate recreational runners who remain uninjured from those diagnosed with an overuse running injury during a 2-year observational period. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Inclusion criteria were running a minimum of 5 miles per week and being injury free for at least the past 6 months. Data were collected at baseline on training, medical and injury histories, demographics, anthropometrics, strength, gait biomechanics, and psychosocial variables. Injuries occurring over the 2-year observation period were diagnosed by an orthopaedic surgeon on the basis of predetermined definitions. RESULTS Of the 300 runners who entered the study, 199 (66%) sustained at least 1 injury, including 73% of women and 62% of men. Of the injured runners, 111 (56%) sustained injuries more than once. In bivariate analyses, significant ( P ≤ .05) factors at baseline that predicted injury were as follows: Short Form Health Survey-12 mental component score (lower mental health-related quality of life), Positive and Negative Affect Scale negative affect score (more negative emotions), sex (higher percentage of women were injured), and knee stiffness (greater stiffness was associated with injury); subsequently, knee stiffness was the lone significant predictor of injury (odds ratio = 1.18) in a multivariable analysis. Flexibility, quadriceps angle, arch height, rearfoot motion, strength, footwear, and previous injury were not significant risk factors for injury. CONCLUSION The results of this study indicate the following: (1) among recreational runners, women sustain injuries at a higher rate than men; (2) greater knee stiffness, more common in runners with higher body weights (≥80 kg), significantly increases the odds of sustaining an overuse running injury; and (3) contrary to several long-held beliefs, flexibility, arch height, quadriceps angle, rearfoot motion, lower extremity strength, weekly mileage, footwear, and previous injury are not significant etiologic factors across all overuse running injuries.
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Affiliation(s)
- Stephen P Messier
- J.B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - David F Martin
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Shannon L Mihalko
- J.B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Edward Ip
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Paul DeVita
- Department of Kinesiology, East Carolina University, Greenville, North Carolina, USA
| | - D Wayne Cannon
- Wayne Cannon Physical Therapy and Associates, Winston-Salem, North Carolina, USA
| | - Monica Love
- J.B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Danielle Beringer
- J.B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Santiago Saldana
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Rebecca E Fellin
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Joseph F Seay
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
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Napier C, MacLean CL, Maurer J, Taunton JE, Hunt MA. Kinetic risk factors of running-related injuries in female recreational runners. Scand J Med Sci Sports 2018; 28:2164-2172. [DOI: 10.1111/sms.13228] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2018] [Indexed: 11/30/2022]
Affiliation(s)
- C. Napier
- Department of Physical Therapy; Faculty of Medicine; University of British Columbia; Vancouver BC Canada
- Fortius Lab; Fortius Institute; Burnaby BC Canada
| | - C. L. MacLean
- Department of Physical Therapy; Faculty of Medicine; University of British Columbia; Vancouver BC Canada
- Fortius Lab; Fortius Institute; Burnaby BC Canada
| | - J. Maurer
- Fortius Lab; Fortius Institute; Burnaby BC Canada
| | - J. E. Taunton
- Fortius Lab; Fortius Institute; Burnaby BC Canada
- Division of Sports Medicine; Department of Family Practice; Faculty of Medicine; University of British Columbia; Vancouver BC Canada
| | - M. A. Hunt
- Department of Physical Therapy; Faculty of Medicine; University of British Columbia; Vancouver BC Canada
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Hulme A, Nielsen RO, Timpka T, Verhagen E, Finch C. Risk and Protective Factors for Middle- and Long-Distance Running-Related Injury. Sports Med 2018; 47:869-886. [PMID: 27785775 DOI: 10.1007/s40279-016-0636-4] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite a rapidly growing body of research, a systematic evidence compilation of the risk and protective factors for middle- and long-distance running-related injury (RRI) was lacking. OBJECTIVES Our objective was to compile the evidence about modifiable and non-modifiable training-related and behavioral risk and protective factors for middle- and long-distance RRI. METHODS We searched five databases (PubMed, CINAHL, MEDLINE, SPORTDiscus, and PsycINFO) for the dates 1 January 1970 to 31 December 2015, inclusive, for original peer-reviewed articles. The eligible designs were cross-sectional, case-control, longitudinal observational studies, and randomized controlled trials involving runners competing at distances from ≥800 m to ≤42.2 km. Outcomes were any specific and/or general RRI, and exposures included training-related and behavioral factors. We extracted authors and date, study design, injury type(s), descriptors and comparators for each exposure, and results and measures of association from the selected studies. Methodological quality was independently appraised using two separate checklists: a modified checklist for observational study designs and the Physiotherapy Evidence Database (PEDro) scale for randomized controlled trials. RESULTS Among 73 articles eligible for inclusion, 19 (26.0%) and 30 (41.0%) were of high or satisfactory methodological quality, respectively. As a non-modifiable exposure, a history of previous injury was found to be associated with an increased risk of both general and specific RRI. In terms of modifiable exposures, irregular and/or absent menstruation was found to be associated with an increased risk of stress fracture development, whereas the use of oral contraceptives was found to be associated with a decreased risk. High clinical, methodological, and statistical heterogeneity meant it was not feasible to estimate a pooled effect size across similar studies. CONCLUSIONS A history of previous injury was associated with an increased risk of both general and specific RRI. The use of oral contraceptives was found to be associated with a decreased risk of skeletal stress fracture. Conversely, irregular and/or absent menstruation was associated with an increased risk. The varied effect directions and/or a number of statistically insignificant results associated with the majority of factors hindered our ability to draw any definitive conclusions about their relationship to RRI risk.
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Affiliation(s)
- Adam Hulme
- Australian Collaboration for Research into Injury in Sports and its Prevention (ACRISP), Federation University Australia, SMB Campus, PO Box 663, Ballarat, VIC, 3353, Australia.
| | | | - Toomas Timpka
- Department of Medical and Health Sciences, Linköping University, 581 83 , Linköping, Sweden
| | - Evert Verhagen
- Australian Collaboration for Research into Injury in Sports and its Prevention (ACRISP), Federation University Australia, SMB Campus, PO Box 663, Ballarat, VIC, 3353, Australia.,Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, Vrije University Medical Centre, Amsterdam, The Netherlands
| | - Caroline Finch
- Australian Collaboration for Research into Injury in Sports and its Prevention (ACRISP), Federation University Australia, SMB Campus, PO Box 663, Ballarat, VIC, 3353, Australia
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Hamill J, Gruber AH. Is changing footstrike pattern beneficial to runners? JOURNAL OF SPORT AND HEALTH SCIENCE 2017; 6:146-153. [PMID: 30356626 PMCID: PMC6189005 DOI: 10.1016/j.jshs.2017.02.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 12/02/2016] [Accepted: 01/04/2017] [Indexed: 05/31/2023]
Abstract
Some researchers, running instructors, and coaches have suggested that the "optimal" footstrike pattern to improve performance and reduce running injuries is to land using a mid- or forefoot strike. Thus, it has been recommended that runners who use a rearfoot strike would benefit by changing their footstrike although there is little scientific evidence for suggesting such a change. The rearfoot strike is clearly more prevalent. The major reasons often given for changing to a mid- or forefoot strike are (1) it is more economical; (2) there is a reduction in the impact peak and loading rate of the vertical component of the ground reaction force; and (3) there is a reduction in the risk of a running-related injuries. In this paper, we critique these 3 suggestions and provide alternate explanations that may provide contradictory evidence for altering one's footstrike pattern. We have concluded, based on examining the research literature, that changing to a mid- or forefoot strike does not improve running economy, does not eliminate an impact at the foot-ground contact, and does not reduce the risk of running-related injuries.
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Affiliation(s)
- Joseph Hamill
- Biomechanics Laboratory, Department of Kinesiology, University of Massachusetts, Amherst, MA 01003, USA
| | - Allison H. Gruber
- Biomechanics Laboratory, Department of Kinesiology, Indiana University, Bloomington, IN 47405, USA
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The effects of fatigue on lower extremity kinematics, kinetics and joint coupling in symptomatic female runners with iliotibial band syndrome. Clin Biomech (Bristol, Avon) 2016; 39:84-90. [PMID: 27718393 DOI: 10.1016/j.clinbiomech.2016.09.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 09/27/2016] [Accepted: 09/29/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Altered hip and knee kinematics and joint coupling have been documented in runners with iliotibial band syndrome. Symptoms often present themselves after several minutes of running, yet the effect of fatigue warrants further exploration. The purpose of this study was to determine the effect of a run to fatigue in runners with iliotibial band syndrome, as compared to healthy controls. METHODS Twenty uninjured and 12 female runners with iliotibial band syndrome performed a treadmill run to fatigue. Prior-to and following a run to fatigue, overground running data were collected. Variables of interest included stance phase: peak hip adduction and internal rotation, peak hip abductor and external rotator joint moments and frontal-sagittal plane hip and knee joint coupling. FINDINGS Fatigue resulted in decreased peak hip adduction angles in injured runners. Fatigue did not affect injured runners differently than controls with respect to the remaining variables. Coupling differences did not exist between healthy and injured runners with respect to the loading or propulsive phases of stance. INTERPRETATION While clinicians often strengthen hip abductor muscles and provide gait re-training to decrease stance phase hip adduction, our results suggest that, when exerted, female runners with iliotibial band syndrome independently modify their running gait to decrease hip adduction, potentially as a result of pain. Fatigue did not have an effect on the remaining study variables. It is possible that reducing the length of the iliotibial band through minimizing hip adduction reduces pain, but the other variables examined are not sensitive to this phenomenon.
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Soligard T, Schwellnus M, Alonso JM, Bahr R, Clarsen B, Dijkstra HP, Gabbett T, Gleeson M, Hägglund M, Hutchinson MR, Janse van Rensburg C, Khan KM, Meeusen R, Orchard JW, Pluim BM, Raftery M, Budgett R, Engebretsen L. How much is too much? (Part 1) International Olympic Committee consensus statement on load in sport and risk of injury. Br J Sports Med 2016; 50:1030-41. [DOI: 10.1136/bjsports-2016-096581] [Citation(s) in RCA: 453] [Impact Index Per Article: 56.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2016] [Indexed: 01/02/2023]
Abstract
Athletes participating in elite sports are exposed to high training loads and increasingly saturated competition calendars. Emerging evidence indicates that poor load management is a major risk factor for injury. The International Olympic Committee convened an expert group to review the scientific evidence for the relationship of load (defined broadly to include rapid changes in training and competition load, competition calendar congestion, psychological load and travel) and health outcomes in sport. We summarise the results linking load to risk of injury in athletes, and provide athletes, coaches and support staff with practical guidelines to manage load in sport. This consensus statement includes guidelines for (1) prescription of training and competition load, as well as for (2) monitoring of training, competition and psychological load, athlete well-being and injury. In the process, we identified research priorities.
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Damavandi M, Eslami M, Pearsall DJ. Side-sloped surfaces substantially affect lower limb running kinematics. Sports Biomech 2016; 16:1-12. [PMID: 27241856 DOI: 10.1080/14763141.2016.1171895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Running on side-sloped surfaces is a common obstacle in the environment; however, how and to what extent the lower extremity kinematics adapt is not well known. The purpose of this study was to determine the effects of side-sloped surfaces on three-dimensional kinematics of hip, knee, and ankle during stance phase of running. Ten healthy adult males ran barefoot along an inclinable runway in level (0°) and side-sloped (10° up-slope and down-slope inclinations, respectively) configurations. Right hip, knee, and ankle angles along with their time of occurrence were analysed using repeated measures MANOVA. Up-slope hip was more adducted (p = 0.015) and internally rotated (p = 0.030). Knee had greater external rotations during side-sloped running at heel-strike (p = 0.005), while at toe-off, it rotated externally and internally during up-slope and down-slope running, respectively (p = 0.001). Down-slope ankle had greatest plantar flexion (p = 0.001). Up-slope ankle had greatest eversion compared with down-slope (p = 0.043), while it was more externally rotated (p = 0.030). These motion patterns are necessary to adjust the lower extremity length during side-sloped running. Timing differences in the kinematic events of hip adduction and external rotation, and ankle eversion were observed (p = 0.006). Knowledge on these alterations is a valuable tool in adopting strategies to enhance performance while preventing injury.
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Affiliation(s)
- Mohsen Damavandi
- a Faculty of Physical Education and Sport Sciences , Hakim Sabzevari University , Sabzevar , Iran
| | - Mansour Eslami
- b Faculty of Physical Education and Sport Sciences , University of Mazandaran , Babolsar , Iran
| | - David J Pearsall
- c Department of Kinesiology and Physical Education , McGill University , Montreal , Canada
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van der Worp H, Vrielink JW, Bredeweg SW. Do runners who suffer injuries have higher vertical ground reaction forces than those who remain injury-free? A systematic review and meta-analysis. Br J Sports Med 2016; 50:450-7. [DOI: 10.1136/bjsports-2015-094924] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2015] [Indexed: 01/30/2023]
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Hulme A, Finch CF. From monocausality to systems thinking: a complementary and alternative conceptual approach for better understanding the development and prevention of sports injury. Inj Epidemiol 2015; 2:31. [PMID: 26691678 PMCID: PMC4673096 DOI: 10.1186/s40621-015-0064-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 12/03/2015] [Indexed: 11/10/2022] Open
Abstract
The science of sports injury control, including both its cause and prevention, has largely been informed by a biomedical and mechanistic model of health. Traditional scientific practice in sports injury research has routinely involved collapsing the broader socioecological landscape down in order to analyse individual-level determinants of injury - whether biomechanical and/or behavioural. This approach has made key gains for sports injury prevention research and should be further encouraged and allowed to evolve naturally. However, the public health, Applied Human Factors and Ergonomics, and injury epidemiological literature more broadly, has accepted the value of a socioecological paradigm for better understanding disease and injury processes, and sports injury research will fall further behind unless it does the same. A complementary and alternative conceptual approach towards injury control known as systems thinking that builds on socioecological science, both methodologically and analytically, is readily available and fast developing in other research areas. This review outlines the historical progression of causal concepts in the field of epidemiology over the course of the modern scientific era. From here, causal concepts in injury epidemiology, and models of aetiology as found in the context of sports injury research are presented. The paper finishes by proposing a new research agenda that considers the potential for a systems thinking approach to further enhance sports injury aetiological understanding. A complementary systems paradigm, however, will require that sports injury epidemiologists bring their knowledge and skillsets forwards in an attempt to use, adapt, and even refine existing systems-based approaches. Alongside the natural development of conventional scientific methodologies and analyses in sports injury research, progressing forwards to a systems paradigm is now required.
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Affiliation(s)
- Adam Hulme
- Australian Centre for Research into Injury in Sports and its Prevention (ACRISP), Federation University Australia, SMB Campus, PO Box 663, Ballarat, Victoria 3353 Australia
| | - Caroline F Finch
- Australian Centre for Research into Injury in Sports and its Prevention (ACRISP), Federation University Australia, SMB Campus, PO Box 663, Ballarat, Victoria 3353 Australia
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Aderem J, Louw QA. Biomechanical risk factors associated with iliotibial band syndrome in runners: a systematic review. BMC Musculoskelet Disord 2015; 16:356. [PMID: 26573859 PMCID: PMC4647699 DOI: 10.1186/s12891-015-0808-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 11/06/2015] [Indexed: 01/03/2023] Open
Abstract
Background Iliotibial band syndrome is the second most common running injury. A gradual increase in its occurrence has been noted over the past decade. This may be related to the increasing number of runners worldwide. Since the last systematic review, six additional papers have been published, providing an opportunity for this review to explore the previously identified proximal risk factors in more detail. The aim of this systematic review is thus to provide an up to date quantitative synthesis of the trunk, pelvis and lower limb biomechanical risk factors associated with Iliotibial band syndrome in runners and to provide an algorithm for future research and clinical guidance. Methods An electronic search was conducted of literature published up until April 2015. The critical appraisal tool for quantitative studies was used to evaluate methodological quality of eligible studies. Forest plots displayed biomechanical findings, mean differences and confidence intervals. Level of evidence and clinical impact were evaluated for each risk factor. A meta-analysis was conducted where possible. Result Thirteen studies were included (prospective (n = 1), cross-sectional (n = 12)). Overall the methodological score of the studies was moderate. Female shod runners who went onto developing Iliotibial band syndrome presented with increased peak hip adduction and increased peak knee internal rotation during stance. Female shod runners with Iliotibial band syndrome presented with increased: peak knee internal rotation and peak trunk ipsilateral during stance. Conclusion Findings indicate new quantitative evidence about the biomechanical risk factors associated with Iliotibial band syndrome in runners. Despite these findings, there are a number of limitations to this review including: the limited number of studies, small effect sizes and methodological shortcomings. This review has considered these shortcomings and has summarised the best available evidence to guide clinical decisions and plan future research on Iliotibial band syndrome aetiology and risk.
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Affiliation(s)
- Jodi Aderem
- Faculty of Medicine and Health Sciences, Physiotherapy Division, University of Stellenbosch, PO Box 19063, Francie van Zijl Drive, Tygerberg, 7505, South Africa.
| | - Quinette A Louw
- Faculty of Medicine and Health Sciences, Physiotherapy Division, University of Stellenbosch, PO Box 19063, Francie van Zijl Drive, Tygerberg, 7505, South Africa.
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Hsi WL. Analysis of medial deviation of center of pressure after initial heel contact in forefoot varus. J Formos Med Assoc 2015; 115:203-9. [PMID: 25957121 DOI: 10.1016/j.jfma.2015.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 02/16/2015] [Accepted: 03/15/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/PURPOSE After initial heel contact, the rearfoot everts and causes medial deviation of the center of pressure (CoP). Although rearfoot angle in single-limb stance has been associated with forefoot varus (FV) ≥ 8°, medial CoP deviation has not. METHODS After 12 participants with FV < 8° (neutral group) and 11 participants with FV ≥ 8° (FV group) stepped one heel initially onto an array of pressure sensors parallel to its Y coordinate axis, when the CoP of array deviated most medially, the X coordinate of the CoP of each row was calculated to find the most medial CoP of the row. Starting since the row with the most medial CoP just began to have the same sensors with pressures >0 kPa as when it had the most medial CoP, the medial deviations of the CoP of the array, the most medial CoP of the row, and its relative position in the row (CoP%), were compared between neutral and FV groups. RESULTS The medial deviations of the most medial CoP of the row (1.1 ± 0.6 vs. 1.6 ± 0.3 mm, p = 0.049) and CoP% (2.9 ± 1.4 vs. 4.2 ± 1.1%, p = 0.023) were significantly different between neutral and FV groups, whereas that of the CoP of the array (1.1 ± 0.6 vs. 1.4 ± 0.6 mm, p = 0.36) was not. CONCLUSION The most medial CoP of the row and CoP% detected increased medial CoP deviation in FV ≥ 8°, and may be applied to other clinical conditions where rearfoot angle and CoP of the array after initial heel contact cannot detect significant differences.
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Affiliation(s)
- Wei-Li Hsi
- Department of Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.
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Phinyomark A, Osis S, Hettinga BA, Leigh R, Ferber R. Gender differences in gait kinematics in runners with iliotibial band syndrome. Scand J Med Sci Sports 2015; 25:744-53. [DOI: 10.1111/sms.12394] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2014] [Indexed: 10/24/2022]
Affiliation(s)
- A. Phinyomark
- Faculty of Kinesiology; University of Calgary; Calgary Alberta Canada
| | - S. Osis
- Faculty of Kinesiology; University of Calgary; Calgary Alberta Canada
- Running Injury Clinic; Calgary Alberta Canada
| | - B. A. Hettinga
- Faculty of Kinesiology; University of Calgary; Calgary Alberta Canada
- Running Injury Clinic; Calgary Alberta Canada
| | - R. Leigh
- Faculty of Kinesiology; University of Calgary; Calgary Alberta Canada
| | - R. Ferber
- Faculty of Kinesiology; University of Calgary; Calgary Alberta Canada
- Running Injury Clinic; Calgary Alberta Canada
- Faculty of Nursing; University of Calgary; Calgary Alberta Canada
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Loew LM, Brosseau L, Tugwell P, Wells GA, Welch V, Shea B, Poitras S, De Angelis G, Rahman P. Deep transverse friction massage for treating lateral elbow or lateral knee tendinitis. Cochrane Database Syst Rev 2014; 2014:CD003528. [PMID: 25380079 PMCID: PMC7154576 DOI: 10.1002/14651858.cd003528.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background Deep transverse friction massage, one of several physical therapy interventions suggested for the management of tendinitis pain, was first demonstrated in the 1930s by Dr James Cyriax, a renowned orthopedic surgeon in England. Its goal is to prevent abnormal fibrous adhesions and abnormal scarring. This is an update of a Cochrane review first published in 2001.Objectives To assess the benefits and harms of deep transverse friction massage for treating lateral elbow or lateral knee tendinitis.Search methods We searched the following electronic databases: the specialized central registry of the Cochrane Field of Physical and Related Therapies,the Cochrane Central Register of Controlled Trials (CENTRAL),MEDLINE, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Clinicaltrials.gov, and the Physiotherapy Evidence Database (PEDro), up until July 2014. The reference lists of these trials were consulted for additional studies.Selection criteria All randomized controlled trials (RCTs) and controlled clinical trials (CCTs) comparing deep transverse friction massage with control or other active interventions for study participants with two eligible types of tendinitis (ie, extensor carpi radialis tendinitis (lateral elbow tendinitis, tennis elbow or lateral epicondylitis or lateralis epicondylitis humeri) and iliotibial band friction syndrome (lateral knee tendinitis)) were selected. Only studies published in English and French languages were included.Data collection and analysis Two review authors independently assessed the studies on the basis of inclusion and exclusion criteria. Results of individual trials were extracted from the included study using extraction forms prepared by two independent review authors before the review was begun.Data were cross-checked by a third review author. Risk of bias of the included studies was assessed using the "Risk of bias"tool of The Cochrane Collaboration. A pooled analysis was performed using mean difference (MD) for continuous outcomes and risk ratio (RR)for dichotomous outcomes with 95% confidence intervals (CIs).Main results Two RCTs (no new additional studies in this update) with 57 participants met the inclusion criteria. These studies demonstrated high risk of performance and detection bias, and the risk of selection, attrition, and reporting bias was unclear.The first study included 40 participants with lateral elbow tendinitis and compared (1) deep transverse friction massage combined with therapeutic ultrasound and placebo ointment (n = 11) versus therapeutic ultrasound and placebo ointment only (n = 9) and (2)deep transverse friction massage combined with phonophoresis (n = 10) versus phonophoresis only (n = 10). No statistically significant differences were reported within five weeks for mean change in pain on a 0 to 100 visual analog scale (VAS) (MD -6.60, 95%CI -28.60 to 15.40; 7% absolute improvement), grip strength measured in kilograms of force (MD 0.10, 95% CI -0.16 to 0.36) and function ona 0 to 100 VAS (MD -1.80, 95% CI -0.18.64 to 15.04; 2% improvement), pain-free function index measured as the number of painfree items (MD 1.10, 95% CI -1.00 to 3.20) and functional status (RR 3.3, 95% CI 0.4 to 24.3) for deep transverse friction massage,and therapeutic ultrasound and placebo ointment compared with therapeutic ultrasound and placebo ointment only. Likewise for deep transverse friction massage and phonophoresis compared with phonophoresis alone, no statistically significant differences were found for pain (MD -1.2, 95% CI -20.24 to 17.84; 1% improvement), grip strength (MD -0.20, 95% CI -0.46 to 0.06) and function (MD3.70, 95% CI -14.13 to 21.53; 4% improvement). In addition, the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach was used to evaluate the quality of evidence for the pain outcome, which received a score of "very low".Pain relief of 30% or greater, quality of life, patient global assessment, adverse events, and withdrawals due to adverse events were not assessed or reported.The second study included 17 participants with iliotibial band friction syndrome (knee tendinitis) and compared deep transverse friction massage with physical therapy intervention versus physical therapy intervention alone, at two weeks. Deep transverse friction massage with physical therapy intervention showed no statistically significant differences in the three measures of pain relief on a 0 to 10 VAS when compared with physical therapy alone: daily pain (MD -0.40, 95% CI -0.80 to -0.00; absolute improvement 4%), pain while running (scale from 0 to 150) (MD -3.00, 95% CI -11.08 to 5.08), and percentage of maximum pain while running (MD -0.10, 95% CI -3.97 to 3.77). For the pain outcome, absolute improvement showed a 4% reduction in pain. However, the quality of the body of evidence received a grade of "very low."Pain relief of 30% or greater, function, quality of life, patient global assessment of success, adverse events, and withdrawals due to adverse events were not assessed or reported.Authors' conclusions We do not have sufficient evidence to determine the effects of deep transverse friction on pain, improvement in grip strength, and functional status for patients with lateral elbow tendinitis or knee tendinitis, as no evidence of clinically important benefits was found.The confidence intervals of the estimate of effects overlapped the null value for deep transverse friction massage in combination with physical therapy compared with physical therapy alone in the treatment of lateral elbow tendinitis and knee tendinitis. These conclusions are limited by the small sample size of the included randomized controlled trials. Future trials, utilizing specific methods and adequate sample sizes, are needed before conclusions can be drawn regarding the specific effects of deep transverse friction massage on lateral elbow tendinitis.
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Affiliation(s)
- Laurianne M Loew
- University of OttawaSchool of Rehabilitation Sciences, Faculty of Health Sciences451 Smyth RoadOttawaONCanadaK1H 8M5
| | - Lucie Brosseau
- University of OttawaSchool of Rehabilitation Sciences, Faculty of Health Sciences451 Smyth RoadOttawaONCanadaK1H 8M5
| | - Peter Tugwell
- Faculty of Medicine, University of OttawaDepartment of MedicineOttawaONCanadaK1H 8M5
| | - George A Wells
- University of OttawaDepartment of Epidemiology and Community MedicineRoom H128140 Ruskin StreetOttawaONCanadaK1Y 4W7
| | - Vivian Welch
- University of OttawaBruyère Research Institute43 Bruyere StreetOttawaONCanadaK1N 5C8
| | - Beverley Shea
- University of OttawaDepartment of Epidemiology and Community MedicineRoom H128140 Ruskin StreetOttawaONCanadaK1Y 4W7
| | - Stephane Poitras
- University of OttawaSchool of Rehabilitation Sciences, Faculty of Health Sciences451 Smyth RoadOttawaONCanadaK1H 8M5
| | - Gino De Angelis
- University of OttawaDepartment of Epidemiology and Community MedicineRoom H128140 Ruskin StreetOttawaONCanadaK1Y 4W7
| | - Prinon Rahman
- University of OttawaSchool of Rehabilitation Sciences, Faculty of Health Sciences451 Smyth RoadOttawaONCanadaK1H 8M5
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Excessive progression in weekly running distance and risk of running-related injuries: an association which varies according to type of injury. J Orthop Sports Phys Ther 2014; 44:739-47. [PMID: 25155475 DOI: 10.2519/jospt.2014.5164] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN An explorative, 1-year prospective cohort study. Objective To examine whether an association between a sudden change in weekly running distance and running-related injury varies according to injury type. BACKGROUND It is widely accepted that a sudden increase in running distance is strongly related to injury in runners. But the scientific knowledge supporting this assumption is limited. METHODS A volunteer sample of 874 healthy novice runners who started a self-structured running regimen were provided a global-positioning-system watch. After each running session during the study period, participants were categorized into 1 of the following exposure groups, based on the progression of their weekly running distance: less than 10% or regression, 10% to 30%, or more than 30%. The primary outcome was running-related injury. RESULTS A total of 202 runners sustained a running-related injury. Using Cox regression analysis, no statistically significant differences in injury rates were found across the 3 exposure groups. An increased rate of distance-related injuries (patellofemoral pain, iliotibial band syndrome, medial tibial stress syndrome, gluteus medius injury, greater trochanteric bursitis, injury to the tensor fascia latae, and patellar tendinopathy) existed in those who progressed their weekly running distance by more than 30% compared with those who progressed less than 10% (hazard ratio = 1.59; 95% confidence interval: 0.96, 2.66; P = .07). CONCLUSION Novice runners who progressed their running distance by more than 30% over a 2-week period seem to be more vulnerable to distance-related injuries than runners who increase their running distance by less than 10%. Owing to the exploratory nature of the present study, randomized controlled trials are needed to verify these results, and more experimental studies are needed to validate the assumptions. Still, novice runners may be well advised to progress their weekly distances by less than 30% per week over a 2-week period.
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A Review of Treatments for Iliotibial Band Syndrome in the Athletic Population. ACTA ACUST UNITED AC 2013; 2013:367169. [PMID: 26464876 PMCID: PMC4590904 DOI: 10.1155/2013/367169] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 08/29/2013] [Indexed: 01/15/2023]
Abstract
Iliotibial band syndrome (ITBS) is a common injury in runners and other long distance athletes with the best management options not clearly established. This review outlines both the conservative and surgical options for the treatment of iliotibial band syndrome in the athletic population. Ten studies met the inclusion criteria by focusing on the athletic population in their discussion of the treatment for iliotibial band syndrome, both conservative and surgical. Conservative management consisting of a combination of rest (2–6 weeks), stretching, pain management, and modification of running habits produced a 44% complete cure rate, with return to sport at 8 weeks and a 91.7% cure rate with return to sport at 6 months after injury. Surgical therapy, often only used for refractory cases, consisted of excision or release of the pathologic distal portion of the iliotibial band or bursectomy. Those studies focusing on the excision or release of the pathologic distal portion of the iliotibial band showed a 100% return to sport rate at both 7 weeks and 3 months after injury. Despite many options for both surgical and conservative treatment, there has yet to be consensus on one standard of care. Certain treatments, both conservative and surgical, in our review are shown to be more effective than others; however, further research is needed to delineate the true pathophysiology of iliotibial band syndrome in athletes, as well as the optimal treatment regimen.
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Atkins LT, James CR, Sizer PS, Jonely H, Brismée JM. Reliability and concurrent criterion validity of a novel technique for analyzing hip kinematics during running. Physiother Theory Pract 2013; 30:210-7. [DOI: 10.3109/09593985.2013.830349] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Louw M, Deary C. The biomechanical variables involved in the aetiology of iliotibial band syndrome in distance runners - A systematic review of the literature. Phys Ther Sport 2013; 15:64-75. [PMID: 23954385 DOI: 10.1016/j.ptsp.2013.07.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 05/10/2013] [Accepted: 07/19/2013] [Indexed: 01/14/2023]
Abstract
The aim of this literature review was to identify the biomechanical variables involved in the aetiology of iliotibial band syndrome (ITBS) in distance runners. An electronic search was conducted using the terms "iliotibial band" and "iliotibial tract". The results showed that runners with a history of ITBS appear to display decreased rear foot eversion, tibial internal rotation and hip adduction angles at heel strike while having greater maximum internal rotation angles at the knee and decreased total abduction and adduction range of motion at the hip during stance phase. They further appear to experience greater invertor moments at their feet, decreased abduction and flexion velocities at their hips and to reach maximum hip flexion angles earlier than healthy controls. Maximum normalised braking forces seem to be decreased in these athletes. The literature is inconclusive with regards to muscle strength deficits in runners with a history of ITBS. Prospective research suggested that greater internal rotation at the knee joint and increased adduction angles of the hip may play a role in the aetiology of ITBS and that the strain rate in the iliotibial bands of these runners may be increased compared to healthy controls. A clear biomechanical cause for ITBS could not be devised due to the lack of prospective research.
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Affiliation(s)
- Maryke Louw
- Department of Physiotherapy, School of Health Professions, University of Brighton, UK.
| | - Clare Deary
- Department of Physiotherapy, School of Health Professions, University of Brighton, UK
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Abstract
Tendinopathy and chronic tendon issues related to tendinosis are conditions difficult to treat. These conditions often lead to patients' quality of life declining because of the inability to participate in exercise, occupation-related activities, and activities of daily living. By better understanding the pathophysiology related to the development of tendinosis, clinicians will be better able to understand the treatment options available and their limitations while allowing novel therapies to be developed. Conservative treatment of tendinosis starting with a sound rehabilitation program seems to be the best place to start while reserving surgical approaches for cases that have failed conservative management.
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Differences in kinetic variables between injured and noninjured novice runners: A prospective cohort study. J Sci Med Sport 2013; 16:205-10. [DOI: 10.1016/j.jsams.2012.08.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 06/28/2012] [Accepted: 08/03/2012] [Indexed: 11/19/2022]
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van der Worp MP, van der Horst N, de Wijer A, Backx FJG, Nijhuis-van der Sanden MWG. Iliotibial band syndrome in runners: a systematic review. SPORTS MEDICINE (AUCKLAND, N.Z.) 2013; 42:969-92. [PMID: 22994651 DOI: 10.2165/11635400-000000000-00000] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The popularity of running is still growing and, as participation increases, the incidence of running-related injuries will also rise. Iliotibial band syndrome (ITBS) is the most common injury of the lateral side of the knee in runners, with an incidence estimated to be between 5% and 14%. In order to facilitate the evidence-based management of ITBS in runners, more needs to be learned about the aetiology, diagnosis and treatment of this injury. OBJECTIVE This article provides a systematic review of the literature on the aetiology, diagnosis and treatment of ITBS in runners. SEARCH STRATEGY The Cochrane Library, MEDLINE, EMBASE, CINAHL, Web of Science, and reference lists were searched for relevant articles. SELECTION CRITERIA Systematic reviews, clinical trials or observational studies involving adult runners (>18 years) that focused on the aetiology, diagnosis and/or treatment of ITBS were included and articles not written in English, French, German or Dutch were excluded. DATA COLLECTION AND ANALYSIS Two reviewers independently screened search results, assessed methodological quality and extracted data. The sum of all positive ratings divided by the maximum score was the percentage quality score (QS). Only studies with a QS higher than 60% were included in the analysis. The following data were extracted: study design; number and characteristics of participants; diagnostic criteria for ITBS; exposure/treatment characteristics; analyses/outcome variables of the study; and setting and theoretical perspective on ITBS. MAIN RESULTS The studies of the aetiology of ITBS in runners provide limited or conflicting evidence and it is not clear whether hip abductor weakness has a major role in ITBS. The kinetics and kinematics of the hip, knee and/or ankle/foot appear to be considerably different in runners with ITBS to those without. The biomechanical studies involved small samples, and data seem to have been influenced by sex, height and weight of participants. Although most studies monitored the management of ITBS using clinical tests, these tests have not been validated for this patient group. While the articles were inconsistent regarding the treatment of ITBS, hip/knee coordination and running style appear to be key factors in the treatment of ITBS. Runners might also benefit from mobilization, exercises to strengthen the hip, and advice about running shoes and running surface. CONCLUSION The methodological quality of research into the management of ITBS in runners is poor and the results are highly conflicting. Therefore, the study designs should be improved to prevent selection bias and to increase the generalizability of findings.
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Affiliation(s)
- Maarten P van der Worp
- Academic Institute Hogeschool Utrecht, University of Applied Sciences Utrecht, Department of Physical Therapy, Utrecht, The Netherlands.
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McBeth JM, Earl-Boehm JE, Cobb SC, Huddleston WE. Hip muscle activity during 3 side-lying hip-strengthening exercises in distance runners. J Athl Train 2013; 47:15-23. [PMID: 22488226 DOI: 10.4085/1062-6050-47.1.15] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Lower extremity overuse injuries are associated with gluteus medius (GMed) weakness. Understanding the activation of muscles about the hip during strengthening exercises is important for rehabilitation. OBJECTIVE To compare the electromyographic activity produced by the gluteus medius (GMed), tensor fascia latae (TFL), anterior hip flexors (AHF), and gluteus maximus (GMax) during 3 hip-strengthening exercises: hip abduction (ABD), hip abduction with external rotation (ABD-ER), and clamshell (CLAM) exercises. DESIGN Controlled laboratory study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty healthy runners (9 men, 11 women; age = 25.45 ± 5.80 years, height = 1.71 ± 0.07 m, mass = 64.43 ± 7.75 kg) participated. INTERVENTION(S) A weight equal to 5% body mass was affixed to the ankle for the ABD and ABD-ER exercises, and an equivalent load was affixed for the CLAM exercise. A pressure biofeedback unit was placed beneath the trunk to provide positional feedback. MAIN OUTCOME MEASURE(S) Surface electromyography (root mean square normalized to maximal voluntary isometric contraction) was recorded over the GMed, TFL, AHF, and GMax. RESULTS Three 1-way, repeated-measures analyses of variance indicated differences for muscle activity among the ABD (F(3,57) = 25.903, P < .001), ABD-ER (F(3,57) = 10.458, P < .001), and CLAM (F(3,57) = 4.640, P = .006) exercises. For the ABD exercise, the GMed (70.1 ± 29.9%), TFL (54.3 ± 19.1%), and AHF (28.2 ± 21.5%) differed in muscle activity. The GMax (25.3 ± 24.6%) was less active than the GMed and TFL but was not different from the AHF. For the ABD-ER exercise, the TFL (70.9 ± 17.2%) was more active than the AHF (54.3 ± 24.8%), GMed (53.03 ± 28.4%), and GMax (31.7 ± 24.1%). For the CLAM exercise, the AHF (54.2 ± 25.2%) was more active than the TFL (34.4 ± 20.1%) and GMed (32.6 ± 16.9%) but was not different from the GMax (34.2 ± 24.8%). CONCLUSIONS The ABD exercise is preferred if targeted activation of the GMed is a goal. Activation of the other muscles in the ABD-ER and CLAM exercises exceeded that of GMed, which might indicate the exercises are less appropriate when the primary goal is the GMed activation and strengthening.
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van der Worp MP, van der Horst N, de Wijer A, Backx FJG, Nijhuis-van der Sanden MWG. Iliotibial Band Syndrome in Runners. Sports Med 2012. [DOI: 10.1007/bf03262306] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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45
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Hein T, Schmeltzpfenning T, Krauss I, Maiwald C, Horstmann T, Grau S. Using the variability of continuous relative phase as a measure to discriminate between healthy and injured runners. Hum Mov Sci 2012; 31:683-94. [DOI: 10.1016/j.humov.2011.07.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Revised: 03/16/2011] [Accepted: 07/06/2011] [Indexed: 10/17/2022]
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Abstract
Rehabilitating the injured runner involves a thorough evaluation of the runner. The running history is at least as critical as the physical examination to determine the risk factors for injury and goals for rehabilitation. The medical assessment should include an office situation in which the runner can be seen walking and running to ensure that the rehabilitation program is complete and successful.
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Affiliation(s)
- Terry L Nicola
- UIC Sports Medicine Center, 839 West Roosevelt Avenue, Suite #102, Chicago, IL 60608, USA.
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47
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Abstract
Iliotibial band syndrome is a common overuse injury typically seen in runners, cyclists, and military recruits. Affected patients report lateral knee pain associated with repetitive motion activities. The diagnosis is usually made based on a characteristic history and physical examination, with imaging studies reserved for cases of recalcitrant disease to rule out other pathologic entities. Several etiologies have been proposed for iliotibial band syndrome, including friction of the iliotibial band against the lateral femoral epicondyle, compression of the fat and connective tissue deep to the iliotibial band, and chronic inflammation of the iliotibial band bursa. The mainstay of treatment is nonsurgical; however, in persistent or chronic cases, surgical management is indicated.
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Baker RL, Souza RB, Fredericson M. Iliotibial band syndrome: soft tissue and biomechanical factors in evaluation and treatment. PM R 2011; 3:550-61. [PMID: 21665168 DOI: 10.1016/j.pmrj.2011.01.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 12/16/2010] [Accepted: 01/04/2011] [Indexed: 01/26/2023]
Abstract
Muscle performance factors and altered loading mechanics have been linked to a variety of lower extremity musculoskeletal disorders. In this article, biomechanical risk factors associated with iliotibial band syndrome (ITBS) are described, and a strategy for incorporating these factors into the clinical evaluation of and treatment for that disorder is presented. Abnormal movement patterns in runners and cyclists with ITBS are discussed, and the pathophysiological characteristics of this syndrome are considered in light of prior and current studies in anatomy. Differential diagnoses and the use of imaging, medications, and injections in the treatment of ITBS are reviewed. The roles of hip muscle strength, kinematics, and kinetics are detailed, and the assessment and treatment of muscle performance factors are discussed, with emphasis on identifying and treating movement dysfunction. Various stages of rehabilitation, including strengthening progressions to reduce soft-tissue injury, are described in detail. ITBS is an extremely common orthopedic condition that presents with consistent dysfunctional patterns in muscle performance and movement deviation. Through careful assessment of lower quarter function, the clinician can properly identify individuals and initiate treatment.
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Affiliation(s)
- Robert L Baker
- Emeryville Sports Physical Therapy, 2322 Powell Street, Emeryville, CA 94608, USA.
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Grau S, Krauss I, Maiwald C, Axmann D, Horstmann T, Best R. Kinematic classification of iliotibial band syndrome in runners. Scand J Med Sci Sports 2011; 21:184-9. [DOI: 10.1111/j.1600-0838.2009.01045.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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50
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Abstract
Published articles on iliotibial band friction syndrome have been reviewed. These articles cover the epidemiology, etiology, anatomy, pathology, prevention, and treatment of the condition. This article describes (1) the various etiological models that have been proposed to explain iliotibial band friction syndrome; (2) some of the imaging methods, research studies, and clinical experiences that support or call into question these various models; (3) commonly proposed treatment methods for iliotibial band friction syndrome; and (4) the rationale behind these methods and the clinical outcome studies that support their efficacy.
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