Influence of Step Rate on Shin Injury and Anterior Knee Pain in High School Runners

Association between running biomechanics and lower limb musculotendinous changes over an adolescent marathon training program

BACKGROUND

Prospective musculotendinous changes have been observed among adolescents completing marathon training programs. However, examinations of potential factors influencing musculotendinous characteristics do not currently exist. Evaluations of biomechanical parameters and the influence on musculotendinous features and changes over time are warranted.

RESEARCH QUESTION

What are the relationships between adolescent running biomechanics and 1) lower extremity musculotendinous characteristics cross-sectionally, and 2) changes in musculotendinous properties over 6-months?

METHODS

Thirty-three adolescent runners participated in this study (19 F, 14 M; 15.8 ± 1.6 years). Ultrasound images of lower extremity musculotendinous structures were obtained to determine thickness and echogenicity. Following ultrasound measures, outdoor running biomechanics were assessed using wearable sensors to collect spatiotemporal, kinetic, and kinematic measures. A subset of participants had repeat ultrasound evaluations following a 6-month running program (n = 11; 6 F, 5 M). Hierarchical linear models were used to assess the relationships between biomechanics and ultrasound measures. Pearson's correlations were used to assess the relationship between biomechanics the change in musculotendinous characteristics (baseline to 6-months).

RESULTS

The strongest relationships between measures were for the Achilles tendon (R2=0.39, F=0.85, p = 0.10), and flexor digitorum brevis (R2=0.38, F=2.38, p = 0.06). The interaction between pronation excursion and velocity was a significant predictor for Achilles tendon thickness (p = 0.03), and medial gastrocnemius thickness (p = 0.05). Contact time was a significant predictor for intrinsic foot muscle thickness (p = 0.01). There were moderate correlations across biomechanical measures and changes in musculotendinous thickness and echogenicity.

SIGNIFICANCE

Biomechanical characteristics often noted with running-related injuries were moderately related to tissue-level characteristics, and changes during running training.

Influence of cadence manipulation on running biomechanics in high school cross-country runners

Increasing cadence is an intervention to reduce injury risk for adolescent long-distance runners. It is unknown how adolescents respond biomechanically when running with a higher than preferred cadence. We examined the influence of increasing cadence on peak joint angles, moments and powers, and ground reaction forces in long-distance runners. We collected three-dimensional kinematics and kinetics for 31 high school cross-country runners during overground running at their preferred cadence (baseline), +5%, and +10% baseline cadence. We performed repeated-measures ANOVAs to compare peak joint angles, moments and powers, and ground reactions forces among cadence conditions. Increasing cadence reduced peak pelvis, hip, knee, and ankle joint angles (p ≤ .01), peak knee moment and powers (p < .001), peak ankle power (p ≤ .01), and peak ground reaction forces (p ≤ .01) but increased peak hip moment and powers (p < .001). Increasing cadence by 10% elicited greater magnitude changes compared to increasing cadence by 5%. Increasing cadence may be a beneficial intervention to reduce lower extremity peak joint angles and knee kinetics for adolescent long-distance runners. The increase in hip kinetics when running at a higher than preferred cadence indicates this intervention increases the loads applied to the hip for adolescent long-distance runners.

Association Between Running Characteristics and Lower Extremity Musculoskeletal Injuries in United States Military Academy Cadets

Background

Running-related overuse injuries are common among recreational runners; however, there is currently little prospective research investigating the role of running characteristics on overuse injury development.

Purpose

To investigate the relationship between running characteristics and lower extremity musculoskeletal injury (MSKI).

Study Design

Cohort study; Level of evidence, 2.

Methods

The study included 827 incoming cadets of the class of 2020 at the United States Military Academy. Before cadet basic training, running spatiotemporal parameters (stride length, ground contact time, and cadence) were recorded for each participant, and foot-strike pattern was analyzed. Demographic data were recorded and analyzed as potential covariates. Lower extremity MSKIs sustained over the 9 weeks of cadet basic training were documented. Kaplan-Meier survival curves were estimated, with time to incident lower extremity MSKI as the primary outcome, by level of the independent predictor variables. Risk factors or potential covariates were carried forward into multivariate Cox proportional hazards regression models.

Results

Approximately 18.1% of participants incurred a lower extremity MSKI resulting in ≥3 days of activity limitation during cadet basic training. Univariate analysis indicated that participants with the shortest stride length (<133.0 cm) were 39% more likely to incur any lower extremity MSKI and 45% more likely to incur an overuse MSKI than those with the longest stride length (>158.5 cm), and that participants with the longest ground contact time (>0.42 seconds) were twice as likely to incur any MSKI than those with the shortest contact time (<0.28 seconds). After adjusting for sex, weekly distance running 3 months before cadet basic training, and history of injury, multivariate regression analysis indicated that participants with the longest contact times were significantly more likely to incur overuse lower extremity MSKI than those with the shortest contact times (hazard ratio, 2.15; 95% CI, 1.06-4.37). There was no significant difference in risk of MSKI associated with foot-strike pattern or cadence.

Conclusion

Study participants running with the longest ground contact times were 2.15 times more likely to incur an overuse lower extremity MSKI during cadet basic training than those with the shortest contact times. Also, study participants with the shortest stride length were 45% more likely to incur an overuse MSKI than those with the longest stride length.

Influence of Sudden Changes in Foot Strikes on Loading Rate Variability in Runners

Foot strike patterns influence vertical loading rates during running. Running retraining interventions often include switching to a new foot strike pattern. Sudden changes in the foot strike pattern may be uncomfortable and may lead to higher step-to-step variability. This study evaluated the effects of running with an imposed and usual foot strike on vertical loading rate variability and amplitude. Twenty-seven participants (16 men and 11 women; age range: 18-30 years) ran on an instrumented treadmill with their usual foot strike for 10 min. Then, the participants were instructed to run with an unusual foot strike for 6 min. We calculated the vertical instantaneous and vertical average loading rates and their variances over 200 steps to quantify vertical loading rate variability. We also calculated the amplitude and variability of the shank acceleration peak using an inertial measurement unit. The vertical loading rate and shank acceleration peak amplitudes were higher when running with a rearfoot strike, regardless of the foot strike conditions (i.e., usual or imposed). The vertical loading rate and shank acceleration peak variability were higher when running with an imposed rearfoot strike than when running with a usual forefoot strike. No differences were found in the vertical loading rate and shank acceleration peak variabilities between the imposed forefoot strike and usual rearfoot strike conditions. This study offers compelling evidence that adopting an imposed (i.e., unusual) rearfoot strike amplifies loading rate and shank acceleration peak variabilities.

Preferred temporal-spatial parameters, physical maturation, and sex are related to vertical and braking forces in adolescent long-distance runners

For adults, increasing cadence reduces ground reaction forces, but a lower preferred cadence does not predispose adults to experience higher ground reaction forces. Pubertal growth and motor control changes influence running mechanics, but it is unknown if preferred cadence or step length are associated with ground reaction forces for pre-adolescent and adolescent runners. Pre-adolescent and adolescent runners underwent an overground running analysis at a self-selected speed. Mixed model multiple linear regressions investigated the associations of preferred cadence, step length, physical maturation, and sex on ground reaction forces, while accounting for running speed and leg length. Running with a lower preferred cadence or longer preferred step length was associated with larger peak braking and vertical forces (p ≤ .01), being less physically mature was associated with larger vertical impact peak force and vertical loading rate (p ≤ .01), and being a male was associated with larger loading rates (p ≤ .01). A lower preferred cadence or longer preferred step length were associated with higher braking and vertical forces and being less physically mature or a male were associated with higher loading rates. An intervention to increase cadence/decrease step length could be considered if ground reaction forces are a concern for an adolescent runner.

Do Plantar-Flexor Muscle Structure and Function Contribute to Medial Tibial Stress Syndrome in Long-Distance Runners? A Case Report

Two long-distance runners developed medial tibial stress syndrome (MTSS; male age = 26.3 years, female age = 47.5 years) after baseline assessment of plantar-flexor muscle structure and function and spatiotemporal running variables. B-mode ultrasound and lean leg girth characterized plantar-flexor muscle structure. Handheld dynamometry and a single-leg heel raise-to-failure protocol characterized plantar-flexor muscle function. Finally, spatiotemporal running variables were determined during a treadmill protocol. The 2 runners who developed MTSS demonstrated less plantar-flexor strength and endurance capacity than published comparative control data and marked variability in muscle structure. Reduced plantar-flexor strength and endurance capacity were thought to contribute to an impaired ability to resist tibial-bending moments during midstance due to earlier muscle fatigue. Earlier muscle fatigue could, in turn, contribute to increased tibial-bending moments and MTSS development. Therefore, assessing plantar-flexor muscle strength and endurance might help to identify athletes at risk of developing MTSS.

Clinical assessment, treatment, and referral trends for adolescent runners seeking care at an injured runners' clinic

PURPOSE

Over a 10-year time frame, this study aimed to evaluate diagnosis, treatment, and referral trends for adolescent runners seeking care for running-related injuries (RRIs) at a clinic that specializes in running medicine.

METHODS

This study was a retrospective chart review of 392 adolescent runners (2,326 encounters) who sought care for RRIs between the years 2011 and 2021. Descriptive statistics were used to summarize clinical assessments, referrals, assistive devices, and medications prescribed or administered overall and by injury type. Chi-square analyses were used to compare proportions of services rendered across the 10-year time frame.

RESULTS

Patients most frequently received manual evaluations or special tests during clinic visits. Most visits resulted in at least one referral (91%), primarily for physical therapy or gait-training. Assistive devices and medications/supplements were offered at only 18% of patient visits. The majority of assessments (X2 = 69.7, p = 0.002), treatments (X2: 23.6-43.8, p: <  0.001-0.003), and referrals (X2 = 132, p <  0.001) were for shin injuries. Larger proportions of nutrition assessments (X2 = 40.7, p <  0.001), interventions (X2 = 26.8, p = 0.003), and referrals (X2 = 27.5, p = 0.002) were performed in or after the year 2015.

CONCLUSION

Clinic visits for shin injuries required the most clinical resources per episode of care. There were observed shifts in clinical assessment and treatment approaches to include more expanded nutritional and physiologic considerations.

The Dogma of Running Injuries: Perceptions of Adolescent and Adult Runners

CONTEXT

Adults perceive certain factors to increase or decrease the risk of sustaining running-related injuries, but many of their perceptions are not supported by research. Little is known about the perceptions that adolescent runners hold. Investigating perceptions for adolescent runners is needed to assist in the development of future injury educational materials, as these resources may need to be tailored differently for adolescents and adults.

OBJECTIVE

To identify factors that adolescent runners perceive as risk or protective factors for running-related injuries and to compare these perceptions with those of adult runners.

DESIGN

Cross-sectional study.

SETTING

Online survey.

PATIENTS OR OTHER PARTICIPANTS

We surveyed 302 adolescent (164 females, 138 males; age = 16.0 ± 1.4 years [range, 12-19 years]) and 357 adult runners (197 women, 160 men; age = 40.7 ± 11.8 years [range, 20-77 years]).

MAIN OUTCOME MEASURE(S)

Participants completed a survey with questions about whether factors related to training habits, footwear, biomechanics, strength, stretching, or nutrition influence the risk of sustaining a running-related injury. If ≥75% of adolescents indicated that a factor increases or decreases the risk of sustaining an injury, we considered that factor to be a perceived risk or protective factor, respectively. We also performed Fisher's exact test to compare the proportion of adolescent and adult runners who responded with "increase," "decrease," "neither increase or decrease," or "I don't know" to each question.

RESULTS

Adolescent runners perceived training habits, footwear, biomechanics, strength, stretching, and nutrition to increase or decrease the risk of sustaining a running-related injury. A larger proportion of adolescents than adults perceived that more footwear cushioning and stretching decrease injury risk, but a smaller proportion perceived that overtraining increases injury risk and strength decreases injury risk.

CONCLUSIONS

Differences in perceptions exist between adolescent and adult runners, and future educational materials and research questions may need to be tailored for different running populations.

Increasing Step Rate Reduces Peak and Cumulative Insole Force in Collegiate Runners

PURPOSE

The primary goal of this study was to examine changes in peak insole force and cumulative weighted peak force (CWPF)/km with increased step rate in collegiate runners. The secondary goal was to determine whether sacral acceleration correlates with insole force when increasing step rate.

METHODS

Twelve collegiate distance runners ran 1000 m outdoors at 3.83 m·s -1 at preferred and 10% increased step rates while insole force and sacral acceleration were recorded. Cumulative weighted peak force/km was calculated from insole force based on cumulative damage models. The effects of step rate on peak insole force and CWPF·km -1 were tested using paired t tests or Wilcoxon tests. Correlation coefficients between peak axial (approximately vertical) sacral acceleration times body mass and peak insole force were calculated on cohort and individual levels.

RESULTS

Peak insole force and CWPF·km -1 decreased ( P < 0.001) with increased step rate. Peak axial sacral acceleration did not correlate with peak insole force on the cohort level ( r = 0.35, P = 0.109) but did within individuals (mean, r = 0.69-0.78; P < 0.05).

CONCLUSIONS

Increasing step rate may reduce peak vGRF and CWPF·km -1 in collegiate runners. Therefore, clinicians should consider step rate interventions to reduce peak and cumulative vGRF in this population. Individual-specific calibrations may be required to assess changes in peak vGRF in response to increasing step rate using wearable accelerometers.

The biomechanics of running and running styles: a synthesis

Running movements are parametrised using a wide variety of devices. Misleading interpretations can be avoided if the interdependencies and redundancies between biomechanical parameters are taken into account. In this synthetic review, commonly measured running parameters are discussed in relation to each other, culminating in a concise, yet comprehensive description of the full spectrum of running styles. Since the goal of running movements is to transport the body centre of mass (BCoM), and the BCoM trajectory can be derived from spatiotemporal parameters, we anticipate that different running styles are reflected in those spatiotemporal parameters. To this end, this review focuses on spatiotemporal parameters and their relationships with speed, ground reaction force and whole-body kinematics. Based on this evaluation, we submit that the full spectrum of running styles can be described by only two parameters, namely the step frequency and the duty factor (the ratio of stance time and stride time) as assessed at a given speed. These key parameters led to the conceptualisation of a so-called Dual-axis framework. This framework allows categorisation of distinctive running styles (coined 'Stick', 'Bounce', 'Push', 'Hop', and 'Sit') and provides a practical overview to guide future measurement and interpretation of running biomechanics.

Risk Factors for Running-Related Injury in High School and Collegiate Cross-country Runners: A Systematic Review

OBJECTIVE: To summarize and describe risk factors for running-related injuries (RRIs) among high school and collegiate cross-country runners. DESIGN: Descriptive systematic review. LITERATURE SEARCH: Four databases (Scopus, SPORTDiscus, CINAHL, Cochrane) were searched from inception to August 2023. STUDY SELECTION CRITERIA: Studies assessing RRI risk factors in high school or collegiate runners using a prospective design with at least 1 season of follow-up were included. DATA SYNTHESIS: Results across each study for a given risk factor were summarized and described. The NOS and GRADE frameworks were used to evaluate quality of each study and certainty of evidence for each risk factor. RESULTS: Twenty-four studies were included. Overall, study quality and certainty of evidence were low to moderate. Females or runners with prior RRI or increased RED-S (relative energy deficiency in sport) risk factors were most at risk for RRI, as were runners with a quadriceps angle of >20° and lower step rates. Runners with weaker thigh muscle groups had increased risk of anterior knee pain. Certainty of evidence regarding training, sleep, and specialization was low, but suggests that changes in training volume, poorer sleep, and increased specialization may increase RRI risk. CONCLUSION: The strongest predictors of RRI in high school and collegiate cross-country runners were sex and RRI history, which are nonmodifiable. There was moderate certainty that increased RED-S risk factors increased RRI risk, particularly bone stress injuries. There was limited evidence that changes in training and sleep quality influenced RRI risk, but these are modifiable factors that should be studied further in this population. J Orthop Sports Phys Ther 2024;54(2):1-13. Epub 16 November 2023. doi:10.2519/jospt.2023.11550.

Gait biomechanics do not differ between adolescents with and without patellofemoral pain

OBJECTIVES

To determine if adolescents with patellofemoral pain exhibit different biomechanical characteristics to asymptomatic adolescents during walking and running.

METHODS

Twenty-eight adolescents with patellofemoral pain (16 male, 12 female, mean [SD] age: 14.3 [1.7] years) and 24 asymptomatic adolescents (13 male, 11 female, mean [SD] age: 14.1 [1.6] years) participated. Participants walked and ran on an instrumented treadmill in a standardized athletic shoe. Continuous hip, knee, and ankle joint angles and moments, and frontal plane pelvic motion were compared between groups using one-dimensional statistical parametric mapping independent t-tests (alpha <0.05). Cadence and stride length were compared between groups using independent t-tests.

RESULTS

During walking, adolescents with patellofemoral pain had a higher hip extension moment at 7%-8% of the gait cycle (p = 0.04) and walked with a shorter stride length (mean difference [95% confidence interval] = -0.07 [-0.1, -0.01] m). There were no other differences between groups during walking. During running, adolescents with patellofemoral pain had greater knee flexion than asymptomatic adolescents at 35%-40% of the gait cycle (p = 0.04) and ran with a higher cadence (mean difference [95% confidence interval] = 5.8 [2.0, 9.5] steps/min). There were no other statistically significant differences between groups during running.

CONCLUSIONS

Adolescents with patellofemoral pain demonstrate few biomechanical differences to asymptomatic adolescents during walking and running. The identified differences are likely of limited clinical importance. Biomechanical alterations which have been previously associated with patellofemoral pain in adults, may not need to be the target of management of adolescent patellofemoral pain.

Biomechanical changes identified during a marathon race among high-school aged runners

BACKGROUND

Despite the increasing popularity of endurance running competitions among adolescent runners, there is currently limited information regarding expected biomechanical changes across the duration of a long-distance running event, and the relationship between young runners' biomechanics and running performance. Wearable technology offers an ecological means to continuously assess runners' biomechanical data during outdoor running competitions.

RESEARCH QUESTION

Do adolescent athletes adopt changes in sensor-derived biomechanics throughout a marathon race, and are there relationships between race performance and biomechanical features among young marathoners?

METHODS

Fourteen high-school aged runners (9 M, 5 F; age: 16 ± 1 years, height: 170.8 ± 7.5 cm; mass: 63.6 ± 9.4 kg) wore lace-mounted sensors to record step-by-step biomechanics during a marathon race. Official race segment completion times were extracted across 5 race segments (5-K, 15-K, Half Marathon [21.1-K], 35-K, Marathon [42.2-K]). Within-participant repeated measures of covariance (pace) were conducted to assess changes in biomechanics across the race, with Bonferroni post-hoc comparisons. Pearson's r correlations were performed to assess the relationship between race finish times and biomechanics.

RESULTS

Pace was significantly slower (p-range: 0.002-0.005), contact times significantly longer, and stride lengths significantly shorter in the final segment compared to middle segments (p-range: 0.003-0.004). The rate of shock accumulation was significantly higher in the final race segment compared to the first three segments (p-range: 0.001-0.002). Moderate relationships existed between finish times and pace (r = -0.63), stride length (r = -0.62), and contact time (r = 0.51).

SIGNIFICANCE

Adolescent runners altered their gait patterns in the final marathon segment compared to earlier segments. Spatiotemporal measures were moderately correlated with race finish times, suggesting a link between faster run pace, increased stride lengths, and reduced contact time for improved running performance during an endurance race.

Interaction of Biomechanical, Anthropometric, and Demographic Factors Associated with Patellofemoral Pain in Rearfoot Strike Runners: A Classification and Regression Tree Approach

BACKGROUND

Patellofemoral pain (PFP) is among the most common injuries in runners. While multiple risk factors for patellofemoral pain have been investigated, the interactions of variables contributing to this condition have not been explored. This study aimed to classify runners with patellofemoral pain using a combination of factors including biomechanical, anthropometric, and demographic factors through a Classification and Regression Tree analysis.

RESULTS

Thirty-eight runners with PFP and 38 healthy controls (CON) were selected with mean (standard deviation) age 33 (16) years old and body mass index 22.3 (2.6) kg/m2. Each ran at self-selected speed, but no between-group difference was identified (PFP = 2.54 (0.2) m/s x CON = 2.55 (0.1) m/s, P = .660). Runners with patellofemoral pain had different patterns of interactions involving braking ground reaction force impulse, contact time, vertical average loading rate, and age. The classification and regression tree model classified 84.2% of runners with patellofemoral pain, and 78.9% of healthy controls. The prevalence ratios ranged from 0.06 (95% confidence interval: 0.02-0.23) to 9.86 (95% confidence interval: 1.16-83.34). The strongest model identified runners with patellofemoral pain as having higher braking ground reaction force impulse, lower contact times, higher vertical average loading rate, and older age. The receiver operating characteristic curve demonstrated high accuracy at 0.83 (95% confidence interval: 0.74-0.93; standard error: 0.04; P < .001).

CONCLUSIONS

The classification and regression tree model identified an influence of multiple factors associated with patellofemoral pain in runners. Future studies may clarify whether addressing modifiable biomechanical factors may address this form of injury.

Using wearable technology data to explain recreational running injury: A prospective longitudinal feasibility study

OBJECTIVES

Investigate 1) if collecting and analysing wristwatch inertial measurement unit (IMU) and global positioning system (GPS) data using a commercially-available training platform was feasible in recreational runners and 2) which variables were associated with subsequent injury.

DESIGN

Prospective longitudinal cohort.

PARTICIPANTS

Healthy recreational runners.

MAIN OUTCOME MEASURES

We set a priori feasibility thresholds for recruitment (maximum six-months), acceptance (minimum 80%), adherence (minimum 70%), and data collection (minimum 80%). Participants completed three patient-reported outcome measures (PROMS) detailing their psychological health, sleep quality, and intrinsic motivation to run. We extracted baseline anthropometric, biomechanical, metabolic, and training load data from their IMU/GPS wristwatch for analysis. Participants completed a weekly injury status surveillance questionnaire over the next 12-weeks. Feasibility outcomes were analysed descriptively and injured versus non-injured group differences with 95% confidence intervals were calculated for PROM/IMU/GPS data.

RESULTS

149 participants consented; 86 participants completed (55 men, 31 women); 21 developed an injury (0.46 injuries/1000km). Feasibility outcomes were satisfied (recruitment = 47 days; acceptance = 133/149 [89%]; adherence = 93/133 [70%]; data collection = 86/93 [92%]). Acute load by calculated effort was associated with subsequent injury (mean difference -562.14, 95% CI -1019.42, -21.53).

CONCLUSION

Collecting and analysing wristwatch IMU/GPS data using a commercially-available training platform was feasible in recreational runners.

Adolescent and young adult hip and knee strength profiles relate to running gait biomechanics

OBJECTIVES

Compare and assess relationships between strength and running biomechanics among healthy adolescents and young adult males and females.

DESIGN

Retrospective cohort.

SETTING

Clinic.

PARTICIPANTS

802 healthy participants (570 F, 232 M; 16.6 ± 2.3 years).

MAIN OUTCOME MEASURES

Mass-normalized knee flexor and extensor strength, hip adductor and abductor strength, hamstrings-to-quadriceps (H:Q), and abductor-to-adductor (Abd:Add) ratios were obtained using hand-held dynamometry. Mass-normalized peak vertical ground reaction force (vGRF), %stance, cadence, and stride length were obtained using an instrumented treadmill. Multivariate analyses of variance were used to compare strength and biomechanics across ages and sexes. Linear regressions were used to assess the relationships between strength and biomechanics, accounting for speed, age, and sex. Independent t-tests were used to compare strength between strength ratio profiles.

RESULTS

Strength and running biomechanics significantly differed between sexes (p-range: <0.001-0.05) and age groups (p-range: <0.001-0.02). Strength and strength ratios were significantly associated with increased cadence (p-range:0.001-0.04) and stride lengths (p-range:0.004-0.03), and decreased vGRF (p < 0.001). Lower H:Q ratios had significantly lower strength measures (p < 0.001). Higher Abd:Add ratios had significantly increased abductor strength (p < 0.001).

CONCLUSIONS

Strength and running biomechanics differed by sexes and ages. Hip and knee strength and strength ratios were related to select spatiotemporal and kinetic biomechanical features.

Reference Values and Determinants of Spatiotemporal and Kinetic Variables in Recreational Runners

Background

Identifying atypical lower limb biomechanics may help prevent the occurrence or recurrence of running-related injuries. No reference values for spatiotemporal or kinetic variables in healthy recreational runners are available in the scientific literature to support clinical management.

Purpose

To (1) present speed- and sex-stratified reference values for spatiotemporal and kinetic variables in healthy adult recreational runners; (2) identify the determinants of these biomechanical variables; and (3) develop reference regression equations that can be used as a guide in a clinical context.

Study Design

Descriptive laboratory study.

Methods

This study involved 860 healthy recreational runners (age, 19-65 years [38.5% women]) tested on an instrumented treadmill at their preferred running speed in randomly allocated, standardized running shoes with either hard or soft cushioning. Twelve common spatiotemporal and kinetic variables-including contact time, flight time, duty factor, vertical oscillation, step cadence, step length, vertical impact peak (VIP), time to VIP, vertical average loading rate, vertical stiffness, peak vertical ground-reaction force (GRF), and peak braking force-were derived from GRF recordings. Reference values for each biomechanical variable were calculated using descriptive statistics and stratified by sex and running speed category (≤7, 8, 9, 10, 11, 12, 13, 14, and ≥15 km/h). Correlations and multiple regression analyses were performed to identify potential determinants independently associated with each biomechanical variable and generate reference equations.

Results

The mean running speed was 10.5 ± 1.3 km/h and 9 ± 1.1 km/h in men and women, respectively. While all potential predictors were significantly correlated with many of the 12 biomechanical variables, only running speed showed high correlations (r > 0.7). The adjusted R2 of the multiple regression equations ranged from 0.19 to 0.88.

Conclusion

This study provides reference values and equations that may guide clinicians and researchers in interpreting spatiotemporal and kinetic variables in recreational runners.

Clinical Relevance

The reference values can be used as targets for clinicians working with recreational runners in cases where there is a clinical suspicion of a causal relationship between atypical biomechanics and running-related injury.

The relationship of muscle oxygen saturation analyzer with other monitoring and quantification tools in a maximal incremental treadmill test

Introduction: The study aims to explore whether NIRS derived data can be used to identify the second ventilatory threshold (VT2) during a maximal incremental treadmill test in non-professional runners and to determine if there is a correlation between SmO₂ and other valid and reliable exercise performance assessment measures or parameters for maximal incremental test, such as lactate concentration (LT), RPE, HR, and running power (W). Methods: 24 participants were recruited for the study (5 women and 19 men). The devices used consisted of the following: i) a muscle oxygen saturation analyzer placed on the vastus lateralis of the right leg, ii) the Stryd power meter for running, iii) the Polar H7 heart rate band; and iv) the lactate analyzer. In addition, a subjective perceived exertion scale (RPE 1-10) was used. All of the previously mentioned devices were used in a maximal incremental treadmill test, which began at a speed of 8 km/h with a 1% slope and a speed increase of 1.2 km/h every 3 min. This was followed by a 30-s break to collect the lactate data between each 3-min stage. Spearman correlation was carried out and the level of significance was set at p < 0.05. Results: The VT2 was observed at 87,41 ± 6,47% of the maximal aerobic speed (MAS) of each participant. No relationship between lactate data and SmO₂ values (p = 0.076; r = -0.156) at the VT2 were found. No significant correlations were found between the SmO₂ variables and the other variables (p > 0.05), but a high level of significance and strong correlations were found between all the following variables: power data (W), heart rate (HR), lactate concentration (LT) and RPE (p < 0.05; r > 0.5). Discussion: SmO₂ data alone were not enough to determine the VT2, and there were no significant correlations between SmO₂ and the other studied variables during the maximal incremental treadmill test. Only 8 subjects had a breakpoint at the VT2 determined by lactate data. Conclusion: The NIRS tool, Humon Hex, does not seem to be useful in determining VT2 and it does not correlate with the other variables in a maximal incremental treadmill test.

Wearable technology assessing running biomechanics and prospective running-related injuries in Active Duty Soldiers

The purpose of this study was to determine if running biomechanical variables measured by wearable technology were prospectively associated with running injuries in Active Duty Soldiers. A total of 171 Soldiers wore a shoe pod that collected data on running foot strike pattern, step rate, step length and contact time for 6 weeks. Running-related injuries were determined by medical record review 12 months post-study enrollment. Differences in running biomechanics between injured and non-injured runners were compared using independent t-tests or ANCOVA for continuous variables and chi-square analyses for the association of categorical variables. Kaplan-Meier survival curves were used to estimate the time to a running-related injury. Risk factors were carried forward to estimate hazard ratios using Cox proportional hazard regression models. Forty-one participants (24%) sustained a running-related injury. Injured participants had a lower step rate than non-injured participants, but step rate did not have a significant effect on time to injury. Participants with the longest contact time were at a 2.25 times greater risk for a running-related injury; they were also relatively slower, heavier, and older. Concomitant with known demographic risk factors for injury, contact time may be an additional indicator of a running-related injury risk in Active Duty Soldiers.

Differences in kinetic variables between injured and uninjured rearfoot runners: A hierarchical cluster analysis

Running is a popular form of physical activity with a high incidence of running-related injuries. However, the etiology of running-related injuries remains elusive, possibly due to the heterogeneity of movement patterns. The purpose of this study was to investigate whether different clusters existed within a large group of injured and uninjured runners based on their kinetic gait patterns. A sample of 134 injured and uninjured runners were acquired from an existing database and 12 discrete kinetic and spatiotemporal variables which are commonly associated with running injuries were extracted from the ground reaction force waveforms. A principal components analysis followed by an unsupervised hierarchical cluster analysis was performed. The results revealed two distinct clusters of runners which were not associated with injury status (OR = 1.14 [0.57, 2.30], χ²  = 0.143, p = 0.706) or sex (OR = 1.72 [0.85, 3.49], χ²  = 2.3258, p = 0.127). These results suggest that while there appeared to be evidence for two distinct clusters within a large sample of injured and uninjured runners, there is no association between the kinetic variables and running related injuries.

Kinematic and Kinetic Gait Characteristics in People with Patellofemoral Pain: A Systematic Review and Meta-analysis

BACKGROUND

Patellofemoral pain (PFP) is a prevalent knee condition with many proposed biomechanically orientated etiological factors and treatments.

OBJECTIVE

We aimed to systematically review and synthesize the evidence for biomechanical variables (spatiotemporal, kinematic, kinetic) during walking and running in people with PFP compared with pain-free controls, and determine if biomechanical variables contribute to the development of PFP.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

We searched Medline, CINAHL, SPORTDiscus, Embase, and Web of Science from inception to October 2021.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

All study designs (prospective, case-control [± interventional component, provided pre-intervention data were reported for both groups], cross-sectional) comparing spatiotemporal, kinematic, and/or kinetic variables during walking and/or running between people with and without PFP.

RESULTS

We identified 55 studies involving 1300 people with PFP and 1393 pain-free controls. Overall pooled analysis identified that people with PFP had slower gait velocity [moderate evidence, standardized mean difference (SMD) - 0.50, 95% confidence interval (CI) - 0.72, - 0.27], lower cadence (limited evidence, SMD - 0.43, 95% CI - 0.74, - 0.12), and shorter stride length (limited evidence, SMD - 0.46, 95% CI - 0.80, - 0.12). People with PFP also had greater peak contralateral pelvic drop (moderate evidence, SMD - 0.46, 95% CI - 0.90, - 0.03), smaller peak knee flexion angles (moderate evidence, SMD - 0.30, 95% CI - 0.52, - 0.08), and smaller peak knee extension moments (limited evidence, SMD - 0.41, 95% CI - 0.75, - 0.07) compared with controls. Females with PFP had greater peak hip flexion (moderate evidence, SMD 0.83, 95% CI 0.30, 1.36) and rearfoot eversion (limited evidence, SMD 0.59, 95% CI 0.03, 1.14) angles compared to pain-free females. No significant between-group differences were identified for all other biomechanical variables. Data pooling was not possible for prospective studies.

CONCLUSION

A limited number of biomechanical differences exist when comparing people with and without PFP, mostly characterized by small-to-moderate effect sizes. People with PFP ambulate slower, with lower cadence and a shortened stride length, greater contralateral pelvic drop, and lower knee flexion angles and knee extension moments. It is unclear whether these features are present prior to PFP onset or occur as pain-compensatory movement strategies given the lack of prospective data.

TRIAL REGISTRATION

PROSPERO # CRD42019080241.

Validation of an Ear-Worn Wearable Gait Analysis Device

Wearable devices capable of measuring gait parameters may provide a means to more economical gait analysis compared to conventional equipment comprising of a motion capture system and a forced treadmill. Beflex Coach (Beflex, Republic of Korea) is one such device but worn on the ear as Bluetooth earphones, unlike other wearables worn on the wrist, feet, or torso. In this study, the validity of the device was examined against a motion capture system and a forced treadmill for walking and running parameters. Five walking parameters (cadence, single support time, double support time, vertical oscillation (VO), and instantaneous vertical loading rate (IVLR)) and six running parameters (cadence, stance time, flight time, peak force, VO, and IVLR) were studied. Twenty young adults participated in walking or running on a forced treadmill at different speeds (walking: 0.8, 1.25, and 1.7 m/s for walking; running: 2, 2.5, and 3 m/s) while the two systems operated simultaneously. As a result, all parameters showed excellent associations (ICC > 0.75) and good agreements in Bland-Altman plots. The results of the study support the potential use of the ear-worn device as an inexpensive gait analysis equipment.

Healthy Running Habits for the Distance Runner: Clinical Utility of the American College of Sports Medicine Infographic

ABSTRACT

Healthy running form is characterized by motion that minimizes mechanical musculoskeletal injury risks and improves coactivation of muscles that can buffer impact loading and reduce stresses related to chronic musculoskeletal pain. The American College of Sports Medicine Consumer Outreach Committee recently launched an infographic that describes several healthy habits for the general distance runner. This review provides the supporting evidence, expected acute motion changes with use, and practical considerations for clinical use in patient cases. Healthy habits include: taking short, quick, and soft steps; abdominal bracing; elevating cadence; linearizing arm swing; controlling forward trunk lean, and; avoiding running through fatigue. Introduction of these habits can be done sequentially one at a time to build on form, or more than one over time. Adoption can be supported by various feedback forms and cueing. These habits are most successful against injury when coupled with regular dynamic strengthening of the kinetic chain, adequate recovery with training, and appropriate shoe wear.

Reliability of 2-Dimensional Video Analysis in Adolescent Runners

Background

The literature on the reliability of qualitative and quantitative measures for running video analysis in the adolescent population is limited. Reliability of 2-dimensional (2D) video analysis has been reported in adult runners, but these findings may not apply to youth runners.

Purpose

We sought to determine the intra-rater and inter-rater reliability of sagittal and frontal plane kinematics using 2D video analysis in healthy adolescent runners.

Methods

High-definition (1080p) videos were recorded of 10 healthy runners between 14 and 18 years old running on a treadmill at self-selected speed with markers attached to the cervical spine, pelvis, and lower extremities. Kinematic variables in the sagittal and frontal planes were measured using Dartfish Motion Analysis Software by 3 raters (2 sports medicine physical therapists and a research assistant). Intra- and inter-rater reliability were calculated using intraclass correlation coefficients (ICCs).

Results

Of the 10 runners, 4 (40%) were male and the mean age was 16 ± 1.5 years. The intra-rater ICC for all kinematic variables ranged from 0.574 to 0.999 for the experienced physical therapist, and 0.367 to 0.973 for the inexperienced research assistant. The inter-rater ICC for all raters ranged from -0.01 to 0.941. Eleven kinematic variables showed substantial agreement and 4 showed almost perfect agreement. Step width and foot progression showed fair and poor agreement, respectively.

Conclusions

Running analysis using 2D video can be performed reliably in adolescents on all kinematic variables except for step width and foot progression. Inexperienced raters can be properly trained in the video analysis of running kinematics to consistently assess the same runner.

Cadence in youth long-distance runners is predicted by leg length and running speed

BACKGROUND

Lower cadence has been previously associated with injury in long-distance runners. Variations in cadence may be related to experience, speed, and anthropometric variables. It is unknown what factors, if any, predict cadence in healthy youth long-distance runners.

RESEARCH QUESTION

Are demographic, anthropometric and/or biomechanical variables able to predict cadence in healthy youth long-distance runners.

METHODS

A cohort of 138 uninjured youth long-distance runners (M = 62, F = 76; Mean ± SD; age = 13.7 ± 2.7; mass = 47.9 ± 13.6 kg; height = 157.9 ± 14.5 cm; running volume = 19.2 ± 20.6 km/wk; running experience: males = 3.5 ± 2.1 yrs, females = 3.3 ± 2.0 yrs) were recruited for the study. Multiple linear regression (MLR) models were developed for total sample and for each sex independently that only included variables that were significantly correlated to self-selected cadence. A variance inflation factor (VIF) assessed multicollinearity of variables. If VIF≥ 5, variable(s) were removed and the MLR analysis was conducted again.

RESULTS

For all models, VIF was > 5 between speed and normalized stride length, therefore we removed normalized stride length from all models. Only leg length and speed were significantly correlated (p < .001) with cadence in the regression models for total sample (R² = 51.9 %) and females (R² = 48.2 %). The regression model for all participants was Cadence = -1.251 *Leg Length + 3.665 *Speed + 254.858. The regression model for females was Cadence = -1.190 *Leg Length + 3.705 *Speed + 249.688. For males, leg length, cadence, and running experience were significantly predictive (p < .001) of cadence in the model (R² = 54.7 %). The regression model for males was Cadence = -1.268 *Leg Length + 3.471 *Speed - 1.087 *Running Experience + 261.378.

SIGNIFICANCE

Approximately 50 % of the variance in cadence was explained by the individual's leg length and running speed. Shorter leg lengths and faster running speeds were associated with higher cadence. For males, fewer years of running experience was associated with a higher cadence.

One size does not fit all: Influence of sex and maturation on temporal-spatial parameters for adolescent long-distance runners

Runners and coaches are often interested in identifying the "ideal" running form to reduce the risk of injury and improve performance. While differences in pelvis and hip motion have been reported among adolescent female and male long-distance runners of different stages of physical maturation, the influence of sex and/or maturation on temporal-spatial parameters is unknown for adolescent runners. Adolescent runners of different stages of physical maturation (pre-, mid-, post-pubertal) completed an overground running analysis at a self-selected speed. We performed 2 × 3 ANCOVAs (covariate = running speed) to compare temporal-spatial parameters among sex and maturation groups. Pre-adolescents ran with higher cadences and shorter step lengths than mid- (p ≤ .01) and post-pubertal adolescents (p ≤ .01), respectively. Mid-pubertal males and post-pubertal females also ran with higher cadences and shorter step lengths than post-pubertal males (p ≤ .01). When step length was normalized to leg length, less physically mature runners demonstrated longer normalized step lengths (p ≤ .01). Caution is advised when using a "one-size-fits-all" approach for recommending an "ideal" cadence and/or step length for adolescent long-distance runners. A runner's sex, stage of physical maturation and leg length should be considered when assessing and prescribing cadence and/or step length.

A hierarchical clustering approach for examining potential risk factors for bone stress injury in runners

Bone stress injuries (BSI) are overuse injuries that commonly occur in runners. BSI risk is multifactorial and not well understood. Unsupervised machine learning approaches can potentially elucidate risk factors for BSI by looking for groups of similar runners within a population that differ in BSI incidence. Here, a hierarchical clustering approach is used to identify groups of collegiate cross country runners (32 females, 21 males) based on healthy pre-season running (4.47 m·s^-1) gait data which were aggregated and dimensionally reduced by principal component analysis. Five distinct groups were identified using the cluster tree. Visual inspection revealed clear differences between groups in kinematics and kinetics, and linear mixed effects models showed between-group differences in metrics potentially related to BSI risk. The groups also differed in BSI incidence during the subsequent academic year (Rand index = 0.49; adjusted Rand index = -0.02). Groups ranged from those including runners spending less time contacting the ground and generating higher peak ground reaction forces and joint moments to those including runners spending more time on the ground with lower loads. The former groups showed higher BSI incidence, indicating that short stance phases and high peak loads may be risk factors for BSI. Since ground contact duration may itself account for differences in peak loading metrics, we hypothesize that the percentage of time a runner is in contact with the ground may be a useful metric to include in machine learning models for predicting BSI risk.

Biomechanical running gait assessments across prevalent adolescent musculoskeletal injuries

BACKGROUND

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

RESEARCH QUESTIONS

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

METHODS

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

RESULTS

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

SIGNIFICANCE

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

Spatiotemporal and Ground-Reaction Force Characteristics as Risk Factors for Running-Related Injury: A Secondary Analysis of a Randomized Trial Including 800+ Recreational Runners

BACKGROUND

Running biomechanics may play a role in running-related injury development, but to date, only a few modifiable factors have been prospectively associated with injury risk.

PURPOSE

To identify risk factors among spatiotemporal and ground-reaction force characteristics in recreational runners and to investigate whether shoe cushioning modifies the association between running biomechanics and injury risk.

STUDY DESIGN

Case-control study; Level of evidence, 3.

METHODS

Recreational runners (N = 848) were tested on an instrumented treadmill at their preferred running speed in randomly allocated, standardized running shoes (with either hard or soft cushioning). Typical kinetic and spatiotemporal metrics were derived from ground-reaction force recordings. Participants were subsequently followed up for 6 months regarding running activity and injury. Cox regression models for competing risk were used to investigate the association between biomechanical risk factors and injury risk, including stratified analyses by shoe version.

RESULTS

In the crude analysis, greater injury risk was found for greater step length (subhazard rate ratio [SHR], 1.01; 95% CI, 1.00-1.02; P = .038), longer flight time (SHR, 1.00; 95% CI, 1.00-1.01; P = .028), shorter contact time (SHR, 0.99; 95% CI, 0.99-1.00; P = .030), and lower duty factor (defined as the ratio between contact time and stride time; SHR, 0.95; 95% CI, 0.91-0.98; P = .005). In the stratified analyses by shoe version, adjusted for previous injury and running speed, lower duty factor was associated with greater injury risk in those using the soft shoes (SHR, 0.92; 95% CI, 0.85-0.99; P = .042) but not in those using the hard shoes (SHR, 0.97; 95% CI, 0.91-1.04; P = .348).

CONCLUSION

Lower duty factor is an injury risk factor, especially for softer shoe use. Contrary to widespread beliefs, vertical impact peak, loading rate, and step rate were not injury risk factors in recreational runners.

REGISTRATION

NCT03115437 (ClinicalTrials.gov identifier).

Adolescent Running Biomechanics - Implications for Injury Prevention and Rehabilitation

Global participation in running continues to increase, especially amongst adolescents. Consequently, the number of running-related injuries (RRI) in adolescents is rising. Emerging evidence now suggests that overuse type injuries involving growing bone (e.g., bone stress injuries) and soft tissues (e.g., tendinopathies) predominate in adolescents that participate in running-related sports. Associations between running biomechanics and overuse injuries have been widely studied in adults, however, relatively little research has comparatively targeted running biomechanics in adolescents. Moreover, available literature on injury prevention and rehabilitation for adolescent runners is limited, and there is a tendency to generalize adult literature to adolescent populations despite pertinent considerations regarding growth-related changes unique to these athletes. This perspective article provides commentary and expert opinion surrounding the state of knowledge and future directions for research in adolescent running biomechanics, injury prevention and supplemental training.

Relationship between Running Spatiotemporal Kinematics and Muscle Performance in Well-Trained Youth Female Athletes. A Cross-Sectional Study

The purpose of this cross-sectional study was to analyse the relationship of neuromuscular performance and spatiotemporal parameters in 18 adolescent distance athletes (age, 15.5 ± 1.1 years). Using the OptoGait system, the power, rhythm, reactive strength index, jump flying time, and jump height of the squat jump, countermovement jump, and eight maximal hoppings test (HT_8max) and the contact time (CT), flying time (FT), step frequency, stride angle, and step length of running at different speeds were measured. Maturity offset was determined based on anthropometric variables. Analysis of variance (ANOVA) of repeated measurements showed a reduction in CT (p < 0.000) and an increase in step frequency, step length, and stride angle (p < 0.001), as the velocity increased. The HT_8max test showed significant correlations with very large effect sizes between neuromuscular performance variables (reactive strength index, power, jump flying time, jump height, and rhythm) and both step frequency and step length. Multiple linear regression found this relationship after adjusting spatiotemporal parameters with neuromuscular performance variables. Some variables of neuromuscular performance, mainly in reactive tests, were the predictors of spatiotemporal parameters (CT, FT, stride angle, and VO). Rhythm and jump flying time in the HT_8max test and power in the countermovement jump test are parameters that can predict variables associated with running biomechanics, such as VO, CT, FT, and stride angle.

Preventing Bone Stress Injuries in Runners with Optimal Workload

Bone stress injuries (BSIs) occur at inopportune times to invariably interrupt training. All BSIs in runners occur due to an "error" in workload wherein the interaction between the number and magnitude of bone tissue loading cycles exceeds the ability of the tissue to resist the repetitive loads. There is not a single optimal bone workload, rather a range which is influenced by the prevailing scenario. In prepubertal athletes, optimal bone workload consists of low-repetitions of fast, high-magnitude, multidirectional loads introduced a few times per day to induce bone adaptation. Premature sports specialization should be avoided so as to develop a robust skeleton that is structurally optimized to withstand multidirectional loading. In the mature skeleton, optimal workload enables gains in running performance but minimizes bone damage accumulation by sensibly progressing training, particularly training intensity. When indicated (e.g., following repeated BSIs), attempts to reduce bone loading magnitude should be considered, such as increasing running cadence. Determining the optimal bone workload for an individual athlete to prevent and manage BSIs requires consistent monitoring. In the future, it may be possible to clinically determine bone loads at the tissue level to facilitate workload progressions and prescriptions.

Lower step rate is associated with a higher risk of bone stress injury: a prospective study of collegiate cross country runners

OBJECTIVES

To determine if running biomechanics and bone mineral density (BMD) were independently associated with bone stress injury (BSI) in a cohort of National Collegiate Athletic Association Division I cross country runners.

METHODS

This was a prospective, observational study of 54 healthy collegiate cross country runners over three consecutive seasons. Whole body kinematics, ground reaction forces (GRFs) and BMD measures were collected during the preseason over 3 years via motion capture on an instrumented treadmill and total body densitometer scans. All medically diagnosed BSIs up to 12 months following preseason data collection were recorded. Generalised estimating equations were used to identify independent risk factors of BSI.

RESULTS

Univariably, step rate, centre of mass vertical excursion, peak vertical GRF and vertical GRF impulse were associated with BSI incidence. After adjusting for history of BSI and sex in a multivariable model, a higher step rate was independently associated with a decreased risk of BSI. BSI risk decreased by 5% (relative risk (RR): 0.95; 95% CI 0.91 to 0.98) with each one step/min increase in step rate. BMD z-score was not a statistically significant risk predictor in the final multivariable model (RR: 0.93, 95% CI 0.85 to 1.03). No other biomechanical variables were found to be associated with BSI risk.

CONCLUSION

Low step rate is an important risk factor for BSI among collegiate cross country runners and should be considered when developing comprehensive programmes to mitigate BSI risk in distance runners.

Factors Associated With Self-Selected Step Rate in High School Cross Country Runners

ABSTRACT

Luedke, LE, Heiderscheit, BC, Williams, DSB, and Rauh, MJ. Factors associated with self-selected step rate in high school cross country runners. J Strength Cond Res 35(4): 1141-1148, 2021-Recommendations for step rate, or cadence, during distance running come from varying perspectives including performance, running economy, and injury risk. Studies of adult runners suggest that running experience and leg length may influence step rate, but limited evidence is available on factors that influence adolescent runner step rates. The purpose was to evaluate relationships between running experience, anthropometric factors, and lower extremity muscle strength with self-selected step rate in adolescent runners. Sixty-eight high school cross country runners (47 young women; age 16.2 ± 1.3 years) reported height, body mass, and running experience. Mean step rate was assessed at 3.3 m·s-1 and self-selected (mean 3.8 ± 0.5 m·s-1) speeds. Leg length and peak isometric strength of the hip abductors, knee extensors, and flexors were also measured. Step rates at 3.3 m·s-1 {r (95% confidence interval [CI]) = 0.44 [0.22, 0.61], p < 0.001} and self-selected (r [95% CI] = 0.45 [0.20, 0.66], p < 0.001) speeds were correlated with running experience. Step rates at 3.3 m·s-1 and self-selected speeds were inversely associated with body mass (r [95% CI] = -0.32 [-0.52, -0.09], p = 0.007 and r [95% CI] = -0.34 [-0.53, -0.11], p = 0.005, respectively), height (r [95% CI] = -0.40 [-0.58, -0.18], p = 0.01 and r [95% CI] = -0.32 [-0.52, -0.09], p = 0.008, respectively), and leg length (r [95% CI] = -0.48 [-0.64, -0.27], p < 0.001 and r [95% CI] = -0.35 [-0.52, -0.12], p = 0.004, respectively). No significant relationships were found between isometric strength values and step rate at either speed (p > 0.05). Adolescent runners with greater running experience displayed higher step rates. Hence, the lower step rates in runners with less experience may factor in the higher injury risk previously reported in novice runners. Runners with shorter leg length displayed higher step rates. Step rate recommendations should consider runner experience and anthropometrics.

Factors Associated With Self-Selected Step Rates Between Collegiate and High School Cross Country Runners

Introduction: Cross country is a popular high school and collegiate sport with a high rate of running-related injuries (RRI). Among high school runners, higher step rates have been associated with greater running experience and decreased body height, and lower step rates have been prospectively associated with increased risk of shin RRI. These associations have not been reported in collegiate cross country runners. The purpose of this study was to compare step rates between collegiate and high school cross country runners. Secondary objectives included determining if step rates in collegiate runners were related to experience and anthropometric variables, and whether their self-selected step rates were prospectively related to lower extremity RRI. Materials and methods: Twenty-nine NCAA Division III collegiate cross country runners (13 females, mean ± SD age 19.7 ± 1.3 years) completed a survey and ran at their self-selected speed. Step rate was assessed with Polar RCX5 wristwatches and S3+ Stride Sensors™ on the first day of the season. Runners were followed during the season for occurrence of time-loss lower extremity RRI. A cohort of 68 high school runners was used for comparison of step rates at their self-selected speeds. Results: Collegiate runners' self-selected step rates (177.1 ± 7.2 spm [steps per minute]) were higher than high school runners' (171.3 ± 8.3 spm) (p = 0.01). Collegiate runners ran at higher self-selected speeds (4.6 ± 0.5 m/s) than the high school runners (3.8 ± 0.5 m/s) (p < 0.001). A lower percentage of collegiate runners ran at ≤166 spm than high school runners. Body mass was negatively correlated with step rate in collegiate runners. During the season, 41.3% of collegiate runners experienced lower extremity RRI. Step rates for collegiate runners who did not experience RRI (178.9 ± 7.7 spm) were not significantly higher than runners who did experience RRI (174.5 ± 5.7 spm) (p = 0.10). Discussion: Higher step rates were found in collegiate than high school runners, but the difference was partially explained by higher self-selected running speeds. Thus, variations in step rate between high school and collegiate runners may be expected based on experience, speed, and body mass.

Effects of a 10-week running-retraining programme on the foot strike pattern of adolescents: A longitudinal intervention study

BACKGROUND

The purpose of this study was to analyse the effects of ten weeks of different running-retraining programmes on rearfoot strike (RFS) prevalence in adolescents.

RESEARCH QUESTION

it is possible to change foot strike pattern in adolescents?

METHODS

A total of 180 children (45.3% girls), aged 13-16 years, participated in this intervention study. The children were randomly assigned to one of three experimental groups (EGs) that each carried out a different retraining programme, based on running technique (n = 39), a 15% increased step frequency (SF) (n = 37) and barefoot training (n = 30), performed for three days each week. A control group (CG) (n = 43) did not perform any retraining. A 2D video-based analysis (240 Hz) was used to determine the RFS.

RESULTS

At baseline, no significant differences in RFS prevalence were found between the EGs and the CG in either the left (χ² = 2.048; p = 0.559) or the right foot (χ² = 0.898; p = 0.825). In the post-test, no significant differences were found for the left foot (χ² = 7.102; p = 0.069), but there were significant differences for the right foot (χ² = 9.239; p = 0.025) were observed. In the re-test, no significant differences were found for either the left foot (χ² = 2.665; p = 0.273) or the right foot (χ² = 2.182; p = 0.325). In addition, no group displayed significant changes in RFS prevalence from the pre-test to the re-test. There was a trend towards a reduction in the RFS prevalence in both the increased SF group and the barefoot group.

MEANING

The main finding of this study was that certain running-retraining programmes performed three times per week for ten weeks are not enough to modify the adolescent foot strike pattern (FSP).

Absolute Reliability and Concurrent Validity of the Stryd System for the Assessment of Running Stride Kinematics at Different Velocities

ABSTRACT

García-Pinillos, F, Roche-Seruendo, LE, Marcen-Cinca, N, Marco-Contreras, LA, and Latorre-Román, PA. Absolute reliability and concurrent validity of the Stryd system for the assessment of running stride kinematics at different velocities. J Strength Cond Res 35(1): 78-84, 2021-This study aimed to determine the absolute reliability and to evaluate the concurrent validity of the Stryd system for measuring spatiotemporal variables during running at different velocities (8-20 km·h-1) by comparing data with another widely used device (the OptoGait system). Eighteen trained male endurance runners performed an incremental running test (8-20 km·h-1 with 3-minute stages) on a treadmill. Spatiotemporal parameters (contact time [CT], flight time [FT], step length [SL], and step frequency [SF]) were measured using 2 different devices (Stryd and OptoGait systems). The Stryd system showed a coefficient of variation (CV) <3%, except for FT (3.7-11.6%). The OptoGait achieved CV <4%, except for FT (6.0-30.6%). Pearson correlation analysis showed large correlations for CT and FT, and almost perfect for SL and SF over the entire protocol. The intraclass correlation coefficients partially support those results. Paired t-tests showed that CT was underestimated (p < 0.05, effect size [ES] > 0.7; ∼4-8%), FT overestimated (p < 0.05, ES > 0.7; ∼7-65%), whereas SL and SF were very similar between systems (ES < 0.1, with differences <1%). The Stryd is a practical portable device that is reliable for measuring CT, FT, SL, and SF during running. It provides accurate SL and SF measures but underestimates CT (0.5-8%) and overestimates FT (3-67%) compared with a photocell-based system.

Multifactorial Determinants of Running Injury Locations in 550 Injured Recreational Runners

PURPOSE

Despite the health benefits of running, the prevalence of running-related injuries (RRI) remains high. The underlying risk factors between these injuries are still not well understood. Therefore, the aim of this study was to compare biomechanical, anthropometric, and demographic injury risk factors between different locations in injured recreational runners.

METHODS

In this retrospective case-control analysis, 550 injured runners (49.6% female) with a medically diagnosed RRI were included. All runners had undergone an instrumented treadmill analysis to determine habitual footstrike pattern, vertical instantaneous load rate, peak vertical ground reaction force (vGRF) and cadence. Injuries were classified by location according to a recent consensus statement. A logistic regression model was used to determine the association between the biomechanical parameters and RRI locations. Because injuries can be associated with age, sex, and body mass index, these variables were also entered into the logistic regression.

RESULTS

Strike pattern and peak vGRF were the only biomechanical variable distinguishing an injury from the group of injuries. A midfoot strike differentiated Achilles tendon injuries (odds ratio [OR], 2.27; 90% confidence interval [CI], 1.17-4.41) and a forefoot strike distinguished posterior lower leg injuries (OR, 2.59; 90% CI, 1.50-4.47) from the rest of the injured group. Peak vGRF was weakly associated with hip injuries (OR, 1.14; 90% CI, 1.05-1.24). Female sex was associated with injuries to the lower leg (OR, 2.65; 90% CI, 1.45-4.87) and hip/groin (OR, 2.22; 90% CI, 1.43-3.45). Male sex was associated with Achilles tendon injuries (OR, 1.923; 90% CI, 1.094-3.378).

CONCLUSIONS

Sex, foot strike pattern, and vGRF were the only factors that distinguished specific injury locations from the remaining injury locations.

Most Military Runners Report Recent Changes in Running Parameters Before Lower Limb Injury Onset

INTRODUCTION

While running is a popular activity because of the health and fitness benefits it provides, the yearly incidence of running-related injuries (RRI) is high across all populations of runners, including military members. The etiology of RRI is multifactorial, and despite the numerous studies on risk factors for RRI, there is no clear consensus in the literature on the relative contribution of several intrinsic or extrinsic risk factors to the development of RRI. Furthermore, little is known on RRI profile and running parameters among Canadian military members. The objectives of this study were to (1) describe the clinical presentation of lower limb RRI and running profile among military members and (2) explore any association between recent changes in running parameters (volume or intensity) and specific RRI diagnoses.

MATERIALS AND METHODS

This cross-sectional study was conducted in 107 military members from the Canadian Armed Forces (Valcartier Military Base) who presented with a restriction or interruption of running because of lower limb running-related pain. The following variables were collected during a physiotherapy evaluation: injury location and diagnosis, running kinematics (foot strike pattern and step rate), degree of minimalism of running shoes, running parameters in the last 3 months before consultation (volume, duration, frequency, and intensity), and recent changes in training before pain onset. Descriptive statistical analyses were conducted to describe the clinical presentation and running profile, while chi-square tests and multiple correspondence analysis were used to explore the association between recent changes in running parameters and diagnosis. This study was approved by the institutional ethics committee, and participants signed a detailed consent form.

RESULTS

Among the 107 participants included in the study (mean age: 30.7 ± 8.9 years; 13 females), the most common diagnoses were patellofemoral pain (26.2%), medial tibial stress syndrome (11.2%), plantar fasciopathy (9.3%), and sciatica (9.3%). The average Minimalist Index of running shoes was 27.6 ± 18.5%. Step rate was 161.7 ± 10.3 steps per minute, and 73.3% of the participants used a rearfoot strike pattern. The majority of military runners reported previous RRI, gradual onset of symptoms, and recent changes in their training parameters (75.7%) before injury onset. No association was found between recent changes in running volume ((χ2(4) = 2.849; P = .606)) or intensity ((χ2(4) = 1.381; P = .855)) and diagnosis.

CONCLUSION

This is the first study to specifically investigate RRI and running profile among Canadian military members. The most common injuries were located at the knee, and the most frequent diagnosis was patellofemoral pain. The majority of military runners reported previous RRI as well as recent changes in their running parameters before injury onset, but unique types of recent changes were not associated with specific diagnoses. This study illustrates the need to further investigate the impact of training loads on the development of RRI.

Gait Retraining Improves Running Impact Loading and Function in Previously Injured U.S. Military Cadets: A Pilot Study

INTRODUCTION

Running-related musculoskeletal injury (RRI) among U.S. military service members continues to negatively impact force readiness. There is a paucity of evidence supporting the use of RRI interventions, such as gait retraining, in military populations. Gait retraining has demonstrated effectiveness in altering running biomechanics and reducing running load. The purpose of this pilot study was to investigate the clinical effect of a gait retraining intervention on a military cadet population recovering from a lower-extremity RRI.

MATERIALS AND METHODS

The study design is a pilot study. Before study initiation, institutional approval was granted by the Keller Army Community Hospital Office of Human Research Protections. Nine rearfoot strike (RFS) runners recovering from a lower-extremity RRI at the U.S. Military Academy were prospectively enrolled and completed a gait retraining intervention. Participants followed-up with their assigned medical provider 6 times over 10 weeks for a clinical evaluation and running gait retraining. Gait retraining was provided utilizing verbal, visual, and audio feedback to facilitate a change in running foot strike pattern from RFS to non-rearfoot strike (NRFS) and increase preferred running step rate. At pre-intervention and post-intervention running ground reaction forces (GRF) [average vertical loading rate (AVLR), peak vertical GRF], kinematic (foot strike pattern) and temporospatial (step rate, contact time) data were collected. Participants self-reported their level of function via the Single Assessment Numeric Evaluation, Patient-Specific Functional Scale, and total weekly running minutes. Paired samples t-tests and Wilcoxon signed rank tests were used to compare pre- and post-intervention measures of interest. Values of P < .05 were considered statistically significant.

RESULTS

Nine patients completed the 10-week intervention (age, 20.3 ± 2.2 years; height, 170.7 ± 13.8 cm; mass, 71.7 ± 14.9 kg; duration of injury symptoms, 192.4 ± 345.5 days; running speed, 2.8 ± 0.38 m/s). All nine runners (100%) transitioned from RFS to NRFS. Left AVLR significantly decreased from 60.3 ± 17.0 bodyweight per second (BW/s) before intervention to 25.9 ± 9.1 BW/s after intervention (P = 0.008; effect size (d) = 2.5). Right AVLR significantly decreased from 60.5 ± 15.7 BW/s to 32.3 ± 12.5 BW/s (P < .001; d = 2.0). Similarly, step rate increased from 169.9 ± 10.0 steps per minute (steps/min) before intervention to 180.5 ± 6.5 steps/min following intervention (P = .005; d = 1.3). Single Assessment Numeric Evaluation scores improved significantly from 75 ± 23 to 100 ± 8 (P = .008; d = 1.5) and Patient-Specific Functional Scale values significantly improved from 6 ± 2.3 to 9.5 ± 1.6 (P = .007; d = 1.8) after intervention. Peak vertical GRF (left, P = .127, d = 0.42; right, P = .052, d = 0.53), contact time (left, P = 0.127, d = 0.42; right, P = 0.052, d = 0.53), and total weekly continuous running minutes (P = 0.095, d = 0.80) remained unchanged at post-intervention. All 9 patients remained injury free upon a 6-month medical record review.

CONCLUSIONS

In 9 military service members with a RRI, a 10-week NRFS gait retraining intervention was effective in improving running mechanics and measures of function. Patients remained injury-free 6 months following enrollment. The outcomes of this pilot study suggest that individuals recovering from certain lower-extremity RRIs may benefit from transitioning to an NRFS running pattern.

Youth running consensus statement: minimising risk of injury and illness in youth runners

Despite the worldwide popularity of running as a sport for children, relatively little is known about its impact on injury and illness. Available studies have focused on adolescent athletes, but these findings may not be applicable to preadolescent and pubescent athletes. To date, there are no evidence or consensus-based guidelines identifying risk factors for injury and illness in youth runners, and current recommendations regarding suitable running distances for youth runners at different ages are opinion based. The International Committee Consensus Work Group convened to evaluate the current science, identify knowledge gaps, categorise risk factors for injury/illness and provide recommendations regarding training, nutrition and participation for youth runners.

Validity of the Stryd Power Meter in Measuring Running Parameters at Submaximal Speeds

This study assessed the Stryd running power meter validity at sub-maximal speeds (8 to 19 km/h). Six recreational runners performed an incremental indoor running test. Power output (PO), ground contact time (GCT) and leg spring stiffness (LSS) were compared to reference measures recorded by portable metabolic analyser, force platforms and motion capture system. A Bayesian framework was conducted for systems validity and comparisons. We observed strong and positive linear relationships between Stryd PO and oxygen consumption ( R 2 = 0.82 , B F 10 > 100 ), and between Stryd PO and external mechanical power ( R 2 = 0.88 , B F 10 > 100 ). Stryd power meter underestimated PO ( B F 10 > 100 ) whereas GCT and LSS values did not show any significant differences with the reference measures ( B F 10 = 0.008 , B F 10 = 0.007 , respectively). We conclude that the Stryd power meter provides valid measures of GCT and LSS but underestimates the absolute values of PO.

Enhanced injury prevention programme for recreational runners (the SPRINT study): design of a randomised controlled trial

Introduction

Running-related injuries (RRIs) are frequent, but no effective injury prevention measures have been identified yet. Therefore, we have set up the INSPIRE trial in 2017, in which the effectiveness of an online injury prevention programme was tested. Although this programme was not effective in reducing the number of RRIs, we gained new insights from this study, which we used to design an enhanced, online multidisciplinary injury prevention programme. The aim of this study is to test the effectiveness of this enhanced injury prevention programme in a group of recreational runners.

Methods and analysis

For this randomised controlled trial, we aim to include 3394 recreational runners aged 18 years or older who register for a running event (distances 10 to 42.2 km). During the preparation for the running event, runners in the intervention group get access to the enhanced online injury prevention programme. This online programme consists of 10 steps, all covering separate items of RRI prevention. Runners in the control group will follow their regular preparation. With three follow-up questionnaires (1 month before, 1 week before and 1 month after the running event), the proportions of self-reported RRIs in the intervention group and the control group are compared.

Ethics and dissemination

An exemption for a comprehensive application has been obtained by the Medical Ethical Committee of the Erasmus MC University Medical Center, Rotterdam, the Netherlands. The results of the study will be disseminated among the running population, published in peer-reviewed international journals and presented on international conferences.

Trial registration number

NL7694

Biomechanical risk factors for running-related injury differ by sample population: A systematic review and meta-analysis

BACKGROUND

The role of biomechanical variables of running gait in the development of running related injury has not been clearly elucidated. Several systematic reviews have examined running biomechanics and its association with particular running related injuries. However, due to retrospective designs, inferences into the cause of these injuries are limited. Although prospective studies have been completed, no quantitative analysis pooling these results has been completed.

METHODS

A systematic review of MEDLINE, CINAHL, and PubMed was completed. Articles included used prospective study designs, human subjects currently completing a regular running program, and a minimum 12-week follow-up period. Excluded articles had no biomechanical data reported, participants who were beginning runners or military recruits, or had an intervention provided.

FINDINGS

Thirteen studies met these criteria. Pooled analyses were completed if two or more studies were available with samples that investigated the same sex and competition level. A qualitative synthesis was completed when pooled analysis was not possible. Five unique running samples were identified and allowed for pooled analyses of variables in mixed-sex collegiate runners and female recreational runners. Moderate evidence exists for increased hip adduction and reduced peak rearfoot eversion as risk factors for running related injury in female recreational runners. Variables differed in other samples of runners.

INTERPRETATION

A runner's sex and competition level may affect the relationship between biomechanical factors and the development of running related injury. Hip adduction and rearfoot eversion may be important factors related to running related injury in female recreational runners. Further investigation of biomechanical factors in running injury is warranted.

Subclassification of recreational runners with a running-related injury based on running kinematics evaluated with marker-based two-dimensional video analysis

OBJECTIVES

To explore whether homogeneous subgroups could be discriminated within a population of recreational runners with a running-related injury based on running kinematics evaluated with marker-based two-dimensional video analysis.

DESIGN

Cross-sectional.

SETTING

Research laboratory.

PARTICIPANTS

Fifty-three recreational runners (15 males, 38 females) with a running-related injury.

MAIN OUTCOME MEASURES

Foot and tibia inclination at initial contact, and hip adduction and knee flexion at midstance were measured in the frontal and sagittal plane with marker-based two-dimensional video analysis during shod running on a treadmill at preferred speed. The four outcome measures were clustered using K-means cluster analysis (n = 2-10). Silhouette coefficients were used to detect optimal clustering.

RESULTS

The cluster analysis led to the classification of two distinct subgroups (mean silhouette coefficient = 0.53). Subgroup 1 (n = 39) was characterized by significantly greater foot inclination and tibia inclination at initial contact compared to subgroup 2 (n = 14).

CONCLUSION

The existence of different subgroups demonstrate that the same running-related injury can be represented by different kinematic presentations. A subclassification based on the kinematic presentation may help clinicians in their clinical reasoning process when evaluating runners with a running-related injury and could inform targeted intervention strategy development.

Use of Wearables: Tracking and Retraining in Endurance Runners

Wearable devices are ubiquitous among runners, coaches, and clinicians with an ever-increasing number of devices coming on the market. In place of gold standard measures in the laboratory, these devices attempt to provide a surrogate means to track running biomechanics outdoors. This review provides an update on recent literature in the field of wearable devices in runners, with an emphasis on criterion validity and usefulness in the coaching and rehabilitation of runners. Our review suggests that while enthusiasm should be tempered, there is still much for runners to gain with wearables. Overall, our review finds evidence supporting the use of wearables to improve running performance, track global training loads applied to the runner, and provide real-time feedback on running speed and run cadence. Case studies illustrate the use of wearables for the purposes of performance and rehabilitation.

A Multifactorial Approach to Overuse Running Injuries: A 1-Year Prospective Study

BACKGROUND

Because of the complex and multifaceted nature of running injuries, a multifactorial approach when investigating running injuries is required.

HYPOTHESIS

Compared with uninjured runners, injured runners would exhibit different running biomechanics, display more fatigue changes, and would run a greater weekly running volume; more injured runners would also report having a previous injury.

STUDY DESIGN

Prospective cohort study.

LEVEL OF EVIDENCE

Level 4.

METHODS

At commencement of the study, data were collected on demographics, anthropometrics, training history, previous injury history, and center-of-mass accelerations during a long-distance overground run. Participants completed weekly training diaries and were monitored for 1 year for an injury.

RESULTS

A total of 76 runners completed the study, with 39 (22 male; 17 female) reporting an injury. Compared with male uninjured runners, male injured runners were heavier and ran a greater weekly distance. Male runners (injured and uninjured) exhibited increases in mediolateral center-of-mass accelerations during the run. Compared with female uninjured runners, female injured runners were heavier, ran with longer flight times and lower step frequencies, and more of them had reported an injury in the previous year and had increased speed training in the weeks prior to injury. Over 60% of male injured runners and over 50% of female injured runners had increased their weekly running distance by >30% between consecutive weeks at least once in the 4 weeks prior to injury.

CONCLUSION

Factors that may be related to injury for male runners include being heavier, running a greater weekly distance, and exhibiting fatigue changes in mediolateral center-of-mass accelerations. Factors that may be related to injury for female runners include being heavier, having an injury in the previous year, running with longer flight times and lower step frequencies, and increasing speed training prior to injury. Increases in weekly running distance in 1 consecutive week (particularly >30%) needs to be monitored in training, and this along with the other factors found may have contributed to injury development.

CLINICAL RELEVANCE

This study found that multiple factors are related to running injuries and that some factors are sex specific. The findings can aid in injury prevention and management.