Relevance of Frequency-Domain Analyses to Relate Shoe Cushioning, Ground Impact Forces and Running Injury Risk: A Secondary Analysis of a Randomized Trial With 800+ Recreational Runners

Gait asymmetry in spatiotemporal and kinetic variables does not increase running-related injury risk in lower limbs: a secondary analysis of a randomised trial including 800+ recreational runners

Objective

To investigate asymmetry in spatiotemporal and kinetic variables in 800+ recreational runners, identify determinants of asymmetry, investigate if asymmetry is related to greater running injury risk and compare spatiotemporal and kinetic variables between the involved and uninvolved limb at baseline in runners having sustained an injury during follow-up.

Methods

836 healthy recreational runners (38.6% women) were tested on an instrumented treadmill at their preferred running speed at baseline and followed up for 6 months. From ground reaction force recordings, spatiotemporal and kinetic variables were derived for each lower limb. The Symmetry Index was computed for each variable. Correlations and multiple regression analyses were performed to identify potential determinants of asymmetry. Cox regression analyses investigated the association between asymmetry and injury risk. Analysis of variance for repeated measures was used to compare the involved and uninvolved limbs in runners who had sustained injuries during follow-up.

Results

107 participants reported at least one running-related injury. Leg length discrepancy and fat mass were the most common determinants of asymmetry, but all correlation coefficients were negligible (0.01-0.13) and explained variance was very low (multivariable-adjusted R2<0.01-0.03). Greater asymmetry for flight time and peak breaking force was associated with lower injury risk (HR (95% CI): 0.80 (0.64 to 0.99) and 0.96 (0.93 to 0.98), respectively). No between-limb differences were observed in runners having sustained an injury.

Conclusion

Gait asymmetry was not associated with higher injury risk for investigated spatiotemporal and kinetic variables.

Trial registration number

NCT03115437.

Numerical Simulation of the Effect of Different Footwear Midsole Structures on Plantar Pressure Distribution and Bone Stress in Obese and Healthy Children

The foot, as the foundation of the human body, bears the vast majority of the body's weight. Obese children bear more weight than healthy children in the process of walking and running. This study compared three footwear midsole structures (solid, lattice, and chiral) based on plantar pressure distribution and bone stress in obese and healthy children through numerical simulation. The preparation for the study included obtaining a thin-slice CT scan of a healthy 9-year-old boy's right foot, and this study distinguished between a healthy and an obese child by applying external loadings of 25 kg and 50 kg in the finite element models. The simulation results showed that the plantar pressure was mainly concentrated in the forefoot and heel due to the distribution of gravity (first metatarsal, fourth metatarsal, and heel bone, corresponding to plantar regions M1, M4, and HM and HL) on the foot in normal standing. Compared with the lattice and solid EVA structures, in both healthy and obese children, the percentage reduction in plantar pressure due to the chiral structure in the areas M1, M4, HM, and HL was the largest with values of 38.69%, 34.25%, 64.24%, and 54.03% for an obese child and 33.99%, 28.25%, 56.08%, and 56.96% for a healthy child. On the other hand, higher pressures (15.19 kPa for an obese child and 5.42 kPa for a healthy child) were observed in the MF area when using the chiral structure than when using the other two structures, which means that this structure can transfer an amount of pressure from the heel to the arch, resulting in a release in the pressure at the heel region and providing support at the arch. In addition, the study found that the chiral structure was not highly sensitive to the external application of body weight. This indicates that the chiral structure is more stable than the other two structures and is minimally affected by changes in external conditions. The findings in this research lay the groundwork for clinical prevention and intervention in foot disorders in obese children and provide new research ideas for shoe midsole manufacturers.

The "impacts cause injury" hypothesis: Running in circles or making new strides?

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.