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Mann RH, Clift BC, Day J, Barker AR. Co-creation of injury prevention measures for competitive adolescent distance runners: knowledge, behavior, and needs of athletes and coaches enrolled on England Athletics' Youth Talent Programme. Ann Med 2024; 56:2334907. [PMID: 38599225 PMCID: PMC11008313 DOI: 10.1080/07853890.2024.2334907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/23/2024] [Indexed: 04/12/2024] Open
Abstract
This study assessed the knowledge, behavior, and needs of competitive adolescent (16-18 years) distance runners and distance running coaches enrolled as part of England Athletics' Youth Talent Programme in relation to the prevention of running-related injury (RRI). Two online surveys were developed and distributed to the distance runners (survey one) and coaches (survey two). Both surveys included sections related to: (1) current knowledge; (2) current behavior; (3) need and support for RRI prevention measures; and (4) possible content and form of RRI prevention measures. A total of 39 distance runners (36% of total possible sample) completed survey 1, and 29 coaches (32% of total possible sample) completed survey 2. Key findings included that the majority of distance runners and coaches: (1) agreed that it is 'very important' to try to prevent RRI; (2) are currently implementing something in practice (e.g., strength training) to prevent RRI; and (3) view the creation of RRI prevention measures as an important initiative. Differences between distance runners and coaches were identified in relation to their understanding of the most common causes of RRI. Interestingly, distance runners identified a modifiable cause of RRI (i.e., too much training) as the most common cause of RRI, while coaches selected a non-modifiable cause of RRI (i.e., growth and maturation). These key findings were supplemented by competitive adolescent runners and distance running coaches detailing their delivery preferences for such RRI prevention measures. Results from this study will help inform subsequent steps of the larger co-creation process, with an emphasis on developing multifaceted and context-specific RRI prevention measures that are deemed to be feasible and acceptable for real-world implementation.
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Affiliation(s)
- Robert H. Mann
- Children’s Health and Exercise Research Centre, Department of Public Health and Sport Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Bryan C. Clift
- Department for Health, University of Bath, Bath, UK
- Centre for Qualitative Research, University of Bath, Bath, UK
| | - Jo Day
- NIHR Applied Research Collaboration South West Peninsula, University of Exeter, Exeter, UK
| | - Alan R. Barker
- Children’s Health and Exercise Research Centre, Department of Public Health and Sport Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
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Nowak AS, Miro EW, Eby SF, Cushman DM. Identification of pre-race ultrasonographic abnormalities of the Achilles tendon and association with future injuries in runners. PHYSICIAN SPORTSMED 2024; 52:299-303. [PMID: 37550955 PMCID: PMC10858303 DOI: 10.1080/00913847.2023.2246179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 08/06/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE To determine if specific morphological changes in ultrasonographic images of Achilles tendons are associated with the development of pain in distance runners. METHODS This study is a blinded, retrospective analysis of 276 Achilles tendon ultrasound images, which were used to determine if specific morphologic findings could positively or negatively predict future Achilles tendon pain development in distance runners. Pre-race ultrasound scans were performed on 138 asymptomatic half- and full marathon runners (276 tendons in total) who were followed for 12 months after their races. Specific patterns of morphologic abnormality were identified (location, size, and appearance of ultrasound abnormality within the tendon). Sonographic findings were blindly assessed by a medical student, a resident, and a physician who has significant sonographic imaging experience. These specific abnormalities were then compared to those who later did or did not develop tendon pain. RESULTS Three findings were found to have significant odds of association with the development of pain: 1) focal deep midsubstance intratendinous hypoechogenicity, 2) focal superficial midsubstance intratendinous hypoechogenicity, and 3) linear hyperechogenicity extending into middle of tendon from calcaneus. CONCLUSION These results suggest that the aforementioned specific morphologic abnormalities in the Achilles tendon may be associated with the future development of pain symptoms in distance runners in this cohort. Looking for these specific abnormalities may increase the specificity of identifying precursors to Achilles tendon pain development.
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Affiliation(s)
- Andrew S. Nowak
- Central Michigan University College of Medicine, Mount Pleasant, MI
| | - Emily W. Miro
- University of Utah, Department of Family and Preventive Medicine, Salt Lake City, UT
| | - Sarah F. Eby
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA
| | - Daniel M. Cushman
- University of Utah, Department of Physical Medicine & Rehabilitation, Salt Lake City, UT
- University of Utah, Department of Orthopaedics, Salt Lake City, UT
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Is EE, Aydog T. Relative Energy Deficiency in Sport (RED-S) and Goldman's Dilemma: A Case Report in 42 Year-Old Woman Endurance Athlete. PHYSICIAN SPORTSMED 2024; 52:304-308. [PMID: 37578841 DOI: 10.1080/00913847.2023.2247960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 08/11/2023] [Indexed: 08/16/2023]
Abstract
Relative Energy Deficiency in Sport (RED-S) defines insufficient calorie intake for the physiological and athletic functions of the athlete, and accordingly deterioration in the musculoskeletal, hormonal, cardiovascular and immune systems. Herein, we present a 42-year-old female long-distance runner with multiple pelvic stress fractures who didn't complete her prescribed treatment program and wanted to keep running despite being aware of the associated pain and risks. The Goldman dilemma refers to the unsettling reality that a significant number of professional athletes may contemplate sacrificing their lives in order to achieve Olympic glory. This disregard for the numerous challenges stemming from an obsession with success is equally applicable to the amateur athlete depicted in this case. Our patient's fractures were examined in relation to RED-S and managed through conservative treatment methods. The RED-S and Goldman dilemma should be kept in mind not only in professional but also in semi-professional, and amateur athletes.
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Affiliation(s)
- Enes Efe Is
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Turkey, Sisli Hamidiye Etfal Teaching and Research Hospital, Istanbul, Turkey
| | - Tolga Aydog
- Department of Physical Medicine and Rehabilitation, Acıbadem University Faculty of Medicine, Istanbul, Turkey
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Gunterstockman BM, Carmel J, Bechard L, Yoder A, Farrokhi S. Rearfoot Strike Run Retraining for Achilles Tendon Pain: A Two-patient Case Series. Mil Med 2024; 189:e942-e947. [PMID: 37975221 DOI: 10.1093/milmed/usad436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/25/2023] [Indexed: 11/19/2023] Open
Abstract
INTRODUCTION Running-related injuries are prevalent in the military and are often related to physical fitness test training. Non-rearfoot striking while running is known to increase the risk of Achilles tendon injuries because of the high eccentric energy absorption by the elastic components of the planarflexor muscle-tendon complex. However, there is limited evidence to suggest benefits of converting runners with Achilles tendon pain to use a rearfoot strike. METHODS This is a case series of two active-duty Service members with chronic, running-related Achilles tendon pain that utilized a natural non-rearfoot strike pattern. Both patients were trained to utilize a rearfoot strike while running through the use of real-time visual feedback from wearable sensors. RESULTS The trained rearfoot strike pattern was retained for over one month after the intervention, and both patients reported improvements in pain and self-reported function. CONCLUSIONS This case series demonstrated the clinical utility of converting two non-rearfoot strike runners to a rearfoot strike pattern to decrease eccentric demands on the plantarflexors and reduce Achilles tendon pain while running.
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Affiliation(s)
| | | | - Laura Bechard
- Naval Medical Center San Diego, San Diego, CA 92134, USA
- Henry Jackson Foundation, Bethesda, MD 20817, USA
| | - Adam Yoder
- Henry Jackson Foundation, Bethesda, MD 20817, USA
- DoD-VA Extremity Trauma and Amputation Center of Excellence, San Diego, CA 92134, USA
| | - Shawn Farrokhi
- Naval Medical Center San Diego, San Diego, CA 92134, USA
- DoD-VA Extremity Trauma and Amputation Center of Excellence, San Diego, CA 92134, USA
- Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
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Bramah C, Tawiah-Dodoo J, Rhodes S, Elliott JD, Dos’Santos T. The Sprint Mechanics Assessment Score: A Qualitative Screening Tool for the In-field Assessment of Sprint Running Mechanics. Am J Sports Med 2024; 52:1608-1616. [PMID: 38544464 PMCID: PMC11064464 DOI: 10.1177/03635465241235525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/03/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Qualitative movement screening tools provide a practical method of assessing mechanical patterns associated with potential injury development. Biomechanics play a role in hamstring strain injury and are recommended as a consideration within injury screening and rehabilitation programs. However, no methods are available for the in-field assessment of sprint running mechanics associated with hamstring strain injuries. PURPOSE To investigate the intra- and interrater reliability of a novel screening tool assessing in-field sprint running mechanics titled the Sprint Mechanics Assessment Score (S-MAS) and present normative S-MAS data to facilitate the interpretation of performance standards for future assessment uses. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 3. METHODS Maximal sprint running trials (35 m) were recorded from 136 elite soccer players using a slow-motion camera. All videos were scored using the S-MAS by a single assessor. Videos from 36 players (18 men and 18 women) were rated by 2 independent assessors blinded to each other's results to establish interrater reliability. One assessor scored all videos in a randomized order 1 week later to establish intrarater reliability. Intraclass correlation coefficients (ICCs) based on single measures using a 2-way mixed-effects model, with absolute agreement with 95% CI and kappa coefficients with percentage agreements, were used to assess the reliability of the overall score and individual score items, respectively. T-scores were calculated from the means and standard deviations of the male and female groups to present normative data values. The Mann-Whitney U test and the Wilcoxon signed-rank test were used to assess between-sex differences and between-limb differences, respectively. RESULTS The S-MAS showed good intrarater (ICC, 0.828 [95% CI, 0.688-0.908]) and interrater (ICC, 0.799 [95% CI, 0.642-0.892]) reliability, with a standard error of measurement of 1 point. Kappa coefficients for individual score items demonstrated moderate to substantial intra- and interrater agreement for most parameters, with percentage agreements ranging from 75% to 88.8% for intrarater and 66.6% to 88.8% for interrater reliability. No significant sex differences were observed for overall scores, with mean values of 4.2 and 3.8 for men and women, respectively (P = .27). CONCLUSION The S-MAS is a new tool developed for assessing sprint running mechanics associated with lower limb injuries in male and female soccer players. The reliable and easy-to-use nature of the S-MAS means that this method can be integrated into practice, potentially aiding future injury screening and research looking to identify athletes who may demonstrate mechanical patterns potentially associated with hamstring strain injuries.
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Affiliation(s)
- Christopher Bramah
- School of Health & Society, University of Salford, Salford, Manchester, UK
- Manchester Institute of Health & Performance, Manchester, UK
| | | | - Samantha Rhodes
- School of Health & Society, University of Salford, Salford, Manchester, UK
- Manchester Institute of Health & Performance, Manchester, UK
- Nuffield Health, Manchester Institute of Health & Performance, UK
| | - Joshua D. Elliott
- Manchester Institute of Health & Performance, Manchester, UK
- Nuffield Health, Manchester Institute of Health & Performance, UK
- Research Institute for Sport and Exercise, University of Canberra, Canberra, Australia
| | - Thomas Dos’Santos
- Department of Sport & Exercise Sciences, Manchester Metropolitan University, Manchester, UK
- Manchester Institute of Sport, Metropolitan University, Manchester, UK
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Edouard P, Dandrieux PE, Junge A, Navarro L, Giroux C, Guex K, Branco P, Guilhem G, Hollander K. Is the risk of muscle injuries higher in the finals than in previous rounds of the 100 m, 200 m and 400 m sprints of international athletics championships? J Sci Med Sport 2024; 27:302-306. [PMID: 38429218 DOI: 10.1016/j.jsams.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 12/05/2023] [Accepted: 02/19/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVES To compare incidence rates of lower limb muscle injuries (LLMIs) and hamstring muscle injuries (HMIs) in 100 m, 200 m and 400 m sprints disciplines between finals, semi-finals and heats of international athletics championships. DESIGN Prospective total population study. METHODS We analysed in-competition LLMIs and HMIs of female and male athletes during eight championships between 2009 and 2022. RESULTS LLMI and HMI incidence rates in 100 m finals were significantly higher than in heats and semi-finals for female and male athletes. HMI incidence rates were significantly higher in 200 m finals than heats and semi-finals for male athletes. CONCLUSIONS LLMI and HMI risk was higher in finals compared to previous rounds during international athletics championships.
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Affiliation(s)
- Pascal Edouard
- Inter-university Laboratory of Human Movement Science (LIBM EA 7424), University Jean Monnet Saint-Etienne, Lyon 1, University Savoie Mont-Blanc, France; Department of Clinical and Exercise Physiology, Sports Medicine Unit, University Hospital of Saint-Etienne, Faculty of Medicine, France; European Athletics Medical & Anti Doping Commission, European Athletics Association (EAA), Switzerland.
| | - Pierre-Eddy Dandrieux
- Inter-university Laboratory of Human Movement Science (LIBM EA 7424), University Jean Monnet Saint-Etienne, Lyon 1, University Savoie Mont-Blanc, France; Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U 1059 Sainbiose, Centre CIS, France; Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Astrid Junge
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany; Center for Health in Performing Arts, MSH Medical School Hamburg, Hamburg, Germany
| | - Laurent Navarro
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U 1059 Sainbiose, Centre CIS, France
| | - Caroline Giroux
- French Institute of Sport (INSEP), Laboratory Sport, Expertise and Performance (EA 7370), France
| | - Kenny Guex
- School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Switzerland; Department of Sprints, Hurdles and Relays, Swiss Athletics, Haus des Sports, Switzerland
| | - Pedro Branco
- European Athletics Medical & Anti Doping Commission, European Athletics Association (EAA), Switzerland
| | - Gaël Guilhem
- French Institute of Sport (INSEP), Laboratory Sport, Expertise and Performance (EA 7370), France
| | - Karsten Hollander
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
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Raiser SN, Schroeder AN, Lawley RJ, Tenforde AS. Bone health and the masters runner. PM R 2024; 16:363-373. [PMID: 38532664 DOI: 10.1002/pmrj.13175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 02/13/2024] [Accepted: 02/25/2024] [Indexed: 03/28/2024]
Abstract
Masters runners are often defined as those ages 35 years and older who train and compete in running events. These runners represent a growing population of the overall running community and experience running-related injuries including bone stress injuries (BSIs). Similar to younger runners, health considerations in masters runners include the goal to optimize bone health with focus on mitigating age-associated loss of bone strength and preventing BSIs through a combination of ensuring appropriate physical activity, optimizing nutrition, and correcting faulty biomechanics. Importantly, BSIs in masters runners may include characteristics of both overuse injury from insufficient recovery and failure of bone weakened by age-related loss of bone (insufficiency fractures). This narrative review covers the limited available research on strategies to optimize bone health in masters runners. Applying knowledge on masters athletes and extrapolating from other populations, we propose strategies on treatment and prevention of BSIs. Finally, the review highlights gaps in knowledge that require further age-specific discoveries to advance treatment and prevention.
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Affiliation(s)
- Sara N Raiser
- Department of Physical Medicine & Rehabilitation, University of Virginia, Charlottesville, Virginia, USA
| | - Allison N Schroeder
- Department of Orthopedics, University Hospitals and Case Western Reserve University, Cleveland, Ohio, USA
| | - Richard J Lawley
- Department of Physical Medicine & Rehabilitation, Loyola University Medical Center, Maywood, Illinois, USA
| | - Adam S Tenforde
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
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Bramah C, Mendiguchia J, Dos'Santos T, Morin JB. Exploring the Role of Sprint Biomechanics in Hamstring Strain Injuries: A Current Opinion on Existing Concepts and Evidence. Sports Med 2024; 54:783-793. [PMID: 37725240 PMCID: PMC11052868 DOI: 10.1007/s40279-023-01925-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/21/2023]
Abstract
Hamstring strain injuries are one of the most common injuries in sprint-based sports with the mechanism of injury considered the result of an interaction between applied mechanical strain and the capacity of the muscle to tolerate strain. To date, injury prevention and rehabilitation strategies have frequently focused on enhancing the capacity of the hamstrings to tolerate strain, with little consideration of factors directly influencing mechanical strain. Sprint running biomechanics are one factor proposed to influence the mechanical strain applied to the hamstrings that may be modified (towards reduced strain) within rehabilitation and injury prevention programs. This article aims to explore the theoretical mechanistic link between sprint running mechanics and hamstring strain injury, along with the available supporting evidence. In doing so, it hopes to provide practitioners with an understanding of mechanical parameters that may influence hamstring strain injury whilst also identifying areas for further research exploration.
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Affiliation(s)
- Christopher Bramah
- School of Health and Society, University of Salford, Allerton Building, Frederick Road Campus, Salford, M6 6PU, UK.
- Manchester Institute of Health and Performance, Manchester, UK.
| | - Jurdan Mendiguchia
- Department of Physical Therapy, ZENTRUM Rehab and Performance Centre, Barañain, Spain
| | - Thomas Dos'Santos
- Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
- Manchester Institute of Sport, Metropolitan University, Manchester, UK
| | - Jean-Benoȋt Morin
- University Jean Monnet Saint-Etienne, Lyon 1, University Savoie Mont-Blanc, Inter-University Laboratory of Human Movement Biology, EA 7424, Saint-Etienne, France
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Guevara SA, Crunkhorn ML, Drew M, Waddington G, Périard JD, Etxebarria N, Toohey LA, Charlton P. Injury and illness in short-course triathletes: A systematic review. J Sport Health Sci 2024; 13:172-185. [PMID: 36898525 PMCID: PMC10980869 DOI: 10.1016/j.jshs.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/04/2022] [Accepted: 01/11/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Determining the incidence and prevalence of injury and illness in short-course triathletes would improve understanding of their etiologies and therefore assist in the development and implementation of prevention strategies. This study synthesizes the existing evidence on the incidence and prevalence of injury and illness and summarizes reported injury or illness etiology and risk factors affecting short-course triathletes. METHODS This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting health problems (injury and illness) in triathletes (all sexes, ages, and experience levels) training and/or competing in short-course distances were included. Six electronic databases (Cochrane Central Register of Controlled Trials, MEDLINE, Embase, APA PsychINFO, Web of Science Core Collection, and SPORTDiscus) were searched. Risk of bias was independently assessed by 2 reviewers using the Newcastle-Ottawa Quality Assessment Scale. Two authors independently completed data extraction. RESULTS The search yielded 7998 studies, with 42 studies eligible for inclusion. Twenty-three studies investigated injuries, 24 studies investigated illnesses, and 5 studies investigated both injuries and illnesses. The injury incidence rate ranged 15.7-24.3 per 1000 athlete exposures, and the illness incidence rate ranged 1.8-13.1 per 1000 athlete days. Injury and illness prevalence ranged between 2%-15% and 6%-84%, respectively. Most injuries reported occurred during running (45%-92%), and the most frequently reported illnesses affected the gastrointestinal (7%-70%), cardiovascular (14%-59%), and respiratory systems (5%-60%). CONCLUSION The most frequently reported health problems in short-course triathletes were: overuse and lower limb injuries associated with running; gastrointestinal illnesses and altered cardiac function, primarily attributable to environmental factors; and respiratory illness mostly caused by infection.
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Affiliation(s)
- Sara A Guevara
- University of Canberra Research Institute for Sport and Exercise (UCRISE), Bruce, ACT 2617, Australia; New South Wales Institute of Sport, Sydney, NSW 2127, Australia
| | - Melissa L Crunkhorn
- University of Canberra Research Institute for Sport and Exercise (UCRISE), Bruce, ACT 2617, Australia; Queensland Academy of Sport, Brisbane, QLD 4111, Australia; Triathlon Australia, Gold Coast, QLD 4227, Australia.
| | - Michael Drew
- University of Canberra Research Institute for Sport and Exercise (UCRISE), Bruce, ACT 2617, Australia
| | - Gordon Waddington
- University of Canberra Research Institute for Sport and Exercise (UCRISE), Bruce, ACT 2617, Australia; Australian Institute of Sport, Bruce, ACT 2617, Australia
| | - Julien D Périard
- University of Canberra Research Institute for Sport and Exercise (UCRISE), Bruce, ACT 2617, Australia
| | - Naroa Etxebarria
- University of Canberra Research Institute for Sport and Exercise (UCRISE), Bruce, ACT 2617, Australia
| | - Liam A Toohey
- University of Canberra Research Institute for Sport and Exercise (UCRISE), Bruce, ACT 2617, Australia; Australian Institute of Sport, Bruce, ACT 2617, Australia
| | - Paula Charlton
- University of Canberra Research Institute for Sport and Exercise (UCRISE), Bruce, ACT 2617, Australia; Triathlon Australia, Gold Coast, QLD 4227, Australia
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Chen W, Cloosterman KLA, Bierma-Zeinstra SMA, van Middelkoop M, de Vos RJ. Epidemiology of insertional and midportion Achilles tendinopathy in runners: A prospective cohort study. J Sport Health Sci 2024; 13:256-263. [PMID: 36963760 PMCID: PMC10980873 DOI: 10.1016/j.jshs.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 02/05/2023] [Accepted: 02/24/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Achilles tendinopathy (AT) is a common problem among runners. There is only limited evidence for risk factors for AT, and most studies have not defined the AT subcategories. No study has compared the incidence and risk factors between insertional AT and midportion AT, though they are considered distinct. This study aimed to assess incidence and risk factors of AT based on data from a large prospective cohort. The secondary aim was to explore differences in risk factors between insertional and midportion AT. METHODS Participants were recruited from among registered runners at registration for running events. Questionnaires were completed at baseline, 1 month before the event, 1 week before the event, and 1 month after the event. Information concerning demographics, training load, registered events, and running-related injuries were collected at baseline. The follow-up questionnaires collected information about new injuries. A pain map was used to diagnose midportion and insertional AT. The primary outcome was the incidence of AT. Multivariable logistic regression analysis was applied to identify risk factors for the onset. RESULTS We included 3379 participants with a mean follow-up of 20.4 weeks. The incidence of AT was 4.2%. The proportion of insertional AT was 27.7% and of midportion AT was 63.8%; the remaining proportion was a combined type of insertional and midportion AT. Men had a significantly higher incidence (5%, 95% confidence interval (95%CI): 4.1%-6.0%) than women (2.8%, 95%CI: 2.0%-3.8%). AT in the past 12 months was the most predominant risk factor for new-onset AT (odds ratio (OR) = 6.47, 95%CI: 4.27 -9.81). This was similar for both subcategories of AT (insertional: OR = 5.45, 95%CI: 2.51-11.81; midportion: OR = 6.96, 95%CI: 4.24-11.40). Participants registering for an event with a distance of 10/10.55 km were less likely to develop a new-onset AT (OR = 0.59, 95%CI: 0.36-0.97) or midportion AT (OR = 0.47, 95%CI: 0.23 -0.93). Higher age had a significant negative association with insertional AT (OR = 0.97, 95%CI: 0.94-1.00). CONCLUSION The incidence of new-onset AT among recreational runners was 4.2%. The proportion of insertional and midportion AT was 27.7% and 63.8%, respectively. AT in the past 12 months was the predominant risk factor for the onset of AT. Risk factors varied between insertional and midportion AT, but we could not identify clinically relevant differences between the 2 subtypes.
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Affiliation(s)
- Wenbo Chen
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC University Medical Center, Rotterdam 3015GD, the Netherlands; Department of General Practice, Erasmus MC University Medical Center, Rotterdam 3015GD, the Netherlands; Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China.
| | - Kyra L A Cloosterman
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam 3015GD, the Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC University Medical Center, Rotterdam 3015GD, the Netherlands; Department of General Practice, Erasmus MC University Medical Center, Rotterdam 3015GD, the Netherlands
| | - Marienke van Middelkoop
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam 3015GD, the Netherlands
| | - Robert-Jan de Vos
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC University Medical Center, Rotterdam 3015GD, the Netherlands
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Joachim MR, Heiderscheit BC, Kliethermes SA. Changes in Sleep, Stress, and Fatigue Were Not Prospectively Associated With Running-Related Injuries Among High School Cross Country Runners. Sports Health 2024; 16:247-253. [PMID: 38148661 PMCID: PMC10916783 DOI: 10.1177/19417381231217347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Running-related injuries (RRI) are common among adolescent runners; however, our understanding of RRI risk factors in this population is limited. Sleep, stress, and fatigue are risk factors in other youth sports but have not been studied in high school runners. This study prospectively assessed the effect of changes in sleep duration and quality, stress, and fatigue on RRI among high school cross country runners. HYPOTHESIS Less and poorer quality sleep and greater stress and fatigue, compared with the previous week, would be associated with RRI. STUDY DESIGN Prospective, observational study. LEVEL OF EVIDENCE Level 2b. METHODS Runners completed a preseason demographics and injury history survey and daily surveys regarding sleep duration and quality, stress, fatigue, and current RRI. Values were summed within each week, and change scores were calculated relative to the previous week. Runners completing ≥75% of daily surveys were analyzed; sensitivity analyses for those completing ≥50% and ≥90% were also conducted. Generalized estimating equations assessed the association between change in each predictor, including its interaction with sex, and RRI, controlling for year in school, previous RRI, and repeated observations. RESULTS A total of 434 runners enrolled in the study; 161 (37%) completed ≥75% of daily surveys. No associations between change in sleep duration, sleep quality, or fatigue and RRI were observed (P values ≥0.24). A significant change in stress × sex interaction with RRI was observed (P < 0.01). Associations among boys (P = 0.06) and girls (P = 0.07) were marginally significant. Sensitivity results were similar. CONCLUSION Short-term changes in sleep duration, quality, and fatigue were not associated with RRI, but a significant interaction between change in stress and sex suggests that stress may influence RRI risk in high school cross country runners. CLINICAL RELEVANCE Large changes in stress levels should be monitored throughout the season, as these changes may precede RRI occurrence in this population.
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Affiliation(s)
- Mikel R Joachim
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin
- Badger Athletic Performance, University of Wisconsin-Madison, Madison, Wisconsin
| | - Bryan C Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin
- Badger Athletic Performance, University of Wisconsin-Madison, Madison, Wisconsin
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Stephanie A Kliethermes
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin
- Badger Athletic Performance, University of Wisconsin-Madison, Madison, Wisconsin
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Fisher R, Kasper K, Trigg S, Davila K, Mette GT, Rivera K, Danley L, Salazar A, Cockerell M. Running Gait Training Improves Outcomes at United States Air Force Basic Military Training. Mil Med 2024; 189:692-697. [PMID: 35998101 DOI: 10.1093/milmed/usac251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/21/2022] [Accepted: 08/08/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The aim is to investigate the impact of large-group, motor learning-based running gait training on injury risk in United States Air Force (USAF) Basic Military Training (BMT). DESIGN A prospective quasi-experimental program evaluation is used. MATERIALS AND METHODS Medical providers taught running gait form to groups of trainees in the first week of training of BMT from August 2020 to March 2021. The main outcome measures included risk ratio of reported injuries, removal from training because of injury, and separation from service because of injury. RESULTS Of BMT trainees, 2,205 underwent group, motor learning-based running gait training; this was compared with two intake groups (nA = 3,941 and nB = 2,041) who were only given introductions to sports medicine staff in a classroom setting. Reported pain complaints increased (χ2 = 27.4A and 20.83B, P < .001). Risk ratios for more severe injuries necessitating time out of training or separation from USAF were reduced, although these were statistically not significant (13%, P = .48 and 22%, P = .29, respectively). Leadership implemented gait training across BMT, and data from the following 8 weeks of intake (n = 6,223) demonstrated similar trends in increases in patient reports of pain (χ2 = 67.25, P < .001) but significantly reduced risk ratios of removal from training (32%, χ2 = 16.35, P < .001) or separation (32%, χ2 = 12.54, P < .001). CONCLUSIONS While not previously shown to mitigate injury, large-group, running gait training was associated with a significant reduction in injury severity defined by training delays and separation from service in USAF BMT.
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Affiliation(s)
- Reid Fisher
- 37th Training Wing, JBSA-Lackland, TX 78236, USA
- University of the Incarnate Word, San Antonio, TX 78209, USA
| | - Korey Kasper
- 559th Medical Group, JBSA-Lackland, TX 78236, USA
| | - Steven Trigg
- 559th Medical Group, JBSA-Lackland, TX 78236, USA
| | | | - G T Mette
- 37th Training Wing, JBSA-Lackland, TX 78236, USA
| | | | - Lyle Danley
- Texas A&M Mays Business School, College Station, TX 77843-4117, USA
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Esmaeili A, Hosseininejad SE, Jafarnezhadgero A, Dionisio VC. The interaction effect of different footwear types and static navicular drop or dynamic ankle pronation on the joint stiffness of the lower limb during running. Gait Posture 2024; 108:28-34. [PMID: 37979323 DOI: 10.1016/j.gaitpost.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 11/03/2023] [Accepted: 11/10/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Although the effects of footwear type on joint stiffness have previously been investigated, researchers did not consider foot flexibility. Thus, the present investigation aimed to determine the interaction effects of footwear type, static navicular drop and dynamic ankle pronation on dynamic joint stiffness in running. RESEARCH QUESTION Does the footwear types in interaction with the foot posture affect the stiffness of the joints of the lower limb? METHODS Forty-seven male individuals participated in this study. Firstly, they were divided into the high navicular, low navicular, and normal navicular drop. Secondly, they were divided into the high dynamic ankle pronation, low dynamic ankle pronation, and normal dynamic ankle pronation groups. Participants performed three running trials at 3 ± 0.2 m/s at minimalist footwear, conventional footwear, and barefoot conditions. We collected the ground reaction forces and three-dimensional kinematic data and calculated joint stiffness over the stance phase. RESULTS There was no significant main effect of navicular drop or dynamic ankle pronation on dynamic joint stiffness for the ankle, knee, and hip (p > 0.05). However, footwear type significantly affected dynamic joint stiffness. The pairwise comparison revealed that the ankle and hip dynamic joint stiffness magnitudes in the conventional footwear condition were greater than in the barefoot and minimalist footwear conditions (p 0.001). In contrast, the knee dynamic joint stiffness magnitude in the conventional footwear condition was lesser than in barefoot and minimalist footwear conditions (p 0.001). SIGNIFICANCE The navicular drop or dynamic ankle pronation did not influence lower limb joint stiffness, and there was no significant interaction between navicular drop or dynamic ankle pronation and footwear on lower limb dynamic joint stiffness. However, conventional footwear increased the ankle and hip dynamic joint stiffness while reducing knee dynamic joint stiffness, leading to changes in transfer energy, which could have implications for relative injury risk.
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Affiliation(s)
- Ali Esmaeili
- Department of Motor Behavior and Sport Biomechanics, Faculty of Sports Sciences, University of Mazandaran, Babolsar, Iran
| | - Sayed Esmaeil Hosseininejad
- Department of Motor Behavior and Sport Biomechanics, Faculty of Sports Sciences, University of Mazandaran, Babolsar, Iran.
| | - AmirAli Jafarnezhadgero
- Department of Sport Biomechanics, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Valdeci Carlos Dionisio
- Faculty of Physical Education and Physiotherapy, Federal University of Uberlandia, Uberlândia, MG, Brazil
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Van Hooren B, van Rengs L, Meijer K. Per-step and cumulative load at three common running injury locations: The effect of speed, surface gradient, and cadence. Scand J Med Sci Sports 2024; 34:e14570. [PMID: 38389144 DOI: 10.1111/sms.14570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/02/2024] [Accepted: 01/15/2024] [Indexed: 02/24/2024]
Abstract
Understanding how loading and damage on common running injury locations changes across speeds, surface gradients, and step frequencies may inform training programs and help guide progression/rehabilitation after injuries. However, research investigating tissue loading and damage in running is limited and fragmented across different studies, thereby impairing comparison between conditions and injury locations. This study examined per-step peak load and impulse, cumulative impulse, and cumulative weighted impulse (hereafter referred to as cumulative damage) on three common injury locations (patellofemoral joint, tibia, and Achilles tendon) across different speeds, surface gradients, and cadences. We also explored how cumulative damage in the different tissues changed across conditions relative to each other. Nineteen runners ran at five speeds (2.78, 3.0, 3.33, 4.0, 5.0 m s-1 ), and four gradients (-6, -3, +3, +6°), and three cadences (preferred, ±10 steps min-1 ) each at one speed. Patellofemoral, tibial, and Achilles tendon loading and damage were estimated from kinematic and kinetic data and compared between conditions using a linear mixed model. Increases in running speed increased patellofemoral cumulative damage, with nonsignificant increases for the tibia and Achilles tendon. Increases in cadence reduced damage to all tissues. Uphill running increased tibial and Achilles tendon, but decreased patellofemoral damage, while downhill running showed the reverse pattern. Per-step and cumulative loading, and cumulative loading and cumulative damage indices diverged across conditions. Moreover, changes in running speed, surface gradient, and step frequency lead to disproportional changes in relative cumulative damage on different structures. Methodological and practical implications for researchers and practitioners are discussed.
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Affiliation(s)
- Bas Van Hooren
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Lars van Rengs
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Kenneth Meijer
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
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Joachim MR, Kuik ML, Krabak BJ, Kraus EM, Rauh MJ, Heiderscheit BC. Risk Factors for Running-Related Injury in High School and Collegiate Cross-country Runners: A Systematic Review. J Orthop Sports Phys Ther 2024; 54:1-13. [PMID: 37970801 DOI: 10.2519/jospt.2023.11550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
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.
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16
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Nielsen R, Ramskov D, Blacket CT, Malisoux L. Running-Related Injuries Among More Than 7000 Runners in 87 Different Countries: The Garmin-RUNSAFE Running Health Study. J Orthop Sports Phys Ther 2024; 54:1-9. [PMID: 37970820 DOI: 10.2519/jospt.2023.11959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVE: To describe the cumulative injury proportion after 1000 and 2000 km of running among runners from 87 countries worldwide using wearable devices. Secondly, examine if the cumulative injury proportion differed between runners from different countries. DESIGN: Cohort study with an 18-month follow-up. METHODS: Runners aged ≥18 years who were familiar with the English language, and who were using a Garmin sports watch that supported tracking of running were eligible for inclusion. The exposure was residential country; self-reported running-related injury was the primary outcome. A generalized linear model was used to estimate the cumulative injury proportion for each country and the cumulative risk difference between the countries (country with the lowest risk used as reference). Data were analyzed at 1000 and 2000 km. RESULTS: The proportions of injured runners among the 7605 included runners from 87 different countries were 57.6% [95% CI: 56.9%, 59.0%] at 1000 km and 69.8% [95% CI: 68.3%, 71.4%] at 2000 km. Runners from the Czech Republic (40.3% [95% CI: 28.7%, 51.9%]), Austria (41.1% [95% CI: 25.9%, 52.2%]), and Germany (41.9% [95% CI: 36.0%, 47.9%]) had the lowest cumulative injury proportions at 1000 km, whereas Ireland (75.4% [95% CI: 60.4%, 90.4%]), Great Britain and Northern Ireland (73.2% [95% CI: 69.3%, 77.1%]), and Finland (67.5% [95% CI: 47.2%, 87.7%]) had the highest proportions. At 2000 km, Poland (47.7% [95% CI: 36.0%, 59.4%]), Slovenia (52.2% [95% CI: 28.5%, 75.8%]), and Croatia (54.2% [95% CI: 35.6%, 72.7%]) had the lowest proportions of injured runners. The highest cumulative injury proportions were reported in Great Britain and Northern Ireland (83.6% [95% CI: 79.6%, 87.6%]) and the Netherlands (78.3% [95% CI: 70.6%, 85.9%]). CONCLUSION: More than half of the population of adult runners from 87 countries using wearable devices sustained a running-related injury during follow-up. There were considerable between-country differences in injury proportions. J Orthop Sports Phys Ther 2024;54(2):1-9. Epub 16 November 2023. doi:10.2519/jospt.2023.11959.
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Garofolini A, Mickle KJ, McLaughlin P, Taylor SB. Assessing the effects of foot strike patterns and shoe types on the control of leg length and orientation in running. Sci Rep 2024; 14:2220. [PMID: 38278965 PMCID: PMC10817954 DOI: 10.1038/s41598-024-52446-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/18/2024] [Indexed: 01/28/2024] Open
Abstract
This research investigates the stabilization of leg length and orientation during the landing phase of running, examining the effects of different footwear and foot strike patterns. Analyzing kinematic data from twenty male long-distance runners, both rearfoot and forefoot strikers, we utilized the Uncontrolled Manifold approach to assess stability. Findings reveal that both leg length and orientation are indeed stabilized during landing, challenging the hypothesis that rearfoot strikers exhibit less variance in deviations than forefoot strikers, and that increased footwear assistance would reduce these deviations. Surprisingly, footwear with a lower minimalist index enhanced post-landing stability, suggesting that cushioning contributes to both force dissipation and leg length stability. The study indicates that both foot strike patterns are capable of effectively reducing task-relevant variance, with no inherent restriction on flexibility for rearfoot strikers. However, there is an indication of potential reliance on footwear for stability. These insights advance our understanding of the biomechanics of running, highlighting the role of footwear in stabilizing leg length and orientation, which has significant implications for running efficiency and injury prevention.
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Affiliation(s)
| | - Karen J Mickle
- School of Environmental and Life Sciences, University of Newcastle, Ourimbah, NSW, Australia
| | - Patrick McLaughlin
- Institute for Health and Sport (IHES), Victoria University, Melbourne, Australia
| | - Simon B Taylor
- Institute for Health and Sport (IHES), Victoria University, Melbourne, Australia
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Neal BS, Bramah C, McCarthy-Ryan MF, Moore IS, Napier C, Paquette MR, Gruber AH. Using wearable technology data to explain recreational running injury: A prospective longitudinal feasibility study. Phys Ther Sport 2024; 65:130-136. [PMID: 38181563 DOI: 10.1016/j.ptsp.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 01/07/2024]
Abstract
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.
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Affiliation(s)
- Bradley S Neal
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Wivenhoe Park, Colchester, Essex, CO4 3SQ, United Kingdom.
| | - Christopher Bramah
- Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, United Kingdom; The Manchester Institute of Health and Performance, Manchester, United Kingdom
| | - Molly F McCarthy-Ryan
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Isabel S Moore
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Christopher Napier
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University Faculty of Science, Burnaby, British Columbia, Canada
| | | | - Allison H Gruber
- Department of Kinesiology, School of Public Health - Bloomington, Indiana University, Bloomington, IN, 47405, USA
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Joachim MR, Kliethermes SA, Heiderscheit BC. Preinjury Knee and Ankle Mechanics during Running Are Reduced among Collegiate Runners Who Develop Achilles Tendinopathy. Med Sci Sports Exerc 2024; 56:128-133. [PMID: 37703042 DOI: 10.1249/mss.0000000000003276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
INTRODUCTION Achilles tendinopathies (AT) are common in runners, but prospective data assessing running mechanics associated with developing AT are limited. Asymmetry in running mechanics is also considered a risk factor for injury, although it is unknown if the problematic mechanics occur on the injured limb only or are present bilaterally. PURPOSE This study aimed to prospectively identify differences in preinjury running biomechanics in collegiate runners who did and did not develop AT and determine if between-limb asymmetries were associated with which limb developed AT. METHODS Running gait data were obtained preseason on healthy collegiate cross-country runners, and AT incidence was prospectively recorded each year. Spatiotemporal, ground reaction forces, and joint kinematics and kinetics were analyzed. Linear mixed-effects models assessed differences in biomechanics between those who did and did not develop AT during the subsequent year. Generalized linear mixed-effects models determined if the asymmetry direction was associated with which limb developed an AT, with odds ratios (OR) and 95% confidence intervals (95% CI) reported. RESULTS Data from 106 runners were analyzed and 15 developed AT. Preinjury biomechanics of runners who developed AT showed less peak knee flexion (noninjured: 45.9° (45.2°-46.6°), injured: 43.2° (41.5°-44.9°), P < 0.001), ankle dorsiflexion (noninjured: 28.7° (28.0°-30.2°), injured: 26.0° (23.8°-28.3°), P = 0.01), and knee extensor moment (noninjured: -2.18 (N·m)·kg -1 (-2.24 to -2.12 (N·m)·kg -1 ), injured: -2.00 (N·m)·kg -1 (-2.17 to -1.84 (N·m)·kg -1 ), P = 0.02). The limb demonstrating less peak knee flexion had greater odds of sustaining an AT (OR, 1.29 (1.00-1.65), P = 0.05). CONCLUSIONS Knee and ankle kinematics, in addition to knee kinetics, were associated with developing an AT. Monitoring these mechanics may be useful for prospectively identifying runners at risk of developing AT.
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Rice H, Kurz M, Mai P, Robertz L, Bill K, Derrick TR, Willwacher S. Speed and surface steepness affect internal tibial loading during running. J Sport Health Sci 2024; 13:118-124. [PMID: 36931595 PMCID: PMC10818105 DOI: 10.1016/j.jshs.2023.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/08/2022] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Internal tibial loading is influenced by modifiable factors with implications for the risk of stress injury. Runners encounter varied surface steepness (gradients) when running outdoors and may adapt their speed according to the gradient. This study aimed to quantify tibial bending moments and stress at the anterior and posterior peripheries when running at different speeds on surfaces of different gradients. METHODS Twenty recreational runners ran on a treadmill at 3 different speeds (2.5 m/s, 3.0 m/s, and 3.5 m/s) and gradients (level: 0%; uphill: +5%, +10%, and +15%; downhill: -5%, -10%, and -15%). Force and marker data were collected synchronously throughout. Bending moments were estimated at the distal third centroid of the tibia about the medial-lateral axis by ensuring static equilibrium at each 1% of stance. Stress was derived from bending moments at the anterior and posterior peripheries by modeling the tibia as a hollow ellipse. Two-way repeated-measures analysis of variance were conducted using both functional and discrete statistical analyses. RESULTS There were significant main effects for running speed and gradient on peak bending moments and peak anterior and posterior stress. Higher running speeds resulted in greater tibial loading. Running uphill at +10% and +15% resulted in greater tibial loading than level running. Running downhill at -10% and -15% resulted in reduced tibial loading compared to level running. There was no difference between +5% or -5% and level running. CONCLUSION Running at faster speeds and uphill on gradients ≥+10% increased internal tibial loading, whereas slower running and downhill running on gradients ≥-10% reduced internal loading. Adapting running speed according to the gradient could be a protective mechanism, providing runners with a strategy to minimize the risk of tibial stress injuries.
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Affiliation(s)
- Hannah Rice
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo 0806, Norway.
| | - Markus Kurz
- Sports Tech Research Centre, Mid Sweden University, Östersund SE-831 25, Sweden; Department of Mechanical and Process Engineering, Offenburg University of Applied Sciences, Offenburg 77652, Germany
| | - Patrick Mai
- Department of Mechanical and Process Engineering, Offenburg University of Applied Sciences, Offenburg 77652, Germany; Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne 50933, Germany
| | - Leon Robertz
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne 50933, Germany
| | - Kevin Bill
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne 50933, Germany
| | - Timothy R Derrick
- Department of Kinesiology, Iowa State University, Ames, IA 50011, USA
| | - Steffen Willwacher
- Department of Mechanical and Process Engineering, Offenburg University of Applied Sciences, Offenburg 77652, Germany; Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne 50933, Germany
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Rasmussen J, Skejø S, Waagepetersen RP. Predicting Tissue Loads in Running from Inertial Measurement Units. Sensors (Basel) 2023; 23:9836. [PMID: 38139682 PMCID: PMC10747732 DOI: 10.3390/s23249836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/28/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Runners have high incidence of repetitive load injuries, and habitual runners often use smartwatches with embedded IMU sensors to track their performance and training. If accelerometer information from such IMUs can provide information about individual tissue loads, then running watches may be used to prevent injuries. METHODS We investigate a combined physics-based simulation and data-based method. A total of 285 running trials from 76 real runners are subjected to physics-based simulation to recover forces in the Achilles tendon and patella ligament, and the collected data are used to train and test a data-based model using elastic net and gradient boosting methods. RESULTS Correlations of up to 0.95 and 0.71 for the patella ligament and Achilles tendon forces, respectively, are obtained, but no single best predictive algorithm can be identified. CONCLUSIONS Prediction of tissues loads based on body-mounted IMUs appears promising but requires further investigation before deployment as a general option for users of running watches to reduce running-related injuries.
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Affiliation(s)
- John Rasmussen
- Department of Materials and Production, Aalborg University, Fibigerstraede 16, 9220 Aalborg East, Denmark
| | - Sebastian Skejø
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus, Denmark;
- Research Unit for General Practice, Aarhus University, Bartholins Allé 2, 8000 Aarhus, Denmark
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Nijs A, Roerdink M, Beek PJ. Exploring running styles in the field through cadence and duty factor modulation. PLoS One 2023; 18:e0295423. [PMID: 38060518 PMCID: PMC10703220 DOI: 10.1371/journal.pone.0295423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
According to the dual-axis model, running styles can be defined by cadence and duty factor, variables that have been associated with running performance, economy and injury risk. To guide runners in exploring different running styles, effective instructions to modulate cadence and duty factor are needed. Such instructions have been established for treadmill running, but not for overground running, during which speed can be varied. In this study, five participants completed eight field training sessions over a 4-week training period with acoustic instructions to modulate cadence, duty factor, and, in combination, running style. Instructions were provided via audio files. Running data were collected with sports watches. Participants' experiences with guided-exploration training were evaluated with the user experience questionnaire. Data analysis revealed acoustic pacing and verbal instructions to be effective in respectively modulating cadence and duty factor, albeit with co-varying effects on speed and the non-targeted variable (i.e. duty factor or cadence). Combining acoustic pacing and verbal instructions mitigated these co-varying effects considerably, allowing for running-style modulations in intended directions (particularly towards the styles with increased cadence and increased duty factor). User experience of this form of guided-exploration training was overall positive, but could be improved in terms of autonomy (dependability). In conclusion, combining acoustic pacing and verbal instructions for running-style modulation is effective in overground running.
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Affiliation(s)
- Anouk Nijs
- Department of Human Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Melvyn Roerdink
- Department of Human Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Peter Jan Beek
- Department of Human Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Joachim MR, Kliethermes SA, Heiderscheit BC. Preseason Vertical Center of Mass Displacement During Running and Bone Mineral Density Z-Score Are Risk Factors for Bone Stress Injury Risk in Collegiate Cross-country Runners. J Orthop Sports Phys Ther 2023; 53:1-8. [PMID: 37860857 DOI: 10.2519/jospt.2023.11860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
OBJECTIVES: To (1) assess relationships between running biomechanics, bone health, and bone stress injuries (BSIs), and (2) determine which variables constitute the most parsimonious BSI risk model among collegiate cross-country runners. DESIGN: Prospective, observational cohort study. METHODS: Running gait and bone mineral density (BMD) data from healthy collegiate cross-country runners were collected at preseason over 6 seasons. A generalized estimating equation model with backward selection was used to develop the most parsimonious model for estimating BSI risk, controlling for sex, running speed, and prior BSI. The variables assessed were spatiotemporal, ground reaction force, and joint kinematics, based on previous literature. Quasi-likelihood under the independence model criterion values and R2 values were used to select the best-fitting model. RESULTS: Data from 103 runners were included in the analysis. The best-fitting model included vertical center of mass (COM) displacement and BMD z-score. Injury risk increased with greater vertical COM displacement (unit = 0.5 cm; relative risk [RR] = 1.14; 95% confidence interval [CI]: 1.01, 1.29; P = .04) and decreased with greater BMD z-score (unit = 0.5; RR = 0.83; 95% CI: 0.72, 0.95; P = .007). The model performed similarly when step rate was included instead of vertical COM displacement. CONCLUSION: Vertical COM displacement and BMD z-score contributed to the best model for estimating risk the risk of bone stress injury in cross-country runners. Step rate was also an important variable for assessing injury risk. J Orthop Sports Phys Ther 2023;53(12):1-8. Epub 20 October 2023. doi:10.2519/jospt.2023.11860.
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Affiliation(s)
- Mikel R Joachim
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, WI
- Badger Athletic Performance, University of Wisconsin-Madison, Madison, WI
| | - Stephanie A Kliethermes
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, WI
- Badger Athletic Performance, University of Wisconsin-Madison, Madison, WI
| | - Bryan C Heiderscheit
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, WI
- Badger Athletic Performance, University of Wisconsin-Madison, Madison, WI
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI
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DeJong Lempke AF, Meehan WP, Whitney KE. Running gait adaptations among adolescent runners with soft tissue impairments following lateral ankle sprains. PM R 2023; 15:1557-1564. [PMID: 37249347 DOI: 10.1002/pmrj.13000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/24/2023] [Accepted: 05/01/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Lateral ankle sprains (LAS) frequently lead to residual soft tissue impairments, often attributed to biomechanical dysfunction during movement. OBJECTIVE To compare running biomechanics between adolescent runners with soft tissue pathologies following LAS (injured) and healthy runners (control) and between limbs. DESIGN Retrospective cohort study. SETTING Hospital-affiliated sports injury prevention center. PARTICIPANTS Twenty-five adolescent runners with a history of LAS and current ankle impingement or tendinopathy (23 female, 2 male; age: 15 ± 2 years; body mass index [BMI]: 19.5 ± 2.5 kg/m2 ; symptom duration: 1.1 ± 0.9 years), and 23 healthy controls without any LAS history (19 female, 4 male; age: 15 ± 1 years; BMI: 19.2 ± 2.7 kg/m2 ) were included in this study. INTERVENTIONS All participants completed a clinical gait assessment in which they ran at a self-selected speed on a force-plate instrumented treadmill, while two video cameras recorded two-dimensional sagittal and coronal views. MAIN OUTCOME MEASURES Foot rotation, step width, contact time, and cadence were compared between groups and limbs (involved, uninvolved [or "better" for bilateral cases]) using a multivariate analysis of variance (MANOVA). Rearfoot landing and foot strike type were compared between groups and limbs using a chi-square analysis. RESULTS The injured group had significantly increased step width (F = 4.71, p = .04; mean difference [MD] with SE: 1.5 [0.7] cm) compared to controls. The injured groups' involved limb had longer contact time (F = 4.62, p = .03; MDgroup : 12 [7] ms, MDlimb : 22 [11] ms) with more internal foot rotation (F = 14.60, p < .001; MDgroup : 2.2 [1.2] degrees, MDlimb : 4.2 [1.3] degrees) compared to controls and their contralateral limb. There were no significant differences for cadence (F = 2.43, p = .13; MD: 4 [3] steps/min), foot landing (X2 = 1.28, p = .53), or foot strike (X2 = 1.24, p = .54). CONCLUSIONS Spatiotemporal and kinematic running adaptations may predispose young runners with initial LAS to secondary soft tissue dysfunction due to loss of stability from ligamentous structures and an overreliance on myotendinous control. Clinicians may consider targeting these maladaptations during gait-training interventions.
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Affiliation(s)
| | - William P Meehan
- Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Kristin E Whitney
- Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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DeJong Lempke AF, Jackson S, Stracciolini A, D'Hemecourt PA, Meehan WP, Whitney KE. Adolescent exercise-related lower leg pain musculotendinous characteristics. PM R 2023; 15:1392-1402. [PMID: 36749145 DOI: 10.1002/pmrj.12960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/18/2023] [Accepted: 01/29/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND Exercise-related lower leg pain (ERLLP) is one of the most common injuries among adolescent runners; however, there is limited information available on lower extremity musculotendinous characteristics in relationship to injury. Ultrasound imaging has previously been used to evaluate musculotendinous structures among adults with chronic lower limb injuries. Similar measurement approaches may be adopted to assess young runners with ERLLP. OBJECTIVE To compare ultrasound-derived lower extremity musculotendinous thickness, echogenicity, and muscle fiber pennation angles between adolescent runners with and without ERLLP. DESIGN Cross-sectional design. SETTING Hospital-affiliated sports injury prevention center. PARTICIPANTS Twenty-eight adolescent runners with (N = 14) and without ERLLP (N = 14). INTERVENTIONS Runners' patellar and Achilles tendons, and tibialis anterior, medial gastrocnemius, abductor hallicus, and flexor digitorum brevis muscles were assessed with ultrasound imaging using standardized procedures. MAIN OUTCOME MEASURES Separate repeated measures multivariate analyses of covariance (covariate: gender) were used to compare groups and limbs for mass-normalized musculotendinous thickness, musculotendinous echogenicity, and extrinsic ankle muscle fiber pennation angles. RESULTS The adolescent ERLLP group had reduced average muscle size for all structures except the tibialis anterior compared to the uninjured group (mean difference [MD] range: -0.12-0.49 mm/kg; p range: .002-.05), and reduced average medial gastrocnemius pennation angles on their case limb compared to their contralateral limb and the uninjured group (MD range: -3.7-6.4°; p < .001). The ERLLP group additionally had reduced average patellar and Achilles tendon size (MD range: -0.14--0.15 mm/kg; p range: .02-.03), and lower Achilles tendon echogenicity compared to uninjured counterparts (MD: -18; p = .02). CONCLUSIONS Adolescent runners with ERLLP exhibited morphological musculotendinous changes that may occur either as a result of or as a contributing factor to pain and persistent dysfunction. The findings highlight key targets for rehabilitation for young, injured runners, particularly intrinsic foot muscle strengthening.
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Affiliation(s)
- Alexandra F DeJong Lempke
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
- Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Sarah Jackson
- Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Andrea Stracciolini
- Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Pierre A D'Hemecourt
- Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - William P Meehan
- Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Kristin E Whitney
- Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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DeJong Lempke AF, Whitney KE, Stracciolini A, Ackerman KE, d'Hemecourt PA, Willwerth SB, Meehan WP. Outpatient Runners Clinic Visit Trends and Injury Characteristics Among 392 Child and Adolescent Patients: A 10-year Chart Review. Clin J Sport Med 2023; 33:e166-e171. [PMID: 37432356 DOI: 10.1097/jsm.0000000000001172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/23/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVE To evaluate clinic visits and running-related injury (RRI) characteristics among child and adolescent runners seeking care at an outpatient clinic over a 10-year time frame. DESIGN Retrospective chart review. SETTING Outpatient hospital-affiliated Injured Runners Clinic. PATIENTS Children and adolescent runners (6-17 years) with RRIs. INDEPENDENT VARIABLES We examined electronic medical records (EMRs) among child and adolescent patients in the hospital database from 2011 to 2021 to obtain RRI characteristics and key demographic factors. MAIN OUTCOME MEASURES We assessed volume and frequency of patient visits to the clinic by RRI characteristics. Chi square analyses were used to compare the proportion of clinic visits over time and injury trends by body region and diagnosis. RESULTS There were 392 patients (sex: 277 F; mean age: 16.1 ± 1.3 years) and an average of 5 clinic visits per diagnosis (5 ± 4 visits; min: 1 visit, max: 31 visits). Number of visits generally increased over time up to 2016 but declined most drastically during the years of the pandemic (2020-2021; χ 2 = 644, P < 0 .001). Of the 654 new injury diagnoses, 77.68% were attributed to repetitive stress. Bone stress injuries to the tibia were the most common RRI (χ 2 = 1940, P < 0 .001; N = 132; 20.2% of all injuries) and constituted most of the clinic visits (χ 2 = 9271, P < 0 .001; N = 591; 25.4% of all visits). CONCLUSION We identified that adolescents with overuse injuries, particularly bone stress injuries to the tibia, constituted most of the visits to the outpatient healthcare setting. Clinicians should emphasize injury prevention efforts in clinical practice to reduce RRI burden.
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Affiliation(s)
| | - Kristin E Whitney
- Micheli Center for Sports Injury Prevention, Waltham, Massachusetts
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts; and
| | - Andrea Stracciolini
- Micheli Center for Sports Injury Prevention, Waltham, Massachusetts
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts; and
| | - Kathryn E Ackerman
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts; and
- Wu Tsai Female Athlete Program, Boston Children's Hospital, Boston, Massachusetts
| | - Pierre A d'Hemecourt
- Micheli Center for Sports Injury Prevention, Waltham, Massachusetts
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts; and
| | - Sarah B Willwerth
- Micheli Center for Sports Injury Prevention, Waltham, Massachusetts
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts
| | - William P Meehan
- Micheli Center for Sports Injury Prevention, Waltham, Massachusetts
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts; and
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Nilssen PK, Connolly CP, Johnson KB, Cho SP, Cohoe BH, Miller TK, Laird RH, Sallis RE, Hiller WDB. Medical Encounters and Treatment Outcomes in Ironman-Distance Triathlon. Med Sci Sports Exerc 2023; 55:1968-1976. [PMID: 37332229 DOI: 10.1249/mss.0000000000003235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
PURPOSE This study aimed to examine the injury and illness characteristics, treatments, and outcomes at elite ultraendurance triathlon events. METHODS We quantified participant demographics, injury types, treatments, and disposition for medical encounters at 27 Ironman-distance triathlon championships from 1989 to 2019. We then calculated the likelihood of concurrent medical complaints in each encounter. RESULTS We analyzed 10,533 medical encounters among 49,530 race participants for a cumulative incidence of 221.9/1000 participants (95% confidence interval [CI] = 217.7-226.2). Younger (<35 yr; 259.3/1000, 95% CI = 251.6-267.2) and older athletes (70+ yr; 254.0/1000, 95% CI = 217.8-294.4) presented to the medical tent at higher rates than middle-age adults (36-69 yr; 180.1/1000, 95% CI = 175.4-185.0). Female athletes also presented at higher rates when compared with males (243.9/1000, 95% CI = 234.9-253.2 vs 198.0/1000, 95% CI = 193.4-202.6). The most common complaints were dehydration (438.7/1000, 95% CI = 426.2-451.6) and nausea (400.4/1000, 95% CI = 388.4-412.6). Intravenous fluid was the most common treatment (483/1000; 95% CI = 469.8-496.4). Of the athletes who received medical care, 116.7/1000 (95% CI = 110.1-123.4) did not finish the race, and 17.1/1000 (95% CI = 14.7-19.8) required hospital transport. Athletes rarely presented with an isolated medical condition unless their injury was dermatologic or musculoskeletal in nature. CONCLUSIONS Ultraendurance triathlon events have high rates of medical encounters among female athletes, as well as both younger and older age categories. Gastrointestinal and exertional-related symptoms are among the most common complaints. Intravenous infusions were the most common treatment after basic medical care. Most athletes entering the medical tent finished the race, and a small percentage were dispatched to the hospital. A more thorough understanding of common medical occurrences, including concurrent presentations and treatments, will allow for improved care and optimal race management.
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Affiliation(s)
- Paal K Nilssen
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
| | | | - Kasey B Johnson
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
| | - Stephanie P Cho
- College of Education, Washington State University, Pullman, WA
| | - Blake H Cohoe
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
| | | | | | | | - W Douglas B Hiller
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
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Nurse CA, Lewis CL, Shefelbine SJ. Frontal plane pelvic kinematics during high velocity running: Association with hamstring injury history. Phys Ther Sport 2023; 64:133-139. [PMID: 37890340 DOI: 10.1016/j.ptsp.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023]
Abstract
INTRODUCTION Hamstring injuries are the most prevalent non-contact soft tissue injury in sports, with a larger portion of injuries being recurrent. The sagittal plane running kinematics correlated to hamstring injury history has been well documented. However, analysis of frontal plane kinematics allows for observation of stability and symmetry. This study aimed to examine the frontal plane running kinematics of elite collegiate level sprinters, with and without previous hamstring injury, compared to healthy counterparts. METHODS Thirty-nine participants performed three 50-m sprints, with three inertial measurement unit sensors placed on the pelvis: one on each iliac crest and one on the sacrum. Participants were classified based on sex, competitive status, and injury history. To investigate differences based on group classification, the data were used to analyze mediolateral motion (relative magnitude of mediolateral acceleration) and asymmetry (difference in acceleration between right and left iliac crests) during each stance phase throughout the run. RESULTS Injured sprinters displayed significantly greater mediolateral motion and asymmetry during stances than healthy counterparts. CONCLUSIONS This study demonstrates that frontal plane running stance dynamics are different in athletes with previous hamstring injury than healthy athletes. These athletes may benefit from rehabilitation strategies targeting postural control and stability during dynamic tasks.
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Affiliation(s)
- Cameron A Nurse
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, 37215, USA.
| | - Cara L Lewis
- Department of Physical Therapy, Boston University, Boston, MA, 02215, MA, USA.
| | - Sandra J Shefelbine
- Department of Bioengineering, Northeastern University, Boston, MA, 02115, USA; Department of Mechanical Engineering & Industrial Engineering, Northeastern University, Boston, MA, 02115, USA.
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Xia Y, Shen S, Jia SW, Teng J, Gu Y, Fekete G, Korim T, Zhao H, Wei Q, Yang F. Gender differences in footwear characteristics between half and full marathons in China: a cross-sectional survey. Sci Rep 2023; 13:13020. [PMID: 37563273 PMCID: PMC10415251 DOI: 10.1038/s41598-023-39718-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 07/29/2023] [Indexed: 08/12/2023] Open
Abstract
There are concerns about the risk of injuries caused by marathons in China. Since male and female runners have different injury risks, gender differences in running shoe functionality should be further complemented. A supervised questionnaire survey of 626 marathon runners was collected. The questionnaire was categorized into four sections: (1) participant profile, (2) importance of shoe properties, (3) functional evaluation of shoe properties and (4) importance ranking of shoe properties. The Mann-Whitney U test, Fisher's exact test of cross tabulation and Chi-square test, and two-way ANOVA were used to analyze the results of this survey. The significance level was set at P < 0.05. The full marathon participants were older than the half marathon participants. There was no gender difference in the importance of shoe features to elite runners. In addition, women are more concerned about upper elasticity and have higher requirements for running shoes than men. Women were more focused on injury prevention, while men were more focused on running performance. Heel cushioning was identified by all participants as the most important running shoe feature. There were no gender differences between elite players' demand for running shoes, but significant gender differences were found between genders at other running levels.
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Affiliation(s)
- Yuyu Xia
- School of Social Sciences, Tsinghua University, Beijing, China
| | - Siqin Shen
- Faculty of Sports Science, Ningbo University, Ningbo, China
- Faculty of Engineering, University of Pannonia, Veszprém, Hungary
- Savaria Institute of Technology, Eötvös Loránd University, Szombathely, Hungary
| | - Sheng-Wei Jia
- School of Social Sciences, Tsinghua University, Beijing, China.
- Li Ning Sports Science Research Center, Li Ning (China) Sports Goods Company Limited, Beijing, China.
| | - Jin Teng
- Department of Sports Biomechanics, Beijing Sport University, Beijing, China
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Gusztáv Fekete
- Savaria Institute of Technology, Eötvös Loránd University, Szombathely, Hungary
| | - Tamás Korim
- Department of Materials Engineering, Faculty of Engineering, University of Pannonia, Veszprém, Hungary
| | - Haotian Zhao
- Department of Physical Education, Jiangnan University, Wuxi, 214122, China
| | - Qiang Wei
- Department of Physical Education, Tangshan Normal University, Tangshan, China
| | - Fan Yang
- Li Ning Sports Science Research Center, Li Ning (China) Sports Goods Company Limited, Beijing, China.
- Department of Physical Education and Research, China University of Mining and Technology-Beijing, Beijing, 100083, China.
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Lopes AD, Mascarinas A, Hespanhol L. Are alterations in running biomechanics associated with running injuries? A systematic review with meta-analysis. Braz J Phys Ther 2023; 27:100538. [PMID: 37651773 PMCID: PMC10480598 DOI: 10.1016/j.bjpt.2023.100538] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 08/09/2023] [Accepted: 08/16/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND No systematic review has investigated the main biomechanical variables as predictors of running-related injuries. OBJECTIVE To investigate the main biomechanical variables associated with running-related injuries. METHODS Medline via PubMed, EMBASE, SPORTDiscus, Web of Science, and CINAHL were searched from inception until 1 November 2021. Each study included must have investigated the association of at least one biomechanical variable (kinetics, kinematics, electromyography, or pressure distribution) with running injuries. The meta-analysis was conducted, and a modified version of the Downs and Black Quality Index was used for methodological quality evaluation. RESULTS Across the 82 studies included, 5465 runners were investigated. The meta-analysis was conducted with 11 biomechanical variables from 51 articles (n=2395). The peak hip adduction angle was the sole biomechanical variable associated with running injury and was found to be higher in injured runners (0.57, 95% CI 0.21, 0.94) compared to uninjured runners. However, this result was highly influenced by two studies (out of five studies) conducted by the same group of authors. CONCLUSION Clinicians, coaches, and runners should be aware that minimal evidence supports that alterations of running biomechanics are associated with running-related injuries. Heterogeneity in evaluation conditions and inconsistency in the naming and definitions of biomechanical variables make definitive conclusions challenging. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO, CRD42017068839.
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Affiliation(s)
- Alexandre Dias Lopes
- Department of Physical Therapy, Movement & Rehabilitation Sciences, Northeastern University, Boston, MA, USA.
| | | | - Luiz Hespanhol
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Sao Paulo, SP, Brazil; Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health and the Amsterdam Public Health research institute, VU University Medical Center Amsterdam, Amsterdam, the Netherlands
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Mills K, Collins NJ, Vicenzino B. Transitioning to Barefoot Running Using a Minimalist Shoe Intermediary: A Prospective Cohort Study. Med Sci Sports Exerc 2023; 55:787-793. [PMID: 36728822 DOI: 10.1249/mss.0000000000003111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The objectives of this study are, first, to investigate the probability of runners successfully transitioning from running in a traditional shoe to barefoot. Second, to identify prognostic indicators of failure of transition to barefoot running. METHODS Over 20 wk, 76 healthy runners (female, 40; age, 35.04 yr [SD, 8.9 yr]; body weight, 69.9 kg [SD 13.4 kg]) attempted to transition from running in traditional shoes to running barefoot. A minimalist shoe was used as an intermediary. Participants ran for 4 wk exclusively in provided traditional shoes followed by 4 wk of transitioning to minimalist shoes. This process was repeated to transition to barefoot running. Participants were followed up until they withdrew from the study or successfully transitioned to running barefoot. A survival analysis examined the weeks of successful transition. Along with sex and age, baseline measures of traditional shoe overall comfort, footstrike pattern, midfoot width mobility and plantar foot pressure pain threshold were examined as prognostic variables for failure to transition using Cox regression. RESULTS The cumulative probability of successful transition to running barefoot was 70.8% (95% confidence interval [CI], 61%-83%). The primary footwear-related reason for withdrawal was pain, primarily in the foot ( n = 7), two runners had confirmed injuries. Runners exhibiting a rearfoot strike pattern and higher midfoot width mobility were more likely to fail to transition (hazard ratios [HR], 4.02; 95% CI, 1.33-12.16 and HR, 1.22; 95% CI, 1.05-1.42). CONCLUSIONS Most runners who wish to run barefoot will be able to transition. Our study indicates that there may be biomechanical and anatomical characteristics that are prognostic of failing to transition when using a 20-wk transition period and an intermediary minimalist shoe. Whether a different transition process increases the probability of a success remains to be seen.
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Affiliation(s)
- Kathryn Mills
- Department of Health Sciences, Macquarie University, Sydney, AUSTRALIA
| | | | - Bill Vicenzino
- University of Queensland School of Health and Rehabilitation Sciences: Physiotherapy, University of Queensland, Brisbane, AUSTRALIA
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Blyton SJ, Snodgrass SJ, Pizzari T, Birse SM, Likens AD, Edwards S. The impact of previous musculoskeletal injury on running gait variability: A systematic review. Gait Posture 2023; 101:124-133. [PMID: 36801698 DOI: 10.1016/j.gaitpost.2023.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 01/02/2023] [Accepted: 01/25/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Growing evidence suggests that identifying movement variability alterations in pathological vs. healthy gait may further understanding of injury mechanisms related to gait biomechanics; however, in the context of running and musculoskeletal injuries the role of movement variability remains unclear. RESEARCH QUESTION What is the impact of a previous musculoskeletal injury on running gait variability? METHODS Medline, CINAHL, Embase, Cochrane library and SPORTDiscus were searched from inception until February 2022. Eligibility criteria were (a) included a musculoskeletal injury group, (b) compared running biomechanics data to a control group, (c) measured movement variability for at least one dependent variable, (d) provided a statistical between-group comparison of variability outcomes. Exclusion criteria were neurological conditions impacting gait, upper body musculoskeletal injuries and age < 18 years old. A summative synthesis was performed instead of a meta-analysis due to methodological heterogeneity. RESULTS Seventeen case-control studies were included. The most common deviations in variability observed among the injured groups were: (1) high and low knee-ankle/foot coupling variability and (2) low trunk-pelvis coupling variability. Significant (p < 0.05) between-group differences in movement variability were identified in 8 of 11; 73% of studies of runners with injury-related symptoms, and 3 of 7; 43% of studies of recovered or asymptomatic populations. SIGNIFICANCE This review identified limited to strong evidence that running variability is altered in adults with a recent history of injury for specific joint couplings only. Individuals with ankle instability or pain employed altered running strategies more often than those who have recovered from injury. Altered variability strategies have been proposed to contribute to future running-related injuries, therefore these findings are relevant to clinicians managing active populations.
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Affiliation(s)
- Sarah J Blyton
- School of Environmental and Life Sciences, The University of Newcastle, Ourimbah, New South Wales, Australia.
| | - Suzanne J Snodgrass
- Discipline of Physiotherapy, The University of Newcastle, Callaghan, New South Wales, Australia.
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia.
| | - Samantha M Birse
- School of Environmental and Life Sciences, The University of Newcastle, Ourimbah, New South Wales, Australia.
| | - Aaron D Likens
- Department of Biomechanics and Center for Research in Human Movement Variability, The University of Nebraska, Omaha, United States.
| | - Suzi Edwards
- School of Health Sciences, The University of Sydney, Camperdown, New South Wales, Australia.
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Kennedy MA, Fortington LV, Penney M, Hart NH, d’Hemecourt PA, Sugimoto D. Running Marathons in High School: A 5-Year Review of Injury in a Structured Training Program. Int J Environ Res Public Health 2023; 20:4426. [PMID: 36901436 PMCID: PMC10001535 DOI: 10.3390/ijerph20054426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE The aim in this study was to quantify the number, nature, and severity of injuries sustained by male and female high school students who took part in a running training program that culminated in the completion of a half or full marathon. DESIGN This study is a retrospective clinical audit. METHODS Injury reports from high school students (grades 9-12) who participated in a half or full marathon 30-week progressive training program comprising four training days per week (three running days and one cross-training day) were reviewed. The number of runners completing a marathon, together with the number, nature, severity of injuries, and treatment types, as reported to the program physiotherapist, were the main outcome measures. RESULTS Program completion was 96% (n = 448/469). Of all participants, 186 (39.6%) were injured, with 14 withdrawing from the program due to injury. For those who completed a marathon, 172 (38%) reported 205 musculoskeletal injuries (age of injured runners: 16.3 ± 1.1 years; 88 girls (51.2%) and 84 boys (48.8%)). More than half (n = 113, 55.1%) of the reported injuries were soft tissue injuries. Most injuries were localized to the lower leg (n = 88, 42.9%) and were of a minor nature (n = 181, 90%), requiring only 1-2 treatments. CONCLUSIONS There was a low number of relatively minor injuries for high school participants taking part in a graduated and supervised marathon training program. The injury definition was conservative (i.e., any attendance to physiotherapist) and the relative severity of injuries was minor (i.e., requiring 1-2 treatment sessions). Overall, these results do not support a need to restrict high school students from taking part in marathon running, though continued emphasis on graduated program development and close supervision of young participants is recommended.
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Affiliation(s)
- Mary A. Kennedy
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia
- Nutrition and Health Innovation Research Institute, Edith Cowan University, Joondalup, WA 6027, Australia
| | - Lauren V. Fortington
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia
| | - Matt Penney
- Advanced Sports Therapy, Wellesley, MA 02481, USA
- Sports Rehabilitation Unlimited, Middleton, MA 01949, USA
| | - Nicolas H. Hart
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5000, Australia
- Human Performance Research Centre, School of Sport, Exercise and Rehabilitation, University of Technology (UTS), Sydney, NSW 2021, Australia
- Institute for Health Research, University of Notre Dame Australia, Perth, WA 6027, Australia
| | - Pierre A. d’Hemecourt
- Division of Sports Medicine, Department of Orthopaedics, Boston Children’s Hospital, Waltham, MA 02115, USA
- Harvard Medical School, Harvard University, Boston, MA 02115, USA
- The Micheli Center for Sports Injury Prevention, Boston Children’s Hospital, Waltham, MA 02453, USA
| | - Dai Sugimoto
- The Micheli Center for Sports Injury Prevention, Boston Children’s Hospital, Waltham, MA 02453, USA
- Faculty of Sport Sciences, Waseda University, Tokyo 202-0021, Japan
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Zhang M, Cui J, Liu H. Effect of Flat Running Shoes on Hip Kinematics in Male Recreational Runners. Int J Environ Res Public Health 2022; 19:16473. [PMID: 36554352 PMCID: PMC9778694 DOI: 10.3390/ijerph192416473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Abstract
Patellofemoral joint pain and iliotibial band syndrome are very common running-related injuries. Excessive contralateral pelvic drop, hip adduction, and hip internal rotation have been suggested to be associated with the two injuries. The purpose of this repeated measures and the cross-sectional study was to investigate the effect of flat running shoes on these kinematic variables compared with that of conventional running shoes with a 10 mm drop. Eighteen male recreational runners were recruited to run in flat shoes and conventional shoes with a 10 mm drop, in random order. Impact force data and lower extremity kinematics were synchronously obtained using two Kistler force plates and eight motion infrared cameras, whereas differences in the impact force and hip kinematics were compared using statistical parametric mapping. Regarding hip kinematics, the hip flexion (p = 0.004) and adduction angles (p = 0.004) decreased significantly at 30-70% and 62-85% of the stance phase, respectively, while wearing flat running shoes; the contralateral pelvic drop angle (p = 0.001) decreased significantly at 31-75% of the stance phase while wearing flat running shoes. The knee internal rotation angle (p = 0.035) decreased significantly at 8-17% of the stance phase while wearing flat running shoes compared with conventional running shoes. Given that these kinematic variables are associated with patellofemoral joint pain and iliotibial band syndrome, flat running shoes may have potential benefits for the prevention or treatment of knee injuries.
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Affiliation(s)
- Masen Zhang
- Biomechanics Laboratory, School of Sport Science, Beijing Sport University, Beijing 100084, China
| | - Jing Cui
- Biomechanics Laboratory, School of Sport Science, Beijing Sport University, Beijing 100084, China
| | - Hui Liu
- China Institute of Sport and Health Science, Beijing Sport University, Beijing 100084, China
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Vincent HK, Vincent KR. Healthy Running Habits for the Distance Runner: Clinical Utility of the American College of Sports Medicine Infographic. Curr Sports Med Rep 2022; 21:463-469. [PMID: 36508604 DOI: 10.1249/jsr.0000000000001019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
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.
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Affiliation(s)
- Heather K Vincent
- Department of Physical Medicine and Rehabilitation, UF Health Running Medicine and Sports Performance Center, College of Medicine, University of Florida, Gainesville, FL
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Godin A, Gremeaux V, Servant G, Besson C, Fourchet F, Mourot L. [Prevention and management of running-related injuries]. Rev Med Suisse 2022; 18:1874-1879. [PMID: 36200967 DOI: 10.53738/revmed.2022.18.798.1874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Running related injury is a complex, multifactorial phenomenon that remains difficult to explain. However, there are available tools for clinicians allowing prevention (primary or tertiary) and rehabilitation optimization, thus reducing the consequences of the injury and time before returning to participation. These tools rely mainly on training load monitoring and clinical evaluation of stride biomechanical analysis. Unfortunately, they currently remain poorly known by practitioners, while allowing the opportunity to address the challenge of managing the injured runner, including a faster return to run, but also the prevention of a potential recurrence. It requires targeted intervention and education of the patient on the factors leading to the injury.
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Affiliation(s)
- Antoine Godin
- Physiothérapeute, Unité de recherche EA3920 - Marqueurs pronostiques et facteurs de régulation des pathologies cardiaques et vasculaires, Plateforme exercice, performance, santé et innovation, Université de Bourgogne Franche-Comté, 25000 Besancon, France
| | - Vincent Gremeaux
- Division de médecine physique et réadaptation, Département de l'appareil locomoteur, Centre de médecine du sport, Swiss Olympic Medical Center, Centre hospitalier universitaire vaudois, 1011 Lausanne
- Institut des sciences du sport, Université de Lausanne, 1015 Lausanne
| | - Guillaume Servant
- Département de physiothérapie et laboratoire d'analyse du mouvement, Swiss Olympic Medical Center, Hôpital La Tour, 1217 Meyrin/Genève
| | - Cyril Besson
- Division de médecine physique et réadaptation, Département de l'appareil locomoteur, Centre de médecine du sport, Swiss Olympic Medical Center, Centre hospitalier universitaire vaudois, 1011 Lausanne
- Institut des sciences du sport, Université de Lausanne, 1015 Lausanne
| | - François Fourchet
- Département de physiothérapie et laboratoire d'analyse du mouvement, Swiss Olympic Medical Center, Hôpital La Tour, 1217 Meyrin/Genève
| | - Laurent Mourot
- Physiothérapeute, Unité de recherche EA3920 - Marqueurs pronostiques et facteurs de régulation des pathologies cardiaques et vasculaires, Plateforme exercice, performance, santé et innovation, Université de Bourgogne Franche-Comté, 25000 Besancon, France
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Tinker M, Betten A, Morris S, Gibson N, Allison G, Ng L, Williams G, Chappell A. A comparison of the kinematics and kinetics of barefoot and shod running in children with cerebral palsy. Gait Posture 2022; 98:271-278. [PMID: 36215856 DOI: 10.1016/j.gaitpost.2022.09.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 09/19/2022] [Accepted: 09/24/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The biomechanics of barefoot and shod running are different for typically developing children but unknown for children with cerebral palsy (CP). Such differences may have implications for injury and performance. AIMS The primary aims of this study were to compare the lower limb biomechanics of barefoot and shod running in children with CP, and to determine whether any differences were the same in GMFCS levels I and II. METHODS This cross-sectional study examined 38 children with CP (n = 24 (GMFCS) level I; n = 14 GMFCS II), running overground at 3 speeds (jog, run, sprint) in barefoot and shod conditions. Marker trajectories and force plate data were recorded, and lower limb kinematics, kinetics and spatiotemporal variables were derived. Differences between barefoot and shod running were analysed using linear mixed models. RESULTS For both GMFCS levels, barefoot running resulted in higher loading rates, but smaller impact peaks at all speeds. Barefoot running was associated with greater hip and knee power; less ankle dorsiflexion and hip flexion at initial contact, and less ankle and knee range of motion during stance, compared to shod running, at all speeds. Barefoot stride length was shortened, and cadence increased compared to shod during jogging and running but not sprinting. For GMFCS level I only, barefoot running involved a higher incidence of forefoot strike, greater ankle power generation and less hip range of motion during stance. SIGNIFICANCE Running barefoot may facilitate running performance by increasing power generation at the ankle in children with CP, GMFCS level I. Higher barefoot loading rates may have implications for performance and injury.
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Affiliation(s)
- M Tinker
- School of Allied Health, Curtin University, Bentley WA 6102, Australia
| | - A Betten
- School of Allied Health, Curtin University, Bentley WA 6102, Australia
| | - S Morris
- School of Allied Health, Curtin University, Bentley WA 6102, Australia
| | - N Gibson
- School of Allied Health, Curtin University, Bentley WA 6102, Australia; Perth Children's Hospital, Nedlands WA 6009, Australia
| | - G Allison
- School of Allied Health, Curtin University, Bentley WA 6102, Australia
| | - L Ng
- School of Allied Health, Curtin University, Bentley WA 6102, Australia
| | - G Williams
- School of Physiotherapy, University of Melbourne, Victoria 3010, Australia
| | - A Chappell
- School of Allied Health, Curtin University, Bentley WA 6102, Australia; Western Kids Health, Mt Hawthorn WA 6016, Australia.
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38
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Taylor-Haas JA, Garcia MC, Rauh MJ, Peel S, Paterno MV, Bazett-Jones DM, Ford KR, Long JT. Cadence in youth long-distance runners is predicted by leg length and running speed. Gait Posture 2022; 98:266-270. [PMID: 36209689 DOI: 10.1016/j.gaitpost.2022.09.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/28/2022] [Accepted: 09/24/2022] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- Jeffery A Taylor-Haas
- Division of Occupational and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
| | - Micah C Garcia
- Motion Analysis Lab, Division of Occupational and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Exercise and Rehabilitation Sciences, The University of Toledo, OH, United States.
| | - Mitchell J Rauh
- Doctor of Physical Therapy Program, San Diego State University, San Diego, CA, United States.
| | - Shelby Peel
- School of Kinesiology and Nutrition, University of Southern Mississippi, Hattiesburg, MS, United States.
| | - Mark V Paterno
- Division of Occupational and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
| | - David M Bazett-Jones
- Department of Exercise and Rehabilitation Sciences, The University of Toledo, OH, United States.
| | - Kevin R Ford
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, High Point, NC, United States.
| | - Jason T Long
- Division of Occupational and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Motion Analysis Lab, Division of Occupational and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States; Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
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Burke A, Dillon S, O’Connor S, Whyte EF, Gore S, Moran KA. Comparison of impact accelerations between injury-resistant and recently injured recreational runners. PLoS One 2022; 17:e0273716. [PMID: 36084137 PMCID: PMC9462674 DOI: 10.1371/journal.pone.0273716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/11/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction/Purpose Previous injury has consistently been shown to be one of the greatest risk factors for running-related injuries (RRIs). Runners returning to participation following injury may still demonstrate injury-related mechanics (e.g. repetitive high impact loading), potentially exposing them to further injuries. The aim of this study was to determine if the magnitude (Peakaccel) and rate of loading (Rateaccel) at the tibia and sacrum differ between runners who have never been injured, those who have acquired injury resistance (runners who have not been injured in the past 2 years) and those who have been recently injured (RRI sustained 3–12 months ago). Methods Runners completed an online survey capturing details of their RRI history over the previous 2 years. Never injured runners were matched by sex, quarterly annual mileage and typical training speed to runners who had acquired injury resistance and to runners who had been recently injured. Differences in Peakaccel and Rateaccel of the tibia and sacrum were assessed between the three groups during a treadmill run at a set speed, with consideration for sex. Results A total of 147 runners made up the three injury status groups (n: 49 per group). There was a significant main effect of injury status for Peakaccel and Rateaccel at the sacrum, with recently injured runners demonstrating significantly greater Rateaccel than never injured and acquired injury resistant runners. There was also a significant main effect for sex, with females demonstrating greater tibial Peakaccel, sacrum Peakaccel and Rateaccel than males. Conclusion Rateaccel at the sacrum distinguishes recently injured runners from never injured runners and runners who may have acquired injury resistance, potentially highlighting poor impact acceleration attenuation in recently injured runners.
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Affiliation(s)
- Aoife Burke
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Insight SFI Research Centre for Data Analytics, Dublin City University, Dublin, Ireland
- * E-mail:
| | - Sarah Dillon
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Insight SFI Research Centre for Data Analytics, Dublin City University, Dublin, Ireland
| | - Siobhán O’Connor
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Centre for Injury Prevention and Performance, Athletic Therapy and Training, Dublin City University, Dublin, Ireland
| | - Enda F. Whyte
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Centre for Injury Prevention and Performance, Athletic Therapy and Training, Dublin City University, Dublin, Ireland
| | - Shane Gore
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Insight SFI Research Centre for Data Analytics, Dublin City University, Dublin, Ireland
| | - Kieran A. Moran
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Insight SFI Research Centre for Data Analytics, Dublin City University, Dublin, Ireland
- Centre for Injury Prevention and Performance, Athletic Therapy and Training, Dublin City University, Dublin, Ireland
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Tenforde AS, DeLuca S, Wu AC, Ackerman KE, Lewis M, Rauh MJ, Heiderscheit B, Krabak BJ, Kraus E, Roberts W, Troy KL, Barrack MT. Prevalence and factors associated with bone stress injury in middle school runners. PM R 2022; 14:1056-1067. [PMID: 34251763 DOI: 10.1002/pmrj.12673] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 06/22/2021] [Accepted: 07/02/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Bone stress injury (BSI) in youth runners is clinically important during times of skeletal growth and is not well studied. OBJECTIVE To evaluate the prevalence, anatomical distribution, and factors associated with running-related BSI in boy and girl middle school runners. DESIGN Retrospective cross-sectional study. SETTING Online survey distributed to middle school runners. METHODS Survey evaluated BSI history, age, grade, height, weight, eating behaviors, menstrual function, exercise training, and other health characteristics. MAIN OUTCOME MEASUREMENTS Prevalence and characteristics associated with history of BSI, stratified by cortical-rich (eg, tibia) and trabecular-rich (pelvis and femoral neck) locations. PARTICIPANTS 2107 runners (n = 1250 boys, n = 857 girls), age 13.2 ± 0.9 years. RESULTS One hundred five (4.7%) runners reported a history of 132 BSIs, with higher prevalence in girls than boys (6.7% vs 3.8%, p = .004). The most common location was the tibia (n = 51). Most trabecular-rich BSIs (n = 16, 94% total) were sustained by girls (pelvis: n = 6; femoral neck: n = 6; sacrum: n = 4). In girls, consuming <3 daily meals (odds ratio [OR] = 18.5, 95% confidence interval [CI] = 7.3, 47.4), eating disorder (9.8, 95% CI = 2.0, 47.0), family history of osteoporosis (OR = 6.9, 95% CI = 2.6, 18.0), and age (OR = 1.6, 95% CI = 1.0, 2.6) were associated with BSI. In boys, family history of osteoporosis (OR = 3.2, 95% CI = 1.2, 8.4), prior non-BSI fracture (OR = 3.2, 95% CI = 1.6, 6.7), and running mileage (OR = 1.1, 95% CI = 1.0, 1.1) were associated with BSI. Participating in soccer or basketball ≥2 years was associated with lower odds of BSI for both sexes. CONCLUSION Whereas family history of osteoporosis and prior fracture (non-BSI) were most strongly related to BSI in the youth runners, behaviors contributing to an energy deficit, such as eating disorder and consuming <3 meals daily, also emerged as independent factors associated with BSI. Although cross-sectional design limits determining causality, our findings suggest promoting optimal skeletal health through nutrition and participation in other sports including soccer and basketball may address factors associated with BSI in this population.
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Affiliation(s)
- Adam S Tenforde
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Stephanie DeLuca
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander C Wu
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Kathryn E Ackerman
- Harvard Medical School, Boston, Massachusetts, USA
- Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Margo Lewis
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Mitchell J Rauh
- Doctor of Physical Therapy Program, San Diego State University, San Diego, California, USA
| | - Bryan Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, Wisconsin, USA
| | - Brian J Krabak
- Rehabilitation, Orthopedics and Sports Medicine, University of Washington, Seattle, Washington, USA
| | - Emily Kraus
- Stanford Children's Orthopedic and Sports Medicine Center, Stanford University, Stanford, California, USA
| | - William Roberts
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Karen L Troy
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, Massachusetts, USA
| | - Michelle T Barrack
- Department of Family and Consumer Sciences, California State University, Long Beach, California, USA
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Schmida EA, Wille CM, Stiffler-Joachim MR, Kliethermes SA, Heiderscheit BC. Vertical Loading Rate Is Not Associated with Running Injury, Regardless of Calculation Method. Med Sci Sports Exerc 2022; 54:1382-1388. [PMID: 35320147 PMCID: PMC9288487 DOI: 10.1249/mss.0000000000002917] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Loading rate (LR), the slope of the vertical ground reaction force (vGRF), is commonly used to assess running-related injury risk. However, the relationship between LR and running-related injuries, including bone stress injuries (BSI), is unclear. Inconsistent findings may result from the numerous LR calculation methods that exist and their application across different running speeds. PURPOSE This study aimed to assess the influence of calculation method and running speed on LR values and to determine the association of LR during healthy running with subsequent injury. METHODS Healthy preseason running data and subsequent injury records from Division I cross-country athletes ( n = 79) over four seasons (2015-2019) at 2.68 m·s -1 , preferred training pace, and 4.47 m·s -1 were collected. LR at each speed was calculated four ways: 1) maximum and 2) average slope from 20% to 80% of vGRF magnitude at impact peak (IP), 3) average slope from initial contact to IP, and 4) average slope from 3% to 12% of stance time. Linear mixed effects models and generalized estimation equations were used to assess LR associations. RESULTS LR values differed depending on speed and calculation method ( P value <0.001). The maximum slope from 20% to 80% of the vGRF at 4.47 m·s -1 produced the highest LR estimate and the average slope from initial contact to IP at 2.68 m·s -1 produced the lowest. Sixty-four injuries (20 BSI) were observed. No significant association was found between LR and all injuries or BSI across any calculation method ( P values ≥0.13). CONCLUSIONS Calculation method and running speed result in significantly different LR values. Regardless of calculation method, no association between LR and subsequent injury was identified. Thus, healthy baseline LR may not be useful to prospectively assess running-related injury risk.
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Affiliation(s)
- Elizabeth A. Schmida
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI
| | - Christa M. Wille
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI
| | - Mikel R. Stiffler-Joachim
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI
| | - Stephanie A. Kliethermes
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI
| | - Bryan C. Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI
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de Oliveira V, Santos D, Sinisgalli R, Vancini R, Costa G, Nikolaidis PT, Knechtle B, Weiss K, Andrade M, de Lira C. Factors associated with perceived performance drops and musculoskeletal injuries in Brazilian recreational triathletes. Eur Rev Med Pharmacol Sci 2022; 26:5651-5659. [PMID: 36066136 DOI: 10.26355/eurrev_202208_29498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aim of the study was to investigate sleep characteristics, use of supplements, and training volume of recreational triathletes, and to verify possible associations with perceived performance drops and occurrence of injuries. MATERIALS AND METHODS Recreational triathletes (n=942) answered a questionnaire inquiring about their demographic characteristics, performance, injuries and training volume. RESULTS When comparing athletes who slept more (9-10 hours) with those who slept less, less sleep was associated with a higher prevalence of perceived performance drops. Regarding difficulties in initiating sleep, the absence of initiating difficulties (p<0.001) was a protective factor against perceived performance drops. Regarding weekly training volume, compared to those who trained more than 20 hours, training less than 3 hours (p<0.001), 3-5 hours (p<0.001), or 12-14 hours (p<0.001) were protective factors against perceived performance drops. Concerning training volume and injuries, we found that compared to those who trained more than 20 hours, training 18-20 hours (p<0.001), 15-17 hours (p<0.001), 12-14 hours (p<0.001), 6-8 hours (p<0.001), or 3-5 hours (p<0.001) were protective factors against injuries. CONCLUSIONS Triathletes with a lower sleep quantity and those who have difficulties initiating sleep frequently experience drops in performance. Training volumes can influence both performance and the likelihood of injuries.
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Affiliation(s)
- V de Oliveira
- Human and Exercise Physiology Division, Faculty of Physical Education and Dance, Federal University of Goiás, Goiânia, Brazil.
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Lacey A, Whyte E, O’Keeffe S, O’Connor S, Moran K. A qualitative examination of the factors affecting the adoption of injury focused wearable technologies in recreational runners. PLoS One 2022; 17:e0265475. [PMID: 35793284 PMCID: PMC9258862 DOI: 10.1371/journal.pone.0265475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/10/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose Understanding the perceived efficacy and ease of use of technologies will influence initial adoption and sustained utilization. The objectives of this study were to determine the metrics deemed important by runners for monitoring running-related injury (RRI) risk, and identify the facilitators and barriers to their use of injury focused wearable technologies. Methods A qualitative focus group study was undertaken. Nine semi-structured focus groups with male (n = 13) and female (n = 14) recreational runners took place. Focus groups were audio and video recorded, and transcribed verbatim. Transcripts were thematically analysed. A critical friend approach was taken to data coding, and multiple methods of trustworthiness were executed. Results Excessive loading and inadequate recovery were deemed the most important risk factors to monitor for RRI risk. Other important factors included training activities, injury status and history, and running technique. The location and method of attachment of a wearable device, the design of a smartphone application, and receiving useful injury-related information will affect recreational runners’ adoption of injury focused technologies. Conclusions Overtraining, training-related and individual-related risk factors are essential metrics that need to be monitored for RRI risk. RRI apps should include the metrics deemed important by runners, once there is supporting evidence-based research. The difficulty and/or ease of use of a device, and receiving useful feedback will influence the adoption of injury focused running technologies. There is a clear willingness from recreational runners to adopt injury focused wearable technologies whilst running.
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Affiliation(s)
- Aisling Lacey
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Insight SFI Research Centre for Data Analytics, Dublin, Ireland
- * E-mail:
| | - Enda Whyte
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Centre for Injury Prevention and Performance, School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Sinéad O’Keeffe
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Centre for Injury Prevention and Performance, School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Siobhán O’Connor
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Centre for Injury Prevention and Performance, School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Kieran Moran
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Insight SFI Research Centre for Data Analytics, Dublin, Ireland
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Kelly DK, Wiegand K, Freedman Silvernail J. Dynamic stability in runners with and without plantar fasciitis. Gait Posture 2022; 96:301-305. [PMID: 35753179 DOI: 10.1016/j.gaitpost.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 05/29/2022] [Accepted: 06/02/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Plantar fasciitis (PF) is a common overuse injury experienced by runners. PF may decrease the ability of the plantar fascia to create tension and reduce stability of the foot. Stability of the foot is necessary for whole-body dynamic stability during running which consists of cyclical periods of single leg stance. Given that a major risk factor for running-related injury is previous injury, evaluating dynamic stability in runners with PF, runners with resolved PF, and healthy runners may elucidate differences between these individuals and clarify risk for secondary injury in these groups. RESEARCH QUESTION Is dynamic stability reduced in runners with PF and runners with resolved PF compared to healthy runners? METHODS Thirty runners were recruited for this retrospective comparative study based on mileage and injury status: current PF (PF), resolved PF (RPF), or healthy (CON). Kinematic and kinetic data were collected during running and dynamic stability was determined by time-to-contact (TtC) analysis for early, mid, and late stance to the anterior, posterior, medial, and lateral boundary of the foot. Dynamic stability was compared between groups one-way ANOVAs (α = 0.05) and Tukey post-hoc tests conducted when appropriate. Cohen's d effect sizes (d) were reported for all TtC comparisons (small = 0.20, medium = 0.50, large = 0.80). RESULTS TtC values were shorter in PF compared to the other groups to all boundaries during mid-stance. TtC was significantly greater in PF compared to RPF to the anterior boundary during late stance. SIGNIFICANCE Shorter TtC observed in PF compared to the other groups during midstance may indicate reduced dynamic stability during the most stable portion of running which may lead to increased injury risk.
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Affiliation(s)
- Devin K Kelly
- University of Nevada Las Vegas, 4505 S Maryland Pkwy, Las Vegas, NV 89154, USA
| | - Kristyne Wiegand
- Whittier College, 13406 E Philadelphia St, Whittier, CA 90602, USA
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Rygiel V, Labrador H, Jaworski CA, Chiampas G. Review of Injury Patterns of the 2018 Bank of America Chicago Marathon to Optimize Medical Planning. Curr Sports Med Rep 2022; 21:149-154. [PMID: 35522438 DOI: 10.1249/jsr.0000000000000955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Medical planning for a marathon requires an understanding of the volumes and types of injuries experienced by runners during a race. This chart review of medical records from the 2018 Bank of America Chicago Marathon (N = 1016) measured volume and types of injuries at the race aid stations to determine the impact that race distance has on medical resource utilization. The type and volume of each injured runner diagnosis was compared between quartiles of the race using a chisquare analysis. The most common presenting complaints were musculoskeletal (MSK), followed by medical/other, and then wound care. The proportion of MSK complaints increased over the course of the race, whereas the percentage of medical and wound care complaints was highest at the finish line tents. Understanding the expected volume and type of injuries along the course of a race optimizes medical planning and leads to better utilization of resources and staff.
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Affiliation(s)
- Valerie Rygiel
- Department of Sports Medicine, Midwest Orthopaedic Consultants, Oak Lawn, IL
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Feletti F, Saini G, Naldi S, Casadio C, Mellini L, Feliciani G, Zamprogno E. Injuries in Medium to Long-Distance Triathlon: A Retrospective Analysis of Medical Conditions Treated in Three Editions of the Ironman Competition. J Sports Sci Med 2022; 21:58-67. [PMID: 35250334 PMCID: PMC8851118 DOI: 10.52082/jssm.2022.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 12/07/2021] [Indexed: 06/14/2023]
Abstract
Triathlon's popularity is rapidly increasing, and epidemiological data relating to its related medical conditions is crucial to the development of proper medical plans and safety guidelines for it. This study examined the data from the medical reports collected during three consecutive editions of Ironman Italy, from 2017 to 2019. Out of 10,653 race-starters, 3.3% required medical attention sustaining 472 medical conditions. A significantly higher injury risk was found for females versus males (χ2 = 9.78, p = 0.02) and in long-distance (IR: 4.09/1,000hours) rather than in Olympic/middle distance races (IR: 1.75/1,000hours). Most (68.4%) conditions (including muscular exhaustion, hypothermia, and dehydration) were systemic, whilst only 10.2% were acute traumatic injuries. Of a total of 357 triathletes requiring medical assistance, 8.1% were a candidate for hospitalisation. The equipment and personnel that are required for the medical assistance in future triathlon events were estimated based on Maurer's algorithm, and ten practical recommendations for triathlon medical support were formulated.
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Affiliation(s)
- Francesco Feletti
- Department of Diagnostic Imaging, Ausl Romagna, S. Maria delle Croci Hospital, Ravenna Italy
| | - Gaia Saini
- Department of Emergency, Ausl Romagna, S. Maria delle Croci Hospital, Ravenna, Italy
| | - Stefano Naldi
- Department of Surgery, Unit of Emergency Surgery, S. Maria delle Croci Hospital, Ravenna, Italy
| | - Carlo Casadio
- Associazione dietetica e nutrizione clinica italiana, Rome, Italy
- Comitato di Ravenna, Croce Rossa Italiana, Ravenna, Italy
| | - Lorenzo Mellini
- Department of Diagnostic Imaging, Ausl Romagna, S. Maria delle Croci Hospital, Ravenna Italy
| | - Giacomo Feliciani
- Istituto Scientifico Romagnolo per lo studio e la cura dei tumori - IRCCS, Meldola (FC), Italy
| | - Emanuela Zamprogno
- Critical Care Team I-Help BSO
- Confederazione Nazionale Misericordie d'Italia
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Chang LG, Zaman NN, Chang RG. Clinical Vignette of a Runner's Frustrating Groin Pain. Am J Phys Med Rehabil 2022; 101:e5-e7. [PMID: 34173776 DOI: 10.1097/phm.0000000000001832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Lawrence G Chang
- From the Department of Physical Medicine and Rehabilitation, Burke Rehabilitation Hospital, White Plains, New York (LGC); Department of Physical Medicine and Rehabilitation, Tufts Medical Center, Boston, Massachusetts (NNZ); and Department of Rehabilitation and Human Performance, Mount Sinai Medical Center, Mount Sinai Union Square, New York, New York (RGC)
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Chen TLW, Wong DWC, Wang Y, Tan Q, Lam WK, Zhang M. Changes in segment coordination variability and the impacts of the lower limb across running mileages in half marathons: Implications for running injuries. J Sport Health Sci 2022; 11:67-74. [PMID: 32992036 PMCID: PMC8848018 DOI: 10.1016/j.jshs.2020.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/18/2020] [Accepted: 08/10/2020] [Indexed: 05/08/2023]
Abstract
BACKGROUND Segment coordination variability (CV) is a movement pattern associated with running-related injuries. It can also be adversely affected by a prolonged run. However, research on this topic is currently limited. The purpose of this study was to investigate the effects of a prolonged run on segment CV and vertical loading rates during a treadmill half marathon. METHODS Fifteen healthy runners ran a half marathon on an instrumental treadmill in a biomechanical laboratory. Synchronized kinematic and kinetic data were collected every 2 km (from 2 km until 20 km), and the data were processed by musculoskeletal modeling. Segment CVs were computed from the angle-angle plots of selected pelvis-thigh, thigh-shank, and shank-rearfoot couplings using a modified vector coding technique. The loading rate of vertical ground reaction force was also calculated. A one-way MANOVA with repeated measures was performed on each of the outcome variables to examine the main effect of running mileage. RESULTS Significant effects of running mileage were found on segment CVs (p ≤ 0.010) but not on loading rate (p = 0.881). Notably, during the early stance phase, the CV of pelvis frontal vs. thigh frontal was significantly increased at 20 km compared with the CV at 8 km (g = 0.59, p = 0.022). The CV of shank transverse vs. rearfoot frontal decreased from 2 km to 8 km (g = 0.30, p = 0.020) but then significantly increased at both 18 km (g = 0.05, p < 0.001) and 20 km (g = 0.36, p < 0.001). CONCLUSION At the early stance, runners maintained stable CVs on the sagittal plane, which could explain the unchanged loading rate throughout the half marathon. However, increased CVs on the frontal/transverse plane may be an early sign of fatigue and indicative of possible injury risk. Further studies are necessary for conclusive statements in this regard.
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Affiliation(s)
- Tony Lin-Wei Chen
- Department of Biomedical Engineering, Faculty of Engineering, Hong Kong Polytechnic University, Hong Kong SAR 999077, China; Li Ning Sports Science Research Center, Li Ning (China) Sports Goods Co. Ltd, Beijing 101111, China
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, Hong Kong Polytechnic University, Hong Kong SAR 999077, China; Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen 518057, China
| | - Yan Wang
- Department of Biomedical Engineering, Faculty of Engineering, Hong Kong Polytechnic University, Hong Kong SAR 999077, China; Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen 518057, China
| | - Qitao Tan
- Department of Biomedical Engineering, Faculty of Engineering, Hong Kong Polytechnic University, Hong Kong SAR 999077, China
| | - Wing-Kai Lam
- Li Ning Sports Science Research Center, Li Ning (China) Sports Goods Co. Ltd, Beijing 101111, China; Department of Kinesiology, Shenyang Sports Institute, Shenyang 110102, China.
| | - Ming Zhang
- Department of Biomedical Engineering, Faculty of Engineering, Hong Kong Polytechnic University, Hong Kong SAR 999077, China; Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen 518057, China.
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Djun MHT, Chay JTC. The Association Between Foot Structure and Foot Kinematics During Slow Running. J Am Podiatr Med Assoc 2021; 111. [PMID: 32780124 DOI: 10.7547/18-098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Clinicians routinely assess foot posture as part of their assessment and management of foot pathologies. Flat or high-arched foot postures have been linked to kinematic deviations and increased risk of foot injuries. The Foot Posture Index (FPI) is a valid clinical tool used to classify feet into high-arched, normal-arched, and flat foot groups and predicts foot function during walking well. Walking and running are distinct locomotion styles, and studies have not been performed to correlate FPI to foot function during running. This study aims to investigate the association of FPI scores to foot kinematics during running. The results will further inform clinicians who perform static assessment of feet of individuals who are runners. METHODS Sixty-nine participants had their feet assessed using the FPI scoring system. Based on these scores, the feet were categorized as flat foot, normal-arched, and high-arched. Rearfoot eversion and forefoot dorsiflexion (arch flattening) of the foot were analysed during slow running between 1.4 and 2.2 m/sec. The Pearson correlation was used to analyse the FPI scores on an interval scale, with Cohen's d used to report effect size. One-way analysis of variance and a Bonferroni post hoc test was used to analyze data by category. Level of significance was set at P < .05. RESULTS Thirty-four flat feet, 26 normal-arched feet, and nine high-arched feet were analyzed. The FPI scores correlated significantly with rearfoot eversion (moderate effect size) and forefoot dorsiflexion (low effect size). Rearfoot eversion was greatest in the flat foot, followed by the normal-arched foot and the high-arched foot. Forefoot dorsiflexion was significantly higher in the flat foot compared with the high-arched group. CONCLUSIONS Foot Posture Index scores are positively correlated with rearfoot eversion and forefoot dorsiflexion during running. Clinicians can use this information to aid their foot assessment and management of individuals who are runners.
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Peterson SL, Kingsbury TD, Djafar T, Stewart J, Kuhn KM. Military Service Members with Major Lower Extremity Fractures Return to Running with a Passive-dynamic Ankle-foot Orthosis: Comparison with a Normative Population. Clin Orthop Relat Res 2021; 479:2375-2384. [PMID: 34166305 PMCID: PMC8509958 DOI: 10.1097/corr.0000000000001873] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/07/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lower extremity fractures represent a high percentage of reported injuries in the United States military and can devastate a service member's career. A passive dynamic ankle-foot orthosis (PD-AFO) with a specialized rehabilitation program was initially designed to treat military service members after complex battlefield lower extremity injuries, returning a select group of motivated individuals back to running. For high-demand users of the PD-AFO, the spatiotemporal gait parameters, agility, and quality of life is not fully understood with respect to uninjured runners. QUESTIONS/PURPOSES Do patients who sustained a lower extremity fracture using a PD-AFO with a specialized rehabilitation program differ from uninjured service members acting as controls, as measured by (1) time-distance and biomechanical parameters associated with running, (2) agility testing (using the Comprehensive High-level Activity Mobility Predictor performance test and Four Square Step Test), and (3) the Short Musculoskeletal Function Assessment score. METHODS We conducted a retrospective data analysis of a longitudinally collected data registry of patients using a PD-AFO from 2015 to 2017 at a single institution. The specific study cohort were patients with a unilateral lower extremity fracture who used the PD-AFO for running. Patients had to be fit with a PD-AFO, have completed rehabilitation, and have undergone a three-dimensional (3-D) running analysis at a self-selected speed at the completion of the program. Of the 90 patients who used the PD-AFO for various reasons, 10 male service members with lower extremity fractures who used a PD-AFO for running (median [range] age 29 years [22 to 41], height 1.8 meters [1.7 to 1.9], weight 91.6 kg [70 to 112]) were compared with 15 uninjured male runners in the military (median age 33 years [21 to 42], height 1.8 meters [1.7 to 1.9], weight 81.6 kg [71.2 to 98.9]). The uninjured runners were active-duty service members who voluntarily participated in a gait analysis at their own self-selected running speeds; to meet eligibility for inclusion as an uninjured control, the members had to be fit for full duty without any medical restrictions, and they had to be able to run 5 miles. The controls were then matched to the study group by age, weight, and height. The primary study outcome variables were the running time-distance parameters and frontal and sagittal plane kinematics of the trunk and pelvis during running. The Four Square Step Test, Comprehensive High-level Activity Mobility Predictor scores, and Short Musculoskeletal Function Assessment scores were analyzed for all groups as secondary outcomes. Nonparametric analyses were performed to determine differences between the two groups at p < 0.05. RESULTS For the primary outcome, patients with a PD-AFO exhibited no differences compared with uninjured runners in median (range) running velocity (3.9 meters/second [3.4 to 4.2] versus 4.1 meters/second [3.1 to 4.8], median difference 0.2; p = 0.69), cadence (179 steps/minute [169 to 186] versus 173 steps/minute [159 to 191], median difference 5.8; p = 0.43), stride length (2.6 meters [2.4 to 2.9] versus 2.8 meters [2.3 to 3.3], median difference 0.2; p = 0.23), or sagittal plane parameters such as peak pelvic tilt (24° [15° to 33°] versus 22° [14° to 28°], median difference 1.6°; p = 0.43) and trunk forward flexion (16.2° [7.3° to 23°) versus 15.4° [4.2° to 21°), median difference 0.8°; p > 0.99) with the numbers available. For the secondary outcomes, runners with a PD-AFO performed worse in Comprehensive High-level Activity Mobility Predictor performance testing than uninjured runners did, with their four scores demonstrating a median (range) single-limb stance of 35 seconds (32 to 58) versus 60 seconds (60 to 60) (median difference 25 seconds; p < 0.001), t-test result of 15 seconds (13 to 20) versus 13 seconds (10 to 14) (median difference 2 seconds; p < 0.001), and Illinois Agility Test result of 22 seconds (20 to 25) versus 18 seconds (16 to 20) (median difference 4; p < 0.001). Edgren side step test result of 20 meters (16 to 26) versus 24 meters (16 to 29) (median difference 4 meters; p = 0.11) and the Four Square Step Test of 5.5 seconds (4.1 to 7.2) versus 4.2 seconds (3.1 to 7.3) (median difference 1.3 seconds; p = 0.39) were not different between the groups with an effect size of 0.83 and 0.75, respectively. CONCLUSION The results of our study demonstrate that service members run with discernible differences in high-level mobility and demonstrate inferior self-reported patient functioning while having no differences in speed and biomechanics compared with their noninjured counterparts with the sample size available. This study is an early report on functional gains of highly motivated service members with major lower extremity injuries who use a PD-AFO and formalized therapy program to run. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Shian Liu Peterson
- Department of Orthopedic Surgery, Naval Medical Center San Diego, San Diego, CA, USA
| | - Trevor D. Kingsbury
- Department of Physical Therapy, Naval Medical Center San Diego, San Diego, CA, USA
| | - Tatiana Djafar
- Department of Physical Therapy, Naval Medical Center San Diego, San Diego, CA, USA
| | - Julianne Stewart
- Department of Physical Therapy, Naval Medical Center San Diego, San Diego, CA, USA
| | - Kevin M. Kuhn
- Department of Orthopedic Surgery, Scripps Mercy Hospital, San Diego, CA, USA
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