What are the main running-related musculoskeletal injuries? A Systematic Review

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

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.

Identification of pre-race ultrasonographic abnormalities of the Achilles tendon and association with future injuries in runners

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.

TENDINopathy Severity assessment-Achilles (TENDINS-A): evaluation of reliability and validity in accordance with COSMIN recommendations

OBJECTIVE

To evaluate the construct validity (structural validity and hypothesis testing), reliability (test-retest reliability, measurement error and internal consistency) and minimal important change (MIC) of the 13-item TENDINopathy Severity assessment-Achilles (TENDINS-A).

METHODS

Participants with Achilles pain completed an online survey including: demographics, TENDINS-A, Foot and Ankle Outcome Score (FAOS) and Victorian Institute of Sport Assessment-Achilles (VISA-A). Exploratory factor analysis (EFA) assessed dimensionality. Confirmatory factor analysis (CFA) assessed structural validity (root mean square error of approximation (RMSEA); Comparative Fit Index (CFI); Tucker-Lewis Index (TLI); standardised root measure square (SRMS)). Correlations between TENDINS-A and the FAOS or VISA-A assessed hypothesis testing. Intraclass correlation (ICC) assessed test-retest reliability. Cronbach's alpha assessed internal consistency. SE of the measurement (SEM) assessed measurement error. A distribution-based approach assessed MIC.

RESULTS

79 participants (51% female) with a mean (SD) age=42.6 (13.0) years, height=175.0 (11.7) cm and body mass=82.0 (19.1) kg were included. EFA identified three meaningful factors, proposed as pain, symptoms and function. The best model identified using CFA for TENDINS-A had structural validity (RMSEA=0.101, CFI=0.959, TLI=0.947, SRMS=0.068), which included three factors (pain, symptoms and function), but excluded three items from the original TENDINS-A. TENDINS-A exhibited moderate positive correlation with FAOS (r=0.598, p<0.001) and a moderate negative correlation with VISA-A (r=-0.639, p<0.001). Reliability of the TENDINS-A was excellent (ICC=0.930; Cronbach's α=0.808; SEM=6.54 units), with an MIC of 12 units.

CONCLUSIONS

Our evaluation of the revised 10-item TENDINS-A determined it has construct validity and excellent reliability, compared with the VISA-A and FAOS which lack content and construct validity. The TENDINS-A is recommended as the preferred patient-reported outcome measure to assess disability in people with Achilles tendinopathy.

The Statistical Fragility of Trials Comparing Cervical Disc Arthroplasty and Anterior Cervical Discectomy and Fusion: A Meta Analysis

STUDY DESIGN

Meta-analysis.

OBJECTIVE

To assess the robustness of randomized controlled trials (RCTs) that compared cervical disc arthroplasty (CDA) and anterior cervical discectomy and fusion (ACDF) for the treatment of symptomatic degenerative cervical pathology by using fragility indices.

SUMMARY OF BACKGROUND DATA

RCTs comparing these surgical approaches have shown that CDA may be equivalent or even superior to ACDF due to better preservation of normal spinal kinematics.

MATERIALS AND METHODS

RCTs reporting clinical outcomes after CDA versus ACDF for degenerative cervical disc disease were evaluated. Data for outcome measures were classified as continuous or dichotomous. Continuous outcomes included: Neck Disability Index, overall pain, neck pain, radicular arm pain, and modified Japanese Orthopedic Association scores. Dichotomous outcomes included: any adjacent segment disease (ASD), superior-level ASD, and inferior-level ASD. The fragility index (FI) and continuous FI (CFI) were determined for dichotomous and continuous outcomes, respectively. The corresponding fragility quotient (FQ) and continuous FQ were calculated by dividing FI/CFI by sample size.

RESULTS

Twenty-five studies (78 outcome events) were included. Thirteen dichotomous events had a median FI of 7 [interquartile range (IQR): 3-10], and the median FQ was 0.043 (IQR: 0.035-0.066). Sixty-five continuous events had a median CFI of 14 (IQR: 9-22) and a median continuous FQ of 0.145 (IQR: 0.074-0.188). This indicates that, on average, altering the outcome of 4.3 patients out of 100 for the dichotomous outcomes and 14.5 out of 100 for continuous outcomes would reverse trial significance. Of the 13 dichotomous events that included a loss to follow-up data, 8 (61.5%) represented ≥7 patients lost. Of the 65 continuous events reporting the loss to follow-up data, 22 (33.8%) represented ≥14 patients lost.

CONCLUSION

RCTs comparing ACDF and CDA have fair to moderate statistical robustness and do not suffer from statistical fragility.

Asymmetric running is associated with pain during outdoor running in individuals with Achilles tendinopathy in the return-to-sport phase

OBJECTIVES

To determine the relationships between (1) Achilles tendon pain and loading symmetry, and (2) number of running bouts and symptom severity, during two weeks of outdoor running in individuals with Achilles tendinopathy.

DESIGN

Prospective, observational study.

SETTING

Biomechanics laboratory and outdoors.

PARTICIPANTS

Seventeen runners with Achilles tendinopathy in the return-to-sport phase of rehabilitation.

MAIN OUTCOME MEASURES

Symptom severity was recorded with the Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire. Running bouts and Achilles tendon pain during runs were recorded with daily training logs. Ground contact time was collected during runs with wearable sensors. Linear mixed modeling determined if the relationship between Achilles tendon pain and ground contact time symmetry during running was moderated by consecutive run days. Multiple regression determined the relationship between number of running bouts and change in VISA-A scores over two weeks, adjusted for run distance.

RESULTS

Greater ground contact time on the contralateral leg corresponded to increased ipsilateral tendon pain for each consecutive run day (b = -0.028, p < 0.001). Number of running bouts was not associated with 2-week changes in VISA-A scores (p = 0.672).

CONCLUSIONS

Pain during running is associated with injured leg off-loading patterns, and this relationship strengthened with greater number of consecutive run days. Number of running bouts was not related to short-term symptom severity.

Prevalence of Sonographic Achilles Tendon, Patellar Tendon, and Plantar Fascia Abnormalities in Division I Collegiate Athletes From a Variety of Sports

OBJECTIVE

This study aimed to determine the prevalence of ultrasound abnormalities in the Achilles tendon, patellar tendon, and plantar fascia among a large cohort of collegiate student-athletes.

DESIGN

Observational cross-sectional study.

SETTING

Three Division I institutions.

PARTICIPANTS

243 student-athletes participated in this study. Exclusion criteria included those younger than 18 years or who underwent prior surgery/amputation of structures, including anterior cruciate ligament (ACL) surgeries with patellar tendon grafts.

INTERVENTIONS

Ultrasound examination of the Achilles tendon, patellar tendon, and plantar fascia of each leg was performed. An experienced sonographer reviewed each tendon video in a blinded manner, with a separate experienced sonographer separately reviewing to establish inter-rater reliability.

MAIN OUTCOME MEASURES

The primary outcome measured was the presence of any sonographic abnormality including hypoechogenicity, thickening, or neovascularity.

RESULTS

Ultrasound abnormalities were identified in 10.1%, 37.2%, and 3.9% of all Achilles tendons, patellar tendons, and plantar fasciae, respectively. Abnormalities were significantly associated with the presence of concurrent pain for all structures ( P < 0.01). Specifically, athletes with sonographic abnormalities were approximately 4 times [relative risk (RR) = 4.25; 95% confidence interval (CI), 2.05-8.84], 6 times (RR = 5.69; 95% CI, 2.31-14.00), and 5 times (RR = 5.17; 95% CI, 1.76-15.25) more likely to self-report pain in the Achilles tendon, patellar tendon, and plantar fascia, respectively.

CONCLUSIONS

This multi-institutional study completed at 3 Division I institutions is the largest study of its kind to identify the prevalence of sonographic abnormalities in the Achilles tendon, patellar tendon, and plantar fascia among collegiate student-athletes of various sports.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Do the fasciae of the soleus have a role in plantar fasciitis?

Plantar fasciitis is a chronic, self-limiting, and painful disabling condition affecting the inferomedial aspect of the heel, usually extending toward the metatarsophalangeal joints. There is compelling evidence for a strong correlation between Achilles tendon (AT) loading and plantar aponeurosis (PA) tension. In line with this, tightness of the AT is found in almost 80% of patients affected by plantar fasciitis. A positive correlation has also been reported between gastrocnemius-soleus tightness and heel pain severity in this condition. Despite its high prevalence, the exact etiology and pathological mechanisms underlying plantar heel pain remain unclear. Therefore, the aim of the present paper is to discuss the anatomical and biomechanical substrates of plantar fasciitis with special emphasis on the emerging, though largely neglected, fascial system. In particular, the relationship between the fascia, triceps surae muscle, AT, and PA will be analyzed. We then proceed to discuss how structural and biomechanical alterations of the muscle-tendon-fascia complex due to muscle overuse or injury can create the conditions for the onset of PA pathology. A deeper knowledge of the possible molecular mechanisms underpinning changes in the mechanical properties of the fascial system in response to altered loading and/or muscle contraction could help healthcare professionals and clinicians refine nonoperative treatment strategies and rehabilitation protocols for plantar fasciitis.

The Effects of Lower Leg Compression Garments on Lower Extremity Sports Injuries, Subjective Fatigue and Biomechanical Variables: A Systematic Review with Meta-analysis

The objective of this study was to systematically review the literature on the effect of CGs versus non-CGs (such as regular socks) or versus placebo garments on 1) the incidence of lower extremity sports injuries and 2) subjective ratings of fatigue and biomechanical variables in athletes at participating in any sport that required any level of running performance, given that fatigue-related biomechanical alterations may increase the risk of sports injuries. This study was a systematic review with meta-analyses. PubMed, Embase, CINAHL, Cochrane, PEDro, and Scopus were searched for eligible studies until 7 July 2021. Two reviewers independently assessed the risk of bias using the Cochrane Collaboration's tool for risk of bias. Meta-analyses were performed using a random-effects model. The Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence for all outcome measures. Twenty-three studies, all with a high risk of bias, were included. Nineteen studies were used in the meta-analyses. No studies focused on the effect of CGs on the incidence of lower extremity sports injuries in athletes. Seventeen studies investigated the effect of CGs on subjective ratings of fatigue, but meta-analysis showed no difference in effectiveness between CGs versus non-CGs (such as regular socks) and versus placebo CGs (low certainty evidence). Because of heterogeneity, pooling of the results was not possible for the biomechanical variables. Nonetheless, low certainty evidence showed no effect of CGs. We identified no evidence for a beneficial or detrimental effect of lower leg CGs on the occurrence of lower extremity sports injuries, subjective ratings of fatigue, or biomechanical variables in athletes at any level of running performance. Based on the variable use of running tests, definitions used for biomechanical variables, and reporting of CG characteristics and more standardized reporting is recommended for future studies evaluating CGs.

Patient-reported outcomes during telehealth versus in-person follow-up visits for patients treated with extracorporeal shockwave therapy

BACKGROUND

The limited research describing clinical outcomes using telehealth for management of musculoskeletal conditions is primarily within orthopedic surgery care.

OBJECTIVE

To characterize differences in patient reported outcomes using telehealth compared with in-person follow-up visits in patients with Achilles tendinopathy (AT) or plantar fasciitis (PF) treated using extracorporeal shockwave therapy (ESWT).

DESIGN

Retrospective chart review.

SETTING

Outpatient sports medicine clinic.

PATIENTS

82 patients with AT and 46 patients with PF.

INTERVENTIONS

In-person (n = 76) and telehealth (n = 52) follow-up visits.

MAIN OUTCOME MEASUREMENTS

Victorian Institute of Sports Assessment-Achilles (VISA-A) for AT and Foot and Ankle Ability Measure (FAAM) for PF as well as billing level.

RESULTS

There was significant improvement from baseline to final VISA-A (p < .01) and FAAM (p < .01) following ESWT. No significant difference existed in the proportion of patients who met the minimal clinically important difference based on in-person (71.1%) versus telehealth (71.2%) follow-up (p = .99). The in-person group demonstrated higher billing levels compared to the telehealth group (Level: 3.5 ± 0.6 vs. 2.8 ± 0.7, p < .01).

CONCLUSIONS

Given no significant differences in outcomes between two modes of follow-ups, telehealth may serve as an alternative method to guide management of musculoskeletal injuries with ESWT and other procedures.

Epidemiology, etiology and prevention of injuries in competitive ice speed skating-limited current evidence, multiple future priorities: A scoping review

Long-track and short-track ice speed skating are integral to the Winter Olympics. The state of evidence-based injury prevention in these sports is unclear. Our goals were to summarize the current scientific knowledge, to determine the state of research, and to highlight future research areas for injury prevention in ice speed skating. We conducted a scoping review, searching all injury and injury prevention studies in competitive ice speed skaters. The six-stage Translating Research into Injury Prevention Practice (TRIPP) framework summarized the findings. The systematic search yielded 1109 citations. Nineteen studies were included, and additional searches yielded another 13 studies, but few had high-quality design. TRIPP stage 1 studies (n = 24) found competition injury rates from 2% to 18% of participants with various injury locations and types. Seasonal prevalence of physical complaints was up to 84% (for back pain) in long- and short-track. Ten studies covered information on TRIPP stage 2, with two small etiological studies linking injuries to functional strength deficits (short-track) and training load (long-track). Questionnaire studies identified various perceived risk factors for injuries but lacked further scientific evidence. Most TRIPP stage 3 studies (five out of eight) focused on developing protective measures, while two studies found short-track helmets performed poorly compared to helmets used in other sports. No study evaluated the efficacy, the intervention context, or the effectiveness (TRIPP stages 4-6) of the measures. Scientific knowledge on injury prevention in ice speed skating is limited. Future research should prioritize high-quality studies on injury epidemiology and etiology in the sports.

Injury patterns and healthcare utilisation by runners of the New York City Marathon

Objectives

The purpose of this study was to describe injury patterns and healthcare utilisation of marathon runners.

Methods

This was a previously reported 16-week prospective observational study of runners training for the New York City Marathon. Runners completed a baseline survey including demographics, running experience and marathon goal. Injury surveys were collected every 4 weeks during training, as well as 1 week before and 1 week after the race. Injury details collected included anatomic location, diagnosis, onset, and treatment received.

Results

A total of 1049 runners were enrolled. Injuries were reported by 398 (38.4%) during training and 128 (14.1%) during the marathon. The overall prevalence of injury was 447/1049 (42.6%). Foot, knee and hip injuries were most common during training, whereas knee, thigh and foot injuries were most common during the race. The most frequent tissue type affected was the category of muscle, tendon/fascia and bursa. The prevalence of overuse injuries increased, while acute injuries remained constant throughout training. Hamstring injuries had the highest prevalence of diagnosis with 38/564 injuries (6.7%). Of the 447 runners who reported an injury, 224 (50.1%) received medical care. Physical therapy was the most common medical care received with 115/1037 (11.1%) runners during training and 44/907 (4.9%) postrace.

Conclusion

Runners training and participating in a marathon commonly experience injuries, especially of the foot and knee, which often are overuse soft tissue injuries. Half of the injured runners sought out medical care for their injury. Understanding the patterns of injuries affecting marathon runners could help guide future injury prevention efforts.

Predicting overstriding with wearable IMUs during treadmill and overground running

Running injuries are prevalent, but their exact mechanisms remain unknown largely due to limited real-world biomechanical analysis. Reducing overstriding, the horizontal distance that the foot lands ahead of the body, may be relevant to reducing injury risk. Here, we leverage the geometric relationship between overstriding and lower extremity sagittal segment angles to demonstrate that wearable inertial measurement units (IMUs) can predict overstriding during treadmill and overground running in the laboratory. Ten recreational runners matched their strides to a metronome to systematically vary overstriding during constant-speed treadmill running and showed similar overstriding variation during comfortable-speed overground running. Linear mixed models were used to analyze repeated measures of overstriding and sagittal segment angles measured with motion capture and IMUs. Sagittal segment angles measured with IMUs explained 95% and 98% of the variance in overstriding during treadmill and overground running, respectively. We also found that sagittal segment angles measured with IMUs correlated with peak braking force and explained 88% and 80% of the variance during treadmill and overground running, respectively. This study highlights the potential for IMUs to provide insights into landing and loading patterns over time in real-world running environments, and motivates future research on feedback to modify form and prevent injury.

Epidemiology of insertional and midportion Achilles tendinopathy in runners: A prospective cohort study

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.

The effectiveness of customised 3D-printed insoles on perceived pain, comfort, and completion time among frequent Park Runners: Study protocol for a pragmatic randomised controlled trial (The ZOLES RCT)

BACKGROUND

Running, a popular recreational activity, often leads to the experience of pain and discomfort among participants impacting performance and participation longevity. The ZOLES trial evaluates customised 3D-printed insoles for reducing pain in frequent parkrunners aged 35 and over. An innovative process of foot-scanning and responses to questions relating to size, pain, discomfort, and previous medical conditions are combined leading to the production of personalised 3D-printed orthotics.

METHODS

The ZOLES trial is a pragmatic, outcome assessor blinded, randomised, controlled, superiority trial involving 200 recreational runners, randomised to receive either customised 3D-printed insoles (ZOLES) or to a "do-as-usual" control group. The study follows a robust protocol, ensuring adherence to established guidelines for clinical trials, and is based at St Mary's University, Twickenham, London. The primary outcome is change in running-related pain over a 10-week period, assessed using an 11-point Numeric Rating Scale. Secondary outcomes include overall pain and discomfort, running-related comfort, 5k-completion time, time-loss due to injuries, running exposure, and adherence to the intervention. A balanced-block randomisation process is stratified by sex and parkrun location, and an intention-to-treat analyses will be employed on all outcomes in the primary trial report. The trial includes a 52-week post-market surveillance to assess long-term effects of the customised insoles.

DISCUSSION

The ZOLES trial aims to provide insights into real-world applicability and effectiveness of customised 3D-printed insoles in reducing running-related pain and enhancing overall running experience. Despite the limitation of a subjective primary outcome measure without participant blinding, the methodological rigor, including external outcome assessment and data handling, we anticipate results that are academically credible and applicable in real-world settings The results of this trial may have important implications for runners, clinicians, and the sports footwear industry, as evidence for the use of individualised insoles to improve running experience and prevention of pain may become evident.

TRIAL REGISTRATION

The trial was pre-registered at ClinicalTrials.gov with the trial identifier NCT06034210 on September 4, 2023, and publicly posted on September 13, 2023 (https://clinicaltrials.gov/study/NCT06034210).

PROTOCOL VERSION

Version 1, September 27, 2023.

Consensus statements and guideline for the diagnosis and management of plantar fasciitis in Singapore

Introduction

Plantar fasciitis (PF) is a common cause of heel pain among the general population. The lack of standard practice guideline in Singapore presents challenges in education and clinical practice for this painful condition. These consensus statements and guideline were developed to streamline and improve the management of PF, covering key aspects such as diagnosis, investigations, risk factors, treatment modalities, monitoring and return to work/play.

Method

A multidisciplinary expert panel consisting of 6 sports physicians, 2 orthopaedic surgeons, 2 podiatrists and 1 physiotherapist from SingHealth Duke-NUS Sport & Exercise Medicine Centre (SDSC) was convened based on their clinical and academic experience with PF. The Grading of Recommen-dations, Assessment, Development and Evaluations (GRADE) approach was used to evaluate the quality of the evidence and subsequently prepare a set of clinical recommen-dations pertaining to the manage-ment of PF. A modified Delphi process was used to reach consensus.

Results

Eighteen consensus statements were developed to cover key components of PF management, from initial diagnosis to treatment modalities and finally, clinical progression. They were subsequently consolidated under a proposed treatment pathway guideline for PF.

Conclusion

The SDSC consensus statements and guideline provide concise recommendations for the management of PF in Singapore.

Prevalence and Risk Factors for Musculoskeletal Pain when Running During Pregnancy: A Survey of 3102 Women

BACKGROUND

Musculoskeletal pain while running is a concern to women during pregnancy and can lead to running cessation. To support women who wish to run during pregnancy, it is essential to understand the sites, severities and personal risk factors associated with musculoskeletal pain.

OBJECTIVE

The aim was to investigate prevalence and risk factors for musculoskeletal pain when running during pregnancy.

METHODS

An online survey was completed by women who had a child in the past 5 years and ran prior to and during pregnancy. Pain frequency informed prevalence rates by body site, and logistic regression odds ratios (ORs) and 95% confidence intervals were calculated.

RESULTS

A total of 3102 women of 23 ethnicities from 25 countries completed the survey. Women were 22-52 years old when they gave birth and ran 2-129 km/week during the 0.5-35 years before the birth of their youngest child. Women ran significantly less distance and less often during pregnancy than before pregnancy. Most women (86%) experienced pain while running during pregnancy (59% pelvis/sacroiliac joint, 52% lower back, 51% abdomen, 44% breast, 40% hip). The highest prevalence of severe-to-worst pain was at the pelvis/sacroiliac joint (9%). Women at greatest risk of pain while running during pregnancy had a previous injury (OR = 3.44) or were older (OR = 1.04). Women with a previous child were less likely to experience breast pain (OR = 0.76) than those running during their first pregnancy.

CONCLUSION

Healthcare practices to reduce pain should focus on regions of greatest musculoskeletal change during pregnancy, specifically the pelvis, lower back and abdomen. Efforts to support women to run for longer throughout pregnancy should focus on pain at the pelvis and breasts.

Arch height flexibility is associated with plantar fascia tension during running

BACKGROUND

Plantar fascia tension is considered to cause plantar fasciitis, and medial longitudinal arch decrease is believed to be a risk factor for plantar fasciitis. Arch height index (AHI) and arch height flexibility (AHF) are useful indicators for evaluating medial longitudinal arch. However, the relationship between plantar fascia tension during running and these indicators remain unclear.

RESEARCH QUESTION

Are the foot characteristics in AHI and AHF that represent medial longitudinal arch related to plantar fascia tension during running?

METHODS

Twenty-two male participants enrolled in this study. Foot characteristics required for calculating AHI and AHF were measured using the AHI measurement system. AHI was defined as the height from the floor to the dorsum of the foot divided by the truncated foot length with 10% or 50% load. AHF was defined as the change in arch height from the 10% and 50% loads. Marker trajectories of the foot and force plate data during running were measured using a three-dimensional motion analysis system and a force plate. Based on the measured data, the peak values of the plantar fascia tension were analyzed. Pearson's correlation was used to determine the relationship between foot characteristics and plantar fascia tension.

RESULTS

No significant correlation was found between AHI in the 10% load condition and plantar fascia tension (r = -0.36, p = 0.09) or between AHI in the 50% load condition and plantar fascia tension (r = -0.148, p = 0.515). In contrast, a significant moderate positive correlation was observed between AHF and plantar fascia tension (r = 0.568, p < 0.01).

SIGNIFICANCE

AHF is a change in arch height between sitting and standing positions, can be easily used to evaluate plantar fascia tension in clinical settings. This study implies that evaluating AHF is a useful tool in considering plantar fascia tension during running.

Effects of two gait retraining programs on pain, function, and lower limb kinematics in runners with patellofemoral pain: A randomized controlled trial

BACKGROUND

Patellofemoral Pain (PFP) is one of the main injuries in runners. Consistent evidence support strengthening programs to modulate symptoms, however, few studies investigated the effects of gait retraining programs.

OBJECTIVE

To investigate the effects of two different two-week partially supervised gait retraining programs on pain, function, and lower limb kinematics of runners with PFP.

METHODS

Randomized controlled trial. Thirty runners were allocated to gait retraining groups focusing on impact (n = 10) or cadence (n = 10), or to a control group (n = 10). Impact group received guidance to reduce tibial acceleration by 50%, while cadence group was asked to increase cadence by 7.5-10%. The control group did not receive any intervention. Usual and running pain, knee function, and lower limb kinematics (contralateral pelvic drop, hip adduction, knee flexion, ankle dorsiflexion, tibia inclination, and foot inclination) were evaluated before (T0), immediately after the intervention (T2), and six months after the protocol (T24).

RESULTS

A significant group x time interaction was found for running pain (p = 0.010) and knee function (p = 0.019). Both programs had greater improvements in running pain compared to no intervention at T24 (Impact x Control-mean difference (MD) -3.2, 95% CI -5.1 to -1.3, p = 0.001; Cadence x Control-MD -2.9, 95% CI -4.8 to -1.0, p = 0.002). Participants of the impact group had greater improvements in knee function compared to no intervention at T2 (Impact x Control-MD 10.8, 95% CI 1.0 to 20.6, p = 0.027). No between-group differences in usual pain and lower limb kinematics were found (p>0.05).

CONCLUSION

Compared to no intervention, both programs were more effective in improving running pain six months after the protocol. The program focused on impact was more effective in improving knee function immediately after the intervention. Clinical trial registry number: RBR-8yb47v.

A Randomized Pilot Study Comparing the Impact of Strengthening-Based Running Training with Only Running on the Incidence of Running-Related Injuries among Novice Runners

BACKGROUND

Running-related injuries (RRI) are common in novice runners. Reducing early training running volume with strengthening activities may improve RRI without impeding running performance.

OBJECTIVES

1. Gather feasibility data for a randomized, controlled trial comparing a strengthening-based program to a conventional running program; 2. Assess RRI; and 3. Assess running performance.

METHODS

Seventy-four university students (38 females, 21 ± 2.3 years, 68.2 ± 10.8 kg, BMI: 22.6 ± 2.97), all novice runners, were randomized in two groups, i.e., a strengthening and running group (INT) and a running group (CON). The completed sessions, RRI, dropout, and maximal aerobic speed were recorded through an online application.

RESULTS

The INT group had 52.6% attrition, while the CON group had 41.7%. The INT group had 56.6% adherence, while the CON group had 45.7%. The Chi-square test showed no significant difference in RRI incidence across groups (CHI2 = 2.958, p value = 0.08). A two-way ANOVA showed no significant difference in maximal aerobic speed across groups (p = 0.822) or before and after training (p = 0.304).

CONCLUSIONS

This pilot study confirmed the feasibility of this randomized, controlled trial with a needed sample size of 194. However, novice runners had greater attrition rates when starting. Based on those limited data, strengthening activities that replaced running volume did not improve RRI or maximal aerobic speed.

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

BACKGROUND

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

RESULTS

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

CONCLUSIONS

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

KeepRunning: A MoCap-Based Rapid Test to Prevent Musculoskeletal Running Injuries

The worldwide popularisation of running as a sport and recreational practice has led to a high rate of musculoskeletal injuries, usually caused by a lack of knowledge about the most suitable running technique for each runner. This running technique is determined by a runner's anthropometric body characteristics, dexterity and skill. Therefore, this study aims to develop a motion capture-based running analysis test on a treadmill called KeepRunning to obtain running patterns rapidly, which will aid coaches and clinicians in assessing changes in running technique considering changes in the study variables. Therefore, a review and proposal of the most representative events and variables of analysis in running was conducted to develop the KeepRunning test. Likewise, the minimal detectable change (MDC) in these variables was obtained using test-retest reliability to demonstrate the reproducibility and viability of the test, as well as the use of MDC as a threshold for future assessments. The test-retest consisted of 32 healthy volunteer athletes with a running training routine of at least 15 km per week repeating the test twice. In each test, clusters of markers were placed on the runners' body segments using elastic bands and the volunteers' movements were captured while running on a treadmill. In this study, reproducibility was defined by the intraclass correlation coefficient (ICC) and MDC, obtaining a mean value of ICC = 0.94 ± 0.05 for all variables and MDC = 2.73 ± 1.16° for the angular kinematic variables. The results obtained in the test-retest reveal that the reproducibility of the test was similar or better than that found in the literature. KeepRunning is a running analysis test that provides data from the involved body segments rapidly and easily interpretable. This data allows clinicians and coaches to objectively provide indications for runners to improve their running technique and avoid possible injury. The proposed test can be used in the future with inertial motion capture and other wearable technologies.

Towards functionally individualised designed footwear recommendation for overuse injury prevention: a scoping review

Injury prevention is essential in running due to the risk of overuse injury development. Tailoring running shoes to individual needs may be a promising strategy to reduce this risk. Novel manufacturing processes allow the production of individualised running shoes that incorporate features that meet individual biomechanical and experiential needs. However, specific ways to individualise footwear to reduce injury risk are poorly understood. Therefore, this scoping review provides an overview of (1) footwear design features that have the potential for individualisation; and (2) the literature on the differential responses to footwear design features between selected groups of individuals. These purposes focus exclusively on reducing the risk of overuse injuries. We included studies in the English language on adults that analysed: (1) potential interaction effects between footwear design features and subgroups of runners or covariates (e.g., age, sex) for running-related biomechanical risk factors or injury incidences; (2) footwear comfort perception for a systematically modified footwear design feature. Most of the included articles (n = 107) analysed male runners. Female runners may be more susceptible to footwear-induced changes and overuse injury development; future research should target more heterogonous sampling. Several footwear design features (e.g., midsole characteristics, upper, outsole profile) show potential for individualisation. However, the literature addressing individualised footwear solutions and the potential to reduce biomechanical risk factors is limited. Future studies should leverage more extensive data collections considering relevant covariates and subgroups while systematically modifying isolated footwear design features to inform footwear individualisation.

Platelet-rich plasma injections as a treatment for Achilles tendinopathy and plantar fasciitis in athletes

Platelet-rich plasma (PRP) injections represent a growing interest in the use of biologic therapies for treatment of musculoskeletal injuries. One possible application of PRP is in the management of overuse injuries commonly experienced by athletes. The aim of this review is to evaluate and summarize existing evidence regarding the efficacy of PRP in the treatment of Achilles tendinopathy and plantar fasciitis in athletes. Although many lower quality single-armed studies have demonstrated clinical improvement in athletes treated for Achilles tendinopathy with PRP, higher quality randomized controlled trials (RCTs) have shown no clear benefit in athletes. Existing data suggest PRP significantly improves clinical outcomes for plantar fasciitis in the general population, but very few studies and no RCTs are available that specifically analyze outcomes in athletic populations. More research is needed to evaluate how platelet concentration, leukocyte and erythrocyte presence, and sport type may interact to affect clinical outcomes in athletes.

Three-Month Complication Rate of Ultrasound-Guided Soft Tissue Surgical Procedures Across Six Sports Medicine Clinics

OBJECTIVES

To 1) determine the types and frequency of complications within 3 months following ultrasound-guided surgical procedures, and 2) identify any patient demographics, co-morbidities, or procedural characteristics that were associated with an increased risk of complications.

METHODS

A retrospective chart review was performed at six Sports Medicine clinics across the United States. The Clavien-Dindo classification was used to categorize procedural complications on a 5-point scale from 1, representing any deviation in post-procedure care without requiring pharmacological or invasive treatment to 5, representing death. Generalized Estimating Equations for binomial outcomes with a logit link were used to estimate the overall and procedure-specific 3-month complication rates.

RESULTS

Among 1902 patients, 8.1% (n = 154) had diabetes and 6.3% (n = 119) were current smokers. The analysis included 2,369 procedures, which were performed in either the upper extremity (44.1%, n = 1045) or lower extremity (55.2%, n = 1308) regions. The most common procedure was ultrasound-guided tenotomy (69.9%, n = 1655). Additional procedures included, trigger finger release (13.1%, n = 310), tendon scraping (8.0%, n = 189), carpal tunnel release (5.4%, n = 128), soft tissue release (2.1%, n = 50), and compartment fasciotomy (1.6%, n = 37). Overall, there was a complication rate of 1.2% (n = 29 complications; 95% CI: 0.8-1.7%). Individual procedures had complication rates that ranged from 0 to 2.7%. There were 13 Grade I complications in 13 patients, 12 Grade II complications in 10 patients, 4 Grade III complications in 4 patients, and 0 Grade IV or V complications. No associations between complication risk and any patient demographics (age, sex, BMI), co-morbidities (diabetes, smoker), or procedure characteristics (type, region) were identified.

CONCLUSION

This retrospective review provides an evidence-based estimate supporting the low level of risk associated with ultrasound-guided surgical procedures for patients from a variety of geographical settings who are seeking care at private and academic-affiliated clinics.

Biomechanics and Injury Prevention for Barefoot/Minimalist Running

» Biomechanical studies indicate that barefoot/minimalist running coincides with a transition to an anterior foot strike, lower vertical loading rates, higher cadences, less energy absorption at the knee joint, and higher energy absorption at the ankle joint.» The clinical outcome studies indicate improvement of previous injuries and equivocal injury rates in the barefoot/minimal-style running groups.» Foot strike pattern is more important than footwear regarding injury prevention and vertical loading rate.» Minimalist footwear places higher degrees of stress on the ankle joints and an increased injury rate when abruptly transitioning to barefoot running. Runners must weigh the risks and benefits and take caution to properly strengthen their feet and safely transition to minimalist running.

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

Background

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

Purpose

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

Study Design

Descriptive laboratory study.

Methods

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

Results

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

Conclusion

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

Clinical Relevance

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

Injury and performance related biomechanical differences between recreational and collegiate runners

Introduction

Running related injuries (RRI) are common, but factors contributing to running performance and RRIs are not commonly compared between different types of runners.

Methods

We compared running biomechanics previously linked to RRIs and performance between 27 recreational and 35 collegiate runners. Participants completed 5 overground running trials with their dominant limb striking a force plate, while outfitted with standardised footwear and 3-dimensional motion capture markers.

Results

Post hoc comparisons revealed recreational runners had a larger vertical loading rate (194.5 vs. 111.5 BW/s, p < 0.001) and shank angle (6.80 vs. 2.09, p < 0.001) compared with the collegiate runners who demonstrated greater vertical impulse (0.349 vs. 0.233 BWs, p < 0.001), negative impulse (-0.022 vs. -0.013 BWs, p < 0.001), positive impulse (0.024 vs. 0.014 BWs, p < 0.001), and propulsive force (0.390 vs. 0.333 BW, p = 0.002). Adjusted for speed, collegiate runners demonstrated greater total support moment (TSM), plantar flexor moment, knee extensor moment, hip extensor moment, and had greater proportional plantar flexor moment contribution and less knee extensor moment contribution to the TSM compared with recreational runners. Unadjusted for speed, collegiate runners compared with recreational had greater TSM and plantar flexor moment but similar joint contributions to the TSM.

Discussion

Greater ankle joint contribution may be more efficient and allow for greater capacity to increase speed. Improving plantarflexor function during running provides a strategy to improve running speed among recreational runners. Moreover, differences in joint kinetics and ground reaction force characteristics suggests that recreational and collegiate runners may experience different types of RRI.

An analysis of pain intensity, injury incidence, and their associations with socio-demographic factors in high school athletes: A cross-sectional study during the COVID-19 pandemic

This cross-sectional study explored the relationship between pain intensity, injury incidence, and sociodemographic factors in 120 high school athletes (mean age 16.78±0.91) participating in various sports. The aims of this study are to examine the correlation between factors and Verbal Rating Scale (VRS) for pain intensity, to investigate the correlation between sport types and injured region, and to explore the correlation between injured regions and VRS during training and game competition. Using VRS, we found 64 (53.3%) participants experienced pain during training, with varying degrees of intensity. Chi-square analysis revealed a significant association between VRS scores and school grade (p = 0.044) and cool-down practices (p = 0.037). However, no significant associations were found with gender, age, or sport type. In game competition, 29 (24.2%) participants reported experiencing pain. Here, there was no significant association between VRS and any considered variables. Lower limb injuries were predominant (n = 64), particularly to the knee (n = 23) and ankle/foot (n = 18). Certain sports, like Athletics, Karate-Do, Football, and Western Boxing, demonstrated multiple injury sites, whereas Thai boxing was associated primarily with ankle and foot injuries. Pain intensity varied by injury location, with the highest 'worst pain' reported for elbow injuries during training and knee injuries during competition. Significant associations were found between injured region and pain intensity level during both training and competition (p<0.001). Our findings highlight the need for injury prevention strategies and pain management among high school athletes, emphasizing proper cool-down activities. Further research is warranted to confirm these findings and explore underlying mechanisms.

Identifying characteristics of resistance-based therapeutic exercise interventions for Achilles tendinopathy: A scoping review

OBJECTIVE

This scoping review describes resistance-based therapeutic exercise intervention characteristics for Achilles tendinopathy (AT) treatment (e.g., therapeutic dose, underlying mechanisms targeted by exercise) and assesses participant reporting characteristics.

METHODS

Seven electronic databases were searched; studies delivering a resistance exercise-focused treatment for individuals with AT were included. The Template for Intervention Description and Replication (TIDieR) and the ICON 2019 'Recommended standards for reporting participant characteristics in tendinopathy research' checklists framed data extraction, and study quality was assessed using the Mixed Methods Appraisal Tool 2018 version.

RESULTS

68 publications (describing 59 studies and 72 exercise programs) were included. Results demonstrate that therapeutic exercise interventions for AT are well reported according to the TIDieR checklist, and participant characteristics are well reported according to the ICON checklist. Various underlying therapeutic mechanisms were proposed, with the most common being increasing tendon strength, increasing calf muscle strength, and enhancing collagen synthesis.

CONCLUSIONS

While evidence suggests that resistance-based therapeutic exercise interventions are effective in treating AT, more reporting on program fidelity, adherence, and compliance is needed. By summarizing currently published AT exercise programs and reporting key intervention characteristics in a single location, this review can assist clinicians in developing individualized resistance training programs for people with AT.

Impact of Yoga as an Add-On Intervention on Neurocognitive Functions Among Adult Athletes: A Pilot Study

BACKGROUND

Athletes are vulnerable to musculoskeletal injuries and psychiatric conditions. Previous studies have reported the benefits of yoga on cognitive functions among healthy children, adults, and the elderly. This pilot study aimed to test the neurocognitive functions among athletes with/without yoga intervention.

METHODS

A non-randomized, two-armed parallel-group, single-blind comparative trial was used. The participants were grouped into (i) yoga with sports activity (YSA, n = 15) and (ii) sports activity alone (SA, n = 14). The subjects were assessed at the baseline and after a one-month intervention using digit span forward (DSF), digit span backward (DSB), Trail Making Test (TMT) A & B, and Rey Auditory Verbal Learning Test (RAVLT). A comprehensive one-hour yoga training three days a week for two months constitutes selected asanas (postures), pranayama (breathing techniques), relaxation techniques, and meditation techniques. The control group constitutes the routine sports activity for the same period.

RESULTS

A paired sample t-test showed a significant improvement in cognitive performance on TMT A & B duration and RAVLT total score in the YSA group compared with the SA group. However, a significant trend was observed for DSF, DSB, and RAVLT immediate recall. Independent sample t-test (pre-post change scores) showed no significant group difference in cognitive performance, except there was a significant trend observed related to DSF (p = 0.053) and RAVLT distraction (p = 0.09), where the yoga group showed better performance in cognitive functions.

CONCLUSION

The results suggest that yoga may be integrated with sports to enhance neurocognitive functions.

Low-intensity pulsed ultrasound enhances the positive effects of high-intensity treadmill exercise on bone in rats

INTRODUCTION

Moderate exercise benefits bone health, but excessive loading leads to bone fatigue and a decline in mechanical properties. Low-intensity pulsed ultrasound (LIPUS) can stimulate bone formation. The purpose of this study was to explore whether LIPUS could augment the skeletal benefits of high-intensity exercise.

MATERIALS AND METHODS

MC3T3-E1 osteoblasts were treated with LIPUS at 80 mW/cm2 or 30 mW/cm2 for 20 min/day. Forty rats were divided into sham treatment normal control (Sham-NC), sham treatment high-intensity exercise (Sham-HIE), 80 mW/cm2 LIPUS (LIPUS80), and high-intensity exercise combined with 80 mW/cm2 LIPUS (LIPUS80-HIE). The rats in HIE group were subjected to 30 m/min slope treadmill exercise for 90 min/day, 6 days/week for 12 weeks. The LIPUS80-HIE rats were irradiated with LIPUS (1 MHz, 80 mW/cm2) for 20 min/day at bilateral hind limb after exercise.

RESULTS

LIPUS significantly accelerated the proliferation, differentiation, mineralization, and migration of MC3T3-E1 cells. Compared to 30 mW/cm2 LIPUS, 80 mW/cm2 LIPUS got better promotion effect. 12 weeks of high-intensity exercise significantly reduced the muscle force, which was significantly reversed by LIPUS. Compared with the Sham-NC group, Sham-HIE group significantly optimized bone microstructure and enhanced mechanical properties of femur, and LIPUS80-HIE further enhanced the improvement effect on bone. The mechanisms may be related to activate Wnt/β-catenin signal pathway and then up-regulate the protein expression of Runx2 and VEGF, the key factors of osteogenesis and angiogenesis.

CONCLUSION

LIPUS could augment the skeletal benefits of high-intensity exercise through Wnt/β-catenin signal pathway.

Sex differences in the kinematics and kinetics of the foot and plantar aponeurosis during drop-jump

Plantar fasciitis is one of the most common musculoskeletal injuries in runners and jumpers, with a higher incidence in females. However, mechanisms underlying sex-associated differences in its incidence remain unclear. This study investigated the possible differences in landing and jumping kinematics and kinetics of the foot between sexes during drop-jump activities. Twenty-six participants, including 13 males and 13 females, performed drop-jumps from a platform onto force plates. Nineteen trials including ten males and nine females were selected for inverse dynamics analysis. The patterns of stretch and tensile force generated by the plantar aponeurosis (PA) were estimated using a multi-segment foot model incorporating the PA. Our results demonstrated that dorsiflexion, angular velocity, and normalized plantarflexion moment of the midtarsal joint right after the heel landed on the floor were significantly larger in females than in males. Consequently, the PA strain rate and tensile stress tended to be larger in females than in males. Such differences in the kinematics and kinetics of the foot and the PA between sexes could potentially lead to a higher prevalence of foot injuries such as plantar fasciitis in females.

A New Test for Achilles Tendinopathy Based on Kager's Fat Pad Clinical Assessment Predictive Values

Background This study aimed to check the diagnostic accuracy of a new test to identify Achilles tendinopathy.

STUDY DESIGN

Observational study.

METHODS

Seventy patients recruited from a private medical centre met the diagnostic criteria for unilateral Achilles tendinopathy (age, 45.1 ± 12.7 years; weight, 75.00 ± 10 kg; height, 1.75 ± 0.1 m) and were tested based on both Achilles tendons. Seventy patients with a unilateral Achilles tendinopathy ultrasound diagnosis were tested using David's test.

RESULTS

Most (86%) subjects demonstrated Kager's fat pad asymmetry in relation to the Achilles tendon in the complete passive dorsiflexion in the prone position (David's sign). No healthy tendons had David's sign.

CONCLUSIONS

The presence of asymmetry in Kager's fat pad in relation to the Achilles tendon during complete passive dorsiflexion is strongly indicative of ultrasound-diagnosed tendinopathy. David's test demonstrated a sensitivity of 85.71% (95% CI, 77.51% to 93.91%) and a specificity of 100% (95% CI, 100% to 100%), while noting the lack of blinding of the assessors and the uncertainty of the diagnostic measures (95% CI). Asymmetry of the fat pad could potentially serve as a characteristic marker for patients with Achilles tendinopathy.

Exercise behavior, practice, injury, and symptoms of respiratory tract infection of 502 Brazilian adults during lockdown oscillations in two years (2021-2022) of the COVID-19 pandemic

BACKGROUND

In the period between 2020 and 2023, during the COVID-19 (coronavirus disease 2019) pandemic, many countries released their restriction measures so that individuals were able to begin practicing physical exercises and outdoor sports again. The purpose of the current study was to evaluate the physical exercise behavior, symptoms of respiratory tract infection, and training practice, as well as aspects of pain and injuries in the lower limbs of adults during periods of lockdown oscillations in the two years of the COVID-19 pandemic in Brazil.

METHODS

Cross-sectional study.

PARTICIPANTS

A total of 502 adults were evaluated during two consecutive years of the COVID-19 pandemic, corresponding to the years 2021 and 2022. A virtual questionnaire was applied using the Google Forms platform through a link, or a Quick Response Code available in social media environments. The variables collected were: anthropometric characteristics, presence of comorbidities, clinical history for the diagnosis of COVID-19, and behavior related to physical exercise practices, divided into five topics: (1) physical exercise habits; (2) symptoms and health care utilization; (3) habit of practicing physical exercise in relation to the prevention of COVID-19; (4) preventive measures for COVID-19; and (5) feelings and reasons for practicing exercises.

RESULTS

A total 79.0% of the participants returned to the practice of physical exercise after a period of social isolation due to COVID-19, with running (30.0%) and muscle strength training (50.0%) being the most prevalent modalities, in which 62.0% of practitioners carried out the activity individually, without any professional or technical monitoring. With regard to physical preparation, 61.0% reported performing pre-training stretching, 64.0% associated with muscular resistance training. Of these, 89% did not report current injuries or pain symptoms when returning to exercise (69.0%). Total of 60.5% reported experiencing respiratory tract symptoms of COVID-19 and seeking a consultation with a doctor, and 61.0% performed diagnostic test, with RT-PCR (Real time-polymerase chain reaction) being the most common test. Of those tested, 55.0% were positive for COVID-19, without the need for hospitalization (95.0%). The most commonly used measures for the prevention of COVID-19 were the fabric or surgical mask. The predominant feeling in the pandemic was anxiety (50.5%) and the reasons for practicing sports were: physical conditioning (30.9%), a feeling of pleasure (21.3%), and weight loss (20.3%).

CONCLUSION

After two years of the COVID-19 pandemic (2021-2022), with periods of lockdown, there were low reports of injuries and pain symptoms after exercising on the return to physical exercise practices of running and strength training. However, the restrictions negatively affected the exercise behavior due to respiratory tract symptoms of COVID-19 and a reduction in training intensity, performed without any professional or technical supervision. The participants reported the use of a fabric or surgical mask for the prevention of COVID-19, and an increased feeling of anxiety. The reasons given for practicing physical exercise were physical conditioning, a feeling of pleasure, and weight loss.

Pilot Study: The Relationship between Foot Posture and Movement Quality in Non-Professional Male Football Players

(1) Background: This study focusses on establishing the relationship between quality of movement (based on the functional movement screen, or FMS) and foot posture (based on the foot posture index, or FPI-6). We hypothesised that a poor FMS test score may be derived from the foot position in the space measured by FPI-6. (2) Methods: a quasi-experimental and cross-sectional study was designed to analyse foot posture in 30 healthy football players, using the foot posture index and the functional movement screen. (3) Results: No significant relationships were found between movement quality and foot posture. Poor movement quality is present in more than half of all foot positions, supination, pronation, and neutral. Good quality seems to be more associated with a neutral foot position (23.3%) and supinated (16.6%) than a pronated foot position (6.6%). (4) Conclusions: this study found no relationship between the two tests; therefore, we cannot demonstrate that foot posture is relevant in the quality of the movement of the football players studied.

Evaluating the Suitability of the Low Energy Availability in Females Questionnaire (LEAF-Q) for Female Football Players

BACKGROUND

The Low Energy Availability in Females Questionnaire (LEAF-Q) is a screening tool developed to detect endurance athletes and dancers at risk for development of persistent low energy availability (LEA) and the female athlete triad (Triad). This study investigated the applicability of the LEAF-Q in a cohort of sixty professional female football players.

METHODS

The participants were classified as at risk (≥ 8) or not at risk (< 8) for persistent LEA and the Triad according to their LEAF-Q score, before being compared. Receiver operating curves were then conducted to examine the ability of the overall LEAF-Q and subcategories to correctly determine the presence of clinically defined markers of the Triad. Additionally, Youden's index was calculated to determine the best fitting cut-off values.

RESULTS

Thirty-two percent of participants were classified as at risk by the LEAF-Q. We found no statistically significant differences between the two groups for any markers associated with persistent LEA. Except for acceptable accuracy in determining menstrual status, all other LEAF-Q components exhibited poor accuracy and predictive values. Youden's index scores imply that increasing the overall and injury cut-off values to ≥ 10 and ≥ 5 respectively, would yield increased performance.

CONCLUSIONS

Our findings do not support the use of the LEAF-Q for the purpose of detecting LEA and Triad conditions among female football players.

Externally validated machine learning algorithm accurately predicts medial tibial stress syndrome in military trainees: a multicohort study

Objectives

Medial tibial stress syndrome (MTSS) is a common musculoskeletal injury in both sporting and military settings. No reliable treatments exist, and reoccurrence rates are high. Prevention of MTSS is critical to reducing operational burden. Therefore, this study aimed to build a decision-making model to predict the individual risk of MTSS within officer cadets and test the external validity of the model on a separate military population.

Design

Prospective cohort study.

Methods

This study collected a suite of key variables previously established for predicting MTSS. Data were obtained from 107 cadets (34 women and 73 men). A follow-up survey was conducted at 3 months to determine MTSS diagnoses. Six ensemble learning algorithms were deployed and trained five times on random stratified samples of 75% of the dataset. The resultant algorithms were tested on the remaining 25% of the dataset, with models then compared for accuracy. The most accurate new algorithm was tested on an unrelated data sample of 123 Australian Navy recruits to establish external validity of the model.

Results

Calibrated random forest modelling was the most accurate in identifying a diagnosis of MTSS; (area under curve (AUC)=98%, classification accuracy (CA)=96%). External validation on a sample of Navy recruits resulted in comparable accuracy; (AUC=95%, CA=94%). When the model was tested on the combined datasets, similar accuracy was achieved; (AUC=92%, CA=91%).

Conclusion

This model is highly accurate in predicting those who will develop MTSS. The model provides important preventive capacity which should be trialled as a risk management intervention.

Implementation of 2D Running Gait Analysis in Orthopedic Physical Therapy Clinics

Background

Despite 2D motion analysis deemed valid and reliable in assessing gait deviations in runners, current use of video-based motion analysis among orthopedic physical therapists is not prevalent.

Purpose/Hypothesis

To investigate clinician-perceived effectiveness, adherence, and barriers to using a 2D running gait analysis protocol for patients with running-related injuries.

Study Design

Survey.

Methods

Thirty outpatient physical therapy clinics were contacted to assess interest in participation. Participating therapists were trained on 2D running gait analysis protocol and given a running gait checklist. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to assess the implementation process by collecting a baseline survey at the beginning of the study, effectiveness and implementation surveys at two months, and a maintenance survey at six months.

Results

Twelve of the 15 responding clinics met eligibility criteria, giving a Reach rate of 80%. Twelve clinicians from 10 different clinics participated, giving an Adoption rate of 83%. For Effectiveness, the majority of clinicians valued having a checklist, and reported the protocol was easy to conduct, the methodology was reasonable and appropriate, and patients saw the benefits of using the protocol. Assessing Implementation, 92% performed all steps of the protocol on all appropriate runners. Average time spent conducting the protocol was 32 minutes. With respect to Maintenance, 50% reported continuing to use the protocol, while 50% answered they were not to continue use.

Conclusion

Clinicians expressed a perceived benefit of implementing a running gait analysis protocol with common themes of ease of use, being a useful adjunct to evaluating a patient, and increased satisfaction with treating injured runners. Potential barriers for not using the protocol included not having an appropriate clinic setup, time constraints, and not having adequate caseload.

Level of Evidence

3b.

Foot kinematics in runners with plantar heel pain during running gait

BACKGROUND

Plantar heel pain associated with plantar fascia pathology (PHP) is one of the most common running overuse injuries. Degeneration and changes in the mechanical properties of the plantar fascia associated with PHP can result in changes in foot kinematics during gait.

RESEARCH QUESTION

How do running gait foot kinematics differ between female and male runners with and without PHP?

METHODS

Retrospective study of 13 runners with PHP (7 female, 6 male) and a matched group of 13 uninjured runners (6 female, 7 male). A seven-segment foot model was used to quantify six functional articulations (rearfoot complex, lateral and medial midfoot, lateral and medial forefoot, and first metatarsophalangeal). Functional articulation ROM during early, mid, and propulsion running stance subphases was assessed. Two-way ANOVAs and Friedman's two-way ANOVA for ranks tests were conducted for normally distributed variables and non-normally distributed variables, respectively.

RESULTS

During early stance, PHP runners demonstrated significantly increased lateral midfoot eversion ROM compared to uninjured runners. During the propulsion phase, male runners with PHP demonstrated increased medial midfoot eversion and dorsiflexion ROM and increased medial forefoot plantar flexion compared to uninjured male runners. Also during propulsion, females with PHP went through significantly less medial forefoot plantar flexion ROM compared to uninjured female runners.

SIGNIFICANCE

Given the function of the plantar fascia to assist foot supination, the differences in runners with PHP, which were consistent with increased pronation or inadequate supination, may be the result of insufficient tension during the stance phase of running gait caused by degeneration of the plantar fascia. Further, the significant medial midfoot and medial forefoot group by sex interactions during propulsion suggest that PHP may affect male and female runners differently. Understanding the effect of PHP on foot function during running may aid in the development of future rehabilitation programs and/or treatment outcome assessments.

Does orthotics use improve comfort, speed, and injury rate during running? A randomised control trial

BACKGROUND

Running is a hugely popular sport. Unfortunately, running-related injury (RRI) rates are high, particularly amongst amateur and recreational runners. Finding ways to reduce RRI rates and maximise comfort and performance for runners is important. Evidence regarding whether orthotics can successfully improve these parameters is limited and contradicting. Further research is required to provide runners with clearer guidance on the usefulness of orthotics.

AIM

To investigate the effect of Aetrex Orthotics on comfort, speed and RRI rates during recreational running.

METHODS

One hundred and six recreational runners were recruited on a voluntary basis via running clubs and social media pages and randomised into either the intervention or control group. Participants in the intervention group ran with Aetrex L700 Speed Orthotics inserted in their usual running shoes, whilst participants in the control group ran in their usual running shoes with no orthotics. The study ran for an 8-wk period. Participants provided data relating to running comfort, distance, and time during weeks 3-6. Participants provided data relating to any RRIs they sustained during all 8 wks. Running distance and time were used to calculate running speed in miles per hour (mph). For each outcome variable, 95% confidence intervals and P values were calculated to assess the statistical significance between the groups. For comfort and speed data, univariate multi-level analysis was performed, and for outcome variables with significant between group differences, multi-level multivariate analysis was performed to evaluate any confounding effects of gender and age.

RESULTS

Ninety-four participants were included in the final analysis (drop-out rate = 11%). Comfort and speed from 940 runs and 978 injury data reports were analysed. Participants who ran with orthotics reported, on average, speeds 0.30 mph faster (P = 0.20) and comfort scores 1.27 points higher (P ≤ 0.001) than participants who ran with no orthotics. They were also 2.22 times less likely to sustain an injury (P = 0.08) than participants who ran with no orthotics. However, findings were only significant for comfort and not for speed or injury rates. Age and gender were found to be significant predictors of comfort. However, the improvements in comfort reported by participants who ran with orthotics were still significant after adjusting for age and gender.

CONCLUSION

This study found orthotics to improve comfort and speed and prevent RRIs whilst running. However, these findings were only statistically significant for comfort.

Effects of exercise treatment on functional outcome parameters in mid-portion achilles tendinopathy: a systematic review

Exercise interventions are evident in the treatment of mid-portion Achilles tendinopathy (AT). However, there is still a lack of knowledge concerning the effect of different exercise treatments on improving a specific function (e.g., strength) in this population. Thus, this study aimed to systematically review the effect of exercise treatments on different functional outcomes in mid-portion AT. An electronic database of Pubmed, Web of Science, and Cochrane Central Register of Controlled Trials were searched from inception to 21 February 2023. Studies that investigated changes in plantar flexor function with exercise treatments were considered in mid-portion AT. Only randomized controlled trials (RCTs) and clinical controlled trials (CCTs) were included. Functional outcomes were classified by kinetic (e.g., strength), kinematic [e.g., ankle range of motion (ROM)], and sensorimotor (e.g., balance index) parameters. The types of exercise treatments were classified into eccentric, concentric, and combined (eccentric plus concentric) training modes. Quality assessment was appraised using the Physiotherapy Evidence Database scale for RCTs, and the Joanna Briggs Institute scale for CCTs. The search yielded 2,260 records, and a total of ten studies were included. Due to the heterogeneity of the included studies, a qualitative synthesis was performed. Eccentric training led to improvements in power outcomes (e.g., height of countermovement jump), and in strength outcomes (e.g., peak torque). Concentric training regimens showed moderate enhanced power outcomes. Moreover, one high-quality study showed an improvement in the balance index by eccentric training, whereas the application of concentric training did not. Combined training modalities did not lead to improvements in strength and power outcomes. Plantarflexion and dorsiflexion ROM measures did not show relevant changes by the exercise treatments. In conclusion, eccentric training is evident in improving strength outcomes in AT patients. Moreover, it shows moderate evidence improvements in power and the sensorimotor parameter "balance index". Concentric training presents moderate evidence in the power outcomes and can therefore be considered as an alternative to improve this function. Kinematic analysis of plantarflexion and dorsiflexion ROM might not be useful in AT people. This study expands the knowledge what types of exercise regimes should be considered to improve the functional outcomes in AT.

A Hospital-Based Cross-Sectional Study of Patients With Plantar Fasciitis: Is Hyperuricemia Screening Needed?

Background and aim Generally, asymptomatic hyperuricemia is considered a benign metabolic abnormality with little clinical significance in the absence of gout or renal calculus. However, its clinical association with plantar fasciitis is still not known and is a subject of interest. The study aims to investigate the association between asymptomatic hyperuricemia and plantar fasciitis in otherwise healthy patients. Materials and methods A cross-sectional study was performed, which included 284 patients aged 21-65 years with plantar fasciitis and without any comorbidities between February 2020 and November 2022. One hundred and fifty patients with hyperuricemia who attended the endocrinology and medicine outpatient department without heel pain were included as a control group. Serum uric acid levels were assessed in all cases. Student's t-test, correlation tests, and multiple linear regression were used to ascertain the association between uric acid levels and plantar fasciitis. Statistical analyses were conducted using IBM SPSS Statistics for Windows, Version 19.0 (Released 2010; IBM Corp., Armonk, New York, United States). Results Among the 284 patients, 189 were female (66.5%) and 95 were male (33.4%). Their mean age was 43 ± 9 years (range: 21-65 years). The p-values of the duration of symptoms, visual analog scale for pain (VAS), and foot function index (FFI) total score were p = 0.061, p = 0.068, and p < 0.001, respectively. The mean uric acid levels were 7.6 ± 1.5 mg/dL in males and 7.3 ± 1.3 mg/dL in females in the sample group, and 8.3 ± 1.8 mg/dL in males and 8.1 ± 1.5 mg/dL in females in the control group. According to a Pearson correlation analysis, there was no correlation between serum uric acid level and BMI, VAS, duration of symptoms, FFI pain, disability sub-scores, or FFI total score. Conclusion Although asymptomatic hyperuricemia is a common metabolic abnormality, the present study did not find any significant association between it and plantar fasciitis. Therefore, we can conclude that routine screening for asymptomatic hyperuricemia is not recommended in plantar fasciitis. Evidence level: II.

Sex-related differences in hip and groin injuries in adult runners: a systematic review

OBJECTIVES

Hip/groin running-related injuries (RRIs) are relatively uncommon. It is unclear if runners of either sex are disproportionately affected. Our objective was to systematically review differences in hip/groin RRIs between males and females.

DATA SOURCES

A structured and comprehensive search of four medical literature databases was performed (PubMed, Embase, Ovid Medline, and CINAHL). Terms searched were as follows: risk, epidemiology, hip injury, groin injury, overuse injury, running, sprinting, and track and field.

STUDY SELECTION

Studies reporting sex-specific data on hip/groin RRIs in adult runners were included. Data was extracted and reviewed independently by two authors.

STUDY APPRAISAL AND DATA SYNTHESIS

Sex-specific injury rates, risk factors, and return to sport (RTS) following hip/groin RRI were extracted. Risk of bias was assessed using the Joanna-Briggs Institute Critical Appraisal Tool.

RESULTS

Ten studies with 7,353 total runners were included: 2,315 (47%) males and 2,559 (53%) females. The mean age of the included runners was 37.3 ± 8.9 years and the mean weekly running distance was 10.4 ± 8.4 km. Hip/groin injuries comprised 10.1% (491/4,874) of total RRIs, including 6.3% of RRIs sustained by males and 11.0% by females. Three studies reported significantly higher rates of hip/groin RRIs in female runners. One study reported significantly higher rates of gluteus medius and adductor RRIs for females and males, respectively. One study identified female sex as an independent risk factor for hip/groin RRIs. Three studies reported on RTS after hip/groin RRIs: the pooled RTS rate was 81.4% (57/70) at 1 to 368 days after injury.

LIMITATIONS

Data was pooled when possible; however, there was considerable clinical, methodological, and statistical heterogeneity across studies.

CONCLUSIONS

Hip/groin RRIs comprise a greater percentage of total injuries among injured female runners relative to males. Females may be at a higher risk for sustaining hip/groin RRIs though more research on risk factors and RTS is needed.

Chronic diseases and allergies are risk factors predictive of a history of Medial Tibial Stress Syndrome (MTSS) in distance runners: SAFER study XXIV

BACKGROUND

Medial Tibial Stress Syndrome (MTSS) is one of the most common causes of exercise-associated lower leg pain in distance runners.

AIM

To identify risk factors predictive of a history of MTSS in distance runners entering the Two Oceans Marathon races (21.1 km and 56 km).

DESIGN

Cross-sectional study.

SETTING

2012 to 2015 Two Oceans Marathon races (21.1 km and 56 km).

PARTICIPANTS

Consenting race entrants.

METHODS

106,743 race entrants completed an online pre-race medical screening questionnaire. 76,654 consenting runners (71.8%) were studied. 558 verified MTSS injuries were reported in the previous 12 months. Risk factors predictive of a history of MTSS were explored using uni - & multivariate analyses: demographics (race distance, sex, and age groups), training/racing history, history of chronic diseases, allergies, and medication use.

RESULTS

Independent risk factors predictive of a history of MTSS (adjusted for sex, age group, and race distance) were a higher chronic disease composite score (PR = 3.1 times increase risk for every two additional chronic diseases; p < 0.0001) and a history of allergies (PR = 1.9; p < 0.0001). Chronic diseases (PR > 2) predictive of a history of MTSS were: symptoms of CVD (PR = 4.2; p < 0.0001); GIT disease (PR = 3.3; p < 0.0001); kidney/bladder disease (PR = 3.3; p < 0.0001); nervous system/psychiatric disease (PR = 3.2; p < 0.0001); respiratory disease (PR = 2.9; p < 0.0001) a history of CVD (PR = 2.9; p < 0.0001); and risk factors of CVD (PR = 2.4; p < 0.0001) (univariate analysis). Average running speed was associated with higher risk of MTSS.

CONCLUSION

Novel independent risk factors predictive of a history of MTSS in distance runners (56 km, 21.1 km) were multiple chronic diseases and a history of allergies. Identifying athletes at higher risk for MTSS can guide healthcare professionals in their prevention and rehabilitation efforts.

Integration of yoga within exercise and sports science as a preventive and management strategy for musculoskeletal injuries/disorders and mental disorders - A review of the literature

OBJECTIVES

Exercise-induced musculoskeletal injuries/disorders and associated mental disorders are prevalent among athletes. The main objective of this review is to analyze the prospects of Yoga practices as a preventive and management strategy for musculoskeletal injuries/disorders and associated mental disorders often encountered in exercise and sports activities.

METHODS

A review of the literature was performed using electronic databases such as MEDLINE/PubMed and google scholar published between January 1991 and December 2021 which yielded 88 research articles. The keywords used were yoga OR exercise AND musculoskeletal injuries OR disorders, yoga OR exercise AND mental disorders, yoga AND sports injuries, yoga AND stress, yoga OR exercise AND oxidative stress, yoga OR exercise AND inflammation, yoga OR exercise AND diet.

RESULTS

The moderate and regular exercises are beneficial to health. However, high intensity and overtraining physical activities lead to immune suppression, oxidative stress, muscle damage/fatigue, coronary risk, psychiatric disorders and so on due to enormous strain on various physiological functions. Yoga seems to undermine these adverse activities through up-regulating the functions of the parasympathetic nervous system (PNS) and down-regulating the activities of hypothalamohypophysial axis (HPA) which are conducive to healing, recovery, regeneration, reduction in stress, relaxation of mind, better cognitive functions, promotion of mental health, reduction in inflammation and oxidative stress, and so on.

CONCLUSION

Literature suggests that Yoga should be integrated within exercise and sports sciences mainly to prevent & manage musculoskeletal injuries/disorders and associated mental disorders.

Effects of Trail Running versus Road Running-Effects on Neuromuscular and Endurance Performance-A Two Arm Randomized Controlled Study

Running on less predictable terrain has the potential to increase the stimulation of the neuromuscular system and can boost aerobic performance. Hence, the purpose of this study was to analyze the effects of trail versus road running on neuromuscular and endurance performance parameters in running novices. Twenty sedentary participants were randomly assigned to either a trail (TRAIL; n = 10) or road running (ROAD; n = 10) group. A supervised and progressive, moderate intensity, and work-load-matched 8 wk endurance running program on TRAIL or ROAD was prescribed (i.e., randomized). Static balance (BESS test), dynamic balance (Y-balance test), gait analysis (RehaGait test, with regard to stride time single task, stride length dual task, velocity single task), agility performance (t-test), isokinetic leg strength (BIODEX), and predicted VO₂max were assessed in pre- and post-tests. rANOVA analysis revealed no significant time-group interactions. Large effect sizes (Cohen's d) for pairwise comparison were found for TRAIL in the BESS test (d = 1.2) and predicted (pred) VO₂max (d = 0.95). Moderate effects were evident for ROAD in BESS (d = 0.5), stride time single task (d = 0.52), and VO₂max predicted (d = 0.53). Possible moderate to large effect sizes for stride length dual task (72%), velocity single task (64%), BESS test (60%), and the Y-balance test left stance (51%) in favor of TRAIL occurred. Collectively, the results suggested slightly more beneficial tendencies in favor of TRAIL. Additional research is needed to clearly elucidate differences between TRAIL and ROAD, not only in novices but also in experienced exercisers.

Ultrashort echo time magnetization transfer imaging of knee cartilage and meniscus after long-distance running

OBJECTIVE

To assess the detection of changes in knee cartilage and meniscus of amateur marathon runners before and after long-distance running using a 3D ultrashort echo time MRI sequence with magnetization transfer preparation (UTE-MT).

METHODS

We recruited 23 amateur marathon runners (46 knees) in this prospective cohort study. MRI scans using UTE-MT and UTE-T2* sequences were performed pre-race, 2 days post-race, and 4 weeks post-race. UTE-MT ratio (UTE-MTR) and UTE-T2* were measured for knee cartilage (eight subregions) and meniscus (four subregions). The sequence reproducibility and inter-rater reliability were also investigated.

RESULTS

Both the UTE-MTR and UTE-T2* measurements showed good reproducibility and inter-rater reliability. For most subregions of cartilage and meniscus, the UTE-MTR values decreased 2 days post-race and increased after 4 weeks of rest. Conversely, the UTE-T2* values increased 2 days post-race and decreased after 4 weeks. The UTE-MTR values in lateral tibial plateau, central medial femoral condyle, and medial tibial plateau showed a significant decrease at 2 days post-race compared to the other two time points (p < 0.05). By comparison, no significant UTE-T2* changes were found for any cartilage subregions. For meniscus, the UTE-MTR values in medial posterior horn and lateral posterior horn regions at 2 days post-race were significantly lower than those at pre-race and 4 weeks post-race (p < 0.05). By comparison, only the UTE-T2* values in medial posterior horn showed a significant difference.

CONCLUSIONS

UTE-MTR is a promising method for the detection of dynamic changes in knee cartilage and meniscus after long-distance running.

KEY POINTS

• Long-distance running causes changes in the knee cartilage and meniscus. • UTE-MT monitors dynamic changes of knee cartilage and meniscal non-invasively. • UTE-MT is superior to UTE-T2* in monitoring dynamic changes in knee cartilage and meniscus.

"I loved it, absolutely loved it" a qualitative study exploring what student podiatrists learn volunteering as part of an interprofessional medical team at a marathon

BACKGROUND

Final year podiatry students volunteer annually as part of the wider interprofessional medical team at both the Brighton and London Marathon race events, supervised by qualified podiatrists, allied health professionals and physicians. Volunteering has been reported to be a positive experience for all participants and a way of developing a range of professional, transferable, and where appropriate, clinical skills. We sought to explore the lived experience of 25 students who volunteered at one of these events and aimed to: i) examine the experiential learning reported by students while volunteering in a dynamic and demanding clinical field environment; ii) determine whether there were elements of learning that could be translated to the traditional teaching environment in a pre-registration podiatry course.

METHODS

A qualitative design framework informed by the principles of interpretative phenomenological analysis, was adopted to explore this topic. We used IPA principles to enable analysis of four focus groups over a two-year period to generate findings. Focus group conversations were led by an external researcher, recorded, independently transcribed verbatim and anonymised prior to analysis by two different researchers. To enhance credibility, data analysis was followed by independent verification of themes, in addition to respondent validation.

RESULTS

In total, five themes were identified: i) a new inter-professional working environment, ii) identification of unexpected psychosocial challenges, iii) the rigors of a non-clinical environment, iv) clinical skill development, and v) learning in an interprofessional team. Throughout the focus group conversations, a range of positive and negative experiences were reported by the students. This volunteering opportunity fills a gap in learning as perceived by students, particularly around developing clinical skills and interprofessional working. However, the sometimes-frantic nature of a Marathon race event can both facilitate and impede learning. To maximize learning opportunities, particularly in the interprofessional environment, preparing students for new or different clinical settings remains a considerable challenge.

Risk factors of lower extremity injuries in youth athletes

Objective

Lower extremity sports injuries frequently occur during an individual's growth period. The object of the current study was to analyse the risk factors for lower extremity sports injuries for youth athletes. The secondary objective was to clarify the factors related to new injuries after a lower extremity injury.

Methods

We extracted information on youth athletes (aged 10-15 years) with sports-related disorders. Background data and injury situations were collected via a specific application. During the follow-up period, new injuries were also recorded. The athletes were divided into two groups according to injury location (lower extremity or other). We performed a multiple logistic regression analysis to clarify the association between injury location and background data.

Results

1575 complaints of lower extremity disorders and 328 complaints in other body parts were registered. According to the multiple regression analysis, practice time per week was significantly shorter for the lower extremity group than the other locations group (OR 0.98; 95% CI 0.963 to 0.999). Athletes whose future goal was at the recreational level had a significantly low incidence of new injuries after experiencing lower extremity disorders.

Conclusion

The practice environments and psychological factors should receive more attention to prevent lower extremity injuries.