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Mason J, Starc L, Morin JB, McClelland EL, Zech A. Can the recent sex-specific evolutions in elite running performances be attributed to advanced footwear technology? Front Sports Act Living 2024; 6:1386627. [PMID: 38807616 PMCID: PMC11130513 DOI: 10.3389/fspor.2024.1386627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/02/2024] [Indexed: 05/30/2024] Open
Abstract
Recent improvements in elite running performances across all distances have been largely attributed to the introduction of advanced footwear technology (AFT), which features a curved and stiff plate working synergistically with a new generation of midsole foams demonstrating enhanced resilience and compliance. These recent improvements appear to be considerably more pronounced in women's events, highlighted by improvements in road racing world records by an average of 3.7% (range: 2.6%-5.2%) compared to mean progressions of 1.5% (range: 1.3%-1.9%) in the same men's events. Although there is a growing body of research investigating the mechanisms underpinning running performance enhancements derived from AFT, there remains no explanation for potential sex-based differences in their benefits. We overview the currently available evidence and highlight why the recent direction of AFT research provides a barrier to progress by focusing primarily on male athletes. We subsequently provide our perspective on why women may be benefiting from the new generation of shoes more than men, suggest potential mechanisms leading to hypotheses that need to be further investigated in upcoming studies, and finally propose that factors outside of footwear innovation may have concurrently driven the recently observed performance evolutions.
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Affiliation(s)
- Joel Mason
- Department of Human Movement Science and Exercise Physiology, Institute for Sport Science, Friedrich Schiller University Jena, Jena, Germany
| | - Laura Starc
- School of Behavioural and Health Sciences, Australian Catholic University, Strathfield, NSW, Australia
| | - Jean-Benoit Morin
- Inter-University Laboratory of Human Movement Biology, University Jean Monnet Saint-Etienne, Saint-Etienne, France
| | - Emily L. McClelland
- Locomotor Performance Laboratory, Department of Nursing & Health Sciences, Texas Christian University, Fort Worth, TX, United States
| | - Astrid Zech
- Department of Human Movement Science and Exercise Physiology, Institute for Sport Science, Friedrich Schiller University Jena, Jena, Germany
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Joachim MR, Kuik ML, Krabak BJ, Kraus EM, Rauh MJ, Heiderscheit BC. Risk Factors for Running-Related Injury in High School and Collegiate Cross-country Runners: A Systematic Review. J Orthop Sports Phys Ther 2024; 54:1-13. [PMID: 37970801 DOI: 10.2519/jospt.2023.11550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVE: To summarize and describe risk factors for running-related injuries (RRIs) among high school and collegiate cross-country runners. DESIGN: Descriptive systematic review. LITERATURE SEARCH: Four databases (Scopus, SPORTDiscus, CINAHL, Cochrane) were searched from inception to August 2023. STUDY SELECTION CRITERIA: Studies assessing RRI risk factors in high school or collegiate runners using a prospective design with at least 1 season of follow-up were included. DATA SYNTHESIS: Results across each study for a given risk factor were summarized and described. The NOS and GRADE frameworks were used to evaluate quality of each study and certainty of evidence for each risk factor. RESULTS: Twenty-four studies were included. Overall, study quality and certainty of evidence were low to moderate. Females or runners with prior RRI or increased RED-S (relative energy deficiency in sport) risk factors were most at risk for RRI, as were runners with a quadriceps angle of >20° and lower step rates. Runners with weaker thigh muscle groups had increased risk of anterior knee pain. Certainty of evidence regarding training, sleep, and specialization was low, but suggests that changes in training volume, poorer sleep, and increased specialization may increase RRI risk. CONCLUSION: The strongest predictors of RRI in high school and collegiate cross-country runners were sex and RRI history, which are nonmodifiable. There was moderate certainty that increased RED-S risk factors increased RRI risk, particularly bone stress injuries. There was limited evidence that changes in training and sleep quality influenced RRI risk, but these are modifiable factors that should be studied further in this population. J Orthop Sports Phys Ther 2024;54(2):1-13. Epub 16 November 2023. doi:10.2519/jospt.2023.11550.
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Sheikhi B, Akbari H, Heiderscheit B. Cross cultural adaptation, reliability and validity of the Persian version of the university of Wisconsin running injury and recovery index. BMC Musculoskelet Disord 2024; 25:41. [PMID: 38195422 PMCID: PMC10775526 DOI: 10.1186/s12891-024-07171-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/04/2024] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND The University of Wisconsin Running Injury and Recovery Index (UWRI) was developed to evaluate running ability after a running-related injury. The aim of this study was to translate and cross-culturally adapt the UWRI into Persian (UWRI-Persian) and to investigate its psychometric properties in patients with a running-related injury. METHODS The UWRI-Persian was translated using the Beaton guidelines. One hundred and seventy-three native Persian patients with running-related injuries were participated in the study. The exploratory factor analysis was carried out using the principal component analysis method with Varimax rotation. The construct validity of the UWRI-Persian was evaluated using the Pearson correlation with the pain self-efficacy questionnaire (PSEQ), Tampa scale for Kinesiophobia (TKS), and visual analogue scale (VAS). Test-retest reliability was tested among 64 patients who completed the form again after seven days. RESULTS The UWRI-Persian showed excellent internal consistency for total score (α = 0.966). An excellent internal consistency (α = 0.922) was shown for psychological response and good internal consistency (α = 0.887) for running progression. The interclass correlation coefficient for the UWRI-Persian total scores was 0.965 (95% CI, 0.942 to 0.979), indicating high intra-rater reliability. The UWRI-Persian showed a moderate correlation with the PSEQ (r = 0.425) and the TSK (r = 0.457) and a weak correlation with the VAS (r = 0.187). These findings suggest no floor or ceiling effects. CONCLUSIONS The UWRI is a reliable and valid tool for Persian-speaking patients with running-related injuries. The UWRI was successfully translated from English to Persian and demonstrated good to excellent internal consistency, validity and reliability with no floor or ceiling effects.
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Affiliation(s)
- Bahram Sheikhi
- Department of Biomechanics and Sport Injuries, Kharazmi University, Tehran, Iran.
| | - Hadi Akbari
- Department of Sport Sciences, University of Zabol, Zabol, Iran
| | - Bryan Heiderscheit
- Department of Orthopedics and Rehabilitation, Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, US
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Joachim MR, Kliethermes SA, Heiderscheit BC. Preinjury Knee and Ankle Mechanics during Running Are Reduced among Collegiate Runners Who Develop Achilles Tendinopathy. Med Sci Sports Exerc 2024; 56:128-133. [PMID: 37703042 DOI: 10.1249/mss.0000000000003276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
INTRODUCTION Achilles tendinopathies (AT) are common in runners, but prospective data assessing running mechanics associated with developing AT are limited. Asymmetry in running mechanics is also considered a risk factor for injury, although it is unknown if the problematic mechanics occur on the injured limb only or are present bilaterally. PURPOSE This study aimed to prospectively identify differences in preinjury running biomechanics in collegiate runners who did and did not develop AT and determine if between-limb asymmetries were associated with which limb developed AT. METHODS Running gait data were obtained preseason on healthy collegiate cross-country runners, and AT incidence was prospectively recorded each year. Spatiotemporal, ground reaction forces, and joint kinematics and kinetics were analyzed. Linear mixed-effects models assessed differences in biomechanics between those who did and did not develop AT during the subsequent year. Generalized linear mixed-effects models determined if the asymmetry direction was associated with which limb developed an AT, with odds ratios (OR) and 95% confidence intervals (95% CI) reported. RESULTS Data from 106 runners were analyzed and 15 developed AT. Preinjury biomechanics of runners who developed AT showed less peak knee flexion (noninjured: 45.9° (45.2°-46.6°), injured: 43.2° (41.5°-44.9°), P < 0.001), ankle dorsiflexion (noninjured: 28.7° (28.0°-30.2°), injured: 26.0° (23.8°-28.3°), P = 0.01), and knee extensor moment (noninjured: -2.18 (N·m)·kg -1 (-2.24 to -2.12 (N·m)·kg -1 ), injured: -2.00 (N·m)·kg -1 (-2.17 to -1.84 (N·m)·kg -1 ), P = 0.02). The limb demonstrating less peak knee flexion had greater odds of sustaining an AT (OR, 1.29 (1.00-1.65), P = 0.05). CONCLUSIONS Knee and ankle kinematics, in addition to knee kinetics, were associated with developing an AT. Monitoring these mechanics may be useful for prospectively identifying runners at risk of developing AT.
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Iaconisi GN, Gallo N, Caforio L, Ricci V, Fiermonte G, Della Tommasa S, Bernetti A, Dolce V, Farì G, Capobianco L. Clinical and Biochemical Implications of Hyaluronic Acid in Musculoskeletal Rehabilitation: A Comprehensive Review. J Pers Med 2023; 13:1647. [PMID: 38138874 PMCID: PMC10744407 DOI: 10.3390/jpm13121647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/20/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
Hyaluronic acid (HA) naturally occurs as a biopolymer in the human body, primarily in connective tissues like joints and skin. Functioning as a vital element of synovial fluid, it lubricates joints, facilitating fluid movement and diminishing bone friction to protect articular well-being. Its distinctive attributes encompass notable viscosity and water retention capacities, ensuring flexibility and absorbing shock during motion. Furthermore, HA has gained significant attention for its potential benefits in various medical applications, including rehabilitation. Ongoing research explores its properties and functions, especially its biomedical applications in several clinical trials, with a focus on its role in improving rehabilitation outcomes. But the clinical and biochemical implications of HA in musculoskeletal rehabilitation have yet to be fully explored. This review thoroughly investigates the properties and functions of HA while highlighting its biomedical applications in different clinical trials, with a special emphasis on its role in rehabilitation. The presented findings provide evidence that HA, as a natural substance, enhances the outcomes of musculoskeletal rehabilitation through its exceptional mechanical and biochemical effects.
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Affiliation(s)
- Giorgia Natalia Iaconisi
- Department of Biological and Environmental Science and Technologies (Di.S.Te.B.A.), University of Salento, 73100 Lecce, Italy; (G.N.I.); (A.B.)
| | - Nunzia Gallo
- Department of Engineering for Innovation, University of Salento, 73100 Lecce, Italy;
| | - Laura Caforio
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, Aldo Moro University, 70121 Bari, Italy;
| | - Vincenzo Ricci
- Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy;
| | - Giuseppe Fiermonte
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari, 70125 Bari, Italy;
| | - Simone Della Tommasa
- Department for Horses, Faculty of Veterinary Medicine, Leipzig University, 04109 Leipzig, Germany;
| | - Andrea Bernetti
- Department of Biological and Environmental Science and Technologies (Di.S.Te.B.A.), University of Salento, 73100 Lecce, Italy; (G.N.I.); (A.B.)
| | - Vincenza Dolce
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Arcavacata di Rende, Italy;
| | - Giacomo Farì
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy
| | - Loredana Capobianco
- Department of Biological and Environmental Science and Technologies (Di.S.Te.B.A.), University of Salento, 73100 Lecce, Italy; (G.N.I.); (A.B.)
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Lacey A, Whyte E, O’Keeffe S, O’Connor S, Burke A, Moran K. The Running Injury Continuum: A qualitative examination of recreational runners' description and management of injury. PLoS One 2023; 18:e0292369. [PMID: 37792711 PMCID: PMC10550191 DOI: 10.1371/journal.pone.0292369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/19/2023] [Indexed: 10/06/2023] Open
Abstract
INTRODUCTION A critical step in understanding and preventing running-related injuries (RRIs) is appropriately defining RRIs. Current definitions of RRIs may not represent the full process of injury development, failing to capture lower levels of injury that many athletes continue to train through. Understanding runners' description and management of the injury development process may allow for a more appropriate examination of all levels of injury. This study aimed to examine recreational runners' description and management of the injury development process. METHODS A qualitative focus group study was undertaken. Seven semi-structured focus groups with male (n = 13) and female (n = 18) recreational runners took place. Focus groups were audio and video recorded, and transcribed verbatim. Transcripts were reflexively thematically analysed. A critical friend approach was taken to data coding. Multiple methods of trustworthiness were executed. RESULTS Runners describe injury on a nine-level continuum, ranging from injury-free to career-ending injury. There are lower and higher levels of injury. Each level of injury is described across four categories of descriptors; physical description, outcome (effect on running and daily life), psychological description, and management. CONCLUSION The Running Injury Continuum is a tool that can be used for injury surveillance (for healthcare professionals and researchers) and for research investigating RRI risk factors. Healthcare professionals, researchers and coaches must ensure they monitor the development of all levels of RRIs, across all categories of descriptors. Runners need to be educated regarding appropriate self-management strategies for lower level injuries, with access to evidence-based information being a critical management tool.
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Affiliation(s)
- Aisling Lacey
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Insight SFI Research Centre for Data Analytics, Dublin, Ireland
| | - Enda Whyte
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Centre for Injury Prevention and Performance, School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Sinéad O’Keeffe
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Centre for Injury Prevention and Performance, School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Siobhán O’Connor
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Centre for Injury Prevention and Performance, School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Aoife Burke
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Centre for Injury Prevention and Performance, School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Kieran Moran
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Insight SFI Research Centre for Data Analytics, Dublin, Ireland
- Centre for Injury Prevention and Performance, School of Health and Human Performance, Dublin City University, Dublin, Ireland
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Rubio JE, Tong J, Sundaramurthy A, Subramani AV, Kote VB, Baggaley M, Edwards WB, Reifman J. Differences in running biomechanics between young, healthy men and women carrying external loads. Front Bioeng Biotechnol 2023; 11:1250937. [PMID: 37854880 PMCID: PMC10579583 DOI: 10.3389/fbioe.2023.1250937] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/04/2023] [Indexed: 10/20/2023] Open
Abstract
During U.S. Army basic combat training (BCT), women are more prone to lower-extremity musculoskeletal injuries, including stress fracture (SF) of the tibia, with injury rates two to four times higher than those in men. There is evidence to suggest that the different injury rates are, in part, due to sex-specific differences in running biomechanics, including lower-extremity joint kinematics and kinetics, which are not fully understood, particularly when running with external load. To address this knowledge gap, we collected computed tomography images and motion-capture data from 41 young, healthy adults (20 women and 21 men) running on an instrumented treadmill at 3.0 m/s with loads of 0.0 kg, 11.3 kg, or 22.7 kg. Using individualized computational models, we quantified the running biomechanics and estimated tibial SF risk over 10 weeks of BCT, for each load condition. Across all load conditions, compared to men, women had a significantly smaller flexion angle at the trunk (16.9%-24.6%) but larger flexion angles at the ankle (14.0%-14.7%). Under load-carriage conditions, women had a larger flexion angle at the hip (17.7%-23.5%). In addition, women had a significantly smaller hip extension moment (11.8%-20.0%) and ankle plantarflexion moment (10.2%-14.3%), but larger joint reaction forces (JRFs) at the hip (16.1%-22.0%), knee (9.1%-14.2%), and ankle (8.2%-12.9%). Consequently, we found that women had a greater increase in tibial strain and SF risk than men as load increases, indicating higher susceptibility to injuries. When load carriage increased from 0.0 kg to 22.7 kg, SF risk increased by about 250% in women but only 133% in men. These results provide quantitative evidence to support the Army's new training and testing doctrine, as it shifts to a more personalized approach that shall account for sex and individual differences.
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Affiliation(s)
- Jose E. Rubio
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD, United States
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States
| | - Junfei Tong
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD, United States
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States
| | - Aravind Sundaramurthy
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD, United States
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States
| | - Adhitya V. Subramani
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD, United States
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States
| | - Vivek Bhaskar Kote
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD, United States
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States
| | - Michael Baggaley
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- The McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - W. Brent Edwards
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- The McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jaques Reifman
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD, United States
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Ding Y, Yang Y, Xu F, Tan Z, Liu X, Shao X, Kang F, Yan Z, Luo E, Wang J, Luo Z, Cai J, Jing D. Early protection against bone stress injuries by mobilization of endogenous targeted bone remodeling. iScience 2023; 26:107605. [PMID: 37664634 PMCID: PMC10470328 DOI: 10.1016/j.isci.2023.107605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/29/2023] [Accepted: 08/08/2023] [Indexed: 09/05/2023] Open
Abstract
Bone stress injuries are common overuse injuries, especially in soldiers, athletes, and performers. In contrast to various post-injury treatments, early protection against bone stress injuries can provide greater benefit. This study explored the early protection strategies against bone stress injuries by mobilization of endogenous targeted bone remodeling. The effects of various pharmaceutical/biophysical approaches, individual or combinational, were investigated by giving intervention before fatigue loading. We optimized the dosage and administration parameters and found that early intervention with pulsed electromagnetic field and parathyroid hormone (i.e., PEMF+PTH) resulted in the most pronounced protective effects among all the approaches against the bone stress injuries. In addition, the mechanisms by which the strategy mobilizes targeted bone remodeling and enhances the self-repair capacity of bone were systematically investigated. This study proposes strategies to reduce the incidence of bone stress injuries in high-risk populations (e.g., soldiers and athletes), particularly for those before sudden increased physical training.
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Affiliation(s)
- Yuanjun Ding
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Yongqing Yang
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Fei Xu
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Zhifen Tan
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Xiyu Liu
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Xi Shao
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Fei Kang
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Zedong Yan
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Erping Luo
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Jing Wang
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Zhuojing Luo
- Institute of Orthopaedics, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jing Cai
- College of Basic Medicine, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Da Jing
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
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Sonnier JH, Paul RW, Hall AT, Johnson EE, Connors G, Freedman KB, Bishop ME. Rates of Reporting and Analyzing Patient Sex in Sports Medicine Research: A Systematic Review. Am J Sports Med 2023; 51:3035-3041. [PMID: 36416467 DOI: 10.1177/03635465221128909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Sex differences in sports medicine are well documented. However, no studies to date have reviewed the rate at which sex is reported and analyzed in the athlete-specific orthopaedic sports medicine literature. PURPOSE To determine the rates of reporting and analyzing patient sex in athlete-specific sports medicine literature. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS Articles published by the 3 journals of the AOSSM (American Journal of Sports Medicine [AJSM], Orthopaedic Journal of Sports Medicine, and Sports Health: A Multidisciplinary Approach) between 2017 and 2021 were considered for inclusion. Original sports medicine research studies that isolated athletes were included. Studies that isolated sports that are predominantly single sex at the college and/or professional levels (football, baseball, softball, and wrestling) were excluded. RESULTS Of the 5140 publications screened, 559 met the inclusion criteria. In total, 93.9% of all studies reported patient sex, and 34.7% of all studies analyzed patient sex. However, 143 studies only included males and 50 studies only included females (n = 193). When excluding these single-sex studies, analysis of the remaining 366 studies found that the rate of sex-specific analysis increased to 53.0%. Rates of reporting patient sex did not significantly differ by journal or by year. Similarly, rates of analyzing patient sex did not differ by year, but Sports Health analyzed sex the most frequently, and AJSM analyzed sex the least frequently (P = .002). Studies that isolated college (84.1%), youth (66.7%), or recreational (52.6%) athletes analyzed sex at or above the overall rate of 53.0%, but studies of elite athletes (35.7%) tended to analyze sex less frequently. CONCLUSION Patient sex is well reported in the athlete-specific sports medicine literature (93.9% of included studies reported sex), demonstrating that most studies include sex as a demographic variable. However, patient sex was analyzed only in 53.0% of studies that included both male and female patients. Given that athlete-specific sex differences are known to exist within the field of sports medicine, many studies that could benefit from using patient sex as a variable for analysis likely fail to do so.
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Affiliation(s)
| | - Ryan W Paul
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Anya T Hall
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Emma E Johnson
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Gregory Connors
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
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Siegel SD, Mason J, Hamacher D, Rahlf AL, Zech A. Asymmetries of foot strike patterns during running in high-level female and male soccer players. BMC Sports Sci Med Rehabil 2023; 15:86. [PMID: 37452424 PMCID: PMC10349471 DOI: 10.1186/s13102-023-00696-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
BACKROUND Foot strike pattern (FSP) is defined by the way the foot makes initial ground contact and is influenced by intrinsic and extrinsic factors. This study investigated the effect of running speed on asymmetries of FSP. METHODS Seventeen female and nineteen male soccer players performed an incremental running test on an instrumented treadmill starting at 2.0 m/s until complete exhaustion. Force plate data were used to categorize foot strikes into rearfoot (RFS) and non-rearfoot strikes. Additionally, peak vertical ground reaction force (peakGRF) and stride time were calculated. The symmetry index (SI) was used to quantify lateral asymmetries between legs. RESULTS The SI indicated asymmetries of the rate of RFS (%RFS) of approximately 30% at slow running speed which decreased to 4.4% during faster running speed (p = 0.001). There were minor asymmetries in peakGRF and stride time at each running stage. Running speed influenced %RFS (p < 0.001), peakGRF (p < 0.001) and stride time (p < 0.001). Significant interaction effects between running speed and sex were shown for %RFS (p = 0.033), peakGRF (p < 0.001) and stride time (p = 0.041). CONCLUSION FSP of soccer players are asymmetric at slower running speed, but symmetry increases with increasing speed. Future studies should consider that FSP are non-stationary and influenced by running speed but also differ between legs.
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Affiliation(s)
- Stanislav Dimitri Siegel
- Department of Human Movement Science and Exercise Physiology, Institute of Sport Science, Friedrich Schiller University Jena, Seidelstraße 20, Jena, 07749, Germany.
| | - Joel Mason
- Department of Human Movement Science and Exercise Physiology, Institute of Sport Science, Friedrich Schiller University Jena, Seidelstraße 20, Jena, 07749, Germany
| | - Daniel Hamacher
- Methods and Statistics in Sports, Institute of Sport Science, Friedrich Schiller University Jena, Seidelstraße 20, Jena, 07749, Germany
| | - Anna Lina Rahlf
- Department of Sports Science, Institute of Health, Nutrition and Sport Science, Europa-Universität Flensburg, Campusallee 2, Flensburg, 24943, Germany
| | - Astrid Zech
- Department of Human Movement Science and Exercise Physiology, Institute of Sport Science, Friedrich Schiller University Jena, Seidelstraße 20, Jena, 07749, Germany
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Skypala J, Hamill J, Sebera M, Elavsky S, Monte A, Jandacka D. Running-Related Achilles Tendon Injury: A Prospective Biomechanical Study in Recreational Runners. J Appl Biomech 2023:1-9. [PMID: 37419494 DOI: 10.1123/jab.2022-0221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 04/17/2023] [Accepted: 05/09/2023] [Indexed: 07/09/2023]
Abstract
There are relatively few running studies that have attempted to prospectively identify biomechanical risk factors associated with Achilles tendon (AT) injuries. Therefore, the aim was to prospectively determine potential running biomechanical risk factors associated with the development of AT injuries in recreational, healthy runners. At study entry, 108 participants completed a set of questionnaires. They underwent an analysis of their running biomechanics at self-selected running speed. The incidence of AT running-related injuries (RRI) was assessed after 1-year using a weekly questionnaire standardized for RRI. Potential biomechanical risk factors for the development of AT RRI injury were identified using multivariable logistic regression. Of the 103 participants, 25% of the sample (15 males and 11 females) reported an AT RRI on the right lower limb during the 1-year evaluation period. A more flexed knee at initial contact (odds ratio = 1.146, P = .034) and at the midstance phase (odds ratio = 1.143, P = .037) were significant predictors for developing AT RRI. The results suggested that a 1-degree increase in knee flexion at initial contact and midstance was associated with a 15% increase in the risk of an AT RRI, thus causing a limitation of training or a stoppage of running in runners.
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Affiliation(s)
- Jiri Skypala
- Department of Human Movement Studies, Human Motion Diagnostic Center, University of Ostrava, Ostrava,Czech Republic
| | - Joseph Hamill
- Department of Human Movement Studies, Human Motion Diagnostic Center, University of Ostrava, Ostrava,Czech Republic
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA,USA
| | - Michal Sebera
- Department of Human Movement Studies, Human Motion Diagnostic Center, University of Ostrava, Ostrava,Czech Republic
| | - Steriani Elavsky
- Department of Human Movement Studies, Human Motion Diagnostic Center, University of Ostrava, Ostrava,Czech Republic
| | - Andrea Monte
- Department of Human Movement Studies, Human Motion Diagnostic Center, University of Ostrava, Ostrava,Czech Republic
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona,Italy
| | - Daniel Jandacka
- Department of Human Movement Studies, Human Motion Diagnostic Center, University of Ostrava, Ostrava,Czech Republic
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Edler C, Droste JN, Anemüller R, Pietsch A, Gebhardt M, Riepenhof H. Injuries in elite road cyclists during competition in one UCI WorldTour season: a prospective epidemiological study of incidence and injury burden. PHYSICIAN SPORTSMED 2023; 51:129-138. [PMID: 34808064 DOI: 10.1080/00913847.2021.2009744] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
METHODS Fifty-four male athletes from two different teams were involved. Accidents and injuries were recorded immediately after the incident by a team physician present at every race. Exposure, location, type and cause of injury have been recorded. Incidence was calculated. Severity was measured as a cumulative severity score and burden depicted in a risk matrix. RESULTS Total time of exposure was 12537 hours over 3524 athlete days and 544002 kilometers of racing. 98 accidents were recorded, with 83 leading to injury. The total number of recorded injuries was 193. Injury incidence for all injuries was 54,8 (±SD 47,7-62,8) /1000 athlete days, 15,4 (±SD 13,4-17,7) /1000 athlete hours and 35,5 (±SD 30,8-40,8) /100.000 km raced. By far the most frequent types of injury were hematomas, contusions and bruising (n = 141, 73%) followed by lacerations (n = 22; 11,4%). Most injuries affected the arm and elbow (n = 34, 17,6%) followed by the shoulder and clavicle (n = 28, 14,5%) and occurred with contact (79%). Fractures pose a high injury burden due to long time loss, whereas hematomas, contusions and bruising showed the highest incidence numbers but comparably less time loss. CONCLUSION Road cyclists' injuries have been underestimated in previous studies. Hematomas, contusions and bruising pose the highest number of injuries with a broad degree of severity and range of injury burden. Fractures are less common but show the highest injury burden. The upper extremities are involved the most.
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Affiliation(s)
- Christopher Edler
- Department of Prevention, Rehabilitation and Interdisciplinary Sports Medicine, Bg Hospital Hamburg - Teaching Hospital of the University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan-Niklas Droste
- Department of Prevention, Rehabilitation and Interdisciplinary Sports Medicine, Bg Hospital Hamburg - Teaching Hospital of the University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Medicine and Sports Science RB Leipzig Football Club, Leipzig Germany
| | - Ruben Anemüller
- Department of Trauma, Orthopedic Surgery and Sports Traumatology, BG Hospital Hamburg - Teaching Hospital of the University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Aki Pietsch
- Department of Prevention, Rehabilitation and Interdisciplinary Sports Medicine, Bg Hospital Hamburg - Teaching Hospital of the University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Gebhardt
- Department of Surgery and Sports Traumatology, Park Clinic Manhagen, Großhansdorf, Germany
| | - Helge Riepenhof
- Department of Prevention, Rehabilitation and Interdisciplinary Sports Medicine, Bg Hospital Hamburg - Teaching Hospital of the University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Medicine and Sports Science RB Leipzig Football Club, Leipzig Germany
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13
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Zhang Q, Hautier CA, Bonis C, Trama R. Reliability of Soft Tissue Vibration Measurement and Number of Steps Demanded during Treadmill Running. J Sports Sci Med 2023; 22:166-174. [PMID: 36876174 PMCID: PMC9982539 DOI: 10.52082/jssm.2023.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Abstract
The present study aims to determine the test-retest reliability of the input signal (INPUT) of foot impact and soft tissue vibration (STV) of the lower limb muscles during treadmill running. Twenty-six recreational runners participated in three running trials at constant velocity (10 km/h) within two days. The INPUT and STV of gastrocnemius medialis (GAS) and vastus lateralis (VL) were extracted from 100 steps measured by three triaxial accelerometers. The Intraclass Correlation Coefficient (ICC) was calculated to determine the Intra-trial and Inter-day reliability of the different variables. Intra-trial reliability results indicated that most of the INPUT and GAS STV parameters, except for damping coefficient and setting time, have good to excellent reliability (0.75 < ICC < 0.9) from the beginning of the run (10 steps) to the end. In contrast, only 4 VL STV parameters showed good reliability. Furthermore, inter-trial reliability measured on day one showed that the number of reliable parameters reduced, especially for VL STV, and more steps were required (20 < steps < 80) to achieve good reliability. Inter-day reliability results showed that only one VL STV parameter reached good reliability. Therefore, the present results show that the measurement of the foot impact and the calf muscle vibrations present a good to excellent reliability measured on a single trial and two trials carried out on the same day. The reliability of these parameters remains good when comparing two days of experimentation. We recommend measuring impact and STV parameters during treadmill running in the same session.
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Affiliation(s)
- Qingshan Zhang
- School of Athletic Performance, Shanghai University of Sport, Shanghai, China.,Université de Lyon, UCBL1, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, Villeurbanne Cedex, France
| | - Christophe A Hautier
- Université de Lyon, UCBL1, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, Villeurbanne Cedex, France
| | - Chloé Bonis
- Université de Lyon, UCBL1, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, Villeurbanne Cedex, France
| | - Robin Trama
- University of Calgary, Faculty of Kinesiology, Human Performance Lab, Calgary, Alberta, Canada
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Merrick N, Hart NH, Mosler AB, Allen G, Murphy MC. Injury Profiles of Police Recruits Undergoing Basic Physical Training: A Prospective Cohort Study. JOURNAL OF OCCUPATIONAL REHABILITATION 2023; 33:170-178. [PMID: 35917080 PMCID: PMC10025230 DOI: 10.1007/s10926-022-10059-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
Purpose A lack of published epidemiological data among police recruits presents a major challenge when designing appropriate prevention programs to reduce injury burden. We aimed to report the injury epidemiology of Western Australian (WA) Police Force recruits and examine sex and age as injury risk factors. Methods Retrospective analyses were conducted of prospectively collected injury data from WA Police Force recruits between 2018-2021. Injury was defined as 'time-loss' and injury incidence rate per 1000 training days (Poisson exact 95% confidence intervals) was calculated. For each region and type of injury, the incidence, severity, and burden were calculated. The association between age, sex, and injury occurrence were assessed using Cox regression time-to-event analysis. Results A total of 1316 WA Police Force recruits were included, of whom 264 recruits sustained 304 injuries. Injury prevalence was 20.1% and the incidence rate was 2.00 (95%CI 1.78-2.24) injuries per 1000 training days. Lower limb injuries accounted for most of the injury burden. Ligament/ joint injuries had the highest injury tissue/pathology burden. The most common activity injuring recruits was physical training (31.8% of all injuries). Older age (Hazard Ratio = 1.5, 95%CI = 1.2 to 1.9, p = 0.002) and female sex (Hazard Ratio = 1.4, 95%CI = 1.3 to 1.6, p < 0.001) increased risk of injury. Conclusion Prevention programs targeting muscle/tendon and ligament/joint injuries to the lower limb and shoulder should be prioritised to reduce the WA Police Force injury burden. Injury prevention programs should also prioritise recruits who are over 30 years of age or of female sex, given they are a higher risk population.
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Affiliation(s)
- Nicole Merrick
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Nicolas H Hart
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, SA, Australia
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Andrea B Mosler
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Garth Allen
- Western Australian Police Academy, Western Australian Police Force, Joondalup, Western Australia, Australia
| | - Myles C Murphy
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.
- School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia.
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15
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Kennedy MA, Fortington LV, Penney M, Hart NH, d’Hemecourt PA, Sugimoto D. Running Marathons in High School: A 5-Year Review of Injury in a Structured Training Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4426. [PMID: 36901436 PMCID: PMC10001535 DOI: 10.3390/ijerph20054426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE The aim in this study was to quantify the number, nature, and severity of injuries sustained by male and female high school students who took part in a running training program that culminated in the completion of a half or full marathon. DESIGN This study is a retrospective clinical audit. METHODS Injury reports from high school students (grades 9-12) who participated in a half or full marathon 30-week progressive training program comprising four training days per week (three running days and one cross-training day) were reviewed. The number of runners completing a marathon, together with the number, nature, severity of injuries, and treatment types, as reported to the program physiotherapist, were the main outcome measures. RESULTS Program completion was 96% (n = 448/469). Of all participants, 186 (39.6%) were injured, with 14 withdrawing from the program due to injury. For those who completed a marathon, 172 (38%) reported 205 musculoskeletal injuries (age of injured runners: 16.3 ± 1.1 years; 88 girls (51.2%) and 84 boys (48.8%)). More than half (n = 113, 55.1%) of the reported injuries were soft tissue injuries. Most injuries were localized to the lower leg (n = 88, 42.9%) and were of a minor nature (n = 181, 90%), requiring only 1-2 treatments. CONCLUSIONS There was a low number of relatively minor injuries for high school participants taking part in a graduated and supervised marathon training program. The injury definition was conservative (i.e., any attendance to physiotherapist) and the relative severity of injuries was minor (i.e., requiring 1-2 treatment sessions). Overall, these results do not support a need to restrict high school students from taking part in marathon running, though continued emphasis on graduated program development and close supervision of young participants is recommended.
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Affiliation(s)
- Mary A. Kennedy
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia
- Nutrition and Health Innovation Research Institute, Edith Cowan University, Joondalup, WA 6027, Australia
| | - Lauren V. Fortington
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia
| | - Matt Penney
- Advanced Sports Therapy, Wellesley, MA 02481, USA
- Sports Rehabilitation Unlimited, Middleton, MA 01949, USA
| | - Nicolas H. Hart
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5000, Australia
- Human Performance Research Centre, School of Sport, Exercise and Rehabilitation, University of Technology (UTS), Sydney, NSW 2021, Australia
- Institute for Health Research, University of Notre Dame Australia, Perth, WA 6027, Australia
| | - Pierre A. d’Hemecourt
- Division of Sports Medicine, Department of Orthopaedics, Boston Children’s Hospital, Waltham, MA 02115, USA
- Harvard Medical School, Harvard University, Boston, MA 02115, USA
- The Micheli Center for Sports Injury Prevention, Boston Children’s Hospital, Waltham, MA 02453, USA
| | - Dai Sugimoto
- The Micheli Center for Sports Injury Prevention, Boston Children’s Hospital, Waltham, MA 02453, USA
- Faculty of Sport Sciences, Waseda University, Tokyo 202-0021, Japan
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16
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Kelly CPMG. Is There Evidence for the Development of Sex-Specific Guidelines for Ultramarathon Coaches and Athletes? A Systematic Review. SPORTS MEDICINE - OPEN 2023; 9:6. [PMID: 36695958 PMCID: PMC9877268 DOI: 10.1186/s40798-022-00533-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 11/13/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND There is evidence of sex differences in the physiology of endurance exercise, yet most of the advice and guidelines on training, racing, nutrition, and recovery for ultramarathons are based on research that has largely excluded female athletes. The objective was therefore to review the current knowledge of sex differences in ultramarathon runners and determine if sufficient evidence exists for providing separate guidelines for males and females. METHODS This systematic review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three databases were searched for studies investigating differences in elite and recreational male and female ultramarathon runners. Studies were included if they compared males and females and looked at outcomes relating to the performance or health of ultramarathon runners. The quality of the included studies was determined using the Grading of Recommendations Assessment Development and Evaluation (GRADE) approach. RESULTS The search strategy identified 45 studies that met the inclusion criteria. Most studies were observational in design, with only three papers based on randomised controlled trials. The overall quality of the evidence was low. Sex differences in the predictors of ultramarathon performance; physiological responses to training, racing, and recovery; chronic and acute health issues; and pacing strategies were found. There were areas with contradictory findings, and very few studies examined specific interventions. CONCLUSION The results from this review suggest that the development of sex-specific guidelines for ultramarathon coaches and athletes could have a significant effect on the performance and health of female runners. At present, there is insufficient high-quality evidence on which to formulate these guidelines, and further research is required.
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Affiliation(s)
- Claudia P M G Kelly
- College of Medicine and Health, The University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
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17
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Hegedus EJ, Mulligan EP, Beer BA, Gisselman AS, Wooten LC, Stern BD. How Advancement in Bone Science Should Inform the Examination and Treatment of Femoral Shaft Bone Stress Injuries in Running Athletes. Sports Med 2023; 53:1117-1124. [PMID: 36598744 DOI: 10.1007/s40279-022-01802-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2022] [Indexed: 01/05/2023]
Abstract
Stress fractures likely have a 1-2% incidence in athletes in general. In runners, a more vulnerable population, incidence rates likely range between 3.2 and 21% with female runners having greater susceptibility. The incidence of femoral shaft stress fractures is less well known. New basic and translational science research may impact the way clinicians diagnose and treat femoral stress fractures. By using a fictitious case study, this paper applies bone science to suggest new approaches to evaluating and treating femoral shaft stress fractures in the running population.
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Affiliation(s)
- Eric J Hegedus
- Tufts University Doctor of Physical Therapy Program, 101 E Washington St Ste 950, Phoenix, AZ, 85004, USA.
| | - Edward P Mulligan
- Tufts University Doctor of Physical Therapy Program, 101 E Washington St Ste 950, Phoenix, AZ, 85004, USA
| | | | - Angela Spontelli Gisselman
- Tufts University Doctor of Physical Therapy Program, 101 E Washington St Ste 950, Phoenix, AZ, 85004, USA
| | - Liana C Wooten
- Tufts University Doctor of Physical Therapy Program, 101 E Washington St Ste 950, Phoenix, AZ, 85004, USA
| | - Benjamin D Stern
- Tufts University Doctor of Physical Therapy Program, 101 E Washington St Ste 950, Phoenix, AZ, 85004, USA
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18
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Mason J, Kniewasser C, Hollander K, Zech A. Intrinsic Risk Factors for Ankle Sprain Differ Between Male and Female Athletes: A Systematic Review and Meta-Analysis. SPORTS MEDICINE - OPEN 2022; 8:139. [DOI: 10.1186/s40798-022-00530-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 10/18/2022] [Indexed: 11/19/2022]
Abstract
Abstract
Background
Ankle sprains remain prevalent across most team sports. However, despite divergent ankle sprain injury rates in male and female athletes, little is known about potential sex-specific risk factors for ankle sprain.
Objective
To systematically investigate the sex-specific risk factors for ankle sprain.
Methods
Combinations of the key terms were entered into PubMed, Web of Science, Embase and Cochrane Library databases, and prospective studies reporting ankle sprain risk factors in males or females were included for meta-analysis.
Results
Sixteen studies were eligible for inclusion, for a total of 3636 athletes (735 female) and 576 ankle sprains (117 female). Out of 21 prognostic factors, previous ankle sprain injury (odds ratio = 2.74, P < .001), higher body mass index (SMD = 0.50, P < 0.001), higher weight (SMD = 0.24, P = 0.02), lower isometric hip abduction strength (SMD = − 0.52, P < 0.0001) and lower dynamic balance performance (SMD = − 0.48 to − 0.22, P < 0.001–0.04) were identified as risk factors in male athletes. In female athletes, out of 18 factors eligible for meta-analysis, only lower concentric dorsiflexion strength was identified as a risk factor (SMD = − 0.48, P = 0.005).
Conclusion
This meta-analysis provides novel evidence for different risk factor profiles for ankle sprain injuries between female and male athletes. Further studies, particularly in female athletes, are needed to strengthen the evidence.
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Fraser JJ, Pommier R, MacGregor AJ, Silder A, Sander TC. Does policy that provides choice in athletic footwear affect musculoskeletal injury risk in US Coast Guard recruits? BMJ Mil Health 2022:e002211. [PMID: 36175029 DOI: 10.1136/military-2022-002211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/09/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Musculoskeletal injuries (MSKIs) are ubiquitous during initial entry military training, with overuse injuries the most common. A common injury mechanism is running, an activity that is integral to US Coast Guard (USCG) training and a requirement for graduation. The purpose of this study was to assess the effects of a policy that allowed for athletic footwear choice on risk of lower quarter MSKI in USCG recruits. METHODS A retrospective cohort study was performed that included 1230 recruits (1040 men, 190 women) who trained under a policy that allowed self-selection of athletic footwear and 2951 recruits (2329 men, 622 women) who trained under a policy that mandated use of prescribed uniform athletic shoes and served as controls. Demographic data and physical performance were derived from administrative records. Injury data were abstracted from a medical tracking database. Unadjusted risk calculations and multivariable logistic regression assessing the effects of group, age, sex, height, body mass and 2.4 km run times on MSKI were performed. RESULTS Ankle-foot, leg, knee and lumbopelvic-hip complex injuries were ubiquitous in both groups (experimental: 13.13 per 1000 person-weeks; control: 11.69 per 1000 person-weeks). Group was not a significant factor for any of the injuries assessed in either the unadjusted or adjusted analysis, despite widespread reports of pain (58.6%), perceived injury attribution (15.7%), perceived deleterious effect on performance (25.3%), general dissatisfaction (46.3%) and intended discontinuance of use following graduation (87.7%). CONCLUSION MSKI continues to be a major source of morbidity in the recruit training population. The policy that allowed USCG recruits to self-select athletic footwear did not decrease or increase the risk of MSKI. While regulations pertaining to footwear choice did not influence injury outcomes, there was general dissatisfaction with the prescribed uniform athletic footwear conveyed by the recruits and widespread reports of discomfort, perceived deleterious effects from wear and intended discontinued use following training completion.
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Affiliation(s)
- John J Fraser
- Operational Readiness and Health Directorate, Naval Health Research Center, San Diego, California, USA
- Warfighter Performance Department, Naval Health Research Center, San Diego, California, USA
| | - R Pommier
- Samuel J Call Health Services Center, US Coast Guard Training Center, Cape May, New Jersey, USA
| | - A J MacGregor
- Medical Modelling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
| | - A Silder
- Warfighter Performance Department, Naval Health Research Center, San Diego, California, USA
| | - T C Sander
- Department of Physical Therapy and Athletic Training, Grand Valley State University, Grand Rapids, Michigan, USA
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Effects of Foot Orthoses on Pain and the Prevention of Lower Limb Injuries in Runners: Systematic Review and Meta-Analysis. J Sport Rehabil 2022; 31:1067-1074. [PMID: 35894921 DOI: 10.1123/jsr.2021-0302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 04/02/2022] [Accepted: 04/25/2022] [Indexed: 11/18/2022]
Abstract
CONTEXT A variety of approaches have been proposed to prevent lower limb injuries in runners. However, the evidence for the effectiveness of interventions to reduce lower limb pain and injury after intensive running is very weak. OBJECTIVE The authors performed a systematic review to investigate the effects of foot orthoses on pain and the prevention of lower limb injuries in runners. EVIDENCE ACQUISITION The authors searched the MEDLINE/PubMed, Physiotherapy Evidence Database, Scielo, and Cochrane Central (from inception to February 2022) databases for randomized controlled trials that evaluated the effects of foot orthoses in runners. The authors then calculated mean differences and 95% confidence intervals from these trials. Heterogeneity was assessed using the I2 test. Furthermore, the authors compared the criteria between runners with foot orthoses and ones with no intervention (control group). EVIDENCE SYNTHESIS Twelve studies (5321 runners) met our review criteria. The control and the foot orthoses group sustained 721 (37%) and 238 (24%) injuries, respectively. Compared with the control group, the use of foot orthoses resulted in a significant reduction in lower limb injury risk (risk ratio = 0.6; 95% confidence interval, 0.5-0.7; P = .00001, I2 = 54%; 7 studies, N = 2983: moderate-quality evidence). Moreover, the foot orthoses group corresponded to a 40% reduction in the risk of developing lower limb injuries. CONCLUSIONS The use of foot orthoses may help reduce the incidence of lower limb injuries and pain in runners.
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Swanevelder S, Sewry N, Schwellnus M, Jordaan E. Predictors of multiple injuries in individual distance runners: A retrospective study of 75,401 entrants in 4 annual races-SAFER XX. JOURNAL OF SPORT AND HEALTH SCIENCE 2022; 11:339-346. [PMID: 34801747 PMCID: PMC9189693 DOI: 10.1016/j.jshs.2021.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/19/2021] [Accepted: 10/28/2021] [Indexed: 05/31/2023]
Abstract
BACKGROUND There are limited data on factors that predict an increased risk of multiple injuries among distance runners. The objective of this study was to determine risk factors that are predictive of individual runners with a high annual multiple injury risk (MIR). METHODS A retrospective, cross-sectional study at 4 annual (2012-2015) Two Oceans 21.1 km and 56.0 km races in South Africa with 75,401 consenting race entrants. Running-related injury data were collected retrospectively through an online pre-race medical screening questionnaire. The average number of injuries for each runner every year was calculated by taking a runner's race entry history and injury history into account and categorizing entrants into 4 MIR categories (high, intermediate, low, and very low (reference)). Multiple logistic regression modeling (odds ratios) was used to determine whether the following factors were predictive of a high MIR (average > 1 injury/year): demographics, training and racing, chronic-disease history (composite chronic disease score (CCDS)), and history of allergies. RESULTS Of all entrants, 9.2% reported at least 1 injury, and 0.4% of entrants were in the high MIR category; the incidence rate was 2.5 injuries per 10 runner-years (95% confidence interval (95%CI): 2.4-2.7). Significant factors predictive of runners in the high MIR category were: running for > 20 years: OR = 2.0 (95%CI: 1.3-3.1; p = 0.0010); a higher CCDS: OR = 2.2 (95%CI: 2.0-2.4; p < 0.0001); and a history of allergies: OR = 2.8 (95%CI: 2.0-3.8; p < 0.0001). CONCLUSION Runners who have been running recreationally for > 20 years and those with multiple chronic diseases or a history of allergies were at higher risk of multiple running-related injuries. This high-risk group can be targeted for further study and possible injury-prevention interventions.
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Affiliation(s)
- Sonja Swanevelder
- Biostatistics Unit, South African Medical Research Council, Parow 7575, South Africa
| | - Nicola Sewry
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria 0081, South Africa; International Olympic Committee (IOC) Research Centre, Pretoria 0081, South Africa
| | - Martin Schwellnus
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria 0081, South Africa; International Olympic Committee (IOC) Research Centre, Pretoria 0081, South Africa; Emeritus Professor of Sport and Exercise Medicine, Faculty of Health Sciences, University of Cape Town, Bellville 7535, South Africa.
| | - Esme Jordaan
- Biostatistics Unit, South African Medical Research Council, Parow 7575, South Africa; Statistics and Population Studies Department, University of the Western Cape, Bellville 7535, South Africa
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22
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Hoenig T, Ackerman KE, Beck BR, Bouxsein ML, Burr DB, Hollander K, Popp KL, Rolvien T, Tenforde AS, Warden SJ. Bone stress injuries. Nat Rev Dis Primers 2022; 8:26. [PMID: 35484131 DOI: 10.1038/s41572-022-00352-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2022] [Indexed: 01/11/2023]
Abstract
Bone stress injuries, including stress fractures, are overuse injuries that lead to substantial morbidity in active individuals. These injuries occur when excessive repetitive loads are introduced to a generally normal skeleton. Although the precise mechanisms for bone stress injuries are not completely understood, the prevailing theory is that an imbalance in bone metabolism favours microdamage accumulation over its removal and replacement with new bone via targeted remodelling. Diagnosis is achieved by a combination of patient history and physical examination, with imaging used for confirmation. Management of bone stress injuries is guided by their location and consequent risk of healing complications. Bone stress injuries at low-risk sites typically heal with activity modification followed by progressive loading and return to activity. Additional treatment approaches include non-weight-bearing immobilization, medications or surgery, but these approaches are usually limited to managing bone stress injuries that occur at high-risk sites. A comprehensive strategy that integrates anatomical, biomechanical and biological risk factors has the potential to improve the understanding of these injuries and aid in their prevention and management.
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Affiliation(s)
- Tim Hoenig
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Kathryn E Ackerman
- Wu Tsai Female Athlete Program, Boston Children's Hospital, Boston, MA, USA.,Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Belinda R Beck
- School of Health Sciences & Social Work, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Gold Coast, Queensland, Australia.,The Bone Clinic, Brisbane, Queensland, Australia
| | - Mary L Bouxsein
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Orthopedic Surgery, Harvard Medical School and Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - David B Burr
- Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indiana University, Indianapolis, IN, USA.,Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Karsten Hollander
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Kristin L Popp
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,U.S. Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Tim Rolvien
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Adam S Tenforde
- Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, MA, USA.
| | - Stuart J Warden
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indiana University, Indianapolis, IN, USA. .,Department of Physical Therapy, School of Health & Human Sciences, Indiana University, Indianapolis, IN, USA. .,La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia.
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23
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Carbuhn AF, Yu D, Magee LM, McCulloch PC, Lambert BS. Anthropometric Factors Associated With Bone Stress Injuries in Collegiate Distance Runners: New Risk Metrics and Screening Tools? Orthop J Sports Med 2022; 10:23259671211070308. [PMID: 35178462 PMCID: PMC8844446 DOI: 10.1177/23259671211070308] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Lower limb bone stress injury (BSI) of the pelvis, femur, and tibia is prevalent in collegiate track and field distance runners. Bone mineral density (BMD), body composition (BComp), and anthropometric parameters before initial collegiate injury have not been compared between runners with BSI and their noninjured counterparts. PURPOSE To characterize bone health in relation to BComp and anthropometric measurements from total-body dual x-ray absorptiometry (DXA) scans in collegiate male and female distance runners before BSI and develop BMD prediction models. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Distance runners (N = 79) from a single university track and field team were retrospectively enrolled into this study. The runners completed a DXA scan during the fall season (August-November) and participated in sport activities before the scan. Three months after scanning, electronic medical records were reviewed for the occurrence of BSI. An independent-sample t test was used to compare BMD (total and regional [spine, pelvis, and legs]), BComp (% body fat, fat mass, and lean mass), and anthropometric measurements (shoulder width and leg, arm, and trunk length) between runners with versus without BSI (included subgroup analysis by sex). Multiple linear regression with stepwise removal was used to determine variables most predictive of BMD. RESULTS Of the 79 enrolled participants (42 male, 37 female), 18 runners (22.8%; 11 female, 7 male) sustained a lower limb BSI. Compared with the noninjured group, injured runners had lower total and regional BMD (P < .001 for all) and shorter leg and arm lengths (P < .05 for both), whereas injured male runners had lower fat mass and injured female runners had lower lean mass in the legs (P < .05 for both). Injured runners' age-matched total BMD Z score (-0.1 ± 0.6) was considered clinically normal. BComp and anthropometric measures were predictive of total and regional BMD (P < .05; R 2 = 0.64-0.80; percentage error = 3.8%-4.8%). CONCLUSION The DXA scans of injured runners prior to incidence indicated lower BMD compared with noninjured runners. Shorter limb lengths, lower fat mass (male), and lower leg lean mass (female) may also be indicative of risk. Certain BComp and anthropometric measures were predictive of BMD.
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Affiliation(s)
- Aaron F. Carbuhn
- Department of Dietetics and Nutrition, University of Kansas Medical
Center, Kansas City, Kansas, USA
| | - Daniel Yu
- Department of Dietetics and Nutrition, University of Kansas Medical
Center, Kansas City, Kansas, USA
- Kansas Team Health, Kansas Athletics Inc, Lawrence, Kansas,
USA
| | | | - Patrick C. McCulloch
- Department of Orthopedics and Sports Medicine, Houston Methodist
Hospital, Houston, Texas, USA
| | - Bradley S. Lambert
- Department of Orthopedics and Sports Medicine, Houston Methodist
Hospital, Houston, Texas, USA
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24
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Zech A, Hollander K, Junge A, Steib S, Groll A, Heiner J, Nowak F, Pfeiffer D, Rahlf AL. Sex differences in injury rates in team-sport athletes: A systematic review and meta-regression analysis. JOURNAL OF SPORT AND HEALTH SCIENCE 2022; 11:104-114. [PMID: 34052518 PMCID: PMC8847930 DOI: 10.1016/j.jshs.2021.04.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/15/2021] [Accepted: 04/19/2021] [Indexed: 05/24/2023]
Abstract
BACKGROUND Team-sport players have a particularly high injury risk. Although female sex is considered a risk factor, it is still unknown whether female and male team-sport players, in fact, differ in their injury rates. We aimed to compare injury rates between female and male players by systematically reviewing and meta-analyzing injury surveillance studies of both sexes in order to evaluate sex-specific differences in team-sport injuries. METHODS Studies that prospectively collected injury data for high-level female and male players (age ≥16 years) in basketball, field hockey, football (soccer), handball, rugby (union and sevens), and volleyball were included. Two reviewers (AZ and ALR) independently assessed study quality and extracted data for overall, match, training, and severe injuries (>28 days' time loss) as well as data regarding injury locations and types. Incidence rate ratios (IRRs) were pooled in a meta-analysis, and meta-regression analysis was performed when 10 or more studies were available. RESULTS Of 20 studies, 9 studies reported injury data from football, 3 studies from rugby, 3 studies from handball, 1 study from basketball, 1 study from field hockey, 2 studies from volleyball, and 1 study from basketball and field hockey. For overall injuries, the pooled IRR = 0.86 (95% confidence interval (95%CI): 0.76-0.98) indicated significantly more injuries in male than in female players. For injury location, the pooled IRR showed higher injury rates in male athletes than in female athletes for upper extremity, hip/groin, thigh, and foot injuries. Female players had a significantly higher rate of anterior cruciate ligament injuries (IRR = 2.15, 95%CI: 1.27-3.62) than male players. No significant sex-specific differences in IRR were found for match, training, severe injuries, concussions, or ankle sprains. CONCLUSION Our meta-analysis provides evidence for sex-specific differences in the injury rates in team sports. Further epidemiological studies including both sexes in sports other than football are needed in order to strengthen the evidence.
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Affiliation(s)
- Astrid Zech
- Department of Human Movement Science and Exercise Physiology, Friedrich Schiller University Jena, Jena 07749, Germany.
| | | | - Astrid Junge
- MSH Medical School Hamburg, Hamburg 20457, Germany; Swiss Concussion Center, Schulthess Klinik, Zürich 8008, Switzerland
| | - Simon Steib
- Department of Human Movement, Training and Active Aging, Heidelberg University, Heidelberg 69117, Germany
| | - Andreas Groll
- Department of Statistics, Technical University of Dortmund, Dortmund 44227, Germany
| | - Jonas Heiner
- Department of Statistics, Technical University of Dortmund, Dortmund 44227, Germany
| | - Florian Nowak
- Department of Human Movement Science and Exercise Physiology, Friedrich Schiller University Jena, Jena 07749, Germany
| | - Daniel Pfeiffer
- Department of Human Movement Science and Exercise Physiology, Friedrich Schiller University Jena, Jena 07749, Germany
| | - Anna Lina Rahlf
- Department of Sports and Exercise Medicine, Institute of Human Movement Science, University of Hamburg, Hamburg 20146, Germany
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25
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Viljoen CT, Janse van Rensburg DC, Verhagen E, van Mechelen W, Korkie E, Botha T. Epidemiology, Clinical Characteristics, and Risk Factors for Running-Related Injuries among South African Trail Runners. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312620. [PMID: 34886345 PMCID: PMC8656810 DOI: 10.3390/ijerph182312620] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/19/2021] [Accepted: 11/25/2021] [Indexed: 01/25/2023]
Abstract
Trail running involves running on varying natural terrains, often including large elevation gains/losses. Trail running has a high risk of injury, and runners often participate in remote regions where medical support is challenging. The aim of this study was to determine the epidemiology, clinical characteristic, and associated injury risk factors among trail runners. A modified Oslo Sports Trauma Research Center Questionnaire for Health Problems (OSTRC-H) was used biweekly to collect running-related injury (RRI) and training history data prospectively, among 152 participants (males n = 120, females n = 32) over 30 weeks. We report an overall injury rate of 19.6 RRIs per 1000 h and an RRI mean prevalence of 12.3%. The leading anatomical site of RRIs was the lower limb (82.9%), affecting the knee (29.8%), shin/lower leg (18.0%), and the foot/toes (13.7%). A history of previous RRI in the past 12 months (p = 0.0032) and having a chronic disease (p = 0.0188) are independent risk factors for RRIs among trail runners. Two in three trail runners sustain an RRI mainly affecting the knee, shin/lower leg, and foot/toes. A history of previous RRI in the past 12 months and a having chronic disease is independently associated with RRI among trail runners. These results could be used to develop future RRI prevention strategies, combined with clinical knowledge and experience.
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Affiliation(s)
- Carel T. Viljoen
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa;
- Amsterdam Collaboration for Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam University Medical Centers, VU University Medical Center, 1081 HV Amsterdam, The Netherlands; (E.V.); (W.v.M.)
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Pretoria 0186, South Africa;
- Correspondence:
| | - Dina C. Janse van Rensburg
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Pretoria 0186, South Africa;
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa
| | - Evert Verhagen
- Amsterdam Collaboration for Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam University Medical Centers, VU University Medical Center, 1081 HV Amsterdam, The Netherlands; (E.V.); (W.v.M.)
| | - Willem van Mechelen
- Amsterdam Collaboration for Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam University Medical Centers, VU University Medical Center, 1081 HV Amsterdam, The Netherlands; (E.V.); (W.v.M.)
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, QLD 4072, Australia
- Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town 7700, South Africa
- School of Public Health, Physiotherapy and Population Sciences, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Elzette Korkie
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa;
| | - Tanita Botha
- Department of Statistics, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria 0028, South Africa;
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26
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McSweeney SC, Grävare Silbernagel K, Gruber AH, Heiderscheit BC, Krabak BJ, Rauh MJ, Tenforde AS, Wearing SC, Zech A, Hollander K. Adolescent Running Biomechanics - Implications for Injury Prevention and Rehabilitation. Front Sports Act Living 2021; 3:689846. [PMID: 34514384 PMCID: PMC8432296 DOI: 10.3389/fspor.2021.689846] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/23/2021] [Indexed: 12/28/2022] Open
Abstract
Global participation in running continues to increase, especially amongst adolescents. Consequently, the number of running-related injuries (RRI) in adolescents is rising. Emerging evidence now suggests that overuse type injuries involving growing bone (e.g., bone stress injuries) and soft tissues (e.g., tendinopathies) predominate in adolescents that participate in running-related sports. Associations between running biomechanics and overuse injuries have been widely studied in adults, however, relatively little research has comparatively targeted running biomechanics in adolescents. Moreover, available literature on injury prevention and rehabilitation for adolescent runners is limited, and there is a tendency to generalize adult literature to adolescent populations despite pertinent considerations regarding growth-related changes unique to these athletes. This perspective article provides commentary and expert opinion surrounding the state of knowledge and future directions for research in adolescent running biomechanics, injury prevention and supplemental training.
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Affiliation(s)
- Simon C McSweeney
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | | | - Allison H Gruber
- Department of Kinesiology, School of Public Health - Bloomington, Indiana University, Bloomington, IN, United States
| | - Bryan C Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI, United States
| | - Brian J Krabak
- Department of Rehabilitation, Orthopedics and Sports Medicine, University of Washington and Seattle Childrens Hospital, Seattle, WA, United States
| | - Mitchell J Rauh
- Doctor of Physical Therapy Program, San Diego State University, San Diego, CA, United States
| | - Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Scott C Wearing
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Astrid Zech
- Department of Human Movement Science and Exercise Physiology, Institute of Sport Science, Friedrich Schiller University Jena, Jena, Germany
| | - Karsten Hollander
- Institute of Interdisciplinary Exercise Science and Sports Medicine, Faculty of Medicine, MSH Medical School Hamburg, Hamburg, Germany
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27
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Nnamani Silva ON, Armijo PR, Feld LD, Mascarenhas Monteiro JS, Pham R, Tenforde AS. Comment on: "Sex-Specific Differences in Running Injuries: A Systematic Review with Meta-analysis and Meta-regression". Sports Med 2021; 52:187-188. [PMID: 34480738 DOI: 10.1007/s40279-021-01548-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Ogonna N Nnamani Silva
- Harvard Plastic Surgery Residency Program, Harvard Medical School, 75 Francis Street, Boston, MA, USA.
| | | | - Lauren D Feld
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Rachel Pham
- Creighton University School of Medicine, Dignity Health St. Joseph's Hospital, Valleywise Health Medical Center, Phoenix, AZ, USA
| | - Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA, USA
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28
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Hollander K, Wilke J, Zech A. Response to: Comment on: "Sex-Specific Differences in Running Injuries: A Systematic Review with Meta-Analysis and Meta-Regression". Sports Med 2021; 52:189. [PMID: 34480739 PMCID: PMC8761130 DOI: 10.1007/s40279-021-01549-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Karsten Hollander
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Am Kaiserkai 1, 20457, Hamburg, Germany.
| | - Jan Wilke
- Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Frankfurt, Germany
| | - Astrid Zech
- Department of Human Movement Science and Exercise Physiology, Institute of Sport Science, Friedrich Schiller University Jena, Jena, Germany
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29
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Gajardo-Burgos R, Monrroy-Uarac M, Barría-Pailaquilén RM, Norambuena-Noches Y, van Rensburg DCJ, Bascour-Sandoval C, Besomi M. Frequency of Injury and Illness in the Final 4 Weeks before a Trail Running Competition. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105431. [PMID: 34069583 PMCID: PMC8160869 DOI: 10.3390/ijerph18105431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/15/2021] [Accepted: 05/17/2021] [Indexed: 11/16/2022]
Abstract
We aimed to (i) determine self-reported injury and illness frequency in trail runners 4 weeks preceding competition; (ii) compare athletes with and without injury/illness by sex, age, body mass index (BMI) and competition distance; (iii) describe mechanism of injury, anatomical region (injury)/organ system (illness) involved, consequences of injury on preparation and self-perception of injury severity; (iv) compare anatomical region (injury) and organ system (illness) by sex. A total of 654 trail runners (age 36.2, IQR 30.6-43.0; 36.9% females) participated in this retrospective cross-sectional study by completing a self-reported questionnaire. Injury and illness frequency rates were 31.3% (n = 205, CI: 27.7-35.0%) and 22.3% (n = 146, CI: 19.1-25.7%), respectively. No significant difference was found between injured vs. non-injured or ill vs. non-ill study participants by sex, age, BMI and competition distance. Regarding injuries, gradual onset (41.6%) and knee (33.2%) were the most indicated mechanism and anatomical region of injury. At least 85.4% of trail runners changed their training following injury and 79% indicated that their injury would affect their competition performance. Regarding illness, the respiratory tract was the most frequent organ system involved (82.9%). Male and female participants reported similar proportions of anatomical regions (injury) and organ systems (illness) affected. These results could help to generate education strategies and appropriate medical support before and during these competitions.
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Affiliation(s)
- Rubén Gajardo-Burgos
- Facultad de Medicina, Instituto de Aparato Locomotor y Rehabilitación, Universidad Austral de Chile, Valdivia 5090000, Chile; (M.M.-U.); (R.M.B.-P.)
- Correspondence: ; Tel.: +56-632293171; Fax: +56-632293727
| | - Manuel Monrroy-Uarac
- Facultad de Medicina, Instituto de Aparato Locomotor y Rehabilitación, Universidad Austral de Chile, Valdivia 5090000, Chile; (M.M.-U.); (R.M.B.-P.)
| | - René Mauricio Barría-Pailaquilén
- Facultad de Medicina, Instituto de Aparato Locomotor y Rehabilitación, Universidad Austral de Chile, Valdivia 5090000, Chile; (M.M.-U.); (R.M.B.-P.)
- Instituto de Enfermería, Universidad Austral de Chile, Valdivia 5090000, Chile
| | | | - Dina Christa Janse van Rensburg
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa;
- Medical Board Member, International Netball Federation, Manchester M1 5LN, UK
| | - Claudio Bascour-Sandoval
- Departamento de Medicina Interna, Universidad de La Frontera, Temuco 4781218, Chile;
- Carrera de Kinesiología, Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Temuco 4810101, Chile
| | - Manuela Besomi
- Escuela de Kinesiología, Universidad del Desarrollo, Santiago 7610658, Chile;
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30
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Kemler E, Huisstede B. Performance goals of runners are associated with the occurrence of running-related injuries. Phys Ther Sport 2021; 50:153-158. [PMID: 34029987 DOI: 10.1016/j.ptsp.2021.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the relationship between running performance goals and running-related injuries (RRIs). DESIGN Retrospective cross-sectional study. SETTING A total of 970 recreational runners filled in an online questionnaire to collect data on personal characteristics, their running activities, RRIs, and running goals. PARTICIPANTS 970 recreational runners, 1) without a running performance goal, who 2) trained to complete a certain distance, and who 3) trained to complete a certain distance and to participate in a specific running event. MAIN OUTCOME MEASURES RRI, defined as any physical complaint developed during running in the previous 12 months. RESULTS A statistically significant relationship was found between runners who trained for a specific running event and who also wanted to run a certain distance (OR 2.0, 95%CI 1.23-2.98) compared with runners without a running goal. (Hinder from a) Previous injury (OR 3.9, 95%CI 2.79-5.42), overweight (OR 1.6, 95%CI 1.10-2.21), and training for more than 22.5 h/year (OR 1.7, 95%CI 1.04-2.72 and OR 2.3, 95%CI 1.42-3.81) were also associated with RRIs. CONCLUSION Running to achieve running goals, specifically running to complete a certain distance and to participate in an event, is associated with the occurrence of an RRI.
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Affiliation(s)
- Ellen Kemler
- Dutch Consumer Safety Institute (VeiligheidNL), Amsterdam, the Netherlands.
| | - Bionka Huisstede
- Department of Rehabilitation, Physical Therapy Science & Sport, University Medical Center Utrecht, Brain Center, Utrecht University, Utrecht, the Netherlands
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31
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Scheer V, Krabak BJ. Musculoskeletal Injuries in Ultra-Endurance Running: A Scoping Review. Front Physiol 2021; 12:664071. [PMID: 33868030 PMCID: PMC8044296 DOI: 10.3389/fphys.2021.664071] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/12/2021] [Indexed: 02/05/2023] Open
Abstract
Ultra-endurance running (UER) has seen an important increase in participation over the last few decades. Long hours of UER can lead to excessive stress on the body, resulting in musculoskeletal injuries (MSKI). UER is not a uniform sport and events can differ considerably in distance (over 42.195 km), time (e.g., events over 6 h) and multi-day or multi-stage events on various surfaces (e.g., track, on-road, off-road). The aims of this scoping review were therefore: (1) to examine the current evidence of MSKI, providing a synthesis of the most common MSKI by anatomical region and specific diagnosis; (2) categorize MSKI by type of UER activity (competition: time-limited; multi-stage; continuous UER events and training); (3) describe knowledge gaps in the literature and provide advice on potential further research. Our electronic literature search (PubMed, SPORTDiscus, Web of Science) identified a total of 13 studies (9 in competition, and 4 in training). Anatomical site, diagnosis and rate of injuries differ between competition and training as well as between different UER types. MSKI are observed in 18% of multi-stage events (0.7-1.8 injuries/runner and 7.2 injuries/1000 h). Most MSKI involve the lower leg (35.0%), ankle (16.8%), knee (13.1%) and foot (12.6%), with main diagnosis of medial tibial stress syndrome (30.1%) and patella femoral pain syndrome (PFPS; 7.2%). Single, continuous UER events differ between a 1005 km road race with almost all of the injuries due to overuse, with the main anatomical site of the knee (31%), ankle (28%) and lower leg (14%) and main diagnosis of PFPS (15.6%), compared to a 65 km trail race, with 32.8% of MSKI, mainly on the foot [plantar fasciitis (28.6%)], ankle [sprain (28.6%)] and knee. Timed-UER events (injury rate of 2.1 injuries/athlete) observed most injuries on the ankle (36%) and knee (19%), with the main diagnosis of tendinitis of the foot dorsiflexors (30%). Injuries during training most commonly affect, the back (42%), and knee (40%) and bone stress injuries (22%). Main diagnoses include ankle sprain (18%), iliotibial band injury (16%) and Achilles tendinopathy (11%). Future considerations include examining MSKI in different UER events, environments and surfaces, and on larger study populations. Establishing risk factors, examining sex differences and using a standard reporting system of MSKI in UER are also important.
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Affiliation(s)
- Volker Scheer
- Ultra Sports Science Foundation, Pierre-Bénite, France
| | - Brian J Krabak
- University of Washington and Seattle Children's Sports Medicine, Seattle, WA, United States
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32
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Yu L, Mei Q, Xiang L, Liu W, Mohamad NI, István B, Fernandez J, Gu Y. Principal Component Analysis of the Running Ground Reaction Forces With Different Speeds. Front Bioeng Biotechnol 2021; 9:629809. [PMID: 33842444 PMCID: PMC8026898 DOI: 10.3389/fbioe.2021.629809] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/26/2021] [Indexed: 01/10/2023] Open
Abstract
Ground reaction force (GRF) is a key metric in biomechanical research, including parameters of loading rate (LR), first impact peak, second impact peak, and transient between first and second impact peaks in heel strike runners. The GRFs vary over time during stance. This study was aimed to investigate the variances of GRFs in rearfoot striking runners across incremental speeds. Thirty female and male runners joined the running tests on the instrumented treadmill with speeds of 2.7, 3.0, 3.3, and 3.7 m/s. The discrete parameters of vertical average loading rate in the current study are consistent with the literature findings. The principal component analysis was modeled to investigate the main variances (95%) in the GRFs over stance. The females varied in the magnitude of braking and propulsive forces (PC1, 84.93%), whereas the male runners varied in the timing of propulsion (PC1, 53.38%). The female runners dominantly varied in the transient between the first and second peaks of vertical GRF (PC1, 36.52%) and LR (PC2, 33.76%), whereas the males variated in the LR and second peak of vertical GRF (PC1, 78.69%). Knowledge reported in the current study suggested the difference of the magnitude and patterns of GRF between male and female runners across different speeds. These findings may have implications for the prevention of sex-specific running-related injuries and could be integrated with wearable signals for the in-field prediction and estimation of impact loadings and GRFs.
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Affiliation(s)
- Lin Yu
- Loudi Vocational and Technical College, Loudi, China.,Faculty of Sports Sciences and Coaching, Sultan Idris Education University, Tanjong Malim, Malaysia.,Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Qichang Mei
- Faculty of Sports Science, Ningbo University, Ningbo, China.,Research Academy of Grand Health, Ningbo University, Ningbo, China.,Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Liangliang Xiang
- Faculty of Sports Science, Ningbo University, Ningbo, China.,Research Academy of Grand Health, Ningbo University, Ningbo, China.,Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Wei Liu
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Nur Ikhwan Mohamad
- Faculty of Sports Sciences and Coaching, Sultan Idris Education University, Tanjong Malim, Malaysia
| | - Bíró István
- Faculty of Engineering, University of Szeged, Szeged, Hungary
| | - Justin Fernandez
- Research Academy of Grand Health, Ningbo University, Ningbo, China.,Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.,Department of Engineering Science, University of Auckland, Auckland, New Zealand
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo, China.,Research Academy of Grand Health, Ningbo University, Ningbo, China.,Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
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Hollander K, Hamacher D, Zech A. Running barefoot leads to lower running stability compared to shod running - results from a randomized controlled study. Sci Rep 2021; 11:4376. [PMID: 33623054 PMCID: PMC7902604 DOI: 10.1038/s41598-021-83056-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 01/28/2021] [Indexed: 12/24/2022] Open
Abstract
Local dynamic running stability is the ability of a dynamic system to compensate for small perturbations during running. While the immediate effects of footwear on running biomechanics are frequently investigated, no research has studied the long-term effects of barefoot vs. shod running on local dynamic running stability. In this randomized single-blinded controlled trial, young adults novice to barefoot running were randomly allocated to a barefoot or a cushioned footwear running group. Over an 8-week-period, both groups performed a weekly 15-min treadmill running intervention in the allocated condition at 70% of their VO2 max velocity. During each session, an inertial measurement unit on the tibia recorded kinematic data (angular velocity) which was used to determine the short-time largest Lyapunov exponents as a measure of local dynamic running stability. One hundred running gait cycles at the beginning, middle, and end of each running session were analysed using one mixed linear multilevel random intercept model. Of the 41 included participants (48.8% females), 37 completed the study (drop-out = 9.7%). Participants in the barefoot running group exhibited lower running stability than in the shod running group (p = 0.037) with no changes during the intervention period (p = 0.997). Within a single session, running stability decreased over the course of the 15-min run (p = 0.012) without differences between both groups (p = 0.060). Changing from shod to barefoot running reduces running stability not only in the acute phase but also in the longer term. While running stability is a relatively new concept, it enables further insight into the biomechanical influence of footwear.
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Affiliation(s)
- Karsten Hollander
- Faculty of Medicine, MSH Medical School Hamburg, Am Kaiserkai 1, 20457, Hamburg, Germany.
| | - Daniel Hamacher
- Department of Sport Science, Friedrich Schiller University Jena, Jena, Germany
| | - Astrid Zech
- Department of Sport Science, Friedrich Schiller University Jena, Jena, Germany
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