Predictors of multiple injuries in individual distance runners: A retrospective study of 75,401 entrants in 4 annual races-SAFER XX

Risk factors associated with a history of iliotibial band syndrome (hITBS) in distance runners: a cross-sectional study in 76 654 race entrants - a SAFER XXXIII study

BACKGROUND

Despite the numerous health benefits of distance running, it is also associated with the development of 'gradual onset running-related injuries' (GORRIs) one of which is Iliotibial Band Syndrome (ITBS). Novel risk factors associated with a history of ITBS (hITBS) have not been described in a large cohort of distance runners.

OBJECTIVE

To identify risk factors associated with hITBS in distance runners.

DESIGN

Descriptive cross-sectional study.

SETTING

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

PARTICIPANTS

106 743 race entrants completed the online pre-race medical screening questionnaire. A total of 1 314 runners confirmed an accurate hITBS diagnosis.

METHODS

Selected risk factors associated with hITBS explored included: demographics (race distance, sex, age groups), training/running variables, history of existing chronic diseases (including a composite chronic disease score) and history of any allergy. Prevalence (%) and prevalence ratios (PR; 95% CI) are reported (uni- & multiple regression analyzes).

RESULTS

1.63% entrants reported hITBS in a 12-month period. There was a higher (p < 0.0001) prevalence of hITBS in the longer race distance entrants (56 km), females, younger entrants, fewer years of recreational running (PR = 1.07; p = 0.0009) and faster average running speed (PR = 1.02; p = 0.0066). When adjusted for race distance, sex, age groups, a higher chronic disease composite score (PR = 2.38 times increased risk for every two additional chronic diseases; p < 0.0001) and a history of allergies (PR = 1.9; p < 0.0001) were independent risk factors associated with hITBS.

CONCLUSION

Apart from female sex, younger age, fewer years of running and slower running speed, two novel independent risk factors associated with hITBS in distance runners are an increased number of chronic diseases and a history of allergies. Identifying athletes at higher risk for ITBS can guide healthcare professionals in their prevention and rehabilitation efforts.

Years of running, chronic diseases, and allergies are associated with gradual onset Achilles tendon injuries in 61,252 running race entrants: SAFER XXXIX study

BACKGROUND

Gradual-onset Achilles tendon injuries (GoATIs) in runners are common. Data show that chronic diseases are associated with GoATI.

OBJECTIVE

To determine risk factors associated with a history of GoATIs among long-distance runners (21.1 and 56 km) entering a mass community-based running event.

METHODS

Online pre-race medical screening questionnaire data from 76,654 consenting Two Ocean Marathon race entrants (71.8% entrants) were collected prospectively over 4 years (2012-2015); this cross-sectional study is a retrospective analysis of these data. A total of 617 entrants (0.8%) reported a GoATI in the last 12 months; 60,635 entrants reported no history of any running injury (controls). Categories of factors associated with GoATI were explored (univariate and multiple regression analyses): demographics (age group, sex, race, distance), training/racing history, and history of allergy, history of chronic disease, and Composite Chronic Disease Score. Prevalence and prevalence ratios (PRs; 95% CI) are reported.

RESULTS

Factors associated with a higher prevalence of a history of GoATI (univariate analysis vs. controls) were older age (>31 years) (p < .001), male sex (PR = 1.76; p < .001), and longer race distance (56 km vs. 21.1 km) (PR = 2.06; p < .001). Independent factors associated with a history of GoATI (multiple regression) were increased years of recreational running (PR = 1.17 for every 5-year increase, p < .001), higher Composite Chronic Disease Score (PR = 2.07 for every 2-unit increase, p < .001), and allergy history (PR = 1.98 p < .001).

CONCLUSION

Novel independent factors associated with a history of GoATI in distance runners were increased years of recreational running, chronic disease history, and allergy history. Runners at risk for GoATI could be targeted for injury prevention interventions. Future studies should focus on establishing a causal relationship.

The associated factors for physical activity-related injuries among first-year university students in southern China from a biopsychosocial perspective

Background

Understanding the diverse factors influencing physical activity-related injuries is crucial for developing effective interventions that enable individuals to participate in physical activity (PA) while minimizing injury risk. Currently, research evidence on the multiple factors associated with PA-related injuries is inadequate. This study aimed to examine the associations between PA-related injuries and various biological, psychological, and social factors among first-year university students in China.

Methods

We recruited first-year university students from Shantou University in Guangdong Province, China, to participate in our study. Data collection employed a structured self-administered questionnaire, gathering information on PA-related injuries, as well as relevant biological, psychological, and social factors. Binary logistic regression, using a stepwise modeling approach, was employed for the data analysis.

Results

Among 1,051 first-year university students, 28.16% reported having experienced PA-related injuries in the past year. Most of the injuries reported were minor, with the knee or lower leg being the most frequently injured part of the body. Improper posture, environmental conditions, and excessive physical load were the leading causes of PA-related injuries. Multiple logistic regression analysis revealed that female students (OR = 0.67, 95% CI: 0.47-0.94, p = 0.022) had reduced odds of PA-related injuries. Conversely, high neuroticism (OR = 1.61, 95% CI: 1.07-2.41, p = 0.022), being a member of a sports team (OR = 2.09, 95% CI: 1.34-3.27, p < 0.001), PA on the wet ground (OR = 1.73, 95% CI: 1.18-2.54, p = 0.005) increased the odds of PA-related injuries.

Conclusion

Our findings underscore the intricate interplay of various factors contributing to PA-related injuries. Identifying high-risk individuals based on physiological and psychological characteristics, coupled with targeted interventions addressing modifiable risk factors, is crucial for effective prevention.

Acute effect of foot strike patterns on in vivo tibiotalar and subtalar joint kinematics during barefoot running

BACKGROUND

Foot kinematics, such as excessive eversion and malalignment of the hindfoot, are believed to be associated with running-related injuries. The majority of studies to date show that different foot strike patterns influence these specific foot and ankle kinematics. However, technical deficiencies in traditional motion capture approaches limit knowledge of in vivo joint kinematics with respect to rearfoot and forefoot strike patterns (RFS and FFS, respectively). This study uses a high-speed dual fluoroscopic imaging system (DFIS) to determine the effects of different foot strike patterns on 3D in vivo tibiotalar and subtalar joints kinematics.

METHODS

Fifteen healthy male recreational runners underwent foot computed tomography scanning for the construction of 3-dimensional models. A high-speed DFIS (100 Hz) was used to collect 6 degrees of freedom kinematics for participants' tibiotalar and subtalar joints when they adopted RFS and FFS in barefoot condition.

RESULTS

Compared with RFS, FFS exhibited greater internal rotation at 0%-20% of the stance phase in the tibiotalar joint. The peak internal rotation angle of the tibiotalar joint under FFS was greater than under RFS (p < 0.001, Cohen's d = 0.92). RFS showed more dorsiflexion at 0%-20% of the stance phase in the tibiotalar joint than FFS. RFS also presented a larger anterior translation (p < 0.001, Cohen's d = 1.28) in the subtalar joint at initial contact than FFS.

CONCLUSION

Running with acute barefoot FFS increases the internal rotation of the tibiotalar joint in the early stance. The use of high-speed DFIS to quantify the movement of the tibiotalar and subtalar joint was critical to revealing the effects of RFS and FFS during running.

Patellofemoral Pain Syndrome Is Associated With Chronic Disease and Allergies in 60 997 Distance Runner Race Entrants: SAFER XXX Study

OBJECTIVE

Patellofemoral pain syndrome (PFPS) is a common running-related injury. Independent risk factors associated with PFPS have not been described in a large cohort of distance runners.

DESIGN

Descriptive, cross-sectional study.

SETTING

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

PARTICIPANTS

60 997 race entrants.

ASSESSMENT OF RISK FACTORS

Participants completed a compulsory prerace medical screening questionnaire (history of PFPS in the past 12 months, n = 362; no injury history, n = 60 635). Selected risk factors associated with a history of PFPS were explored using univariate & multivariate analyses: demographics, training/running variables, history of chronic diseases (composite chronic disease score), and any allergy.

MAIN OUTCOME MEASURES

Prevalence ratios (PRs, 95% confidence intervals).

RESULTS

Risk factors associated with PFPS (univariate analysis) were increased years of recreational running (PR = 1.09; P = 0.0107), older age (>50 years), and chronic diseases (PR > 2): gastrointestinal disease (PR = 5.06; P < 0.0001), cardiovascular disease (CVD) (PR = 3.28; P < 0.0001), nervous system/psychiatric disease (PR = 3.04; P < 0.0001), cancer (PR = 2.83; P = 0.0005), risk factors for CVD (PR = 2.42; P < 0.0001), symptoms of CVD (PR = 2.38; P = 0.0397), and respiratory disease (PR = 2.00; P < 0.0001). Independent risk factors (multivariate analysis) associated with PFPS (adjusted for age, sex, and race distance) were a higher chronic disease composite score (PR = 2.68 increased risk for every 2 additional chronic diseases; P < 0.0001) and a history of allergies (PR = 2.33; P < 0.0001).

CONCLUSIONS

Novel independent risk factors associated with PFPS in distance runners are a history of multiple chronic diseases and a history of allergies. Identification of chronic diseases and allergies should be considered as part of the clinical assessment of a runner presenting with a history of PFPS.

Self-Reported Olfactory Dysfunction and Diet Quality: Findings from the 2011-2014 National Health and Nutrition Examination Survey (NHANES)

We identified associations between self-reported olfactory dysfunction (OD) and dietary attributes in participants aged ≥40 years (n = 6,356) from the nationally representative 2011–2014 National Health and Nutrition Examination Survey (NHANES). The chemosensory questionnaire and 24-h dietary recalls were administered by trained interviewers. OD was defined as self-report of either smell problems in the last year, worse smell relative to age 25, or perceiving phantom odors. Dietary outcomes included Healthy Eating Index 2015 score (HEI) with adequacy and moderation components (higher scores indicated higher diet quality), dietary diversity, energy density, and intake of major food groups. Survey-weighted linear regression models estimated OD–diet associations, adjusting for socio-demographic, lifestyle, and clinical factors. Adjusted mean difference (95% CI) between those with versus without OD, showed that adults with OD had significantly lower HEI moderation score (−0.67 (−1.22, −0.11)) and diets higher in energy density (0.06 (0.00, 0.11)), and percent energy from saturated fat (0.47 (0.12, 0.81)), total fat (0.96 (0.22, 1.70)), and added sugar (1.00 (0.33, 1.66)). Age and sex-stratified analyses showed that younger females (40–64 years) primarily accounted for the associations with diet quality and total/saturated fat intake. These findings inform dietary screening and recommendations for adults who report OD, including those experiencing transient or persistent smell loss with COVID-19.