Risk models for lower extremity injuries among short- and long distance runners: A prospective cohort study

Increasing Step Frequency Reduces Patellofemoral Joint Stress and Patellar Tendon Force Impulse More at Low Running Speed

PURPOSE

Patellofemoral pain syndrome and patellar tendinopathy are important running-related overuse injuries. This study investigated the interaction of running speed and step frequency alterations on peak and cumulative patellofemoral joint stress (PFJS) and patellar tendon force (PTF) parameters.

METHODS

Twelve healthy individuals completed an incremental running speed protocol on a treadmill at habitual, increased and decreased step frequency. Peak PFJS and PTF, peak rate of PFJS and PTF development, and PFJS and PTF impulse per kilometer (km) were calculated using musculoskeletal modeling.

RESULTS

With increasing running speed, peak PFJS ( P < 0.001) and PTF ( P < 0.001) and peak rate of PFJS ( P < 0.001) and PTF ( P < 0.001) development increased, whereas PFJS ( P < 0.001) and PTF ( P < 0.001) impulse per km decreased. While increasing step frequency by 10%, the peak PFJS ( P < 0.001) and PTF ( P < 0.001) and the PFJS ( P < 0.001) and PTF ( P < 0.001) impulse per kilometer decreased. No significant effect of step frequency alteration was found for the peak rate of PFJS ( P = 0.008) and PTF ( P = 0.213) development. A significant interaction effect was found for PFJS ( P < 0.001) and PTF ( P < 0.001) impulse per km, suggesting that step frequency alteration was more effective at low running speed.

CONCLUSIONS

The effectiveness of step frequency alteration on PFJS and PTF impulse per km is dependent on the running speed. With regard to peak PFJS and PTF, step frequency alteration is equally effective at low and high running speeds. Step frequency alteration was not effective for peak rate of PFJS and PTF development. These findings can assist the optimization of patellofemoral joint and patellar tendon load management strategies.

Aetiological Factors of Running-Related Injuries: A 12 Month Prospective "Running Injury Surveillance Centre" (RISC) Study

BACKGROUND

Running-related injuries (RRIs) are a prevalent issue for runners, with several factors proposed to be causative. The majority of studies to date are limited by retrospective study design, small sample sizes and seem to focus on individual risk factors in isolation. This study aims to investigate the multifactorial contribution of risk factors to prospective RRIs.

METHODS

Recreational runners (n = 258) participated in the study, where injury history and training practices, impact acceleration, and running kinematics were assessed at a baseline testing session. Prospective injuries were tracked for one year. Univariate and multivariate Cox regression was performed in the analysis.

RESULTS

A total of 51% of runners sustained a prospective injury, with the calf most commonly affected. Univariate analysis found previous history of injury < 1 year ago, training for a marathon, frequent changing of shoes (every 0-3 months), and running technique (non-rearfoot strike pattern, less knee valgus, greater knee rotation) to be significantly associated with injury. The multivariate analysis revealed previous injury, training for a marathon, less knee valgus, and greater thorax drop to the contralateral side to be risk factors for injury.

CONCLUSION

This study found several factors to be potentially causative of injury. With the omission of previous injury history, the risk factors (footwear, marathon training and running kinematics) identified in this study may be easily modifiable, and therefore could inform injury prevention strategies. This is the first study to find foot strike pattern and trunk kinematics to relate to prospective injury.

Chronic Disease, Allergies, and Increased Years of Running Are Risk Factors Predicting Gradual Onset Running-Related Injuries in Ultramarathon Runners-SAFER XIX Study in 29 585 Race Entrants

OBJECTIVES

To identify risk factors that predict gradual onset running-related injuries (GORRIs) in ultramarathon runners entering a mass community-based event.

DESIGN

Descriptive cross-sectional study.

SETTING

Two Oceans 56 km ultramarathon 2012 to 2015.

PARTICIPANTS

Race entrants (n = 42 003) completed a compulsory pre-race medical history questionnaire; 29 585 (70.4%) of entrants consented.

DEPENDENT/OUTCOME VARIABLE

A history of GORRIs in the past 12 months among race entrants.

MAIN OUTCOME MEASURES

In a multi-variate model, runner demographics, training variables (years of recreational running, weekly running distance, training running speed), history of chronic disease (composite score), and history of allergies were included as factors predicting GORRIs. Prevalence (%) and prevalence ratios (PR, 95% CIs) are reported.

RESULTS

The lifetime prevalence of GORRIs in ultramarathon runners was 24.4%. Independent factors predicting GORRIs were: higher chronic disease composite score (PR = 2.05 times increase risk for every 2 additional chronic diseases; P < 0.0001), history of allergies (PR = 1.66; P < 0.0001), increased years of recreational running (PR = 1.07 times increased risk for every 5 year increase in running; P < 0.0001), lower average weekly running distance (PR = 0.98 times decreased risk for every 15 km increase weekly running distance; P < 0.0001), and slower average training running speed (PR = 0.96 times decreased risk for every km/h increase in training running speed; P < 0.0001).

CONCLUSIONS

Novel risk factors predicting GORRIs are increased number of chronic diseases and a history of allergies. These factors, together with training variables (years of recreational running, weekly running distance, and training running speed) can be targeted to develop and implement injury prevention, treatment, and rehabilitation interventions in ultramarathon runners.

Running-related demands and vigor in long-distance runners: The moderating role of resources and recovery

Long-distance running is a demanding sport and runners use a variety of coping strategies to deal with these demands. In this study, we investigated running-related demands, resources, and recovery and, as an indicator of well-being, vigor. Specifically, following the Demand-Induced Strain Compensation Recovery Model, we tested to what degree the relation between running-related demands and vigor was moderated by two coping strategies available in running: running-related resources (e.g., training control, running mate/coach support) and running-related recovery (i.e., detachment from running). Demands, resources, recovery, and vigor were all surveyed across three separate dimensions (i.e., physical, cognitive, emotional) in a cross-sectional sample of 623 recreational long-distance runners. Hierarchical regression analyses were used to determine to what degree the demands-vigor relation was moderated by resources and recovery. Evidence for moderations was found for the cognitive and emotional dimensions of vigor, revealing four significant moderating effects of resources or recovery on the demands-vigor relation. Three of these effects involved emotional resources or recovery. Contrary to expectations, results also showed that in two cases higher recovery was associated with lower vigor, rather than higher, when runners experienced high demands. In all, we found modest support for the role of resources and recovery in altering the nature of the demands-vigor relation in recreational long-distance runners. This study highlights the importance of the emotional dimension of demands, resources, and recovery, as those facets were most important in predicting vigor in runners. Practical implications are addressed with regard to emotional resources and recovery for long-distance runners.

The association between running injuries and training parameters: A systematic review

OBJECTIVE

To synthesise the current evidence on the incidence of running-related injuries (RRI) and their association with training parameters (distance, duration, frequency, intensity), as well as recent changes in training parameters.

DATA SOURCES

Searches were conducted in Medline/Ovid, CINAHL, Embase and SportDiscus up to July 7, 2020.

STUDY SELECTION

Included articles had to report prospective data on RRIs and training parameters, or any changes in parameters, and be published in English or French. Two reviewers independently screened titles, abstracts and full-texts.

DATA EXTRACTION

Data extraction and quality assessment (QualSyst) were performed by two independent raters.

DATA SYNTHESIS

Thirty-six articles totaling 23,047 runners were included. Overall, 6,043 runners (26.2%) sustained an RRI (incidence range: 8.8% to 91.3%). The incidence of RRI was 14.9% in novice runners (range: 9.4 to 94.9%), 26.1% in recreational runners (range: 17.9 to 79.3%) and 62.6% in competitive runners (range: 52.6 to 91.3%). The three most frequently injured body parts were the knee (25.8%), foot/ankle (24.4%) and lower leg (24.4%). Overall, there was conflicting evidence about the association between weekly running distance, duration, frequency, intensity or specific changes in training parameters and the onset of RRIs.

CONCLUSIONS

Despite high rates of RRIs, current evidence does not consistently link RRIs with specific training parameters or recent changes in training parameters. Therefore, caution should be taken when recommending optimal parameters or progressions. Given the multifactorial nature of RRIs, future studies also need to consider the interaction between training parameters, as well as psychosocial, hormonal, lifestyle and recovery outcomes to better understand the onset of RRIs.

Lower extremity compression garments use by athletes: why, how often, and perceived benefit

Background

Studies on the benefits of lower extremity compression garments (CGs) have focused on their effects on post-exercise recovery and performance improvement. Less is known about why athletes actually use CGs, the frequency with which they use them, and perceived benefits from using CGs. The purpose of this study was to investigate which athletes use CGs, why athletes use CGs, when CGs are worn by athletes, and, in case of an injury or injury prevention, for which injuries CGs are used.

Methods

This cross-sectional study involved 512 athletes who used lower extremity CGs. Athletes completed a questionnaire on the type of CGs they used, and when and why they used them. They also reported their sports participation, past and current sports injuries, and the perceived benefits of using CGs.

Results

88.1% (n=451) of the athletes were endurance athletes and 11.9% (n=61) were non-endurance athletes. Endurance and non-endurance athletes reported running (84.7%, n=382) and obstacle course racing (24.6%, n=15) the most frequently as primary sports, respectively. The most-used CG was the compression sock (59.2%, n=303). In total, 47.5% (n=246) of the athletes used a CG primarily to prevent re-injury and 14.5% (n=74) to reduce symptoms of a current sports injury. Other primary reported aims were primary prevention (13.6%), post-exercise recovery (14.3%), sports performance improvement (8.8%), and to look good (0.2%). The point prevalence of past and current sports injuries among all athletes was 84.2 and 20.2%, respectively. The most common current sports injuries were shin and calf injuries. Many athletes “always” or “often” used their CGs during training (56.8%, n=279) and competitions (72.9%, n=264). Furthermore, almost 90% of the athletes that aimed to prevent re-injury by using CGs reported that CGs contributed to secondary injury prevention.

Conclusion

88% of the CG-users were endurance athletes, of which 85% were runners. All athletes mainly used CGs to prevent injury recurrence, but also to reduce symptoms of a current sports injury. A majority of the athletes reported positive perceived effects from the CGs. CGs were used more during than after sports participation.

Risk factors for overuse injuries in short- and long-distance running: A systematic review

PURPOSE

The aim of this study was to review information about risk factors for lower extremity running injuries in both short-distance (mean running distance ≤20 km/week and ≤10 km/session) and long-distance runners (mean running distance >20 km/week and >10 km/session).

METHODS

Electronic databases were searched for articles published up to February 2019. Prospective cohort studies using multivariable analysis for the assessment of individual risk factors or risk models for the occurrence of lower extremity running injuries were included. Two reviewers independently selected studies for eligibility and assessed risk of bias with the Quality in Prognostic Studies Tool. The GRADE approach was used to assess the quality of the evidence.

RESULTS

A total of 29 studies were included: 17 studies focused on short-distance runners, 11 studies focused on long-distance runners, and 1 study focused on both types of runners. A previous running-related injury was the strongest risk factor for an injury for long-distance runners, with moderate-quality evidence. Previous injuries not attributed to running was the strongest risk factor for an injury for short-distance runners, with high-quality evidence. Higher body mass index, higher age, sex (male), having no previous running experience, and lower running volume were strong risk factors, with moderate quality evidence, for short-distance runners. Low-quality evidence was found for all risk models as predictors of running-related injuries among short- and long-distance runners.

CONCLUSION

Several risk factors for lower extremity injuries have been identified among short- and long-distance runners, but the quality of evidence for these risk factors for running-related injuries is limited. Running injuries seem to have a multifactorial origin both in short- and long-distance runners.

Runner's Perceptions of Reasons to Quit Running: Influence of Gender, Age and Running-Related Characteristics

Physical inactivity has become a major public health concern and, consequently, the awareness of striving for a healthy lifestyle has increased. As a result, the popularity of recreational sports, such as running, has increased. Running is known for its low threshold to start and its attractiveness for a heterogeneous group of people. Yet, one can still observe high drop-out rates among (novice) runners. To understand the reasons for drop-out as perceived by runners, we investigate potential reasons to quit running among short distance runners (5 km and 10 km) (n = 898). Data used in this study were drawn from the standardized online Eindhoven Running Survey 2016 (ERS16). Binary logistic regressions were used to investigate the relation between reasons to quit running and different variables like socio-demographic variables, running habits and attitudes, interests, and opinions (AIOs) on running. Our results indicate that, not only people of different gender and age show significant differences in perceived reasons to quit running, also running habits, (e.g., running context and frequency) and AIOs are related to perceived reasons to quit running too. With insights into these related variables, potential drop-out reasons could help health professionals in understanding and lowering drop-out rates among recreational runners.

Mental Recovery and Running-Related Injuries in Recreational Runners: The Moderating Role of Passion for Running

This pilot study investigates the moderating role of passion for running in the relation between mental recovery from running and running-related injuries (RRIs). We predict that the relation between recovery and injuries is dependent on the level of passion. A cross-sectional survey study was conducted among 246 Dutch recreational runners. Multivariate logistic regression analyses revealed that the negative association between mental recovery after running and RRIs is moderated (i.e., strengthened) by harmonious passion. Put differently, runners who are able to mentally recover well after running were less likely to report RRIs in the case of harmonious passion. Additionally, findings demonstrated that obsessively passionate runners were more likely to report RRIs. Passionate runners may benefit from education programs to help them integrate running more harmoniously with other aspects of life, and to prevent injuries. In addition, they should be educated about the crucial role of appropriate mental recovery from running. Considering mental aspects in running such as mental recovery from running and passion for running seems to be worthwhile to gain a better understanding of the incidence and/or prevalence of RRIs. Future (quasi-experimental) studies should investigate the issues raised here more profoundly.

Injury incidence and risk factors: a cohort study of 706 8-km or 16-km recreational runners

Objectives

To report (1) the injury incidence in recreational runners in preparation for a 8-km or 16-km running event and (2) which factors were associated with an increased injury risk.

Methods

Prospective cohort study in Amsterdam, the Netherlands. Participants (n=5327) received a baseline survey to determine event distance (8 km or 16 km), main sport, running experience, previous injuries, recent overuse injuries and personal characteristics. Three days after the race, they received a follow-up survey to determine duration of training period, running distance per week, training hours, injuries during preparation and use of technology. Univariate and multivariate regression models were applied to examine potential risk factors for injuries.

Results

1304 (24.5%) participants completed both surveys. After excluding participants with current health problems, no signed informed consent, missing or incorrect data, we included 706 (13.3%) participants. In total, 142 participants (20.1%) reported an injury during preparation for the event. Univariate analyses (OR: 1.7, 95% CI 1.1 to 2.4) and multivariate analyses (OR: 1.7, 95% CI 1.1 to 2.5) showed that injury history was a significant risk factor for running injuries (Nagelkerke R-square=0.06).

Conclusion

An injury incidence for recreational runners in preparation for a running event was 20%. A previous injury was the only significant risk factor for running-related injuries.

Effects of treadmill cushion and running speed on plantar force and metabolic energy consumption in running

BACKGROUND

Repetitive loading with high impact forces are considered as a primary risk factor for overuse injuries. Cushion was proposed in running surface and shoe manufacturing to reduce impact forces and prevent injuries in running.

RESEARCH QUESTION

To investigate the effects of treadmill cushion and running speed on plantar force and metabolic energy consumption in treadmill running.

METHODS

Plantar force data and metabolic data were collected for 20 men during running at 8 km/h and 10 km/h on the treadmill with and without cushion. Two-way ANOVAs with repeated measures were performed to determine the treadmill effects and the speed effects.

RESULTS

Participants significantly decreased peak plantar force on the fore foot at both 10 km/h (P = 0.001) and 8 km/h (P = 0.001) and peak plantar force on the mid foot only at 10 km/h (P = 0.011) while running on the treadmill with cushion compared to the treadmill without cushion. The reduction of peak plantar force at 10 km/h was greater than that at 8 km/h while running on the treadmill with cushion. Participants significantly increased metabolic energy consumption while running on the treadmill with cushion compared to the treadmill without cushion (P = 0.007).

SIGNIFICANCE

Running on the treadmill with cushion significantly decreased plantar force on the fore foot and mid foot, and increased metabolic energy consumption. Running on the treadmill with cushion may be a useful method in the prevention of fore foot injuries and increasing exercise effects.