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Dillon S, Burke A, Whyte EF, O’Connor S, Gore S, Moran KA. Running towards injury? A prospective investigation of factors associated with running injuries. PLoS One 2023; 18:e0288814. [PMID: 37590281 PMCID: PMC10434952 DOI: 10.1371/journal.pone.0288814] [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: 12/08/2022] [Accepted: 07/04/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Given the high incidence and heavy burden of running related injuries, large-scale, prospective multifactorial investigations examining potential risk factors are warranted. This study aimed to identify factors associated with running related injuries and to evaluate their potential in injury screening. STUDY DESIGN Prospective cohort study. MATERIALS AND METHODS Two hundred and seventy-four recreational runners were recruited. Clinical measures (strength, range of motion, foot position), injury and training history (via questionnaire), impact loading (via accelerometery) and running technique measures were collected at baseline. Runners were tracked for injury for one year via fortnightly check-ins. A binary logistic regression, (injury versus no injury), was performed for each variable univariably, and then adjusting for age, sex and mileage. A multivariable regression was also performed to evaluate the model's discriminative ability. RESULTS Of the 225 runners included in the final analysis 52% experienced a running related injury. Injury history in the past year, less navicular drop, and measures of running technique (knee, hip, and pelvis kinematics) were associated with increased odds of injury (p < .05). The multivariable logistic regression model was statistically significant, χ2(11) = 56.45, p < .001, correctly classifying 74% of cases with a sensitivity and specificity of 72% and 76%, respectively. The area under the receiver operating characteristic curve was 0.79 (CI95% = 0.73-0.85), demonstrating acceptable discriminative ability. CONCLUSIONS This study found a number of clinical and running technique factors to be associated with prospective running related injuries among recreational runners. With the exception of injury history, the factors identified as being significantly associated with injury may be modifiable and therefore, could form the basis of interventions. Range of motion, spatiotemporal parameters and strength measures were not associated with injury and thus their utilisation in injury prevention practices should be reconsidered.
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Affiliation(s)
- Sarah Dillon
- School of Allied Health, University of Limerick, Limerick, Ireland
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Insight SFI Research Centre for Data Analytics, Dublin City University, Dublin, Ireland
- Centre for Injury Prevention and Performance, Athletic Therapy and Training, Dublin City University, Dublin, Ireland
| | - Aoife Burke
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Insight SFI Research Centre for Data Analytics, Dublin City University, Dublin, Ireland
- Centre for Injury Prevention and Performance, Athletic Therapy and Training, Dublin City University, Dublin, Ireland
| | - Enda F. Whyte
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Centre for Injury Prevention and Performance, Athletic Therapy and Training, Dublin City University, Dublin, Ireland
| | - Siobhán O’Connor
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Centre for Injury Prevention and Performance, Athletic Therapy and Training, Dublin City University, Dublin, Ireland
| | - Shane Gore
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Insight SFI Research Centre for Data Analytics, Dublin City University, Dublin, Ireland
| | - Kieran A. Moran
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Insight SFI Research Centre for Data Analytics, Dublin City University, Dublin, Ireland
- Centre for Injury Prevention and Performance, Athletic Therapy and Training, Dublin City University, Dublin, Ireland
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Lopes AD, Mascarinas A, Hespanhol L. Are alterations in running biomechanics associated with running injuries? A systematic review with meta-analysis. Braz J Phys Ther 2023; 27:100538. [PMID: 37651773 PMCID: PMC10480598 DOI: 10.1016/j.bjpt.2023.100538] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 08/09/2023] [Accepted: 08/16/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND No systematic review has investigated the main biomechanical variables as predictors of running-related injuries. OBJECTIVE To investigate the main biomechanical variables associated with running-related injuries. METHODS Medline via PubMed, EMBASE, SPORTDiscus, Web of Science, and CINAHL were searched from inception until 1 November 2021. Each study included must have investigated the association of at least one biomechanical variable (kinetics, kinematics, electromyography, or pressure distribution) with running injuries. The meta-analysis was conducted, and a modified version of the Downs and Black Quality Index was used for methodological quality evaluation. RESULTS Across the 82 studies included, 5465 runners were investigated. The meta-analysis was conducted with 11 biomechanical variables from 51 articles (n=2395). The peak hip adduction angle was the sole biomechanical variable associated with running injury and was found to be higher in injured runners (0.57, 95% CI 0.21, 0.94) compared to uninjured runners. However, this result was highly influenced by two studies (out of five studies) conducted by the same group of authors. CONCLUSION Clinicians, coaches, and runners should be aware that minimal evidence supports that alterations of running biomechanics are associated with running-related injuries. Heterogeneity in evaluation conditions and inconsistency in the naming and definitions of biomechanical variables make definitive conclusions challenging. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO, CRD42017068839.
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Affiliation(s)
- Alexandre Dias Lopes
- Department of Physical Therapy, Movement & Rehabilitation Sciences, Northeastern University, Boston, MA, USA.
| | | | - Luiz Hespanhol
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Sao Paulo, SP, Brazil; Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health and the Amsterdam Public Health research institute, VU University Medical Center Amsterdam, Amsterdam, the Netherlands
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Foch E, Brindle RA, Pohl MB. Lower extremity kinematics during running and hip abductor strength in iliotibial band syndrome: A systematic review and meta-analysis. Gait Posture 2023; 101:73-81. [PMID: 36758425 DOI: 10.1016/j.gaitpost.2023.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 01/26/2023] [Accepted: 02/01/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Iliotibial band syndrome is a common overuse injury that is twice as likely to affect female runners compared to male runners. It is unclear if there is a consistent running pattern and strength profile exhibited by female and male runners with iliotibial band syndrome. RESEARCH QUESTION The purpose of this systematic review and meta-analysis was to determine if any differences existed in lower-extremity kinematics and hip strength between runners who retrospectively, currently, or prospectively had iliotibial band syndrome. METHODS Papers included must have reported three-dimensional kinematic running data and/or hip strength data that were statistically analyzed between runners that never developed iliotibial band syndrome and runners with iliotibial band syndrome. Meta-analysis was performed for each kinematic or strength variable reported in at least three studies. Female and male runners were analyzed separately and grouped into three cohorts (retrospective, current, prospective). RESULTS Seventeen articles were included in this systematic review. Data from 10 cross-sectional studies were included for meta-analysis. Female runners with current iliotibial band syndrome exhibited smaller peak hip internal rotation angles and lower isometric hip abductor strength compared to controls. SIGNIFICANCE Although limited biomechanical evidence exists, risk factors for ITBS are different between female and male runners and may vary according to injury status. Specifically, transverse plane hip motion and hip abductor strength weakness may be biomechanical risk factors in female runners with current iliotibial band syndrome only.
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Affiliation(s)
- Eric Foch
- Department of Health Sciences, Central Washington University, Ellensburg, WA, USA.
| | | | - Michael B Pohl
- Department of Exercise Science, University of Puget Sound, Tacoma, WA, USA
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Willwacher S, Kurz M, Robbin J, Thelen M, Hamill J, Kelly L, Mai P. Running-Related Biomechanical Risk Factors for Overuse Injuries in Distance Runners: A Systematic Review Considering Injury Specificity and the Potentials for Future Research. Sports Med 2022; 52:1863-1877. [PMID: 35247202 PMCID: PMC9325808 DOI: 10.1007/s40279-022-01666-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Running overuse injuries (ROIs) occur within a complex, partly injury-specific interplay between training loads and extrinsic and intrinsic risk factors. Biomechanical risk factors (BRFs) are related to the individual running style. While BRFs have been reviewed regarding general ROI risk, no systematic review has addressed BRFs for specific ROIs using a standardized methodology. OBJECTIVE To identify and evaluate the evidence for the most relevant BRFs for ROIs determined during running and to suggest future research directions. DESIGN Systematic review considering prospective and retrospective studies. (PROSPERO_ID: 236,832). DATA SOURCES PubMed. Connected Papers. The search was performed in February 2021. ELIGIBILITY CRITERIA English language. Studies on participants whose primary sport is running addressing the risk for the seven most common ROIs and at least one kinematic, kinetic (including pressure measurements), or electromyographic BRF. A BRF needed to be identified in at least one prospective or two independent retrospective studies. BRFs needed to be determined during running. RESULTS Sixty-six articles fulfilled our eligibility criteria. Levels of evidence for specific ROIs ranged from conflicting to moderate evidence. Running populations and methods applied varied considerably between studies. While some BRFs appeared for several ROIs, most BRFs were specific for a particular ROI. Most BRFs derived from lower-extremity joint kinematics and kinetics were located in the frontal and transverse planes of motion. Further, plantar pressure, vertical ground reaction force loading rate and free moment-related parameters were identified as kinetic BRFs. CONCLUSION This study offers a comprehensive overview of BRFs for the most common ROIs, which might serve as a starting point to develop ROI-specific risk profiles of individual runners. We identified limited evidence for most ROI-specific risk factors, highlighting the need for performing further high-quality studies in the future. However, consensus on data collection standards (including the quantification of workload and stress tolerance variables and the reporting of injuries) is warranted.
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Affiliation(s)
- Steffen Willwacher
- grid.440974.a0000 0001 2234 6983Department for Mechanical and Process Engineering, Offenburg University of Applied Sciences, Offenburg, Germany ,grid.27593.3a0000 0001 2244 5164Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Markus Kurz
- grid.29050.3e0000 0001 1530 0805Department of Quality Technology & Mechanical Engineering, Mid Sweden University, Östersund, Sweden
| | - Johanna Robbin
- grid.440974.a0000 0001 2234 6983Department for Mechanical and Process Engineering, Offenburg University of Applied Sciences, Offenburg, Germany ,grid.27593.3a0000 0001 2244 5164Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Matthias Thelen
- grid.27593.3a0000 0001 2244 5164Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Joseph Hamill
- grid.266683.f0000 0001 2166 5835Biomechanics Laboratory, University of Massachusetts, Amherst, MA USA
| | - Luke Kelly
- grid.1003.20000 0000 9320 7537School of Human Movement and Nutrition Sciences, University of Queensland, St. Lucia, QLD Australia
| | - Patrick Mai
- grid.440974.a0000 0001 2234 6983Department for Mechanical and Process Engineering, Offenburg University of Applied Sciences, Offenburg, Germany ,grid.27593.3a0000 0001 2244 5164Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
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Li J, Sheng B, Qiu L, Yu F, Lv FJ, Lv FR, Yang H. A quantitative MRI investigation of the association between iliotibial band syndrome and patellofemoral malalignment. Quant Imaging Med Surg 2021; 11:3209-3218. [PMID: 34249647 DOI: 10.21037/qims-20-1101] [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: 09/27/2020] [Accepted: 03/10/2021] [Indexed: 11/06/2022]
Abstract
Background The iliotibial band (ITB) has a wide patellar insertion that provides lateral restraint to the patella and maintains the patellofemoral joint's stability. There has been limited investigation into the relationship between patellofemoral malalignment and iliotibial band syndrome (ITBS). Methods We retrospectively analyzed 47 knees with ITBS by retrieving magnetic resonance imaging (MRI) data collected over an approximately 6-year period from our database. The Insall-Salvati ratio, lateral patellofemoral angle (LPA), lateral patellar tilt (LPT), lateral trochlear length (LTL), angle of the non-weight-bearing facet of the lateral femoral condyle (nwb-LFCA), and the ITB-lateral femoral condyle (IT-LFC) distance were measured on MR images. The knees of 47 age- and gender-matched subjects were enrolled as the normal group. Results In the ITBS group, over one third (34%, 16/47) of knees had abnormal patellofemoral measurements, including 8 (17%, 8/47) knees with patellar alta, 11 (23.4%, 11/47) knees with an abnormally decreased LPA, and 5 (10.6%, 5/47) knees with an abnormally increased LPT indicating lateral patellar tilt. Moreover, 8 knees had simultaneous combinations of two or three abnormality parameters, and 8 (17%, 8/47) knees presented with superolateral Hoffa's fat pad edema. The Insall-Salvati ratio, LPT, and nwb-LFCA in the ITBS group were significantly higher than those in the normal group (P=0.001, P<0.001, and P<0.001, respectively); the LPA and IT-LFC distances in the ITBS group were significantly lower (P=0.003, P<0.001, respectively) than those in the normal group. There were mild to moderate correlations between the MRI parameters and ITBS (P=0.006, P<0.001, respectively). Conclusions This study confirmed that a higher position or lateral tilt of the patella and a steeper morphology of the anterior part of the lateral femoral condyle were associated with the development of ITBS, which is helpful in understanding and further exploring the mechanism of ITBS.
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Affiliation(s)
- Jia Li
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bo Sheng
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lanyu Qiu
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fan Yu
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fa-Jin Lv
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fu-Rong Lv
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haitao Yang
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Fernández-López I, Rojano-Ortega D. Lower Limb Biomechanical Factors Related to Running Injuries: A Review and Practical Recommendations. Strength Cond J 2020. [DOI: 10.1519/ssc.0000000000000497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Acute Effects of Wedge Orthoses and Sex on Iliotibial Band Strain During Overground Running in Nonfatiguing Conditions. J Orthop Sports Phys Ther 2019; 49:743-750. [PMID: 31475615 DOI: 10.2519/jospt.2019.8837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Previous research has identified that iliotibial band (ITB) syndrome is more prevalent in females than in males. It has been theorized that high ITB strain rate is a primary etiological factor for developing ITB syndrome. Orthoses are commonly used to influence gait mechanics and may reduce ITB strain rate by influencing alterations in the kinematic chain. OBJECTIVES To identify how wedge orthoses and sex affect ITB strain and strain rate. METHODS Thirty asymptomatic participants (15 male, 15 female) ran with 7° lateral, 3° lateral, 0° (no wedge), 3° medial, and 7° medial wedges in this within-subject, repeated-measures study. Participants ran overground while data were collected with a motion-capture system and force platform. Iliotibial band strain and strain rate were estimated using a novel 6-degrees-of-freedom musculoskeletal model. A mixed-model multivariate analysis of covariance for between-subject comparison of sex and within-subject comparison of wedge was used. RESULTS There were no significant differences in ITB strain or strain rate between wedge conditions. Females had significantly higher ITB strain and strain rate compared to males. CONCLUSION Clinicians should be aware that medial wedges may not acutely alter ITB strain or strain rate. Females exhibited greater peak ITB strain and strain rate, potentially due to increased hip internal rotation compared to males. Further research is needed to investigate longitudinal effects of the wedges. J Orthop Sports Phys Ther 2019;49(10):743-750. Epub 31 Aug 2019. doi:10.2519/jospt.2019.8837.
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Dingenen B, Malliaras P, Janssen T, Ceyssens L, Vanelderen R, Barton CJ. Two-dimensional video analysis can discriminate differences in running kinematics between recreational runners with and without running-related knee injury. Phys Ther Sport 2019; 38:184-191. [DOI: 10.1016/j.ptsp.2019.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 05/25/2019] [Accepted: 05/25/2019] [Indexed: 02/04/2023]
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Shen P, Mao D, Zhang C, Sun W, Song Q. Effects of running biomechanics on the occurrence of iliotibial band syndrome in male runners during an eight-week running programme-a prospective study. Sports Biomech 2019; 20:560-570. [PMID: 30973056 DOI: 10.1080/14763141.2019.1584235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Iliotibial band syndrome (ITBS) is a common injury that is related to running biomechanics. This study aimed to determine the gait characteristics that easily induce ITBS and explore the gait changes after the occurrence of ITBS. Thirty healthy male recreational runners participated in our study. Amongst them, 15 developed ITBS and comprised the ITBS group; the other 15 were healthy and comprised the control group. All participants underwent two gait trials, namely, before the first day of their running and after eight weeks, during which a force platform and a motion capture system collected biomechanical data. After running, the ITBS group exhibited greater anterior pelvic tilt and hip flexion angle than the control group. The ITBS group showed increased trunk inclination angle, whereas the control group demonstrated lower hip flexion, hip adduction angle and hip abductor moment than those at the beginning of running. Decreasing hip flexion, adduction angle and abductor moment may be a reasonable strategy to avoid the occurrence of ITBS. The occurrence of ITBS may be due to the lack of timely gait adjustment. Excessive trunk inclination and anterior pelvic tilt angle may be risks factor in the development of ITBS during running.
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Affiliation(s)
| | - Dewei Mao
- Shandong Sport University, Jinan, China
| | - Cui Zhang
- Shandong Institute of Sport Science, Jinan, China
| | - Wei Sun
- Shandong Institute of Sport Science, Jinan, China
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Kinematic risk factors for lower limb tendinopathy in distance runners: A systematic review and meta-analysis. Gait Posture 2019; 69:13-24. [PMID: 30658311 DOI: 10.1016/j.gaitpost.2019.01.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/05/2018] [Accepted: 01/09/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Abnormal kinematics have been implicated as one of the major risk factors for lower limb tendinopathy (LLT). OBJECTIVE To systematically review evidence for kinematic risk factors for LLT in runners. METHODS Individual electronic searches in PubMed, EMBASE and Web of Science were conducted. Two reviewers screened studies to identify observational studies reporting kinematic risk factors in runners with LLT compared to healthy controls. The Down and Black appraisal scale was applied to assess quality. A meta-analysis was performed provided that at least two studies with similar methodology reported the same factor. RESULTS Twenty-eight studies were included: Achilles tendinopathy (AT) (9), iliotibial band syndrome (ITBS) (17), plantar fasciopathy (PF) (2), patellar tendinopathy (PT) (1), posterior tibial tendon dysfunction (PTTD) (1). Eighteen studies were rated high-quality and ten medium-quality. The meta-analyses revealed strong evidence of higher peak knee internal rotation, moderate evidence of lower peak rearfoot eversion and knee flexion at heel strike and greater peak hip adduction in runners with ITBS. Very limited evidence revealed higher peak ankle eversion in runners with PF and PTTD or higher peak hip adduction in PT. SIGNIFICANCE Peak rearfoot eversion was the only factor reported in all included LLTs; it is a significant factor in ITBS, PT and PTTD but not in AT and PF. More prospective studies are needed to accurately evaluate the role of kinematic risk factors as a cause of LLT. Taken together, addressing rearfoot kinematic and kinematic chain movements accompanied by peak eversion should be considered in the prevention and management of LLT.
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Christopher SM, McCullough J, Snodgrass SJ, Cook C. Do alterations in muscle strength, flexibility, range of motion, and alignment predict lower extremity injury in runners: a systematic review. Arch Physiother 2019; 9:2. [PMID: 30805204 PMCID: PMC6373037 DOI: 10.1186/s40945-019-0054-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 01/20/2019] [Indexed: 12/29/2022] Open
Abstract
Background Injury is common in running and seen to impact up to 94% of recreational runners. Clinicians often use alterations from normal musculoskeletal clinical assessments to assess for risk of injury, but it is unclear if these assessments are associated with future injury. Objectives To identify alterations in muscle strength, flexibility, range of motion, and alignment that may predict lower extremity injury in runners. Methods Articles were selected following a comprehensive search of PubMed, Embase, CINAHL, and SPORTDiscus from database inception to May 2018. Included articles were prospective cohort studies, which specifically analyzed musculoskeletal impairments associated with future running-related injury. Two authors extracted study data, assessed the methodological quality of each study using the Critical Appraisal Tool and assessed the overall quality using the GRADE approach. Results Seven articles met the inclusion criteria. There was very low quality of evidence for the 7 identified clinical assessment alteration categories. Strong hip abductors were significantly associated with running-related injury in one study. Increased hip external-to-internal rotation strength and decreased hip internal range of motion were protective for running injury, each in one study. Decreased navicular drop in females had a protective effect for running-related injury in one study. Conclusions Due to very low quality of evidence for each assessment, confounders present within the studies, a limited number of studies, different measurement methods among studies, measurement variability within clinical assessments, inconsistent definitions of injury and runner, different statistical modeling, and study bias, caution is suggested in interpreting these results.
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Affiliation(s)
- Shefali M Christopher
- 1Department of physical therapy Education, Elon University, Elon, NC 27244 USA.,2School of Health Sciences, The University of Newcastle, Callaghan, Australia
| | | | - Suzanne J Snodgrass
- 2School of Health Sciences, The University of Newcastle, Callaghan, Australia
| | - Chad Cook
- 4Division of Physical Therapy, Duke University, 2200 W. Main Street, Durham, NC 27705 USA
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A normative database of hip and knee joint biomechanics during dynamic tasks using anatomical regression prediction methods. J Biomech 2018; 81:122-131. [DOI: 10.1016/j.jbiomech.2018.10.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 09/26/2018] [Accepted: 10/03/2018] [Indexed: 11/22/2022]
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Hausken S, Barker-Ruchti N, Schubring A, Grau S. Injury-Free Children and Adolescents: Towards Better Practice in Swedish Football (FIT project). RESEARCH IDEAS AND OUTCOMES 2018. [DOI: 10.3897/rio.4.e30729] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This interdisciplinary research project will produce evidence-based recommendations on how injuries in Swedish youth football (soccer) can be prevented. Fewer injuries will positively impact athlete health, performance and career longevity and have the potential to promote life-long physical activity and wellbeing.
Injury pattern research demonstrates that injuries are a significant problem in (Swedish) youth sport. Football has a higher traumatic and overuse injury rate than many contact/collision sports (e.g., field hockey, basketball). In research on youth football, the incidence of overuse training injuries was measured as high as 15.4 injuries per 1000 training hours, and the incidence of traumatic and overuse match injuries was 47.5 injuries per 1000 match hours. The injury frequency is alarming and applies to the 54% of children aged 7-14 and the 39% of youths aged 15-19 years who participate in Swedish organised sports. A large body of research identifies injury risk factors and preventative strategies; however, as the recent IOC consensus statement on youth athletic development points out, the existing, mostly bio-medical knowledge does not provide effective evidence-based injury prevention strategies. To address this deficit, interdisciplinary and context-driven knowledge on injury development in youth sport is needed.
The proposed project will produce scientific evidence through four consecutive studies: a) Questionnaire to register the types, frequency and management of injuries; b) Laboratory testing of biomechanical, clinical and training-specific parameters to establish individual physical and sport-specific dispositions; c) Observation of sporting contexts to understand sporting cultures, coaching methods and coach-athlete relationships; and d) Interviews with coaches and players to recognize knowledge that shapes coaching and training. The sample of youth players will be recruited from Sweden’s most popular and injury-prone sport: football. Each of the four studies will conduct its own data production and analyses, and a collective analysis will produce integrated evidence. Concrete recommendations for best sporting practice will be developed, which will serve sporting federations, sport education institutions, coaches, sport support staff and players.
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Bramah C, Preece SJ, Gill N, Herrington L. Is There a Pathological Gait Associated With Common Soft Tissue Running Injuries? Am J Sports Med 2018; 46:3023-3031. [PMID: 30193080 DOI: 10.1177/0363546518793657] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous research has demonstrated clear associations between specific running injuries and patterns of lower limb kinematics. However, there has been minimal research investigating whether the same kinematic patterns could underlie multiple different soft tissue running injuries. If they do, such kinematic patterns could be considered global contributors to running injuries. HYPOTHESIS Injured runners will demonstrate differences in running kinematics when compared with injury-free controls. These kinematic patterns will be consistent among injured subgroups. STUDY DESIGN Controlled laboratory study. METHODS The authors studied 72 injured runners and 36 healthy controls. The injured group contained 4 subgroups of runners with either patellofemoral pain, iliotibial band syndrome, medial tibial stress syndrome, or Achilles tendinopathy (n = 18 each). Three-dimensional running kinematics were compared between injured and healthy runners and then between the 4 injured subgroups. A logistic regression model was used to determine which parameters could be used to identify injured runners. RESULTS The injured runners demonstrated greater contralateral pelvic drop (CPD) and forward trunk lean at midstance and a more extended knee and dorsiflexed ankle at initial contact. The subgroup analysis of variance found that these kinematic patterns were consistent across each of the 4 injured subgroups. CPD was found to be the most important variable predicting the classification of participants as healthy or injured. Importantly, for every 1° increase in pelvic drop, there was an 80% increase in the odds of being classified as injured. CONCLUSION This study identified a number of global kinematic contributors to common running injuries. In particular, we found injured runners to run with greater peak CPD and trunk forward lean as well as an extended knee and dorsiflexed ankle at initial contact. CPD appears to be the variable most strongly associated with common running-related injuries. CLINICAL RELEVANCE The identified kinematic patterns may prove beneficial for clinicians when assessing for biomechanical contributors to running injuries.
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Affiliation(s)
| | | | - Niamh Gill
- School of Health Sciences, University of Salford, Salford, UK
| | - Lee Herrington
- School of Health Sciences, University of Salford, Salford, UK
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Abstract
The diversity of models of care in contemporary musculoskeletal physical therapy can be confusing for patients and practicing clinicians. There is, however, a common theme to many of these seemingly disparate models of care: symptom modification. Symptom modification aims at reducing symptoms and improving function with a variety of clinical approaches. This Viewpoint explores the role of symptom modification in rehabilitation and specifically addresses (1) symptom modification within the kinesiopathological model of pain, (2) symptom modification in clinical practice, and (3) potential commonality in seemingly divergent models of clinical practice. J Orthop Sports Phys Ther 2018;48(6):430-435. doi:10.2519/jospt.2018.0608.
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Hulme A, Salmon PM, Nielsen RO, Read GJM, Finch CF. From control to causation: Validating a 'complex systems model' of running-related injury development and prevention. APPLIED ERGONOMICS 2017; 65:345-354. [PMID: 28802455 DOI: 10.1016/j.apergo.2017.07.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/10/2017] [Accepted: 07/19/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION There is a need for an ecological and complex systems approach for better understanding the development and prevention of running-related injury (RRI). In a previous article, we proposed a prototype model of the Australian recreational distance running system which was based on the Systems Theoretic Accident Mapping and Processes (STAMP) method. That model included the influence of political, organisational, managerial, and sociocultural determinants alongside individual-level factors in relation to RRI development. The purpose of this study was to validate that prototype model by drawing on the expertise of both systems thinking and distance running experts. MATERIALS AND METHODS This study used a modified Delphi technique involving a series of online surveys (December 2016- March 2017). The initial survey was divided into four sections containing a total of seven questions pertaining to different features associated with the prototype model. Consensus in opinion about the validity of the prototype model was reached when the number of experts who agreed or disagreed with survey statement was ≥75% of the total number of respondents. RESULTS A total of two Delphi rounds was needed to validate the prototype model. Out of a total of 51 experts who were initially contacted, 50.9% (n = 26) completed the first round of the Delphi, and 92.3% (n = 24) of those in the first round participated in the second. Most of the 24 full participants considered themselves to be a running expert (66.7%), and approximately a third indicated their expertise as a systems thinker (33.3%). After the second round, 91.7% of the experts agreed that the prototype model was a valid description of the Australian distance running system. CONCLUSION This is the first study to formally examine the development and prevention of RRI from an ecological and complex systems perspective. The validated model of the Australian distance running system facilitates theoretical advancement in terms of identifying practical system-wide opportunities for the implementation of sustainable RRI prevention interventions. This 'big picture' perspective represents the first step required when thinking about the range of contributory causal factors that affect other system elements, as well as runners' behaviours in relation to RRI risk.
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Affiliation(s)
- A Hulme
- Australian Centre for Research Into Injury in Sports and Its Prevention (ACRISP), Faculty of Health Science and Psychology, Federation University Australia, Ballarat, Victoria, 3353, Australia.
| | - P M Salmon
- Centre for Human Factors and Sociotechnical Systems, Faculty of Arts, Business and Law, University of the Sunshine Coast, Sippy Downs, Queensland, 4558, Australia.
| | - R O Nielsen
- Department of Public Health, Aarhus University, Dalgas Avenue 4, Room 438, Aarhus, 8000, Denmark.
| | - G J M Read
- Centre for Human Factors and Sociotechnical Systems, Faculty of Arts, Business and Law, University of the Sunshine Coast, Sippy Downs, Queensland, 4558, Australia.
| | - C F Finch
- Australian Centre for Research Into Injury in Sports and Its Prevention (ACRISP), Faculty of Health Science and Psychology, Federation University Australia, Ballarat, Victoria, 3353, Australia.
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Olivier B, Naidoo V, Tau M, Quinn SL, Stewart A. The association between hip dysfunction and lower quarter injuries in long distance runners: a systematic review protocol. ACTA ACUST UNITED AC 2017; 15:2433-2436. [DOI: 10.11124/jbisrir-2016-002961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Hafer JF, Brown AM, Boyer KA. Exertion and pain do not alter coordination variability in runners with iliotibial band syndrome. Clin Biomech (Bristol, Avon) 2017; 47:73-78. [PMID: 28618309 DOI: 10.1016/j.clinbiomech.2017.06.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 04/19/2017] [Accepted: 06/07/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Iliotibial band syndrome is a common overuse running injury which results in altered mechanics. While injuries alter discrete mechanics, they may also cause a change in coordination variability, the stride-to-stride organization of runners' movement patterns. Uninjured and injured runners may experience a change in coordination variability during a run to exertion due to fatigue, pain, or a combination of these factors. The aim of the current study was to determine if runners with iliotibial band syndrome and uninjured runners display different segment coordination variability across the course of a run to exertion. METHODS 3D kinematics were collected as 13 uninjured runners and 12 runners with iliotibial band syndrome ran on a treadmill. A modified vector coding technique was used to calculate coordination variability during stance for segment couples of interest. Coordination variability was compared between uninjured and injured runners at the beginning and end of the run. The influence of pain on coordination variability was also examined. FINDINGS There were no differences in coordination variability at the beginning or end of the run between uninjured runners and those with iliotibial band syndrome. The change in coordination variability due to the run was not different between uninjured runners, injured runners who experienced no change in pain, and injured runners who did experience a change in pain. INTERPRETATION Runners do not constrain the patterns of segment motion they use in response to exertion nor does it appear that occurrence of pain during running results in a differential change in coordination variability.
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Affiliation(s)
- Jocelyn F Hafer
- Department of Kinesiology, University of Massachusetts Amherst, USA.
| | - Allison M Brown
- Department of Rehabilitation & Movement Sciences, School of Health Professions, Rutgers, The State University of New Jersey, USA
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Stephen JM, Urquhart DWJ, van Arkel RJ, Ball S, Jaggard MKJ, Lee JC, Church JS. The Use of Sonographically Guided Botulinum Toxin Type A (Dysport) Injections Into the Tensor Fasciae Latae for the Treatment of Lateral Patellofemoral Overload Syndrome. Am J Sports Med 2016; 44:1195-202. [PMID: 26903213 DOI: 10.1177/0363546516629432] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pain in the anterior and lateral parts of the knee during exercise is a common clinical problem for which current management strategies are often unsuccessful. PURPOSE To investigate the effect of an ultrasound-guided botulinum toxin (BT) injection into the tensor fasciae latae (TFL), followed by physical therapy, in patients classified with lateral patellofemoral overload syndrome (LPOS) who failed to respond to conventional treatment. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 45 patients (mean ± SD age, 32.4 ± 8.6 years) who met the inclusion criteria of (1) activity-related anterolateral knee symptoms, (2) symptoms lasting longer than 3 months, (3) a pathological abnormality confirmed by magnetic resonance imaging, and (4) previous failed physical therapy received an ultrasound-guided injection of BT into the TFL followed by physical therapy. Patient-reported outcomes were collected at 5 intervals: before the injection; at 1, 4, and 12 weeks after the injection; and at a mean 5 years after the injection. In 42 patients, relative iliotibial band (ITB) length changes were assessed using the modified Ober test at the first 4 time points. A computational model was run to simulate the effect of TFL weakening on gluteus medius (GMed) activity. Statistical analysis was undertaken using 1-way analysis of variance and paired t tests with Bonferroni post hoc correction. RESULTS There was a significant improvement in Anterior Knee Pain Scale scores from before the injection (61 ± 15) to 1 (67 ± 15), 4 (70 ± 16), and 12 weeks (76 ± 16) after the injection and in 87% of patients (39/45 patients available for follow-up) at approximately 5 years (from 62.9 ± 15.4 to 87.0 ± 12.5) after the injection (all P < .010). A significant effect on the modified Ober test was identified as a result of the intervention, with an increase in leg drop found at 1 (3° ± 5°), 4 (4° ± 5°), and 12 (7° ± 6°) weeks after the injection compared with before the injection (all P < .010). Simulating a progressive reduction in TFL strength resulted in corresponding increases in GMed activity during gait. CONCLUSION An injection of BT into the TFL, combined with physical therapy, resulted in a significant improvement of symptoms in patients with LPOS, which was maintained at 5-year follow-up. This may result from reduced lateral TFL/ITB tension or to an increase in GMed activity in response to inhibition of the TFL.
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Affiliation(s)
- Joanna M Stephen
- Mechanical Engineering Department, Imperial College London, London, UK Fortius Clinic, London, UK
| | | | | | - Simon Ball
- Fortius Clinic, London, UK Chelsea and Westminster Hospital, London, UK
| | | | - Justin C Lee
- Fortius Clinic, London, UK Chelsea and Westminster Hospital, London, UK
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Fukuchi RK, Stefanyshyn DJ, Stirling L, Ferber R. Effects of strengthening and stretching exercise programmes on kinematics and kinetics of running in older adults: a randomised controlled trial. J Sports Sci 2016; 34:1774-81. [PMID: 26805699 DOI: 10.1080/02640414.2015.1137343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The aim of this study was to investigate the effects of strengthening and stretching exercises on running kinematics and kinetics in older runners. One hundred and five runners (55-75 years) were randomly assigned to either a strengthening (n = 36), flexibility (n = 34) or control (n = 35) group. Running kinematics and kinetics were obtained using an eight-camera system and an instrumented treadmill before and after the eight-week exercise protocol. Measures of strength and flexibility were also obtained using a dynamometer and inclinometer/goniometer. A time effect was observed for the excursion angles of the ankle sagittal (P = 0.004, d = 0.17) and thorax/pelvis transverse (P < 0.001, d = 0.20) plane. Similarly, a time effect was observed for knee transverse plane impulse (P = 0.013, d = 0.26) and ground reaction force propulsion (P = 0.042, d = -0.15). A time effect for hip adduction (P = 0.006, d = 0.69), ankle dorsiflexion (P = 0.002, d = 0.47) and hip internal rotation (P = 0.048, d = 0.30) flexibility, and hip extensor (P = 0.001, d = -0.48) and ankle plantar flexor (P = 0.01, d = 0.39) strength were also observed. However, these changes were irrespective of exercise group. The results of the present study indicate that an eight-week stretching or strengthening protocol, compared to controls, was not effective in altering age-related running biomechanics despite changes in ankle and trunk kinematics, knee kinetics and ground reaction forces along with alterations in muscle strength and flexibility were observed over time.
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Affiliation(s)
- Reginaldo K Fukuchi
- a Biomedical Engineering, Centre for Engineering, Modelling and Applied Social Sciences (CECS) , Federal University of ABC (UFABC) , Sao Bernardo do Campo-SP , Brazil
| | - Darren J Stefanyshyn
- b Human Performance Laboratory, Faculty of Kinesiology , University of Calgary , Calgary, Canada
| | - Lisa Stirling
- c Human Performance Laboratory, Faculty of Kinesiology , University of Calgary , Calgary, Canada
| | - Reed Ferber
- d Faculties of Kinesiology and Nursing , University of Calgary , Calgary, Canada
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Aderem J, Louw QA. Biomechanical risk factors associated with iliotibial band syndrome in runners: a systematic review. BMC Musculoskelet Disord 2015; 16:356. [PMID: 26573859 PMCID: PMC4647699 DOI: 10.1186/s12891-015-0808-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 11/06/2015] [Indexed: 01/03/2023] Open
Abstract
Background Iliotibial band syndrome is the second most common running injury. A gradual increase in its occurrence has been noted over the past decade. This may be related to the increasing number of runners worldwide. Since the last systematic review, six additional papers have been published, providing an opportunity for this review to explore the previously identified proximal risk factors in more detail. The aim of this systematic review is thus to provide an up to date quantitative synthesis of the trunk, pelvis and lower limb biomechanical risk factors associated with Iliotibial band syndrome in runners and to provide an algorithm for future research and clinical guidance. Methods An electronic search was conducted of literature published up until April 2015. The critical appraisal tool for quantitative studies was used to evaluate methodological quality of eligible studies. Forest plots displayed biomechanical findings, mean differences and confidence intervals. Level of evidence and clinical impact were evaluated for each risk factor. A meta-analysis was conducted where possible. Result Thirteen studies were included (prospective (n = 1), cross-sectional (n = 12)). Overall the methodological score of the studies was moderate. Female shod runners who went onto developing Iliotibial band syndrome presented with increased peak hip adduction and increased peak knee internal rotation during stance. Female shod runners with Iliotibial band syndrome presented with increased: peak knee internal rotation and peak trunk ipsilateral during stance. Conclusion Findings indicate new quantitative evidence about the biomechanical risk factors associated with Iliotibial band syndrome in runners. Despite these findings, there are a number of limitations to this review including: the limited number of studies, small effect sizes and methodological shortcomings. This review has considered these shortcomings and has summarised the best available evidence to guide clinical decisions and plan future research on Iliotibial band syndrome aetiology and risk.
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Affiliation(s)
- Jodi Aderem
- Faculty of Medicine and Health Sciences, Physiotherapy Division, University of Stellenbosch, PO Box 19063, Francie van Zijl Drive, Tygerberg, 7505, South Africa.
| | - Quinette A Louw
- Faculty of Medicine and Health Sciences, Physiotherapy Division, University of Stellenbosch, PO Box 19063, Francie van Zijl Drive, Tygerberg, 7505, South Africa.
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Tateuchi H, Shiratori S, Ichihashi N. The effect of angle and moment of the hip and knee joint on iliotibial band hardness. Gait Posture 2015; 41:522-8. [PMID: 25542398 DOI: 10.1016/j.gaitpost.2014.12.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 10/10/2014] [Accepted: 12/03/2014] [Indexed: 02/02/2023]
Abstract
Although several studies have described kinematic deviations such as excessive hip adduction in patients with iliotibial band (ITB) syndrome, the factors contributing to increased ITB hardness remains undetermined, owing to lack of direct in vivo measurement. The purpose of this study was to clarify the factors contributing to an increase in ITB hardness by comparing the ITB hardness between the conditions in which the angle, moment, and muscle activity of the hip and knee joint are changed. Sixteen healthy individuals performed the one-leg standing under five conditions in which the pelvic and trunk inclination were changed in the frontal plane. The shear elastic modulus in the ITB was measured as an indicator of the ITB hardness using shear wave elastography. The three-dimensional joint angle and external joint moment in the hip and knee joints, and muscle activities of the gluteus maximus, gluteus medius, tensor fasciae latae, and vastus lateralis, which anatomically connect to the ITB, were also measured. ITB hardness was significantly increased in the posture with pelvic and trunk inclination toward the contralateral side of the standing leg compared with that in all other conditions (increase of approximately 32% compared with that during normal one-leg standing). This posture increased both the hip adduction angle and external adduction moment at the hip and knee joint, although muscle activities were not increased. Our findings suggest that coexistence of an increased adduction moment at the hip and knee joints with an excessive hip adduction angle lead to an increase in ITB hardness.
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Affiliation(s)
- Hiroshige Tateuchi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Sakiko Shiratori
- Division of Physical Therapy, Rehabilitation Units, Shiga University of Medical Science Hospital, Shiga, Japan
| | - Noriaki Ichihashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Phinyomark A, Osis S, Hettinga BA, Leigh R, Ferber R. Gender differences in gait kinematics in runners with iliotibial band syndrome. Scand J Med Sci Sports 2015; 25:744-53. [DOI: 10.1111/sms.12394] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2014] [Indexed: 10/24/2022]
Affiliation(s)
- A. Phinyomark
- Faculty of Kinesiology; University of Calgary; Calgary Alberta Canada
| | - S. Osis
- Faculty of Kinesiology; University of Calgary; Calgary Alberta Canada
- Running Injury Clinic; Calgary Alberta Canada
| | - B. A. Hettinga
- Faculty of Kinesiology; University of Calgary; Calgary Alberta Canada
- Running Injury Clinic; Calgary Alberta Canada
| | - R. Leigh
- Faculty of Kinesiology; University of Calgary; Calgary Alberta Canada
| | - R. Ferber
- Faculty of Kinesiology; University of Calgary; Calgary Alberta Canada
- Running Injury Clinic; Calgary Alberta Canada
- Faculty of Nursing; University of Calgary; Calgary Alberta Canada
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Abstract
STUDY DESIGN Cross-sectional laboratory study. OBJECTIVES To assess differences in hip strength, iliotibial band length, and hip and knee mechanics during running between male runners with iliotibial band syndrome (ITBS) and healthy controls. BACKGROUND Flexibility, strength, and running mechanics are commonly assessed in patients with ITBS. However, these variables have not been evaluated concurrently in this population. METHODS Thirty-four men participated (17 healthy, 17 ITBS). Hip strength was measured with a handheld dynamometer, and iliotibial band length was assessed using an inclinometer while performing the Ober test. Kinetic and 3-D kinematic data were obtained during running. Kinematic variables of interest included frontal and transverse plane hip and knee joint angles during early stance. Independent-samples t tests, as well as effect sizes, were used to assess group differences. RESULTS Compared to the control group, persons with ITBS had a significantly lower Ober measurement (1.2°), weaker hip external rotators (1.2 Nm/kg), greater hip internal rotation (3.7°), and greater knee adduction (3.6°). However, only hip internal rotation and knee adduction exceeded the minimal detectable difference value. CONCLUSION Our results suggest that intervention strategies that target neuromuscular control of the hip and knee may be indicated for males with ITBS.
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Fukuchi RK, Stefanyshyn DJ, Stirling L, Duarte M, Ferber R. Flexibility, muscle strength and running biomechanical adaptations in older runners. Clin Biomech (Bristol, Avon) 2014; 29:304-10. [PMID: 24380685 DOI: 10.1016/j.clinbiomech.2013.12.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 12/05/2013] [Accepted: 12/05/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND The increased injury risk in older runners has been associated with alterations in muscle strength, flexibility, and gait biomechanics. This study investigated whether older runners exhibit changes in muscle strength, flexibility and running biomechanics compared to younger runners, and possible relationships between these changes. METHODS Thirty-five young (20-36yrs) and 35 older (55-71yrs) recreational runners participated in the study. Measures of three-dimensional biomechanical data during treadmill running at 2.7m/s and measures of muscle strength and flexibility were compared between groups. A correlation analysis between biomechanical and clinical variables was also performed. FINDINGS Older runners demonstrated an overall reduction in muscle strength and flexibility, and altered running patterns compared to young runners but correlations between clinical and biomechanical variables were scarce. Reduced hip, ankle and trunk excursions along with reduced knee and ankle positive work were found in older runners. Older runners also exhibited increased knee abduction impulse, ankle abduction impulse and vertical loading rates. In contrast, older runners did not present a distal-to-proximal lower extremity joint moment redistribution. INTERPRETATION We observed age-related reduced strength and flexibility concomitant with alterations in running biomechanics, but a lack of correlation between these variables. This finding hampers the use of single, or even a subset of characteristics to better understand age-related changes in runners. The observed changes are complex and multivariate in nature. Clinicians will most likely have to monitor both clinical and biomechanical characteristics to optimize care. However, future studies need to prospectively address what are biomechanical age-related risk factors in runners.
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Affiliation(s)
- Reginaldo K Fukuchi
- Running Injury Clinic, Faculty of Kinesiology, University of Calgary, Canada; Biomedical Engineering, Federal University of ABC, Santo André, Brazil.
| | - Darren J Stefanyshyn
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Canada
| | - Lisa Stirling
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Canada
| | - Marcos Duarte
- Biomedical Engineering, Federal University of ABC, Santo André, Brazil
| | - Reed Ferber
- Running Injury Clinic, Faculty of Kinesiology, University of Calgary, Canada
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Frontal Plane Running Biomechanics in Female Runners With Previous Iliotibial Band Syndrome. J Appl Biomech 2014; 30:58-65. [DOI: 10.1123/jab.2013-0051] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Proximal factors such as excessive frontal plane pelvis and trunk motion have been postulated to be biomechanical risk factors associated with iliotibial band syndrome. In addition, lateral core endurance deficiencies may be related to increased pelvis and trunk motion during running. The purpose of this cross-sectional investigation was to determine if differences in biomechanics during running, as well as lateral core endurance exist between female runners with previous iliotibial band syndrome and controls. Gait and lateral core endurance were assessed in 34 female runners (17 with previous iliotibial band syndrome). Multivariate analysis of variance was performed to assess between group difference in pelvis, trunk, hip, and knee variables of interest. Runners with previous iliotibial band syndrome exhibited similar peak trunk lateral flexion, peak contralateral pelvic drop, peak hip adduction, and peak external knee adduction moment compared with controls. In addition, trunk-pelvis coordination was similar between groups. Contrary to our hypotheses, both groups exhibited trunk ipsilateral flexion. Lateral core endurance was not different between groups. These findings provide the first frontal plane pelvis and trunk kinematic data set in female runners with previous iliotibial band syndrome. Frontal plane pelvis and trunk motion may not be associated with iliotibial band syndrome.
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Foch E, Milner CE. The influence of iliotibial band syndrome history on running biomechanics examined via principal components analysis. J Biomech 2014; 47:81-6. [DOI: 10.1016/j.jbiomech.2013.10.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 09/27/2013] [Accepted: 10/07/2013] [Indexed: 11/28/2022]
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Frank NS, Callaghan JP, Prentice SD. Lower limb kinematic variability associated with minimal footwear during running. FOOTWEAR SCIENCE 2013. [DOI: 10.1080/19424280.2013.797505] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Louw M, Deary C. The biomechanical variables involved in the aetiology of iliotibial band syndrome in distance runners - A systematic review of the literature. Phys Ther Sport 2013; 15:64-75. [PMID: 23954385 DOI: 10.1016/j.ptsp.2013.07.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 05/10/2013] [Accepted: 07/19/2013] [Indexed: 01/14/2023]
Abstract
The aim of this literature review was to identify the biomechanical variables involved in the aetiology of iliotibial band syndrome (ITBS) in distance runners. An electronic search was conducted using the terms "iliotibial band" and "iliotibial tract". The results showed that runners with a history of ITBS appear to display decreased rear foot eversion, tibial internal rotation and hip adduction angles at heel strike while having greater maximum internal rotation angles at the knee and decreased total abduction and adduction range of motion at the hip during stance phase. They further appear to experience greater invertor moments at their feet, decreased abduction and flexion velocities at their hips and to reach maximum hip flexion angles earlier than healthy controls. Maximum normalised braking forces seem to be decreased in these athletes. The literature is inconclusive with regards to muscle strength deficits in runners with a history of ITBS. Prospective research suggested that greater internal rotation at the knee joint and increased adduction angles of the hip may play a role in the aetiology of ITBS and that the strain rate in the iliotibial bands of these runners may be increased compared to healthy controls. A clear biomechanical cause for ITBS could not be devised due to the lack of prospective research.
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Affiliation(s)
- Maryke Louw
- Department of Physiotherapy, School of Health Professions, University of Brighton, UK.
| | - Clare Deary
- Department of Physiotherapy, School of Health Professions, University of Brighton, UK
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van der Worp MP, van der Horst N, de Wijer A, Backx FJG, Nijhuis-van der Sanden MWG. Iliotibial band syndrome in runners: a systematic review. SPORTS MEDICINE (AUCKLAND, N.Z.) 2013; 42:969-92. [PMID: 22994651 DOI: 10.2165/11635400-000000000-00000] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The popularity of running is still growing and, as participation increases, the incidence of running-related injuries will also rise. Iliotibial band syndrome (ITBS) is the most common injury of the lateral side of the knee in runners, with an incidence estimated to be between 5% and 14%. In order to facilitate the evidence-based management of ITBS in runners, more needs to be learned about the aetiology, diagnosis and treatment of this injury. OBJECTIVE This article provides a systematic review of the literature on the aetiology, diagnosis and treatment of ITBS in runners. SEARCH STRATEGY The Cochrane Library, MEDLINE, EMBASE, CINAHL, Web of Science, and reference lists were searched for relevant articles. SELECTION CRITERIA Systematic reviews, clinical trials or observational studies involving adult runners (>18 years) that focused on the aetiology, diagnosis and/or treatment of ITBS were included and articles not written in English, French, German or Dutch were excluded. DATA COLLECTION AND ANALYSIS Two reviewers independently screened search results, assessed methodological quality and extracted data. The sum of all positive ratings divided by the maximum score was the percentage quality score (QS). Only studies with a QS higher than 60% were included in the analysis. The following data were extracted: study design; number and characteristics of participants; diagnostic criteria for ITBS; exposure/treatment characteristics; analyses/outcome variables of the study; and setting and theoretical perspective on ITBS. MAIN RESULTS The studies of the aetiology of ITBS in runners provide limited or conflicting evidence and it is not clear whether hip abductor weakness has a major role in ITBS. The kinetics and kinematics of the hip, knee and/or ankle/foot appear to be considerably different in runners with ITBS to those without. The biomechanical studies involved small samples, and data seem to have been influenced by sex, height and weight of participants. Although most studies monitored the management of ITBS using clinical tests, these tests have not been validated for this patient group. While the articles were inconsistent regarding the treatment of ITBS, hip/knee coordination and running style appear to be key factors in the treatment of ITBS. Runners might also benefit from mobilization, exercises to strengthen the hip, and advice about running shoes and running surface. CONCLUSION The methodological quality of research into the management of ITBS in runners is poor and the results are highly conflicting. Therefore, the study designs should be improved to prevent selection bias and to increase the generalizability of findings.
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Affiliation(s)
- Maarten P van der Worp
- Academic Institute Hogeschool Utrecht, University of Applied Sciences Utrecht, Department of Physical Therapy, Utrecht, The Netherlands.
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van der Worp MP, van der Horst N, de Wijer A, Backx FJG, Nijhuis-van der Sanden MWG. Iliotibial Band Syndrome in Runners. Sports Med 2012. [DOI: 10.1007/bf03262306] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Hein T, Schmeltzpfenning T, Krauss I, Maiwald C, Horstmann T, Grau S. Using the variability of continuous relative phase as a measure to discriminate between healthy and injured runners. Hum Mov Sci 2012; 31:683-94. [DOI: 10.1016/j.humov.2011.07.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Revised: 03/16/2011] [Accepted: 07/06/2011] [Indexed: 10/17/2022]
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Abstract
Iliotibial band syndrome is a common overuse injury typically seen in runners, cyclists, and military recruits. Affected patients report lateral knee pain associated with repetitive motion activities. The diagnosis is usually made based on a characteristic history and physical examination, with imaging studies reserved for cases of recalcitrant disease to rule out other pathologic entities. Several etiologies have been proposed for iliotibial band syndrome, including friction of the iliotibial band against the lateral femoral epicondyle, compression of the fat and connective tissue deep to the iliotibial band, and chronic inflammation of the iliotibial band bursa. The mainstay of treatment is nonsurgical; however, in persistent or chronic cases, surgical management is indicated.
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