Risk factors for lower extremity injuries among half marathon and marathon runners of the Lage Landen Marathon Eindhoven 2012: A prospective cohort study in the Netherlands

Predictors of half-marathon performance in male recreational athletes

Few research has been conducted on predictors of recreational runners' performance, especially in half-marathon running. The purpose of our study was (a) to investigate the relationship of half-marathon race time with training, anthropometry and physiological characteristics, and (b) to develop a formula to predict half-marathon race time in male recreational runners. Recreational runners (n=134, age 44.2±8.7 years; half-marathon race time 104.6±16.2 min) underwent a physical fitness battery consisting of anthropometric and physiological tests. The participants were classified into five performance groups (fast, 73-92 min; above average, 93-99 min; average 100-107 min; below average, 108-117 min; slow group, 118-160 min). A prediction equation was developed in an experimental group (EXP, n=67), validated in a control group (CON, n=67) and prediction bias was estimated with 95 % confidence intervals (CI). Performance groups differed in half-marathon race time, training days, training distance, age, weight, (body mass index) BMI, body fat (BF) and maximum oxygen uptake (VO2max) (p≤0.001, η2≥0.132), where faster groups had better scores than the slower groups. Half-marathon race time correlated with physiological, anthropometric and training characteristics, with the faster the runner, the better the score in these characteristics (e.g., VO2max, r=0.59; BMI, r=-0.55; weekly running distance, r=-0.53, p<0.001). Race time in EXP might be calculated (R2=0.63, standard error of the estimate=9.9) using the equation 'Race time (min)=80.056+2.498×BMI-0.594×VO2max-0.191×weekly training distance in km'. Validating this formula in CON, no bias was shown (difference between observed and predicted value 2.3±12.8 min, 95 % CI -0.9, 5.4, p=0.153). Half-marathon race time was related to and could be predicted by BMI, VO2max and weekly running distance. Based on these relationships, a prediction formula for race time was developed providing a practical tool for recreational runners and professionals working with them.

Factors associated with injuries in first-time marathon runners from the New York City marathon

OBJECTIVES

To determine how baseline characteristics of first-time marathon runners and training patterns are associated with risk of injuries during training and the race.

METHODS

First-time adult marathon runners who were registered for the 2017 New York City Marathon were monitored starting 12 weeks prior to the race. Baseline data collection included demographics and running experience. Running frequency, distance, and injury occurrence were self-reported using online surveys every 2 weeks.

RESULTS

A total of 720 runners participated of which 675 completed the study. There were 64/675 (9.5%) who had major injuries during training or the race that preventing starting or finishing the race. An additional 332 (49.2%) had minor injuries interfering with training and/or affecting race performance. Injury incidence was not significantly different based on age or sex. Runners who completed a half marathon prior to the study were less likely to report getting injured [multivariable odds ratio (OR) 0.40, (0.22, 0.76), p= 0.005]. Runners who averaged <4 training runs per week during the study were less likely to report getting injured compared to those who averaged ≥4 per week [relative risk 1.36, (1.13-1.63), p= 0.001]. Longest training run distance during the study was inversely associated with race-day injury incidence [OR 0.87 (0.81, 0.94), p< 0.001].

CONCLUSION

Injuries are common among first-time marathon runners. We found that risk of injury during training was associated with lack of half marathon experience and averaging ≥4 training runs per week. Longer training runs were associated with a lower incidence of race-day injuries. These results can inform the development of targeted injury-prevention interventions.

An analysis of self-reported upper and lower limb injuries in Polish obstacle course races participants

BACKGROUND

Obstacle course racing (OCR) is characterized by various distance, terrain, obstacles and weather conditions. We hypothesized that various specific factors could increase the probability of traumas, especially limb injuries.

METHODS

An online questionnaire survey was conducted among OCR participants in Poland. The questionnaire consisted of 5 sets of questions: demographic parameters, participating in obstacle course races last year, characteristic of the trainings, participant-assessed race safety and injury characteristics.

RESULTS

We analyzed the data collected from 153 obstacle course races participants: 95 men (62.1%) and 58 women (37.9%), mean age 30.3±7.4 years. Forty-two respondents (27.4%) reported race-related extremity injury. In univariable analysis the risk of limb injuries increased with longer time per week devoted to training sessions with obstacles (P=0.025) and participating in higher number of obstacle course races last year (P=0.006). Furthermore, training in groups during preparation was associated with a higher risk of limb trauma (P=0.015). Moreover, people doing more running interval sessions per week (P=0.0343) and spending more time on interval training sessions per week - both run (P=0.0098) and other than run (P=0.0063) are more prone to suffer limb injuries in OCR.

CONCLUSIONS

The prevalence of limb injuries in OCR is elevated and it is desirable to be reduced by establishment and elimination above mentioned risk factors. Further researches are needed for deepening the knowledge of injuries in OCR.

Incidence and Risk Factors of Low Back Pain in Marathon Runners

Purpose

The occurrence of low back pain (LBP) in marathon runners has been poorly understood. This study aimed to describe the risk factors and identify whether these factors can cause LBP in these athletes.

Methods

A self-developed questionnaire was randomly distributed to 850 runners of running a half or a full marathon. Participants responded with the questionnaire focusing on previous training and running conditions after their competitions.

Results

On the basis of the remaining 800 valid questionnaires, the incidence of LBP was 4.50% (n = 36). A total of 572 (71.5%) males and 228 (28.5%) females, with an average age range of 33.9 ± 9.0 years, came from different occupations with different physical activity characteristics. However, no significant associations between occupation and runners with LBP (p > 0.05) were found. In the final models, risk factors, including warm-up activities (p=0.012, OR = 2.617), fatigue (p = 0.008, OR = 2.680), running gait posture (p=0.041, OR = 2.273), and environmental temperature (p=0.020, OR = 6.584), were significantly associated with LBP in marathoners.

Conclusion

Although LBP was uncommon in marathoners, it was linked to the factors such as insufficient warm-up activities, fatigue, poor running gait posture, and uncomfortable environmental temperature. Future studies need to validate these results. Nevertheless, these findings could still be useful for protecting the lower back area of runners clinically.

Sex-Specific Differences in Running Injuries: A Systematic Review with Meta-Analysis and Meta-Regression

BACKGROUND

Running is a popular sport with high injury rates. Although risk factors have intensively been investigated, synthesized knowledge about the differences in injury rates of female and male runners is scarce.

OBJECTIVE

To systematically investigate the differences in injury rates and characteristics between female and male runners.

METHODS

Database searches (PubMed, Web of Science, PEDro, SPORTDiscus) were conducted according to PRISMA guidelines using the keywords "running AND injur*". Prospective studies reporting running related injury rates for both sexes were included. A random-effects meta-analysis was used to pool the risk ratios (RR) for the occurrence of injuries in female vs. male runners. Potential moderators (effect modifiers) were analysed using meta-regression.

RESULTS

After removal of duplicates, 12,215 articles were screened. Thirty-eight studies were included and the OR of 31 could be pooled in the quantitative analysis. The overall injury rate was 20.8 (95% CI 19.9-21.7) injuries per 100 female runners and 20.4 (95% CI 19.7-21.1) injuries per 100 male runners. Meta-analysis revealed no differences between sexes for overall injuries reported per 100 runners (RR 0.99, 95% CI 0.90-1.10, n = 24) and per hours or athlete exposure (RR 0.94, 95% CI 0.69-1.27, n = 6). Female sex was associated with a more frequent occurrence of bone stress injury (RR (for males) 0.52, 95% CI 0.36-0.76, n = 5) while male runners had higher risk for Achilles tendinopathies (RR 1. 86, 95% CI 1.25-2.79, n = 2). Meta-regression showed an association between a higher injury risk and competition distances of 10 km and shorter in female runners (RR 1.08, 95% CI 1.00-1.69).

CONCLUSION

Differences between female and male runners in specific injury diagnoses should be considered in the development of individualised and sex-specific prevention and rehabilitation strategies to manage running-related injuries.

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.

One in four trail running race entrants sustained an injury in the 12 months training preceding the 2019 SkyRun race

OBJECTIVE

To determine the epidemiology and clinical characteristics of RRIs among trail runners who entered the 2019 SkyRun races.

DESIGN

Descriptive cross-sectional study.

SETTING

2019 SkyRun races.

PARTICIPANTS

Consent for data analysis was given by 305 of 412 (74%) race entrants.

MAIN OUTCOME MEASURES

Retrospective annual incidence (RRIs/1000 h), point prevalence (%), frequency (%), characteristics (anatomical region, body area, tissue type, pathology type) and injury severity (mean severity score; 95% CI) of RRIs.

RESULTS

28.2% of participants reported at least one RRI. The retrospective annual incidence was 49.5 RRIs per 1000h and the point prevalence was 1.3%. Most injuries occurred in the lower limb (87.3%), with the knee (26.5%), ankle (21.6%), and foot (16.7%) reported as the most frequently injured body areas. Muscle/tendon accounted for 44.1% of tissue type injuries. Tendinopathy (27.5%), joint sprain (19.6%), and muscle injury (15.7%) were the most common pathology types reported. The mean injury severity score was 31.6.

CONCLUSIONS

One in 4 trail runners reported at least one RRI in the 12 months leading up to a race. RRIs mostly affected the lower limb specifically the knee, ankle and foot. Future research should establish injury risk factors to ultimately develop specific injury prevention strategies.

Common Running Musculoskeletal Injuries and Associated Factors among Recreational Gorge Marathon Runners: An Investigation from 2013 to 2018 Taroko Gorge Marathons

Many studies exist on the incidence and related risk factors of running injuries, such as those obtained during marathons. However, in gorge-terrain marathons, an insufficient number of reports exist in the relevant literature. Therefore, this study aimed to explore the incidence of musculoskeletal injuries occurring in participants in the 2013 to 2018 Taroko Gorge Marathons in Taiwan and the distribution of running injuries and related influencing factors. A total of 718 runners who entered the physiotherapy station presented with records of treatment and injuries and filled out a running-related injury and self-training questionnaire for further statistical analysis. The association between risk factors and injury were evaluated by logistic regression. The injured areas on the lower extremities after the gorge marathon were as follows: 28% in the knees, 20% in the posterior calves, 13% in the thighs, 10% in the ankles, and 8% in the feet. The analysis of injury-related risk factors showed that male athletes demonstrated a higher risk of thigh injury than female athletes (OR = 2.42, p = 0.002). Underweight runners exhibited a higher risk of thigh injury (OR = 3.35, p = 0.006). We conclude that in the gorge marathon the rates of knee, calf, thigh, and foot injuries are significantly increased. Medical professionals, coaches, and runners may use the findings of this study to reduce the potential risk of running injuries in marathons.

Prediction modelling studies for medical usage rates in mass gatherings: A systematic review

Background

Mass gathering manifestations attended by large crowds are an increasingly common feature of society. In parallel, an increased number of studies have been conducted that developed and/or validated a model to predict medical usage rates at these manifestations.

Aims

To conduct a systematic review to screen, analyse and critically appraise those studies that developed or validated a multivariable statistical model to predict medical usage rates at mass gatherings. To identify those biomedical, psychosocial and environmental predictors that are associated with increased medical usage rates and to summarise the predictive performance of the models.

Method

We searched for relevant prediction modelling studies in six databases. The predictors from multivariable regression models were listed for each medical usage rate outcome (i.e. patient presentation rate (PPR), transfer to hospital rate (TTHR) and the incidence of new injuries). The GRADE methodology (Grades of Recommendation, Assessment, Development and Evaluation) was used to assess the certainty of evidence.

Results

We identified 7,036 references and finally included 16 prediction models which were developed (n = 13) or validated (n = 3) in the USA (n = 8), Australia (n = 4), Japan (n = 1), Singapore (n = 1), South Africa (n = 1) and The Netherlands (n = 1), with a combined audience of >48 million people in >1700 mass gatherings. Variables to predict medical usage rates were biomedical (i.e. age, gender, level of competition, training characteristics and type of injury) and environmental predictors (i.e. crowd size, accommodation, weather, free water availability, time of the manifestation and type of the manifestation) (low-certainty evidence). Evidence from 3 studies indicated that using Arbon’s or Zeitz’ model in other contexts significantly over- or underestimated medical usage rates (from 22% overestimation to 81% underestimation).

Conclusions

This systematic review identified multivariable models with biomedical and environmental predictors for medical usage rates at mass gatherings. Since the overall certainty of the evidence is low and the predictive performance is generally poor, proper development and validation of a context-specific model is recommended.

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.

In training for a marathon: Runners and running-related injury prevention

OBJECTIVE

To investigate which preventive measures runners use when preparing for a half- or full-marathon and whether the use of these measures at baseline and during the preparation-period differs between runners who sustained no/non-substantial running-related injuries (NSIRs) or substantial running-related injuries (SIRs).

DESIGN

Prospective cohort study.

SETTING

16-week period before the Utrecht Marathon.

PARTICIPANTS

Runners who subscribed for the half- or full-marathon.

MAIN OUTCOME MEASURES

The occurrence of RRIs was registered every 2-weeks, using the Dutch version of the Oslo Sport Trauma Research Center (OSTRC) questionnaire on Health Problems. The OSTRC was used to differentiate between runners with SIRs (question 2/3 score>12) and NSIRs (question 2/3 score<13). The use of different preventive measures, was registered every 4-weeks.

RESULTS

51.6% of the runners reported at least one RRI in the 12-months prior to this study (history of RRIs). The SIRs with a history of RRIs more often asked for running shoe advice than NSIRs with a history of RRIs (67.9%vs43.4%, P < 0.05); 18.9% of the SIRs with a history of RRIs used supportive materials for knee and/or ankle versus 0% of NSIRs with a history of RRIs (P < 0.05).

CONCLUSION

SIRs with a history of RRIs might be using their preventive measures for symptom reduction or secondary prevention.

Incidence and characteristics of severe exercise-associated collapse at the world's largest half-marathon

Background

Whilst many health benefits are associated with regular exercise, medical complications may occur during higher-intensity activities, such as long distance running contests. The most common complication is collapse. However, the incidence and characteristics of these collapses are not very well studied.

Method

This is a retrospective study of severe collapse, defined as a patient in need of advanced medical care after a collapse, during the large Gothenburg’s half marathon, Göteborgsvarvet. The study included 230,501 competitors during the study-period of 5 years (2013–2017) with data being collected from medical race tents and using ambulance data. Vital signs, treatment and blood gas samples were noted and analyzed.

Results

The incidence of severe collapse was 1.53 per 1000 starting runners. The average age for patients was 34 years old and no difference in incidence were seen between male and female runners. The typical collapsed runner presented with tachycardia, normal systolic blood pressure, elevated body temperature and metabolic acidosis. The most common medical encounter was exercise-associated collapse.

Conclusion

The incidence of severe collapse was similar to findings in other studies, even though this study was set in different part of the world. Typical characteristics of a collapsed runner were identified providing new information which could be beneficial in the medical planning of larger running competitions and future preventative interventions. Importantly, life threatening conditions seem uncommon; no case of hyponatremia and only two cases of hypoglycemia were seen.

Effects of tailored advice on injury prevention knowledge and behaviours in runners: Secondary analysis from a randomised controlled trial

OBJECTIVES

To determine whether biweekly tailored advice was more effective than general advice at baseline alone for enhancing evidence-based running-related injury (RRI) prevention knowledge and behaviours in runners.

DESIGN

Randomised controlled trial, blinded statistical analysis, secondary analysis.

SETTING

Recreational running clinics.

PARTICIPANTS

Running clinics were cluster randomised into intervention or control groups. All participants (n = 51) received general RRI prevention advice (baseline), after which the intervention group (n = 31) received additional biweekly tailored advice (weeks 3-11), before all participants completed a Final Questionnaire (week 13).

MAIN OUTCOME MEASURES

Between-group differences in change of evidence-based RRI prevention knowledge and behaviours.

RESULTS

Compared to baseline, the number of correct knowledge responses significantly increased in the intervention group (5.77, 95% CI 4.73, 6.81) and remained unchanged in controls (0.25, 95% CI -1.04, 1.55), outlining a positive effect only in the intervention group (p = 2.06 × 10^-8). The number of correct behaviour responses significantly increased in the intervention group (1.94, 95% CI 0.94, 2.93) however this increase was not significantly greater than controls (p = 0.075).

CONCLUSIONS

Biweekly tailored advice improved RRI prevention knowledge in runners. Further research into the impact of knowledge and behavioural change on RRI occurrence is warranted. ISRCTN 17357362.

'Take a Mental Break!' study: Role of mental aspects in running-related injuries using a randomised controlled trial

BACKGROUND

Running-related injuries (RRIs) can be considered the primary enemy of runners. Most literature on injury prediction and prevention overlooks the mental aspects of overtraining and under-recovery, despite their potential role in injury prediction and prevention. Consequently, knowledge on the role of mental aspects in RRIs is lacking.

OBJECTIVE

To investigate mental aspects of overtraining and under-recovery by means of an online injury prevention programme.

METHODS AND ANALYSIS

The 'Take a Mental Break!' study is a randomised controlled trial with a 12 month follow-up. After completing a web-based baseline survey, half and full marathon runners were randomly assigned to the intervention group or the control group. Participants of the intervention group obtained access to an online injury prevention programme, consisting of a running-related smartphone application. This app provided the participants of the intervention group with information on how to prevent overtraining and RRIs with special attention to mental aspects. The primary outcome measure is any self-reported RRI over the past 12 months. Secondary outcome measures include vigour, fatigue, sleep and perceived running performance. Regression analysis will be conducted to investigate whether the injury prevention programme has led to a lower prevalence of RRIs, better health and improved perceived running performance.

ETHICS AND DISSEMINATION

The Medical Ethics Committee of the University Medical Center Utrecht, the Netherlands, has exempted the current study from ethical approval (reference number: NL64342.041.17). Results of the study will be communicated through scientific articles in peer-reviewed journals, scientific reports and presentations on scientific conferences.

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

BACKGROUND

Running injuries are very common. Risk factors for running injuries are not consistently described across studies and do not differentiate between runners of long- and short distances within one cohort.

OBJECTIVES

The aim of this study is to determine risk factors for running injuries in recreational long- and short distance runners separately.

DESIGN

A prospective cohort study.

METHODS

Recreational runners from four different running events are invited to participate. They filled in a baseline questionnaire assessing possible risk factors about 4 weeks before the run and one a week after the run assessing running injuries. Using logistic regression we developed an overall risk model and separate risk models based on the running distance.

RESULTS

In total 3768 runners participated in this study. The overall risk model contained 4 risk factors: previous injuries (OR 3.7) and running distance during the event (OR 1.3) increased the risk of a running injury whereas older age (OR 0.99) and more training kilometers per week (OR 0.99) showed a decrease. Models between short- and long distance runners did not differ significantly. Previous injuries increased the risk of a running injury in all models, while more training kilometers per week decreased this risk.

CONCLUSIONS

We found that risk factors for running injuries were not related to running distances. Previous injury is a generic risk factor for running injuries, as is weekly training distance. Prevention of running injuries is important and a higher weekly training volume seems to prevent injuries to a certain extent.

Musculoskeletal Injuries and Training Patterns in Junior Elite Orienteering Athletes

Findings about the relation between musculoskeletal injuries and training patterns in orienteering athletes are sparse. Therefore, the musculoskeletal injuries and training patterns of 31 Swiss elite orienteering athletes aged 18-19 years were analyzed in a retrospective study. Individual training diaries and medical records were used to assess training data and injury history, respectively. Group comparisons and a multiple linear regression (MLR) were performed for statistical analysis. The junior elite orienteering athletes performed 7.38 ± 2.00 training sessions weekly, with a total duration of 455.75 ± 98.22 minutes. An injury incidence rate (IIR) of 2.18 ± 2.13 injuries per 1000 hours of training was observed. The lower extremity was affected in 93% of all injuries, and the knee (33%) was the most commonly injured location. The MLR revealed that gender and six training variables explained 60% of the variance in the injury severity index in this study. Supported by the low IIR in the observed age group, the training protocol of the junior elite orienteering athletes was generally adequate. In comparison to elite track, marathon, and orienteering athletes, the junior elite athletes performed less high-intensity interval training (HIIT). However, more frequent HIIT seems to be a protective factor against injuries.