1
|
Van Hooren B, Plasqui G, Meijer K. The Effect of Wearable-Based Real-Time Feedback on Running Injuries and Running Performance: A Randomized Controlled Trial. Am J Sports Med 2024; 52:750-765. [PMID: 38287728 PMCID: PMC10905988 DOI: 10.1177/03635465231222464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 11/06/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Running technique and running speed are considered important risk factors for running injuries. Real-time feedback on running technique and running speed by wearables may help reduce injury risk. PURPOSE To investigate whether real-time feedback on spatiotemporal metrics and relative speed by commercially available pressure-sensitive insoles would reduce running injuries and improve running performance compared with no real-time feedback. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A total of 220 recreational runners were randomly assigned into the intervention and control groups. Both groups received pressure-sensitive insoles, but only the intervention group received real-time feedback on spatiotemporal metrics and relative speed. The feedback aimed to reduce loading on the joint/segment estimated to exhibit the highest load. Injury rates were compared between the groups using Cox regressions. Secondary outcomes compared included injury severity, the proportion of runners with multiple injuries, changes in self-reported personal best times and motivation (Behavioral Regulation in Exercise Questionnaire-2), and interest in continuing wearable use after study completion. RESULTS A total of 160 participants (73%) were included in analyses of the primary outcome. Intention-to-treat analysis showed no significant difference in injury rate between the groups (Hazard ratio [HR], 1.11; P = .70). This was expected, as 53 of 160 (33%) participants ended up in the unassigned group because they used incorrect wearable settings, nullifying any interventional effects. As-treated analysis showed a significantly lower injury rate among participants receiving real-time feedback (HR, 0.53; P = .03). Similarly, the first-time injury severity was significantly lower (-0.43; P = .042). Per-protocol analysis showed no significant differences in injury rates, but the direction favored the intervention group (HR, 0.67; P = .30). There were no significant differences in the proportion of patients with multiple injuries (HR, 0.82; P = .40) or changes in running performance (3.07%; P = .26) and motivation. Also, ~60% of the participants who completed the study showed interest in continuing wearable use. CONCLUSION Real-time feedback on spatiotemporal metrics and relative speed provided by commercially available instrumented insoles may reduce the rate and severity of injuries in recreational runners. Feedback did not influence running performance and exercise motivation. REGISTRATION NL8472 (Dutch Trial Register).
Collapse
Affiliation(s)
- Bas Van Hooren
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Department of Nutrition and Movement Sciences, Maastricht, the Netherlands
| | - Guy Plasqui
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Department of Nutrition and Movement Sciences, Maastricht, the Netherlands
| | - Kenneth Meijer
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Department of Nutrition and Movement Sciences, Maastricht, the Netherlands
| |
Collapse
|
2
|
Friede MC, Innerhofer G, Fink C, Alegre LM, Csapo R. Conservative treatment of iliotibial band syndrome in runners: Are we targeting the right goals? Phys Ther Sport 2021; 54:44-52. [PMID: 35007886 DOI: 10.1016/j.ptsp.2021.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 12/23/2021] [Accepted: 12/23/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Iliotibial band syndrome (ITBS) is presumably caused by excessive tension in the iliotibial band (ITB) leading to compression and inflammation of tissues lying beneath it. Usually managed conservatively, there is a lack of scientific evidence supporting the treatment recommendations, and high symptom recurrence rates cast doubt on their causal effectiveness. This review discusses the influence of common physiotherapeutic measures on risk factors contributing to tissue compression beneath the ITB. METHODS The potential pathogenic factors are presented on the basis of a simple biomechanical model showing the forces acting on the lateral aspect of the knee. Existent literature on the most commonly prescribed physiotherapeutic interventions is critically discussed against the background of this model. Practical recommendations for the optimization of physiotherapy are derived. RESULTS According to biomechanical considerations, ITBS may be promoted by anatomical predisposition, joint malalignments, aberrant activation of inserting muscles as well as excessive ITB stiffness. Hip abductor strengthening may correct excessive hip adduction but also increase ITB strain. Intermittent stretching interventions are unlikely to change the ITB's length or mechanical properties. Running retraining is a promising yet understudied intervention. CONCLUSIONS High-quality research directly testing different physiotherapeutic treatment approaches in randomized controlled trials is needed.
Collapse
Affiliation(s)
- Miriam C Friede
- Carinthia University of Applied Sciences, Department of Physiotherapy, Klagenfurt, Austria.
| | - Gunnar Innerhofer
- University of Innsbruck, Department of Sport Science, Innsbruck, Austria
| | - Christian Fink
- Gelenkpunkt Sports and Joint Surgery, Innsbruck, Austria; University for Health Sciences, Medical Informatics and Technology, Research Unit for Orthopaedic Sports Medicine and Injury Prevention, Hall, Austria
| | - Luis M Alegre
- University of Castilla-La Mancha, GENUD Toledo Research Group, Toledo, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - Robert Csapo
- University of Vienna, Department of Sport Science, Vienna, Austria
| |
Collapse
|
3
|
Ramskov D, Rasmussen S, Sørensen H, Parner ET, Lind M, Nielsen R. Interactions between running volume and running pace on injury occurrence in recreational runners: A secondary analysis. J Athl Train 2021; 57:557-563. [PMID: 34543419 DOI: 10.4085/1062-6050-0165.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Context The combination of an excessive increase in running pace and volume is essential to consider when investigating associations between running and running-related injury. Objectives The purpose of the present study was to complete a secondary analysis on a dataset from a randomized trial, to investigate the interactions between relative or absolute weekly changes in running volume and running pace on running injury occurrence among a cohort of injury-free recreational runners in Denmark. Design Prospective cohort study Setting Running volume and pace were collected during a 24-week follow-up using global positioning systems (GPS) data. Training data was used to calculate relative and absolute weekly changes in running volume and pace. Patients or Other Participants A total of 586 recreational runners were included in the analysis. All participants were injury-free at inclusion. Main Outcome Measure(s) Running-related injury was the outcome. Injury data were collected weekly using a modified version of the OSTRC questionnaire. Risk difference (RD) was the measure of injury risk. Results A total of 133 runners sustained a running-related injury. A relative weekly change of progression >10% in running volume and progression in running pace (RD=8.1%, 95%CI: - 9.3;25.6%) and an absolute weekly change of progression >5km in running volume and progression in running pace (RD=5.2%, 95%CI: -12.0;22.5%), were not associated with a statistically significant positive interaction. Conclusions As coaches, clinicians and athletes may agree that excessive increase in running pace and excessive increase in running volume are important contributors to injury development, we analyzed the interaction between them. Although a statistically significant positive interaction on an additive scale in runners who progressed both running pace and running volume were not identified in the present study, readers of scientific articles should be aware that interaction is an important analytical approach that could be applied to other datasets in future publications.
Collapse
Affiliation(s)
- Daniel Ramskov
- aDepartment of Public Health, Aarhus University, Aarhus 8000, DK.,dDepartment of Physiotherapy, University College Northern Denmark, Aalborg 9220, DK
| | - Sten Rasmussen
- bOrthopaedic Surgery Research Unit, Aalborg University Hospital, Aalborg 9000, DK.,eDepartment of Clinical Medicine, Aalborg University, Aalborg 9220, DK
| | - Henrik Sørensen
- aDepartment of Public Health, Aarhus University, Aarhus 8000, DK
| | | | - Martin Lind
- cDepartment of Orthopaedics, Aarhus University Hospital, Aarhus 8000, DK
| | - Rasmus Nielsen
- aDepartment of Public Health, Aarhus University, Aarhus 8000, DK
| |
Collapse
|
4
|
Holmes HH, Monaghan PG, Strunk KK, Paquette MR, Roper JA. Changes in Training, Lifestyle, Psychological and Demographic Factors, and Associations With Running-Related Injuries During COVID-19. Front Sports Act Living 2021; 3:637516. [PMID: 34164619 PMCID: PMC8215167 DOI: 10.3389/fspor.2021.637516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/08/2021] [Indexed: 11/13/2022] Open
Abstract
The primary purpose of this study was to examine how the type and magnitude of changes in running behavior, as a consequence of COVID-19 pandemic restrictions, influence running-related injuries. Secondarily, we aimed to examine how lifestyle and psychosocial well-being measures may influence running behavior change. An online survey was advertised to individuals over the age of 18 that currently run or have previously participated in running for exercise. The survey questions examined injury history and new injuries sustained during COVID-19 restrictions, as well as changes related to training behavior changes, training environment changes, social behaviors, and psychosocial well-being. Changes reflected differences in running behaviors prior to COVID-19 restrictions (1 month prior to COVID-19 restrictions being imposed) and during COVID-19 restrictions (May 5 to June 10, 2020). A total of 1,035 runners were included in the analysis. Current injuries sustained during COVID-19 occurred in 9.5% of the runners. Injured runners made a greater number of total changes (p = 0.031) as well as training-related (p = 0.042) and environment-related (p = 0.017) changes compared with uninjured runners. A significant relationship was found between injury and those that reported less time to exercise to changes in work environment (p = 0017). This study highlights the multi-dimensional nature of running-related injuries and the need to consider the interaction of multiple changes in running behavior, rather than isolating single factors. Greater understanding of the underlying causes of running-related injuries can help reduce the risk of future injury.
Collapse
Affiliation(s)
| | | | - Kamden K. Strunk
- Department of Educational Foundations, Leadership and Technology, Auburn University, Auburn, AL, United States
| | - Max R. Paquette
- College of Health Sciences, University of Memphis, Memphis, TN, United States
| | - Jaimie A. Roper
- School of Kinesiology, Auburn University, Auburn, AL, United States
| |
Collapse
|
5
|
Incidence and Risk Factors of Low Back Pain in Marathon Runners. Pain Res Manag 2021; 2021:6660304. [PMID: 33688384 PMCID: PMC7920723 DOI: 10.1155/2021/6660304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 01/27/2021] [Accepted: 02/11/2021] [Indexed: 12/15/2022]
Abstract
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.
Collapse
|
6
|
SHEN SONGCUI, XU YINGJIA, FU WENXIA, LI YANJIE, HUANG JINGJUAN, CHEN LIXIU, LI WENZHAO, PAN YICHAO, LI RUOGU, JU PENGLIANG. THE VALUE OF TREADMILL EXERCISE TEST PARAMETERS TO PREDICT THE MARATHON PERFORMANCE OF YOUNG AND MIDDLE-AGED RECREATIONAL ATHLETES IN CHINA. J MECH MED BIOL 2020. [DOI: 10.1142/s0219519420500578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives: This study will evaluate the results of parameters measured during a treadmill exercise test to predict marathon performances. Methods: We studied 171 Chinese recreational athletes who participated in marathons or half-marathons (42.2[Formula: see text]k or 21.1[Formula: see text]k, respectively) between October 2016 and December 2017. The participants completed a survey that included questions about demographics and training, and they underwent a treadmill exercise test according to the Bruce protocol. The number of years in training, mean weekly hours of training, mean weekly training volume, and performance time in subsequent marathon events were recorded and analyzed in this study. Results: The total exercise times achieved on the treadmill test were significantly longer for men compared to women ([Formula: see text]). The performance times in the half-marathons were significantly shorter for men compared to women ([Formula: see text]). Training volume was the only independent predictor of total exercise time on the treadmill and performance time in marathons and half-marathons (all [Formula: see text]). The value of the total exercise time on the treadmill to predict performance times in half-marathons ([Formula: see text]) was superior to full marathons ([Formula: see text]) and significantly better in study subjects aged 30–39 years ([Formula: see text], [Formula: see text]) and 40–49 years ([Formula: see text], [Formula: see text]) compared to study subjects aged 20–29 years and 50–59 years. The percentage of decrease in the maximal heart rate (MHR) at the end of one minute of recovery time was negatively correlated with performance times in marathons. Conclusions: The total exercise time achieved during an exhaustive treadmill exercise test and percentage of decrease in the MHR at the end of one minute of recovery time are accessible parameters that can help athletes manage their expectations and adjust their training plans. A large study that includes additional countries is needed to confirm the value of treadmill exercise test results for predicting marathon performance.
Collapse
Affiliation(s)
- SONG-CUI SHEN
- Department of Cardiac Function, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, P. R. China
| | - YING-JIA XU
- Department of Cardiology, The Fifth People’s Hospital of Shanghai, Fudan University, Shanghai 200040, P. R. China
| | - WEN-XIA FU
- Department of Cardiac Function, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, P. R. China
| | - YAN-JIE LI
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, P. R. China
| | - JING-JUAN HUANG
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, P. R. China
| | - LI-XIU CHEN
- Department of Cardiac Function, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, P. R. China
| | - WEN-ZHAO LI
- Department of Cardiac Function, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, P. R. China
| | - YI-CHAO PAN
- Department of Cardiac Function, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, P. R. China
| | - RUO-GU LI
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, P. R. China
| | - PENG-LIANG JU
- Department of Cardiac Function, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, P. R. China
| |
Collapse
|
7
|
Linton L, Valentin S. Running coaches and running group leaders' engagement with, and beliefs and perceived barriers to prehabilitation and injury prevention strategies for runners. Phys Ther Sport 2020; 46:54-62. [PMID: 32871363 DOI: 10.1016/j.ptsp.2020.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To identify which pre-and post-run injury risk reduction activities and prehabilitation (prehab) strategies Coaches and Running Group Leaders (Coaches/RGLs) engage in with runners; to explore their beliefs on why runners get injured; to identify Coaches/RGLs confidence providing injury prevention activities, and what they believe are effective for reducing risk of injury; to identify their perceived barriers to including prehab during running coaching/training. DESIGN Survey; Participants: UK Coaches/RGLs (N = 100) OUTCOME MEASURES: Online questionnaire with open, closed and Likert scale questions. RESULTS Most Coaches/RGLs performed active warm-ups (97%), cool-downs (94%),gave injury prevention advice (91%), and advice on recovery strategies (84%) during training. Fewer coaches/RGLs incorporated prehab (67%). Although they collectively exhibited a wide range of knowledge, individually there was less consistency and confidence providing this. Prehab was rated as very important for injury risk reduction, with supervision recommended to facilitate runner engagement. Coaches/RGLs found conflicting advice, time, environment, and resistance from runners as barriers to incorporating prehab into training. CONCLUSION Coaches/RGLs believe prehab is important for runners however lack of confidence and knowledge appeared to limit the wider inclusion of prehab with runners. Coaches/RGLs welcomed reputable information on prehab from evidence-based sources. This may assist in reducing injury.
Collapse
Affiliation(s)
- Linda Linton
- FASIC Sport and Exercise Medicine Clinic, University of Edinburgh, Edinburgh, UK.
| | - Stephanie Valentin
- Institute for Clinical Exercise and Health Science, University West of Scotland, Stevenson Place, Blantyre, UK
| |
Collapse
|
8
|
Jungmalm J, Nielsen RØ, Desai P, Karlsson J, Hein T, Grau S. Associations between biomechanical and clinical/anthropometrical factors and running-related injuries among recreational runners: a 52-week prospective cohort study. Inj Epidemiol 2020; 7:10. [PMID: 32234070 PMCID: PMC7110719 DOI: 10.1186/s40621-020-00237-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this exploratory study was to investigate whether runners with certain biomechanical or clinical/anthropometrical characteristics sustain more running-related injuries than runners with other biomechanical or clinical/anthropometrical characteristics. METHODS The study was designed as a prospective cohort with 52-weeks follow-up. A total of 224 injury-free, recreational runners were recruited from the Gothenburg Half Marathon and tested at baseline. The primary exposure variables were biomechanical and clinical/anthropometrical measures, including strength, lower extremity kinematics, joint range of motion, muscle flexibility, and trigger points. The primary outcome measure was any running-related injury diagnosed by a medical practitioner. Cumulative risk difference was used as measure of association. A shared frailty approach was used with legs as the unit of interest. A total of 448 legs were included in the analyses. RESULTS The cumulative injury incidence proportion for legs was 29.0% (95%CI = 24.0%; 34.8%). A few biomechanical and clinical/anthropometrical factors influence the number of running-related injuries sustained in recreational runners. Runners with a late timing of maximal eversion sustained 20.7% (95%CI = 1.3; 40.0) more injuries, and runners with weak abductors in relation to adductors sustained 17.3% (95%CI = 0.8; 33.7) more injuries, compared with the corresponding reference group. CONCLUSIONS More injuries are likely to occur in runners with late timing of maximal eversion or weak hip abductors in relation to hip adductors.
Collapse
Affiliation(s)
- Jonatan Jungmalm
- Center for Health and Performance, Department of Food and Nutrition and Sport Science, University of Gothenburg, Box 300, SE405 30 Gothenburg, Sweden
| | - Rasmus Østergaard Nielsen
- Section of Sport Science, Department of Public Health, Aarhus University, Dalgas Avenue 4, 8000 Aarhus, Denmark
| | - Pia Desai
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Box 426, SE415 30 Gothenburg, Sweden
| | - Jon Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Box 426, SE415 30 Gothenburg, Sweden
| | - Tobias Hein
- Center for Health and Performance, Department of Food and Nutrition and Sport Science, University of Gothenburg, Box 300, SE405 30 Gothenburg, Sweden
| | - Stefan Grau
- Center for Health and Performance, Department of Food and Nutrition and Sport Science, University of Gothenburg, Box 300, SE405 30 Gothenburg, Sweden
| |
Collapse
|
9
|
Moore IS, Willy RW. Use of Wearables: Tracking and Retraining in Endurance Runners. Curr Sports Med Rep 2020; 18:437-444. [PMID: 31834174 DOI: 10.1249/jsr.0000000000000667] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Wearable devices are ubiquitous among runners, coaches, and clinicians with an ever-increasing number of devices coming on the market. In place of gold standard measures in the laboratory, these devices attempt to provide a surrogate means to track running biomechanics outdoors. This review provides an update on recent literature in the field of wearable devices in runners, with an emphasis on criterion validity and usefulness in the coaching and rehabilitation of runners. Our review suggests that while enthusiasm should be tempered, there is still much for runners to gain with wearables. Overall, our review finds evidence supporting the use of wearables to improve running performance, track global training loads applied to the runner, and provide real-time feedback on running speed and run cadence. Case studies illustrate the use of wearables for the purposes of performance and rehabilitation.
Collapse
Affiliation(s)
- Isabel S Moore
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UNITED KINGDOM
| | - Richard W Willy
- School of Physical Therapy & Health Sciences, University of Montana, Missoula, MT
| |
Collapse
|
10
|
Toresdahl BG, McElheny K, Metzl J, Ammerman B, Chang B, Kinderknecht J. A Randomized Study of a Strength Training Program to Prevent Injuries in Runners of the New York City Marathon. Sports Health 2019; 12:74-79. [PMID: 31642726 DOI: 10.1177/1941738119877180] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Lower extremity overuse injuries are common among runners, especially first-time marathoners. Hip abductor and quadriceps strengthening is often recommended to reduce running-related injuries. HYPOTHESIS A 12-week strength training program would decrease the rate of overuse injuries resulting in marathon noncompletion and improve race finishing time. STUDY DESIGN Randomized trial. LEVEL OF EVIDENCE Level 2. METHODS Twelve weeks before the New York City Marathon, first-time marathon runners age 18 years and older were randomized into a strength training group or an observation group. The strength training group was instructed to perform a 10-minute program 3 times weekly using written and video instruction. This program targeted the quadriceps, hip abductor, and core muscle groups. Injuries were self-reported through biweekly surveys, with major injuries being those that resulted in marathon noncompletion and minor injuries being those that impaired training or race performance. RESULTS A total of 720 runners were enrolled (mean age, 35.9 ± 9.4 years; 69.4% female), of whom 583 runners started the marathon and 579 completed it. The incidence of major injury was 8.9% and minor injury was 48.5%. Fifty two of 64 major injuries were overuse, of which 20 were bone stress injuries. The incidence of overuse injury resulting in marathon noncompletion was 7.1% in the strength training group and 7.3% in the observation group (risk ratio, 0.97; 95% CI, 0.57-1.63; P = 0.90). The mean finishing time was 5 hours 1 ± 60 minutes in the strength training group and 4 hours 58 ± 55 minutes in the observation group (P = 0.35). CONCLUSION There is a high prevalence of injury among first-time marathon runners, but this self-directed strength training program did not decrease overuse injury incidence resulting in marathon noncompletion. CLINICAL RELEVANCE Prevention strategies such as strength training need to be developed and evaluated through clinical trials to reduce the high prevalence of overuse injuries in runners, especially for high-risk populations such as first-time marathon runners.
Collapse
Affiliation(s)
- Brett G Toresdahl
- Primary Care Sports Medicine Service, Hospital for Special Surgery, New York, New York
| | - Kathryn McElheny
- Primary Care Sports Medicine Service, Hospital for Special Surgery, New York, New York
| | - Jordan Metzl
- Primary Care Sports Medicine Service, Hospital for Special Surgery, New York, New York
| | | | | | - James Kinderknecht
- Primary Care Sports Medicine Service, Hospital for Special Surgery, New York, New York
| |
Collapse
|
11
|
Hayes LE, Boulos A, Cruz Jr. AI. Risk factors for in-season injury in varsity collegiate cross-country athletes: an analysis of one season in 97 athletes. J Sports Med Phys Fitness 2019; 59:1536-1543. [DOI: 10.23736/s0022-4707.19.09221-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
12
|
Nielsen RO, Bertelsen ML, Ramskov D, Damsted C, Verhagen E, Bredeweg SW, Theisen D, Malisoux L. Randomised controlled trials (RCTs) in sports injury research: authors—please report the compliance with the intervention. Br J Sports Med 2019; 54:51-57. [DOI: 10.1136/bjsports-2019-100858] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2019] [Indexed: 11/03/2022]
Abstract
BackgroundIn randomised controlled trials (RCTs) of interventions that aim to prevent sports injuries, the intention-to-treat principle is a recommended analysis method and one emphasised in the Consolidated Standards of Reporting Trials (CONSORT) statement that guides quality reporting of such trials. However, an important element of injury prevention trials—compliance with the intervention—is not always well-reported. The purpose of the present educational review was to describe the compliance during follow-up in eight large-scale sports injury trials and address compliance issues that surfaced. Then, we discuss how readers and researchers might consider interpreting results from intention-to-treat analyses depending on the observed compliance with the intervention.MethodsData from seven different randomised trials and one experimental study were included in the present educational review. In the trials that used training programme as an intervention, we defined full compliance as having completed the programme within ±10% of the prescribed running distance (ProjectRun21 (PR21), RUNCLEVER, Start 2 Run) or time-spent-running in minutes (Groningen Novice Running (GRONORUN)) for each planned training session. In the trials using running shoes as the intervention, full compliance was defined as wearing the prescribed running shoe in all running sessions the participants completed during follow-up.ResultsIn the trials that used a running programme intervention, the number of participants who had been fully compliant was 0 of 839 (0%) at 24-week follow-up in RUNCLEVER, 0 of 612 (0%) at 14-week follow-up in PR21, 12 of 56 (21%) at 4-week follow-up in Start 2 Run and 8 of 532 (1%) at 8-week follow-up in GRONORUN. In the trials using a shoe-related intervention, the numbers of participants who had been fully compliant at the end of follow-up were 207 of 304 (68%) in the 21 week trial, and 322 of 423 (76%), 521 of 577 (90%), 753 of 874 (86%) after 24-week follow-up in the other three trials, respectively.ConclusionThe proportion of runners compliant at the end of follow-up ranged from 0% to 21% in the trials using running programme as intervention and from 68% to 90% in the trials using running shoes as intervention. We encourage sports injury researchers to carefully assess and report the compliance with intervention in their articles, use appropriate analytical approaches and take compliance into account when drawing study conclusions. In studies with low compliance, G-estimation may be a useful analytical tool provided certain assumptions are met.
Collapse
|
13
|
HUNTER JESSICAG, GARCIA GINAL, SHIM JAEKUN, MILLER ROSSH. Fast Running Does Not Contribute More to Cumulative Load than Slow Running. Med Sci Sports Exerc 2019; 51:1178-1185. [DOI: 10.1249/mss.0000000000001888] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
14
|
Jungmalm J, Bertelsen ML, Nielsen RO. What proportion of athletes sustained an injury during a prospective study? Censored observations matter. Br J Sports Med 2019; 54:70-71. [DOI: 10.1136/bjsports-2018-100440] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2019] [Indexed: 11/04/2022]
|
15
|
Damsted C, Parner ET, Sørensen H, Malisoux L, Nielsen RO. ProjectRun21: Do running experience and running pace influence the risk of running injury—A 14-week prospective cohort study. J Sci Med Sport 2019; 22:281-287. [DOI: 10.1016/j.jsams.2018.08.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 08/13/2018] [Accepted: 08/16/2018] [Indexed: 12/25/2022]
|
16
|
Progression in Running Intensity or Running Volume and the Development of Specific Injuries in Recreational Runners: Run Clever, a Randomized Trial Using Competing Risks. J Orthop Sports Phys Ther 2018; 48:740-748. [PMID: 29895234 DOI: 10.2519/jospt.2018.8062] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND It has been proposed that training intensity and training volume are associated with specific running-related injuries. If such an association exists, secondary preventive measures could be initiated by clinicians, based on symptoms of a specific injury diagnosis. OBJECTIVES To test the following hypotheses: (1) a running schedule focusing on running intensity (S-I) would increase the risk of sustaining Achilles tendinopathy, gastrocnemius injuries, and plantar fasciitis compared with hypothesized volume-related injuries; and (2) a running schedule focusing on running volume (S-V) would increase the risk of sustaining patellofemoral pain syndrome, iliotibial band syndrome, and patellar tendinopathy compared with hypothesized intensity-related injuries. METHODS In this randomized clinical trial and etiology study, healthy recreational runners were included in a 24-week follow-up, divided into 8-week preconditioning and 16-week specific-focus training periods. Participants were randomized to 1 of 2 running schedules: S-I or S-V. The S-I group progressed the amount of high-intensity running (88% maximal oxygen consumption [VO2max] or greater) each week, and the S-V group progressed total weekly running volume. A global positioning system watch or smartphone collected data on running. Running-related injuries were diagnosed based on a clinical examination. Estimates were reported as risk difference and 95% confidence interval (CI). RESULTS Of 447 runners, a total of 80 sustained an injury (S-I, n = 36; S-V, n = 44). Risk differences (95% CIs) of intensity injuries in the S-I group were -0.8% (-5.0%, 3.4%) at 2 weeks, -0.8% (-6.7%, 5.1%) at 4 weeks, -2.0% (-9.2%, 5.2%) at 8 weeks, and -5.1% (-16.5%, 6.3%) at 16 weeks. Risk differences (95% CIs) of volume injuries in the S-V group were -0.9% (-5.0%, 3.2%) at 2 weeks, -2.0% (-7.5%, 3.5%) at 4 weeks, -3.2% (-9.1%, 2.7%) at 8 weeks, and -3.4% (13.2%, 6.2%) at 16 weeks. CONCLUSION No difference in risk of hypothesized intensity- and volume-specific running-related injuries exists between the 2 running schedules focused on progression in either running intensity or volume. LEVEL OF EVIDENCE Etiology, level 1b. J Orthop Sports Phys Ther 2018;48(10):740-748. Epub 12 Jun 2018. doi:10.2519/jospt.2018.8062.
Collapse
|