1
|
Leugers K, Mathews S, Anderson R, Reilly N, Haltiwanger H, Gonnella M, Goss D. Viability of Structured Gait Retraining for Improving Clinical Outcomes Following Running-related Injury in Active Duty Service Members. Mil Med 2024:usae218. [PMID: 38771705 DOI: 10.1093/milmed/usae218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/30/2024] [Accepted: 04/12/2024] [Indexed: 05/23/2024] Open
Abstract
INTRODUCTION All branches of the U.S. Military have a running component of their physical readiness testing battery. Running-related musculoskeletal injuries affect 20 to 40% of DoD Service Members each year. Running form has not historically been addressed with military running-related injuries. To assess the utility of a structured gait retaining protocol designed to treat the onset of running-related pain and/or injury by correcting identified biomechanical risk factors for injury and improve clinical outcomes. STUDY DESIGN Case series. MATERIALS AND METHODS A total of 160 Active Duty Service Members (ADSMs) with running-related lower-body musculoskeletal injuries were referred by a physical therapist for a multisession gait retraining program termed "Run with CLASS" (Cadence, Lean, Alignment, Soft-landing, Strike). Run with CLASS utilized various drills to emphasize impact progression, proximal strengthening, and proprioception and spatial awareness. RESULTS Results revealed that the implemented gait retraining protocol significantly improved running parameters following lower-body injury as evidenced by increased cadence, improved functional assessment scores, and a marked transition from predominantly heel strike to forefoot strike patterns during running. CONCLUSIONS A 3-week supervised gait retraining program focused on the gait retraining program termed "Run with CLASS" (Cadence, Lean, Alignment, Soft-landing, Strike) was successful in altering biomechanics of self-selected running gait by increasing cadence and transitioning ADSMs to a forefoot foot strike. Additionally, ADSMs reported significant improvements on the self-reported functional scores on the University of Wisconsin Running Injury and Recovery Index and Single Assessment Numerical Evaluation. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- Kelly Leugers
- Physical Therapy, Womack Army Medical Center, Fort Liberty, NC 28310, USA
| | - Sara Mathews
- Physical Therapy, Womack Army Medical Center, Fort Liberty, NC 28310, USA
| | - Rhoda Anderson
- Physical Therapy, Womack Army Medical Center, Fort Liberty, NC 28310, USA
| | - Nicholas Reilly
- Physical Therapy, Womack Army Medical Center, Fort Liberty, NC 28310, USA
- The Geneva Foundation, Womack Army Medical Center, Fort Liberty, NC 28310, USA
| | - Henry Haltiwanger
- Physical Therapy, Womack Army Medical Center, Fort Liberty, NC 28310, USA
| | - Maria Gonnella
- Physical Therapy, Womack Army Medical Center, Fort Liberty, NC 28310, USA
- The Geneva Foundation, Womack Army Medical Center, Fort Liberty, NC 28310, USA
| | - Don Goss
- Physical Therapy, Womack Army Medical Center, Fort Liberty, NC 28310, USA
- The Geneva Foundation, Womack Army Medical Center, Fort Liberty, NC 28310, USA
- Department of Physical Therapy, High Point University, High Point, NC 27268, USA
| |
Collapse
|
2
|
Mousavi SH, Khorramroo F, Jafarnezhadgero A. Gait retraining targeting foot pronation: A systematic review and meta-analysis. PLoS One 2024; 19:e0298646. [PMID: 38427634 PMCID: PMC10906845 DOI: 10.1371/journal.pone.0298646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/27/2024] [Indexed: 03/03/2024] Open
Abstract
Foot pronation is a prevalent condition known to contribute to a range of lower extremity injuries. Numerous interventions have been employed to address this issue, many of which are expensive and necessitate specific facilities. Gait retraining has been suggested as a promising intervention for modifying foot pronation, offering the advantage of being accessible and independent of additional materials or specific time. We aimed to systematically review the literature on the effect of gait retraining on foot pronation. We searched four databases including PubMed, Web of Science, Scopus and Embase from their inception through 20 June 2023. The Downs and Black appraisal scale was applied to assess quality of included studies. Two reviewers screened studies to identify studies reporting the effect of different methods of gait-retraining on foot pronation. Outcomes of interest were rearfoot eversion, foot pronation, and foot arch. Two authors separately extracted data from included studies. Data of interest were study design, intervention, variable, sample size and sex, tools, age, height, weight, body mass index, running experience, and weekly distance of running. Mean differences and 95% confidence intervals (CI) were calculated with random effects model in RevMan version 5.4. Fifteen studies with a total of 295 participants were included. The results of the meta-analysis showed that changing step width does not have a significant effect on peak rearfoot eversion. The results of the meta-analysis showed that changing step width does not have a significant effect on peak rearfoot eversion. Results of single studies indicated that reducing foot progression angle (MD 2.1, 95% CI 0.62, 3.58), lateralizing COP (MD -3.3, 95% CI -4.88, -1.72) can effectively reduce foot pronation. Overall, this study suggests that gait retraining may be a promising intervention for reducing foot pronation; Most of the included studies demonstrated significant improvements in foot pronation following gait retraining. Changing center of pressure, foot progression angle and forefoot strike training appeared to yield more favorable outcomes. However, further research is needed to fully understand its effectiveness and long-term benefits.
Collapse
Affiliation(s)
- Seyed Hamed Mousavi
- Faculty of Sport Sciences and Health, Department of Sport Injuries and Biomechanics, University of Tehran, Tehran, Iran
| | - Fateme Khorramroo
- Faculty of Sport Sciences and Health, Department of Sport Injuries and Biomechanics, University of Tehran, Tehran, Iran
| | - Amirali Jafarnezhadgero
- Faculty of Educational Science and Psychology, Department of Sport Managements and Biomechanics, University of Mohaghegh Ardabili, Ardabil, Iran
| |
Collapse
|
3
|
Wong ASM, Morrice-West AV, Whitton RC, Hitchens PL. Changes in Thoroughbred speed and stride characteristics over successive race starts and their association with musculoskeletal injury. Equine Vet J 2023; 55:194-204. [PMID: 35477925 PMCID: PMC10084173 DOI: 10.1111/evj.13581] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 04/20/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Certain stride characteristics have been shown to affect changes in biomechanical factors that are associated with injuries in human athletes. Determining the relationship between stride characteristics and musculoskeletal injury (MSI) may be key in limiting injury occurrence in the racehorse. OBJECTIVES This study aimed to determine whether changes in race day speed and stride characteristics over career race starts are associated with an increased risk of MSI in racehorses. STUDY DESIGN Case-control study. METHODS Speed, stride length, and stride frequency data were obtained from the final 200 m sectional of n = 5660 race starts by n = 584 horses (case n = 146, control n = 438). Multivariable joint models, combining longitudinal and survival (time to injury) analysis, were generated. Hazard ratios and their 95% confidence intervals (CI) are presented. RESULTS The risk of MSI increased by 1.18 (95% CI 1.09, 1.28; P < 0.001) for each 0.1 m/s decrease in speed and by 1.11 (95% CI 1.02, 1.21; P = 0.01) for each 10 cm decrease in stride length over time (career race starts). A more marked rate of decline in speed and stride length was observed approximately 6 races prior to injury. Risk of MSI was highest early in the horse's racing career. MAIN LIMITATIONS Only final sectional stride characteristics were assessed in the model. The model did not account for time between race starts. CONCLUSIONS Decreasing speed and stride length over multiple races is associated with MSI in racehorses. Monitoring stride characteristics over time may be beneficial for the early detection of MSI.
Collapse
Affiliation(s)
- Adelene S M Wong
- Equine Centre, Melbourne Veterinary School, University of Melbourne, Werribee Victoria, Australia
| | - Ashleigh V Morrice-West
- Equine Centre, Melbourne Veterinary School, University of Melbourne, Werribee Victoria, Australia
| | - R Chris Whitton
- Equine Centre, Melbourne Veterinary School, University of Melbourne, Werribee Victoria, Australia
| | - Peta L Hitchens
- Equine Centre, Melbourne Veterinary School, University of Melbourne, Werribee Victoria, Australia
| |
Collapse
|
4
|
Zhang M, Cui J, Liu H. Effect of Flat Running Shoes on Hip Kinematics in Male Recreational Runners. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16473. [PMID: 36554352 PMCID: PMC9778694 DOI: 10.3390/ijerph192416473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Abstract
Patellofemoral joint pain and iliotibial band syndrome are very common running-related injuries. Excessive contralateral pelvic drop, hip adduction, and hip internal rotation have been suggested to be associated with the two injuries. The purpose of this repeated measures and the cross-sectional study was to investigate the effect of flat running shoes on these kinematic variables compared with that of conventional running shoes with a 10 mm drop. Eighteen male recreational runners were recruited to run in flat shoes and conventional shoes with a 10 mm drop, in random order. Impact force data and lower extremity kinematics were synchronously obtained using two Kistler force plates and eight motion infrared cameras, whereas differences in the impact force and hip kinematics were compared using statistical parametric mapping. Regarding hip kinematics, the hip flexion (p = 0.004) and adduction angles (p = 0.004) decreased significantly at 30-70% and 62-85% of the stance phase, respectively, while wearing flat running shoes; the contralateral pelvic drop angle (p = 0.001) decreased significantly at 31-75% of the stance phase while wearing flat running shoes. The knee internal rotation angle (p = 0.035) decreased significantly at 8-17% of the stance phase while wearing flat running shoes compared with conventional running shoes. Given that these kinematic variables are associated with patellofemoral joint pain and iliotibial band syndrome, flat running shoes may have potential benefits for the prevention or treatment of knee injuries.
Collapse
Affiliation(s)
- Masen Zhang
- Biomechanics Laboratory, School of Sport Science, Beijing Sport University, Beijing 100084, China
| | - Jing Cui
- Biomechanics Laboratory, School of Sport Science, Beijing Sport University, Beijing 100084, China
| | - Hui Liu
- China Institute of Sport and Health Science, Beijing Sport University, Beijing 100084, China
| |
Collapse
|
5
|
Hutchinson LA, Lichtwark GA, Willy RW, Kelly LA. The Iliotibial Band: A Complex Structure with Versatile Functions. Sports Med 2022; 52:995-1008. [PMID: 35072941 PMCID: PMC9023415 DOI: 10.1007/s40279-021-01634-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 11/20/2022]
Abstract
The development of a pronounced iliotibial band (ITB) is an anatomically distinct evolution of humans. The mechanical behaviour of this “new” structure is still poorly understood and hotly debated in current literature. Iliotibial band syndrome (ITBS) is one of the leading causes of lateral knee pain injuries in runners. We currently lack a comprehensive understanding of the healthy behaviour of the ITB, and this is necessary prior to further investigating the aetiology of pathologies like ITBS. Therefore, the purpose of this narrative review was to collate the anatomical, biomechanical and clinical literature to understand how the mechanical function of the ITB is influenced by anatomical variation, posture and muscle activation. The complexity of understanding the mechanical function of the ITB is due, in part, to the presence of its two in-series muscles: gluteus maximus (GMAX) and tensor fascia latae (TFL). At present, we lack a fundamental understanding of how GMAX and TFL transmit force through the ITB and what mechanical role the ITB plays for movements like walking or running. While there is a range of proposed ITBS treatment strategies, robust evidence for effective treatments is still lacking. Interventions that directly target the running biomechanics suspected to increase either ITB strain or compression of lateral knee structures may have promise, but clinical randomised controlled trials are still required.
Collapse
Affiliation(s)
- L A Hutchinson
- School of Human Movement and Nutrition, The University of Queensland, Brisbane, QLD, Australia.
| | - G A Lichtwark
- School of Human Movement and Nutrition, The University of Queensland, Brisbane, QLD, Australia
| | - R W Willy
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, MT, USA
| | - L A Kelly
- School of Human Movement and Nutrition, The University of Queensland, Brisbane, QLD, Australia
| |
Collapse
|
6
|
Matias I, Daza EJ, Wac K. What possibly affects nighttime heart rate? Conclusions from N-of-1 observational data. Digit Health 2022; 8:20552076221120725. [PMID: 36046637 PMCID: PMC9421014 DOI: 10.1177/20552076221120725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/02/2022] [Indexed: 11/15/2022] Open
Abstract
Background Heart rate (HR), especially at nighttime, is an important biomarker for cardiovascular health. It is known to be influenced by overall physical fitness, as well as daily life physical or psychological stressors like exercise, insufficient sleep, excess alcohol, certain foods, socialization, or air travel causing physiological arousal of the body. However, the exact mechanisms by which these stressors affect nighttime HR are unclear and may be highly idiographic (i.e. individual-specific). A single-case or “ n-of-1” observational study (N1OS) is useful in exploring such suggested effects by examining each subject's exposure to both stressors and baseline conditions, thereby characterizing suggested effects specific to that individual. Objective Our objective was to test and generate individual-specific N1OS hypotheses of the suggested effects of daily life stressors on nighttime HR. As an N1OS, this study provides conclusions for each participant, thus not requiring a representative population. Methods We studied three healthy, nonathlete individuals, collecting the data for up to four years. Additionally, we evaluated model-twin randomization (MoTR), a novel Monte Carlo method facilitating the discovery of personalized interventions on stressors in daily life. Results We found that physical activity can increase the nighttime heart rate amplitude, whereas there were no strong conclusions about its suggested effect on total sleep time. Self-reported states such as exercise, yoga, and stress were associated with increased (for the first two) and decreased (last one) average nighttime heart rate. Conclusions This study implemented the MoTR method evaluating the suggested effects of daily stressors on nighttime heart rate, sleep time, and physical activity in an individualized way: via the N-of-1 approach. A Python implementation of MoTR is freely available.
Collapse
Affiliation(s)
- Igor Matias
- Quality of Life Technologies Lab, Center for Informatics, University of Geneva, Geneva, Switzerland
| | | | - Katarzyna Wac
- Quality of Life Technologies Lab, Center for Informatics, University of Geneva, Geneva, Switzerland
| |
Collapse
|
7
|
Gaffney CJ, Cunnington J, Rattley K, Wrench E, Dyche C, Bampouras TM. Weighted vests in CrossFit increase physiological stress during walking and running without changes in spatiotemporal gait parameters. ERGONOMICS 2022; 65:147-158. [PMID: 34319864 DOI: 10.1080/00140139.2021.1961876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/23/2021] [Indexed: 06/13/2023]
Abstract
This study quantified the physiological and biomechanical effects of the 20 lb (9.07 kg, males) and 14 lb (6.35 kg, females) weighted vest used in CrossFit, and whether they were predisposed to injury. Twenty subjects (10 males, 10 females) undertook walking (0%, 5% and 10% gradient) and running trials in two randomised study visits (weighted vest/no weighted vest). Physiological demand during walking was increased with the vest at 10% but not 5% or 0% with no change in gait variables. In the running trial, the weighted vest increased oxygen uptake (males; females) (+0.22L/min, p < 0.01; +0.07 L/min, p < 0.05), heart rate (+11bpm, p < 0.01; +11bpm, p < 0.05), carbohydrate oxidation (+0.6 g/min, p < 0.001; +0.2 g/min, p < 0.01), and energy expenditure (+3.8 kJ/min, p < 0.001; +1.5 kJ/min, p < 0.05) whilst blood lactate was increased only in males (+0.6 mmol/L, p < 0.05). There was no change in stride length or frequency. Weighted vest training increases physiological stress and carbohydrate oxidation without affecting measured gait parameters. Practitioner summary: We examined the effect of weighted vest training prescribed in CrossFit (20 lb/9.07 kg, males and 14 lb/6.35 kg, females) in a randomised controlled trial. We found that physiological stress is increased in both sexes, although three-fold greater in males, but with no change in biomechanical gait that predisposes to lower-limb injury.
Collapse
Affiliation(s)
- Christopher J Gaffney
- Human Performance Laboratory, Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Jack Cunnington
- Human Performance Laboratory, Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Kate Rattley
- Human Performance Laboratory, Lancaster Medical School, Lancaster University, Lancaster, UK
- Biomedical and Life Sciences, Lancaster University, Lancaster, UK
| | - Elizabeth Wrench
- Human Performance Laboratory, Lancaster Medical School, Lancaster University, Lancaster, UK
- Biomedical and Life Sciences, Lancaster University, Lancaster, UK
| | - Chloe Dyche
- Human Performance Laboratory, Lancaster Medical School, Lancaster University, Lancaster, UK
- Biomedical and Life Sciences, Lancaster University, Lancaster, UK
| | - Theodoros M Bampouras
- Human Performance Laboratory, Lancaster Medical School, Lancaster University, Lancaster, UK
| |
Collapse
|
8
|
Increasing Step Rate Affects Rearfoot Kinematics and Ground Reaction Forces during Running. BIOLOGY 2021; 11:biology11010008. [PMID: 35053005 PMCID: PMC8772793 DOI: 10.3390/biology11010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/03/2021] [Accepted: 12/15/2021] [Indexed: 11/25/2022]
Abstract
Simple Summary Excessive movements, or inadequate timing in movement patterns, during running may contribute to the development of some running-related injuries. Specifically, excessive movement at the rearfoot, influencing lower leg rotation, has been a focus on different running-related injuries. One method to change how the lower limbs move is to increase step rate, or cadence. There is little research available describing how the rearfoot is affected by changes in step rate; therefore, the primary purpose of this study was to evaluate the effects of increasing step rate on rearfoot motion during running. Reflective markers were placed on twenty runners’ lower legs and feet in order to capture leg and foot movements while running on a treadmill at the runners’ preferred speed and step rate. Step rate was increased by 5% and 10%, while runners were cued by a metronome. Three-dimensional rearfoot motion was calculated during the stance phase (foot in contact with the ground) of running. The main finding of this study was that increasing step rate decreased peak rearfoot and lower leg rotation. These findings may be useful for rehabilitation for some running-related injuries. Abstract Relatively high frontal and transverse plane motion in the lower limbs during running have been thought to play a role in the development of some running-related injuries (RRIs). Increasing step rate has been shown to significantly alter lower limb kinematics and kinetics during running. The purpose of this study was to evaluate the effects of increasing step rate on rearfoot kinematics, and to confirm how ground reaction forces (GRFs) are adjusted with increased step rate. Twenty runners ran on a force instrumented treadmill while marker position data were collected under three conditions. Participants ran at their preferred pace and step rate, then +5% and +10% of their preferred step rate while being cued by a metronome for three minutes each. Sagittal and frontal plane angles for the rearfoot segment, tibial rotation, and GRFs were calculated during the stance phase of running. Significant decreases were observed in sagittal and frontal plane rearfoot angles, tibial rotation, vertical GRF, and anteroposterior GRF with increased step rate compared with the preferred step rate. Increasing step rate significantly decreased peak sagittal and frontal plane rearfoot and tibial rotation angles. These findings may have implications for some RRIs and gait retraining.
Collapse
|
9
|
Strasser NL, Farina KA. Haglund's Syndrome and Insertional Achilles Tendinopathy. OPER TECHN SPORT MED 2021. [DOI: 10.1016/j.otsm.2021.150850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
10
|
What are the Benefits and Risks Associated with Changing Foot Strike Pattern During Running? A Systematic Review and Meta-analysis of Injury, Running Economy, and Biomechanics. Sports Med 2021; 50:885-917. [PMID: 31823338 DOI: 10.1007/s40279-019-01238-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Running participation continues to increase. The ideal strike pattern during running is a controversial topic. Many coaches and therapists promote non-rearfoot strike (NRFS) running with a belief that it can treat and prevent injury, and improve running economy. OBJECTIVE The aims of this review were to synthesise the evidence comparing NRFS with rearfoot strike (RFS) running patterns in relation to injury and running economy (primary aim), and biomechanics (secondary aim). DESIGN Systematic review and meta-analysis. Consideration was given to within participant, between participant, retrospective, and prospective study designs. DATA SOURCES MEDLINE, EMBASE, CINAHL, and SPORTDiscus. RESULTS Fifty-three studies were included. Limited evidence indicated that NRFS running is retrospectively associated with lower reported rates of mild (standard mean difference (SMD), 95% CI 3.25, 2.37-4.12), moderate (3.65, 2.71-4.59) and severe (0.93, 0.32-1.55) repetitive stress injury. Studies prospectively comparing injury risk between strike patterns are lacking. Limited evidence indicated that running economy did not differ between habitual RFS and habitual NRFS runners at slow (10.8-11.0 km/h), moderate (12.6-13.5 km/h), and fast (14.0-15.0 km/h) speeds, and was reduced in the immediate term when an NRFS-running pattern was imposed on habitual RFS runners at slow (10.8 km/h; SMD = - 1.67, - 2.82 to - 0.52) and moderate (12.6 km/h; - 1.26, - 2.42 to - 0.10) speeds. Key biomechanical findings, consistently including both comparison between habitual strike patterns and following immediate transition from RFS to NRFS running, indicated that NRFS running was associated with lower average and peak vertical loading rate (limited-moderate evidence; SMDs = 0.72-2.15); lower knee flexion range of motion (moderate-strong evidence; SMDs = 0.76-0.88); reduced patellofemoral joint stress (limited evidence; SMDs = 0.63-0.68); and greater peak internal ankle plantar flexor moment (limited evidence; SMDs = 0.73-1.33). CONCLUSION The relationship between strike pattern and injury risk could not be determined, as current evidence is limited to retrospective findings. Considering the lack of evidence to support any improvements in running economy, combined with the associated shift in loading profile (i.e., greater ankle and plantarflexor loading) found in this review, changing strike pattern cannot be recommended for an uninjured RFS runner. PROSPERO REGISTRATION CRD42015024523.
Collapse
|
11
|
Bontemps B, Vercruyssen F, Gruet M, Louis J. Downhill Running: What Are The Effects and How Can We Adapt? A Narrative Review. Sports Med 2020; 50:2083-2110. [PMID: 33037592 PMCID: PMC7674385 DOI: 10.1007/s40279-020-01355-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Downhill running (DR) is a whole-body exercise model that is used to investigate the physiological consequences of eccentric muscle actions and/or exercise-induced muscle damage (EIMD). In a sporting context, DR sections can be part of running disciplines (off-road and road running) and can accentuate EIMD, leading to a reduction in performance. The purpose of this narrative review is to: (1) better inform on the acute and delayed physiological effects of DR; (2) identify and discuss, using a comprehensive approach, the DR characteristics that affect the physiological responses to DR and their potential interactions; (3) provide the current state of evidence on preventive and in-situ strategies to better adapt to DR. Key findings of this review show that DR may have an impact on exercise performance by altering muscle structure and function due to EIMD. In the majority of studies, EIMD are assessed through isometric maximal voluntary contraction, blood creatine kinase and delayed onset muscle soreness, with DR characteristics (slope, exercise duration, and running speed) acting as the main influencing factors. In previous studies, the median (25th percentile, Q1; 75th percentile, Q3) slope, exercise duration, and running speed were - 12% (- 15%; - 10%), 40 min (30 min; 45 min) and 11.3 km h-1 (9.8 km h-1; 12.9 km h-1), respectively. Regardless of DR characteristics, people the least accustomed to DR generally experienced the most EIMD. There is growing evidence to suggest that preventive strategies that consist of prior exposure to DR are the most effective to better tolerate DR. The effectiveness of in-situ strategies such as lower limb compression garments and specific footwear remains to be confirmed. Our review finally highlights important discrepancies between studies in the assessment of EIMD, DR protocols and populations, which prevent drawing firm conclusions on factors that most influence the response to DR, and adaptive strategies to DR.
Collapse
Affiliation(s)
- Bastien Bontemps
- Université de Toulon, Laboratoire IAPS, Toulon, France
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | | | - Mathieu Gruet
- Université de Toulon, Laboratoire IAPS, Toulon, France
| | - Julien Louis
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, L3 3AF, UK.
| |
Collapse
|
12
|
Miller EM, Crowell MS, Morris JB, Mason JS, Zifchock R, Goss DL. Gait Retraining Improves Running Impact Loading and Function in Previously Injured U.S. Military Cadets: A Pilot Study. Mil Med 2020; 186:e1077-e1087. [PMID: 33215669 DOI: 10.1093/milmed/usaa383] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/16/2020] [Accepted: 09/16/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Running-related musculoskeletal injury (RRI) among U.S. military service members continues to negatively impact force readiness. There is a paucity of evidence supporting the use of RRI interventions, such as gait retraining, in military populations. Gait retraining has demonstrated effectiveness in altering running biomechanics and reducing running load. The purpose of this pilot study was to investigate the clinical effect of a gait retraining intervention on a military cadet population recovering from a lower-extremity RRI. MATERIALS AND METHODS The study design is a pilot study. Before study initiation, institutional approval was granted by the Keller Army Community Hospital Office of Human Research Protections. Nine rearfoot strike (RFS) runners recovering from a lower-extremity RRI at the U.S. Military Academy were prospectively enrolled and completed a gait retraining intervention. Participants followed-up with their assigned medical provider 6 times over 10 weeks for a clinical evaluation and running gait retraining. Gait retraining was provided utilizing verbal, visual, and audio feedback to facilitate a change in running foot strike pattern from RFS to non-rearfoot strike (NRFS) and increase preferred running step rate. At pre-intervention and post-intervention running ground reaction forces (GRF) [average vertical loading rate (AVLR), peak vertical GRF], kinematic (foot strike pattern) and temporospatial (step rate, contact time) data were collected. Participants self-reported their level of function via the Single Assessment Numeric Evaluation, Patient-Specific Functional Scale, and total weekly running minutes. Paired samples t-tests and Wilcoxon signed rank tests were used to compare pre- and post-intervention measures of interest. Values of P < .05 were considered statistically significant. RESULTS Nine patients completed the 10-week intervention (age, 20.3 ± 2.2 years; height, 170.7 ± 13.8 cm; mass, 71.7 ± 14.9 kg; duration of injury symptoms, 192.4 ± 345.5 days; running speed, 2.8 ± 0.38 m/s). All nine runners (100%) transitioned from RFS to NRFS. Left AVLR significantly decreased from 60.3 ± 17.0 bodyweight per second (BW/s) before intervention to 25.9 ± 9.1 BW/s after intervention (P = 0.008; effect size (d) = 2.5). Right AVLR significantly decreased from 60.5 ± 15.7 BW/s to 32.3 ± 12.5 BW/s (P < .001; d = 2.0). Similarly, step rate increased from 169.9 ± 10.0 steps per minute (steps/min) before intervention to 180.5 ± 6.5 steps/min following intervention (P = .005; d = 1.3). Single Assessment Numeric Evaluation scores improved significantly from 75 ± 23 to 100 ± 8 (P = .008; d = 1.5) and Patient-Specific Functional Scale values significantly improved from 6 ± 2.3 to 9.5 ± 1.6 (P = .007; d = 1.8) after intervention. Peak vertical GRF (left, P = .127, d = 0.42; right, P = .052, d = 0.53), contact time (left, P = 0.127, d = 0.42; right, P = 0.052, d = 0.53), and total weekly continuous running minutes (P = 0.095, d = 0.80) remained unchanged at post-intervention. All 9 patients remained injury free upon a 6-month medical record review. CONCLUSIONS In 9 military service members with a RRI, a 10-week NRFS gait retraining intervention was effective in improving running mechanics and measures of function. Patients remained injury-free 6 months following enrollment. The outcomes of this pilot study suggest that individuals recovering from certain lower-extremity RRIs may benefit from transitioning to an NRFS running pattern.
Collapse
Affiliation(s)
- Erin M Miller
- Keller Army Community Hospital Division I Sports Physical Therapy Fellowship, Keller Army Community Hospital, West Point, NY 10996, USA
| | - Michael S Crowell
- Keller Army Community Hospital Division I Sports Physical Therapy Fellowship, Keller Army Community Hospital, West Point, NY 10996, USA
| | - Jamie B Morris
- Army-Baylor Doctorate of Physical Therapy Program, United States Army Medical Center of Excellence,Fort Sam Houston, TX 78234, USA
| | - John S Mason
- Keller Army Community Hospital Division I Sports Physical Therapy Fellowship, Keller Army Community Hospital, West Point, NY 10996, USA
| | - Rebeca Zifchock
- Department of Civil and Mechanical Engineering, United States Military Academy, West Point, NY 10996, USA
| | - Donald L Goss
- Department of Physical Therapy, One University Parkway, High Point University, High Point, NC 27268, USA
| |
Collapse
|
13
|
Xu Y, Yuan P, Wang R, Wang D, Liu J, Zhou H. Effects of Foot Strike Techniques on Running Biomechanics: A Systematic Review and Meta-analysis. Sports Health 2020; 13:71-77. [PMID: 32813597 DOI: 10.1177/1941738120934715] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
CONTENT Distance running is one of the most popular physical activities, and running-related injuries (RRIs) are also common. Foot strike patterns have been suggested to affect biomechanical variables related to RRI risks. OBJECTIVE To determine the effects of foot strike techniques on running biomechanics. DATA SOURCES The databases of Web of Science, PubMed, EMBASE, and EBSCO were searched from database inception through November 2018. STUDY SELECTION The initial electronic search found 723 studies. Of these, 26 studies with a total of 472 participants were eligible for inclusion in this meta-analysis. STUDY DESIGN Systematic review and meta-analysis. LEVEL OF EVIDENCE Level 4. DATA EXTRACTION Means, standard deviations, and sample sizes were extracted from the eligible studies, and the standard mean differences (SMDs) were obtained for biomechanical variables between forefoot strike (FFS) and rearfoot strike (RFS) groups using a random-effects model. RESULTS FFS showed significantly smaller magnitude (SMD, -1.84; 95% CI, -2.29 to -1.38; P < 0.001) and loading rate (mean: SMD, -2.1; 95% CI, -3.18 to -1.01; P < 0.001; peak: SMD, -1.77; 95% CI, -2.21 to -1.33; P < 0.001) of impact force, ankle stiffness (SMD, -1.69; 95% CI, -2.46 to -0.92; P < 0.001), knee extension moment (SMD, -0.64; 95% CI, -0.98 to -0.3; P < 0.001), knee eccentric power (SMD, -2.03; 95% CI, -2.51 to -1.54; P < 0.001), knee negative work (SMD, -1.56; 95% CI, -2.11 to -1.00; P < 0.001), and patellofemoral joint stress (peak: SMD, -0.71; 95% CI, -1.28 to -0.14; P = 0.01; integral: SMD, -0.63; 95% CI, -1.11 to -0.15; P = 0.01) compared with RFS. However, FFS significantly increased ankle plantarflexion moment (SMD, 1.31; 95% CI, 0.66 to 1.96; P < 0.001), eccentric power (SMD, 1.63; 95% CI, 1.18 to 2.08;P < 0.001), negative work (SMD, 2.60; 95% CI, 1.02 to 4.18; P = 0.001), and axial contact force (SMD, 1.26; 95% CI, 0.93 to 1.6; P < 0.001) compared with RFS. CONCLUSION Running with RFS imposed higher biomechanical loads on overall ground impact and knee and patellofemoral joints, whereas FFS imposed higher biomechanical loads on the ankle joint and Achilles tendon. The modification of strike techniques may affect the specific biomechanical loads experienced on relevant structures or tissues during running.
Collapse
Affiliation(s)
- Yilin Xu
- Sports Biomechanics Laboratory, Jiangsu Research Institute of Sports Science, Nanjing, Jiangsu, China
| | - Peng Yuan
- Sports Biomechanics Laboratory, Jiangsu Research Institute of Sports Science, Nanjing, Jiangsu, China
| | - Ran Wang
- School of Physical Education and Sport Training, Shanghai University of Sport, Shanghai, China
| | - Dan Wang
- School of Physical Education and Sport Training, Shanghai University of Sport, Shanghai, China
| | - Jia Liu
- Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - Hui Zhou
- School of Automation, Nanjing University of Science and Technology, Nanjing, Jiangsu, China
| |
Collapse
|
14
|
Zeitoune G, Leporace G, Batista LA, Metsavaht L, Lucareli PRG, Nadal J. Do hip strength, flexibility and running biomechanics predict dynamic valgus in female recreational runners? Gait Posture 2020; 79:217-223. [PMID: 32442897 DOI: 10.1016/j.gaitpost.2020.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 04/22/2020] [Accepted: 05/05/2020] [Indexed: 02/02/2023]
Abstract
BACKGOUND Dynamic valgus has been the focus of many studies to identify its association to an increased risk of running-related injuries. However, it is not known which physical and biomechanical variables are associated with this movement dysfunction. RESEARCH QUESTION This study aimed to test the correlation between strength, flexibility and biomechanical variables and dynamic valgus in female runners. METHODS Twenty-nine healthy females ran on a treadmill at 2.92 m/s and performed strength, range of motion and endurance tests. Pelvic, hip and ankle kinematics were measured with a 3D motion analysis system. Six multiple linear regression models were used to identify the ability of physical and biomechanical variables to predict excursion and peak of contralateral pelvic drop, hip adduction and internal rotation. RESULTS Contralateral pelvic drop and hip adduction were positively correlated to ankle eversion and step cadence. Hip internal rotation had a negative correlation with ankle eversion. Despite significance, predictor variables explained less than 30% of dynamic valgus variance during running. No interest variable had significant correlation with the hip strength and hip and ankle passive range of motion. SIGNIFICANCE The results showed that distal joint kinematics and spatiotemporal variables should be considered during biomechanical running analysis to identify their possible relationship with joint overload caused by dynamic valgus. Caution should be taken when linking hip disorders during running to posterolateral hip strength and stiffness, core endurance, and ankle dorsiflexion range of motion since no correlation occurred amongstthese variables in this sample of female runners.
Collapse
Affiliation(s)
- Gabriel Zeitoune
- Instituto Brasil de Tecnologias da Saúde, Rua Visconde de Pirajá 595, room 1201, Ipanema, 22410-003, Rio de Janeiro, Brazil; Programa de Engenharia Biomédica, Universidade Federal do Rio de Janeiro, Brazil
| | - Gustavo Leporace
- Instituto Brasil de Tecnologias da Saúde, Rua Visconde de Pirajá 595, room 1201, Ipanema, 22410-003, Rio de Janeiro, Brazil; Programa de Pós Graduação em Radiologia Clínica, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
| | - Luiz Alberto Batista
- Laboratório de Biomecânica e Comportamento Motor, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leonardo Metsavaht
- Instituto Brasil de Tecnologias da Saúde, Rua Visconde de Pirajá 595, room 1201, Ipanema, 22410-003, Rio de Janeiro, Brazil; Programa de Pós Graduação em Radiologia Clínica, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Jurandir Nadal
- Programa de Engenharia Biomédica, Universidade Federal do Rio de Janeiro, Brazil
| |
Collapse
|
15
|
Kilgore JE, Vincent KR, Vincent HK. Correcting Foot Crossover While Running. Curr Sports Med Rep 2020; 19:4-5. [PMID: 31913915 DOI: 10.1249/jsr.0000000000000670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Jack E Kilgore
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL
| | | | | |
Collapse
|
16
|
Brindle RA, Taylor JB, Rajek C, Weisbrod A, Ford KR. Association Between Temporal Spatial Parameters and Overuse Injury History in Runners: A Systematic Review and Meta-analysis. Sports Med 2019; 50:331-342. [PMID: 31643019 DOI: 10.1007/s40279-019-01207-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Temporal spatial parameters during running are measurable outside of clinical and laboratory environments using wearable technology. Data from wearable technology may be useful for injury prevention, however the association of temporal spatial parameters with overuse injury in runners remains unclear. OBJECTIVE To identify the association between overuse injury and temporal spatial parameters during running. DATA SOURCES Electronic databases were searched using keywords related to temporal spatial parameters, running, and overuse injury, and authors' personal article collections through hand search. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Articles included in this systematic review contained original data, and analytically compared at least one temporal spatial parameter (e.g. cadence) between uninjured and retrospectively or prospectively injured groups of runners. Articles were excluded from this review if they did not meet these criteria or measured temporal spatial parameters via survey. STUDY APPRAISAL AND SYNTHESIS METHOD The internal validity of each article was assessed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Meta-analyses were conducted for temporal spatial parameters if data existed from at least three separate cohorts of the same prospective or retrospective design. Data were pooled and analyzed using an inverse variance fixed-effect model. RESULTS Thirteen articles which tested a total of 24 temporal spatial parameters during running were included in the review. Meta-analyses were conducted on four temporal spatial parameters using data from eleven retrospective studies. Healthy runners and those with a history of overuse injury had a similar average stride time (mean difference: 0.00 s, 95% CI - 0.01 to 0.01 s), contact time (mean difference: 0.00 s, 95% CI 0.00 to 0.01 s), cadence (mean difference: 0.3 steps per minute (spm), 95% CI - 1.8 to 2.5 spm), and stride length (mean difference 0.00 m, 95% CI - 0.05 to 0.05 m) during running. LIMITATIONS Data pooled for meta-analyses were limited to retrospective design studies. Studies included in the systematic review had low methodological consistency. CONCLUSION Based on pooled results from multiple studies, stride time, contact time, cadence, and stride length averages are not distinguishable between runners either with or without a history of overuse injury. More prospective studies are required to determine the association of temporal spatial parameters with overuse injury development in runners. SYSTEMATIC REVIEW REGISTRATION REGISTRY AND NUMBER CRD42018112290.
Collapse
Affiliation(s)
- Richard A Brindle
- Department of Physical Therapy, High Point University, High Point, North Carolina, USA.
| | - Jeffrey B Taylor
- Department of Physical Therapy, High Point University, High Point, North Carolina, USA
| | - Coty Rajek
- Department of Physical Therapy, High Point University, High Point, North Carolina, USA
| | - Anika Weisbrod
- Department of Exercise Science, High Point University, High Point, North Carolina, USA
| | - Kevin R Ford
- Department of Physical Therapy, High Point University, High Point, North Carolina, USA
| |
Collapse
|
17
|
Helton GL, Cameron KL, Zifchock RA, Miller E, Goss DL, Song J, Neary MT. Association Between Running Shoe Characteristics and Lower Extremity Injuries in United States Military Academy Cadets. Am J Sports Med 2019; 47:2853-2862. [PMID: 31498686 DOI: 10.1177/0363546519870534] [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: 01/31/2023]
Abstract
BACKGROUND Running-related overuse injuries are very common among recreational runners, with the reported annual injury rates ranging from 39% to 85%. Relatively few large prospective cohort studies have been conducted to investigate injury risk associated with different running shoe characteristics, and the results of the existing studies are often contradictory. PURPOSE/HYPOTHESIS The purpose was to investigate the relationship between running shoe characteristics and lower extremity musculoskeletal injury. It was hypothesized that the risk of injury would be increased in individuals wearing shoes with minimal torsional stiffness and heel height compared with those wearing shoes with greater levels of torsional stiffness and heel height. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS The study included 1025 incoming cadets. Shoe torsional stiffness and heel height were calculated and recorded. Demographic data were recorded and analyzed as potential covariates. Lower extremity injuries sustained over 9 weeks during cadet basic training were documented by use of the Armed Forces Health Longitudinal Technology Application and the Cadet Illness and Injury Tracking System. Kaplan-Meier survival curves were estimated, with time to incident lower extremity injury as the primary outcome by level of the independent predictor variables. Risk factors or potential covariates were carried forward into multivariable Cox proportional hazards regression models. Absolute and relative risk reduction and numbers needed to treat were calculated. RESULTS Approximately 18.1% of participants incurred a lower extremity injury. Cadets wearing shoes with moderate lateral torsional stiffness were 49% less likely to incur any type of lower extremity injury and 52% less likely to incur an overuse lower extremity injury than cadets wearing shoes with minimal lateral torsional stiffness, both of which were statistically significant observations. Injury risk was similar among cadets wearing shoes with minimal and extreme lateral torsional stiffness. CONCLUSION Shoes with mild to moderate lateral torsional stiffness may be appropriate in reducing risk of lower extremity injury in cadets. Shoes with minimal lateral torsional stiffness should be discouraged in this population.
Collapse
Affiliation(s)
- Gary L Helton
- Baylor University-Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, West Point, New York, USA
| | - Kenneth L Cameron
- Baylor University-Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, West Point, New York, USA
| | - Rebecca A Zifchock
- Department of Civil and Mechanical Engineering, United States Military Academy, West Point, New York, USA
| | - Erin Miller
- Baylor University-Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, West Point, New York, USA
| | - Donald L Goss
- Baylor University-Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, West Point, New York, USA
| | - Jinsup Song
- Temple University School of Podiatric Medicine, Philadelphia, Pennsylvania, USA
| | - Michael T Neary
- Providence Community Health Center, Providence, Rhode Island, USA
| |
Collapse
|
18
|
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.
Collapse
|
19
|
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]
|
20
|
Van Oeveren B, De Ruiter C, Hoozemans M, Beek P, Van Dieën J. Inter-individual differences in stride frequencies during running obtained from wearable data. J Sports Sci 2019; 37:1996-2006. [DOI: 10.1080/02640414.2019.1614137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- B.T. Van Oeveren
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - C.J. De Ruiter
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - M.J.M. Hoozemans
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - P.J. Beek
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - J.H. Van Dieën
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| |
Collapse
|
21
|
Yong JR, Silder A, Montgomery KL, Fredericson M, Delp SL. Acute changes in foot strike pattern and cadence affect running parameters associated with tibial stress fractures. J Biomech 2018; 76:1-7. [PMID: 29866518 PMCID: PMC6203338 DOI: 10.1016/j.jbiomech.2018.05.017] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 05/04/2018] [Accepted: 05/04/2018] [Indexed: 12/01/2022]
Abstract
Tibial stress fractures are a common and debilitating injury that occur in distance runners. Runners may be able to decrease tibial stress fracture risk by adopting a running pattern that reduces biomechanical parameters associated with a history of tibial stress fracture. The purpose of this study was to test the hypothesis that converting to a forefoot striking pattern or increasing cadence without focusing on changing foot strike type would reduce injury risk parameters in recreational runners. Running kinematics, ground reaction forces and tibial accelerations were recorded from seventeen healthy, habitual rearfoot striking runners while running in their natural running pattern and after two acute retraining conditions: (1) converting to forefoot striking without focusing on cadence and (2) increasing cadence without focusing on foot strike. We found that converting to forefoot striking decreased two risk factors for tibial stress fracture: average and peak loading rates. Increasing cadence decreased one risk factor: peak hip adduction angle. Our results demonstrate that acute adaptation to forefoot striking reduces different injury risk parameters than acute adaptation to increased cadence and suggest that both modifications may reduce the risk of tibial stress fractures.
Collapse
Affiliation(s)
- Jennifer R Yong
- Department of Mechanical Engineering, Stanford University, United States
| | - Amy Silder
- Department of Bioengineering, Stanford University, United States
| | | | | | - Scott L Delp
- Department of Mechanical Engineering, Stanford University, United States; Department of Bioengineering, Stanford University, United States; Department of Orthopaedic Surgery, Stanford University, United States.
| |
Collapse
|
22
|
Malisoux L, Delattre N, Urhausen A, Theisen D. Shoe cushioning, body mass and running biomechanics as risk factors for running injury: a study protocol for a randomised controlled trial. BMJ Open 2017; 7:e017379. [PMID: 28827268 PMCID: PMC5724138 DOI: 10.1136/bmjopen-2017-017379] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/04/2017] [Accepted: 07/04/2017] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Repetitive loading of the musculoskeletal system is suggested to be involved in the underlying mechanism of the majority of running-related injuries (RRIs). Accordingly, heavier runners are assumed to be at a higher risk of RRI. The cushioning system of modern running shoes is expected to protect runners again high impact forces, and therefore, RRI. However, the role of shoe cushioning in injury prevention remains unclear. The main aim of this study is to investigate the influence of shoe cushioning and body mass on RRI risk, while exploring simultaneously the association between running technique and RRI risk. METHODS AND ANALYSIS This double-blinded randomised controlled trial will involve about 800 healthy leisure-time runners. They will randomly receive one of two running shoe models that will differ in their cushioning properties (ie, stiffness) by ~35%. The participants will perform a running test on an instrumented treadmill at their preferred running speed at baseline. Then they will be followed up prospectively over a 6-month period, during which they will self-report all their sports activities as well as any injury in an internet-based database TIPPS (Training and Injury Prevention Platform for Sports). Cox regression analyses will be used to compare injury risk between the study groups and to investigate the association among training, biomechanical and anatomical risk factors, and injury risk. ETHICS AND DISSEMINATION The study was approved by the National Ethics Committee for Research (Ref: 201701/02 v1.1). Outcomes will be disseminated through publications in peer-reviewed journals, presentations at international conferences, as well as articles in popular magazines and on specialised websites. TRIAL REGISTRATION NUMBER NCT03115437, Pre-results.
Collapse
Affiliation(s)
- Laurent Malisoux
- Luxembourg Institute of Health, Sports Medicine Research Laboratory, Grand-Duchy of Luxembourg, Luxembourg
| | - Nicolas Delattre
- Decathlon Sports Lab, Movement Sciences Department, Villeneuve d’Ascq, France
| | - Axel Urhausen
- Luxembourg Institute of Health, Sports Medicine Research Laboratory, Grand-Duchy of Luxembourg, Luxembourg
- Sports Clinic, Centre Hospitalier de Luxembourg, Grand-Duchy of Luxembourg, Luxembourg
- International University of Health, Exercise and Sports (LUNEX), Grand-Duchy of Luxembourg, Luxembourg
| | - Daniel Theisen
- Luxembourg Institute of Health, Sports Medicine Research Laboratory, Grand-Duchy of Luxembourg, Luxembourg
| |
Collapse
|
23
|
Hamill J, Gruber AH. Is changing footstrike pattern beneficial to runners? JOURNAL OF SPORT AND HEALTH SCIENCE 2017; 6:146-153. [PMID: 30356626 PMCID: PMC6189005 DOI: 10.1016/j.jshs.2017.02.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 12/02/2016] [Accepted: 01/04/2017] [Indexed: 05/31/2023]
Abstract
Some researchers, running instructors, and coaches have suggested that the "optimal" footstrike pattern to improve performance and reduce running injuries is to land using a mid- or forefoot strike. Thus, it has been recommended that runners who use a rearfoot strike would benefit by changing their footstrike although there is little scientific evidence for suggesting such a change. The rearfoot strike is clearly more prevalent. The major reasons often given for changing to a mid- or forefoot strike are (1) it is more economical; (2) there is a reduction in the impact peak and loading rate of the vertical component of the ground reaction force; and (3) there is a reduction in the risk of a running-related injuries. In this paper, we critique these 3 suggestions and provide alternate explanations that may provide contradictory evidence for altering one's footstrike pattern. We have concluded, based on examining the research literature, that changing to a mid- or forefoot strike does not improve running economy, does not eliminate an impact at the foot-ground contact, and does not reduce the risk of running-related injuries.
Collapse
Affiliation(s)
- Joseph Hamill
- Biomechanics Laboratory, Department of Kinesiology, University of Massachusetts, Amherst, MA 01003, USA
| | - Allison H. Gruber
- Biomechanics Laboratory, Department of Kinesiology, Indiana University, Bloomington, IN 47405, USA
| |
Collapse
|
24
|
Bowersock CD, Willy RW, DeVita P, Willson JD. Independent effects of step length and foot strike pattern on tibiofemoral joint forces during running. J Sports Sci 2016; 35:2005-2013. [PMID: 27800702 DOI: 10.1080/02640414.2016.1249904] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to examine the effects of step length and foot strike pattern along with their interaction on tibiofemoral joint (TFJ) and medial compartment TFJ kinetics during running. Nineteen participants ran with a rear foot strike pattern at their preferred speed using a short (-10%), preferred, and long (+10%) step length. These step length conditions were then repeated using a forefoot strike pattern. Regardless of foot strike pattern, a 10% shorter step length resulted in decreased peak contact force, force impulse per step, force impulse per kilometre, and average loading rate at the TFJ and medial compartment, while a 10% increased step length had the opposite effects (all P < 0.05). A forefoot strike pattern significantly lowered TFJ and medial compartment TFJ average loading rates compared with a rear foot strike pattern (both <0.05) but did not change TFJ or medial compartment peak force, force impulse per step, or force impulse per km. The combination of a shorter step length and forefoot strike pattern produced the greatest reduction in peak medial compartment contact force (P < 0.05). Knowledge of these running modification effects may be relevant to the management or prevention of TFJ injury or pathology among runners.
Collapse
Affiliation(s)
- Collin D Bowersock
- a Department of Kinesiology , East Carolina University , Greenville , NC , USA
| | - Richard W Willy
- b Department of Physical Therapy , East Carolina University , Greenville , NC , USA
| | - Paul DeVita
- a Department of Kinesiology , East Carolina University , Greenville , NC , USA
| | - John D Willson
- b Department of Physical Therapy , East Carolina University , Greenville , NC , USA
| |
Collapse
|
25
|
Santuz A, Ekizos A, Arampatzis A. A Pressure Plate-Based Method for the Automatic Assessment of Foot Strike Patterns During Running. Ann Biomed Eng 2015; 44:1646-55. [DOI: 10.1007/s10439-015-1484-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 10/07/2015] [Indexed: 11/25/2022]
|