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Dillon S, Burke A, Whyte EF, O’Connor S, Gore S, Moran KA. Running towards injury? A prospective investigation of factors associated with running injuries. PLoS One 2023; 18:e0288814. [PMID: 37590281 PMCID: PMC10434952 DOI: 10.1371/journal.pone.0288814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 07/04/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Given the high incidence and heavy burden of running related injuries, large-scale, prospective multifactorial investigations examining potential risk factors are warranted. This study aimed to identify factors associated with running related injuries and to evaluate their potential in injury screening. STUDY DESIGN Prospective cohort study. MATERIALS AND METHODS Two hundred and seventy-four recreational runners were recruited. Clinical measures (strength, range of motion, foot position), injury and training history (via questionnaire), impact loading (via accelerometery) and running technique measures were collected at baseline. Runners were tracked for injury for one year via fortnightly check-ins. A binary logistic regression, (injury versus no injury), was performed for each variable univariably, and then adjusting for age, sex and mileage. A multivariable regression was also performed to evaluate the model's discriminative ability. RESULTS Of the 225 runners included in the final analysis 52% experienced a running related injury. Injury history in the past year, less navicular drop, and measures of running technique (knee, hip, and pelvis kinematics) were associated with increased odds of injury (p < .05). The multivariable logistic regression model was statistically significant, χ2(11) = 56.45, p < .001, correctly classifying 74% of cases with a sensitivity and specificity of 72% and 76%, respectively. The area under the receiver operating characteristic curve was 0.79 (CI95% = 0.73-0.85), demonstrating acceptable discriminative ability. CONCLUSIONS This study found a number of clinical and running technique factors to be associated with prospective running related injuries among recreational runners. With the exception of injury history, the factors identified as being significantly associated with injury may be modifiable and therefore, could form the basis of interventions. Range of motion, spatiotemporal parameters and strength measures were not associated with injury and thus their utilisation in injury prevention practices should be reconsidered.
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Affiliation(s)
- Sarah Dillon
- School of Allied Health, University of Limerick, Limerick, Ireland
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Insight SFI Research Centre for Data Analytics, Dublin City University, Dublin, Ireland
- Centre for Injury Prevention and Performance, Athletic Therapy and Training, Dublin City University, Dublin, Ireland
| | - Aoife Burke
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Insight SFI Research Centre for Data Analytics, Dublin City University, Dublin, Ireland
- Centre for Injury Prevention and Performance, Athletic Therapy and Training, Dublin City University, Dublin, Ireland
| | - Enda F. Whyte
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Centre for Injury Prevention and Performance, Athletic Therapy and Training, Dublin City University, Dublin, Ireland
| | - Siobhán O’Connor
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Centre for Injury Prevention and Performance, Athletic Therapy and Training, Dublin City University, Dublin, Ireland
| | - Shane Gore
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Insight SFI Research Centre for Data Analytics, Dublin City University, Dublin, Ireland
| | - Kieran A. Moran
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Insight SFI Research Centre for Data Analytics, Dublin City University, Dublin, Ireland
- Centre for Injury Prevention and Performance, Athletic Therapy and Training, Dublin City University, Dublin, Ireland
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Blyton SJ, Snodgrass SJ, Pizzari T, Birse SM, Likens AD, Edwards S. The impact of previous musculoskeletal injury on running gait variability: A systematic review. Gait Posture 2023; 101:124-133. [PMID: 36801698 DOI: 10.1016/j.gaitpost.2023.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 01/02/2023] [Accepted: 01/25/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Growing evidence suggests that identifying movement variability alterations in pathological vs. healthy gait may further understanding of injury mechanisms related to gait biomechanics; however, in the context of running and musculoskeletal injuries the role of movement variability remains unclear. RESEARCH QUESTION What is the impact of a previous musculoskeletal injury on running gait variability? METHODS Medline, CINAHL, Embase, Cochrane library and SPORTDiscus were searched from inception until February 2022. Eligibility criteria were (a) included a musculoskeletal injury group, (b) compared running biomechanics data to a control group, (c) measured movement variability for at least one dependent variable, (d) provided a statistical between-group comparison of variability outcomes. Exclusion criteria were neurological conditions impacting gait, upper body musculoskeletal injuries and age < 18 years old. A summative synthesis was performed instead of a meta-analysis due to methodological heterogeneity. RESULTS Seventeen case-control studies were included. The most common deviations in variability observed among the injured groups were: (1) high and low knee-ankle/foot coupling variability and (2) low trunk-pelvis coupling variability. Significant (p < 0.05) between-group differences in movement variability were identified in 8 of 11; 73% of studies of runners with injury-related symptoms, and 3 of 7; 43% of studies of recovered or asymptomatic populations. SIGNIFICANCE This review identified limited to strong evidence that running variability is altered in adults with a recent history of injury for specific joint couplings only. Individuals with ankle instability or pain employed altered running strategies more often than those who have recovered from injury. Altered variability strategies have been proposed to contribute to future running-related injuries, therefore these findings are relevant to clinicians managing active populations.
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Affiliation(s)
- Sarah J Blyton
- School of Environmental and Life Sciences, The University of Newcastle, Ourimbah, New South Wales, Australia.
| | - Suzanne J Snodgrass
- Discipline of Physiotherapy, The University of Newcastle, Callaghan, New South Wales, Australia.
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia.
| | - Samantha M Birse
- School of Environmental and Life Sciences, The University of Newcastle, Ourimbah, New South Wales, Australia.
| | - Aaron D Likens
- Department of Biomechanics and Center for Research in Human Movement Variability, The University of Nebraska, Omaha, United States.
| | - Suzi Edwards
- School of Health Sciences, The University of Sydney, Camperdown, New South Wales, Australia.
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Maqsood R, Khattab A, Bennett AN, Boos CJ. Association between non-acute Traumatic Injury (TI) and Heart Rate Variability (HRV) in adults: A systematic review and meta-analysis. PLoS One 2023; 18:e0280718. [PMID: 36689421 PMCID: PMC9870143 DOI: 10.1371/journal.pone.0280718] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/07/2023] [Indexed: 01/24/2023] Open
Abstract
Heart rate variability (HRV) is a non-invasive measure of autonomic function. The relationship between unselected long-term traumatic injury (TI) and HRV has not been investigated. This systematic review examines the impact of non-acute TI (>7 days post-injury) on standard HRV indices in adults. Four electronic databases (CINAHL, Medline, Scopus, and Web of Science) were searched. The quality of studies, risk of bias (RoB), and quality of evidence (QoE) were assessed using Axis, RoBANS and GRADE, respectively. Using the random-effects model, mean difference (MD) for root mean square of successive differences (RMSSD) and standard deviation of NN-intervals (SDNN), and standardized mean difference (SMD) for Low-frequency (LF): High-Frequency (HF) were pooled in RevMan guided by the heterogeneity score (I2). 2152 records were screened followed by full-text retrieval of 72 studies. 31 studies were assessed on the inclusion and exclusion criteria. Only four studies met the inclusion criteria. Three studies demonstrated a high RoB (mean RoBANS score 14.5±3.31) with a low QoE. TI was associated with a significantly higher resting heart rate. Meta-analysis of three cross-sectional studies demonstrated a statistically significant reduction in RMSSD (MD -8.45ms, 95%CI-12.78, -4.12, p<0.0001) and SDNN (MD -9.93ms, 95%CI-14.82, -5.03, p<0.0001) (low QoE) in participants with TI relative to the uninjured control. The pooled analysis of four studies showed a higher LF: HF ratio among injured versus uninjured (SMD 0.20, 95%CI 0.01-0.39, p<0.04) (very low QoE). Albeit low QoE, non-acute TI is associated with attenuated HRV indicating autonomic imbalance. The findings might explain greater cardiovascular risk following TI. Trial registration PROSPERO registration number: CRD: CRD42021298530.
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Affiliation(s)
- Rabeea Maqsood
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom
| | - Ahmed Khattab
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom
| | - Alexander N. Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, United Kingdom
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Christopher J. Boos
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom
- Department of Cardiology, University Hospital Dorset, NHS Trust, Poole, United Kingdom
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Development of a trail running injury screening instrument: A multiple methods approach. Phys Ther Sport 2022; 56:60-75. [DOI: 10.1016/j.ptsp.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 11/30/2022]
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Mohseni MM, Filmalter SE, Taylor WC, Vadeboncoeur TF, Thomas CS. Factors Associated With Half- and Full-Marathon Race-Related Injuries: A 3-Year Review. Clin J Sport Med 2021; 31:e277-e286. [PMID: 31855590 DOI: 10.1097/jsm.0000000000000775] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 06/19/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To better evaluate the relationships between training, demographics, and injury, this study sought to define race-related injury risk factors for half- and full-marathon runners. DESIGN This 3-year, observational cross-sectional study included adults who participated in a half or full marathon. Prerace and 2-week postrace surveys collected data on demographics, training factors, and injuries. SETTING This study took place during a nationally recognized marathon affiliated with a local hospital. PARTICIPANTS Runners were recruited during the Expo in the days before the race. Postrace surveys were returned by 1043 half marathoners and 624 full marathoners (response rate, 83%). INTERVENTIONS This was an observational study; independent variables included demographic data and race year. MAIN OUTCOME MEASURE The primary outcome was race-related injury that occurred during the race or within 2 weeks after the race. RESULTS Race-related injuries were reported by 24% of half marathoners and 30% of full marathoners. For half and full marathoners, respectively, significant factors for injuries were previous injury, lower peak weekly training mileage, and lower weekly mileage before race training. Factors significant for only half-marathon injuries were younger age, female sex, shorter distance of longest training run, and no formal training program. Factors significant for only full-marathon injuries were higher body mass index, fewer days running per week, and fewer years of running experience. CONCLUSIONS Previous running injuries, undertraining, and inexperience increased race-related injury risk; women had higher risk than men. Decreased risk of injury was associated with training loads of greater than 23 miles/week for half marathoners and 40 miles/week for full marathoners.
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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.
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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
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