Hip muscle loads during running at various step rates

Lower limb muscle activation during outdoor running: differences between sprinters, middle-distance and long-distance runners

Running is one of the most popular sport practices in the world. However, to our knowledge, none of the previous research about the characteristics of outdoor running makes a distinction between the different modalities of runners. Sixty-five healthy runners classified in sprinters, middle distance and long-distance runners performed five series of 100 metres on the synthetic outdoor track at competition pace. Muscle activity of lower limb muscles at initial contact and toe-off, involving the gluteus medius (GMED), gluteus maximus (GMAX), biceps femoris (BF), rectus femoris (RF), tiabilis anterior (TA) and medial gastrocnemius (MGAS), and spatiotemporal parameters were analysed. Sprinters showed high percentages of muscle activity at initial contact, in particular, the TA activity was the highest. The RF activity was significantly the lowest activity registered. At toe-off, sprinters showed the highest activity in all muscles analysed. Middle-distance runners had the highest activity of GMAX, BF and MGAS during the initial contact. In long-distance runners, the GMED and RF activity during the initial contact is highlighted, showing the highest activity of this phase. Different patterns of lower limb muscle activity and spatiotemporal parameters exist depending on the modality of the runner.

The biomechanics of running and running styles: a synthesis

Running movements are parametrised using a wide variety of devices. Misleading interpretations can be avoided if the interdependencies and redundancies between biomechanical parameters are taken into account. In this synthetic review, commonly measured running parameters are discussed in relation to each other, culminating in a concise, yet comprehensive description of the full spectrum of running styles. Since the goal of running movements is to transport the body centre of mass (BCoM), and the BCoM trajectory can be derived from spatiotemporal parameters, we anticipate that different running styles are reflected in those spatiotemporal parameters. To this end, this review focuses on spatiotemporal parameters and their relationships with speed, ground reaction force and whole-body kinematics. Based on this evaluation, we submit that the full spectrum of running styles can be described by only two parameters, namely the step frequency and the duty factor (the ratio of stance time and stride time) as assessed at a given speed. These key parameters led to the conceptualisation of a so-called Dual-axis framework. This framework allows categorisation of distinctive running styles (coined 'Stick', 'Bounce', 'Push', 'Hop', and 'Sit') and provides a practical overview to guide future measurement and interpretation of running biomechanics.

What is the Effect of Changing Running Step Rate on Injury, Performance and Biomechanics? A Systematic Review and Meta-analysis

Background

Running-related injuries are prevalent among distance runners. Changing step rate is a commonly used running retraining strategy in the management and prevention of running-related injuries.

Objective

The aims of this review were to synthesise the evidence relating to the effects of changing running step rate on injury, performance and biomechanics.

Design

Systematic review and meta-analysis.

Data Sources

MEDLINE, EMBASE, CINAHL, and SPORTDiscus.

Results

Thirty-seven studies were included that related to injury (n = 2), performance (n = 5), and biomechanics (n = 36). Regarding injury, very limited evidence indicated that increasing running step rate is associated with improvements in pain (4 weeks: standard mean difference (SMD), 95% CI 2.68, 1.52 to 3.83; 12 weeks: 3.62, 2.24 to 4.99) and function (4 weeks: 2.31, 3.39 to 1.24); 12 weeks: 3.42, 4.75 to 2.09) in recreational runners with patellofemoral pain. Regarding performance, very limited evidence indicated that increasing step rate increases perceived exertion ( − 0.49,  − 0.91 to − 0.07) and awkwardness (− 0.72, − 1.38 to − 0.06) and effort (− 0.69, − 1.34, − 0.03); and very limited evidence that an increase in preferred step rate is associated with increased metabolic energy consumption (− 0.84, − 1.57 to − 0.11). Regarding biomechanics, increasing running step rate was associated with strong evidence of reduced peak knee flexion angle (0.66, 0.40 to 0.92); moderate evidence of reduced step length (0.93, 0.49 to 1.37), peak hip adduction (0.40, 0.11 to 0.69), and peak knee extensor moment (0.50, 0.18 to 0.81); moderate evidence of reduced foot strike angle (0.62, 034 to 0.90); limited evidence of reduced braking impulse (0.64, 0.29 to 1.00), peak hip flexion (0.42, 0.10 to 0.75), and peak patellofemoral joint stress (0.56, 0.07 to 1.05); and limited evidence of reduced negative hip (0.55, 0.20 to 0.91) and knee work (0.84, 0.48 to 1.20). Decreasing running step rate was associated with moderate evidence of increased step length (− 0.76, − 1.31 to − 0.21); limited evidence of increased contact time (− 0.95, − 1.49 to − 0.40), braking impulse (− 0.73, − 1.08 to − 0.37), and negative knee work (− 0.88, − 1.25 to − 0.52); and limited evidence of reduced negative ankle work (0.38, 0.03 to 0.73) and negative hip work (0.49, 0.07 to 0.91).

Conclusion

In general, increasing running step rate results in a reduction (or no change), and reducing step rate results in an increase (or no change), to kinetic, kinematic, and loading rate variables at the ankle, knee and hip. At present there is insufficient evidence to conclusively determine the effects of altering running step rate on injury and performance. As most studies included in this review investigated the immediate effects of changing running step rate, the longer-term effects remain largely unknown.

Prospero Registration

CRD42020167657.

Healthy Running Habits for the Distance Runner: Clinical Utility of the American College of Sports Medicine Infographic

ABSTRACT

Healthy running form is characterized by motion that minimizes mechanical musculoskeletal injury risks and improves coactivation of muscles that can buffer impact loading and reduce stresses related to chronic musculoskeletal pain. The American College of Sports Medicine Consumer Outreach Committee recently launched an infographic that describes several healthy habits for the general distance runner. This review provides the supporting evidence, expected acute motion changes with use, and practical considerations for clinical use in patient cases. Healthy habits include: taking short, quick, and soft steps; abdominal bracing; elevating cadence; linearizing arm swing; controlling forward trunk lean, and; avoiding running through fatigue. Introduction of these habits can be done sequentially one at a time to build on form, or more than one over time. Adoption can be supported by various feedback forms and cueing. These habits are most successful against injury when coupled with regular dynamic strengthening of the kinetic chain, adequate recovery with training, and appropriate shoe wear.

Cadence in youth long-distance runners is predicted by leg length and running speed

BACKGROUND

Lower cadence has been previously associated with injury in long-distance runners. Variations in cadence may be related to experience, speed, and anthropometric variables. It is unknown what factors, if any, predict cadence in healthy youth long-distance runners.

RESEARCH QUESTION

Are demographic, anthropometric and/or biomechanical variables able to predict cadence in healthy youth long-distance runners.

METHODS

A cohort of 138 uninjured youth long-distance runners (M = 62, F = 76; Mean ± SD; age = 13.7 ± 2.7; mass = 47.9 ± 13.6 kg; height = 157.9 ± 14.5 cm; running volume = 19.2 ± 20.6 km/wk; running experience: males = 3.5 ± 2.1 yrs, females = 3.3 ± 2.0 yrs) were recruited for the study. Multiple linear regression (MLR) models were developed for total sample and for each sex independently that only included variables that were significantly correlated to self-selected cadence. A variance inflation factor (VIF) assessed multicollinearity of variables. If VIF≥ 5, variable(s) were removed and the MLR analysis was conducted again.

RESULTS

For all models, VIF was > 5 between speed and normalized stride length, therefore we removed normalized stride length from all models. Only leg length and speed were significantly correlated (p < .001) with cadence in the regression models for total sample (R² = 51.9 %) and females (R² = 48.2 %). The regression model for all participants was Cadence = -1.251 *Leg Length + 3.665 *Speed + 254.858. The regression model for females was Cadence = -1.190 *Leg Length + 3.705 *Speed + 249.688. For males, leg length, cadence, and running experience were significantly predictive (p < .001) of cadence in the model (R² = 54.7 %). The regression model for males was Cadence = -1.268 *Leg Length + 3.471 *Speed - 1.087 *Running Experience + 261.378.

SIGNIFICANCE

Approximately 50 % of the variance in cadence was explained by the individual's leg length and running speed. Shorter leg lengths and faster running speeds were associated with higher cadence. For males, fewer years of running experience was associated with a higher cadence.

Augmented Cooper test: Biomechanical contributions to endurance performance

Running mechanics are modifiable with training and adopting an economical running technique can improve running economy and hence performance. While field measurement of running economy is cumbersome, running mechanics can be assessed accurately and conveniently using wearable inertial measurement units (IMUs). In this work, we extended this wearables-based approach to the Cooper test, by assessing the relative contribution of running biomechanics to the endurance performance. Furthermore, we explored different methods of estimating the distance covered in the Cooper test using a wearable global navigation satellite system (GNSS) receiver. Thirty-three runners (18 highly trained and 15 recreational) performed an incremental laboratory treadmill test to measure their maximum aerobic speed (MAS) and speed at the second ventilatory threshold (sVT2). They completed a 12-minute Cooper running test with foot-worm IMUs and a chest-worn GNSS-IMU on a running track 1–2 weeks later. Using the GNSS receiver, an accurate estimation of the 12-minute distance was obtained (accuracy of 16.5 m and precision of 1.1%). Using this distance, we showed a reliable estimation [R² > 0.9, RMSE ϵ (0.07, 0.25) km/h] of the MAS and sVT2. Biomechanical metrics were extracted using validated algorithm and their association with endurance performance was estimated. Additionally, the high-/low-performance runners were compared using pairwise statistical testing. All performance variables, MAS, sVT2, and average speed during Cooper test, were predicted with an acceptable error (R² ≥ 0.65, RMSE ≤ 1.80 kmh⁻¹) using only the biomechanical metrics. The most relevant metrics were used to develop a biomechanical profile representing the running technique and its temporal evolution with acute fatigue, identifying different profiles for runners with highest and lowest endurance performance. This profile could potentially be used in standardized functional capacity measurements to improve personalization of training and rehabilitation programs.

The development of a HAMstring InjuRy (HAMIR) index to mitigate injury risk through innovative imaging, biomechanics, and data analytics: protocol for an observational cohort study

Background

The etiology of hamstring strain injury (HSI) in American football is multi-factorial and understanding these risk factors is paramount to developing predictive models and guiding prevention and rehabilitation strategies. Many player-games are lost due to the lack of a clear understanding of risk factors and the absence of effective methods to minimize re-injury. This paper describes the protocol that will be followed to develop the HAMstring InjuRy (HAMIR) index risk prediction models for HSI and re-injury based on morphological, architectural, biomechanical and clinical factors in National Collegiate Athletic Association Division I collegiate football players.

Methods

A 3-year, prospective study will be conducted involving collegiate football student-athletes at four institutions. Enrolled participants will complete preseason assessments of eccentric hamstring strength, on-field sprinting biomechanics and muscle–tendon volumes using magnetic-resonance imaging (MRI). Athletic trainers will monitor injuries and exposure for the duration of the study. Participants who sustain an HSI will undergo a clinical assessment at the time of injury along with MRI examinations. Following completion of structured rehabilitation and return to unrestricted sport participation, clinical assessments, MRI examinations and sprinting biomechanics will be repeated. Injury recurrence will be monitored through a 6-month follow-up period. HAMIR index prediction models for index HSI injury and re-injury will be constructed.

Discussion

The most appropriate strategies for reducing risk of HSI are likely multi-factorial and depend on risk factors unique to each athlete. This study will be the largest-of-its-kind (1200 player-years) to gather detailed information on index and recurrent HSI, and will be the first study to simultaneously investigate the effect of morphological, biomechanical and clinical variables on risk of HSI in collegiate football athletes. The quantitative HAMIR index will be formulated to identify an athlete’s propensity for HSI, and more importantly, identify targets for injury mitigation, thereby reducing the global burden of HSI in high-level American football players.

Trial Registration The trial is prospectively registered on ClinicalTrials.gov (NCT05343052; April 22, 2022).

Are Altered Kinematics in Runners With Patellofemoral Pain Sex Specific?

BACKGROUND

Altered kinematics have been frequently observed in runners with patellofemoral pain (PFP), and few studies have aimed to understand the influence of sex on kinematics of this population. The aim of this study was to investigate whether altered hip and knee kinematics in runners with PFP are sex specific.

HYPOTHESIS

Kinematics will be different between female and male runners with and without PFP.

STUDY DESIGN

Case-control study.

LEVEL OF EVIDENCE

Level 2.

METHODS

Eighty-four runners were divided into 4 groups: 42 runners with PFP (20 women, 22 men) and 42 asymptomatic runners (21 women, 21 men). Three-dimensional gait analyses of the hip in the frontal and transverse plane and the knee in the frontal plane were analyzed at self-selected running speed on a treadmill. One-way analysis of covariance was used to test for differences in kinematic variables between groups.

RESULTS

Women with PFP ran with a significantly greater peak hip adduction compared with men with PFP (mean difference [MD] = 4.45°; P = 0.00; effect size [ES] = 0.58) and male control subjects (MD = 4.2°; P = 0.01; ES = 0.54) and greater hip adduction range of motion (ROM) than men with PFP (MD = 3.44°; P = 0.01; ES = 0.49). No significant differences were identified between women with and without PFP. Female control subjects ran with greater peak hip adduction than men with PFP (MD = 5.46°; P < 0.01; ES = 0.58) and male control subjects (MD = 5.21°; P < 0.01; ES = 0.55); greater hip adduction ROM than men with PFP (MD = 4.02°; P = 0.00; ES = 0.52) and male control subjects (MD = 2.91°;P = 0.04; ES = 0.36); and greater peak knee abduction than men with PFP (MD = 3.35°; P = 0.02; ES = 0.44) and male control subjects (MD = 3.69°; P = 0.01; ES = 0.4).

CONCLUSION

Women have greater hip adduction than men regardless of the presence of PFP. There were no kinematics difference between women with and without PFP. Comparisons of hip internal rotation between all groups were nonsignificant.

CLINICAL RELEVANCE

Altered hip and knee kinematics does not appear to be sex specific in runners with PFP.

Running Injury Paradigms and Their Influence on Footwear Design Features and Runner Assessment Methods: A Focused Review to Advance Evidence-Based Practice for Running Medicine Clinicians

Many runners seek health professional advice regarding footwear recommendations to reduce injury risk. Unfortunately, many clinicians, as well as runners, have ideas about how to select running footwear that are not scientifically supported. This is likely because much of the research on running footwear has not been highly accessible outside of the technical footwear research circle. Therefore, the purpose of this narrative review is to update clinical readers on the state of the science for assessing runners and recommending running footwear that facilitate the goals of the runner. We begin with a review of basic footwear construction and the features thought to influence biomechanics relevant to the running medicine practitioner. Subsequently, we review the four main paradigms that have driven footwear design and recommendation with respect to injury risk reduction: Pronation Control, Impact Force Modification, Habitual Joint (Motion) Path, and Comfort Filter. We find that evidence in support of any paradigm is generally limited. In the absence of a clearly supported paradigm, we propose that in general clinicians should recommend footwear that is lightweight, comfortable, and has minimal pronation control technology. We further encourage clinicians to arm themselves with the basic understanding of the known effects of specific footwear features on biomechanics in order to better recommend footwear on a patient-by-patient basis.

Can a Modified Y-Balance Test Predict Running Overuse Injuries over the Course of a Division I Collegiate Cross-Country Season?

BACKGROUND

Collegiate distance runners often suffer from running overuse injuries (ROI). The Y-Balance Test (YBT) has the potential to predict ROI risk in collegiate runners.

PURPOSE

To investigate whether a preseason clinical assessment of dynamic balance, through a modified version of the YBT (mYBT), can predict risk of ROIs during one NCAA Division I cross-country (XC) season.

STUDY DESIGN

Prospective case-control study.

METHODS

Participants from a Division I XC team were screened for mYBT performance in four directions: anterior (AN), posteromedial (PM), posterolateral (PL), and posterior (PO). ROIs were tracked over the course of the XC season. Receiver operating characteristic (ROC) curve analysis (α = 0.05) was utilized to investigate the effectiveness of the mYBT in predicting injury risk.

RESULTS

Nine (5 female, 4 male) of 29 runners developed an ROI during the XC season. Five components of the mYBT were found to predict injuries, including normalized nondominant PO score (AUC = 0.756, p = 0.03; RR = 1.90), AN raw difference and limb asymmetry (AUC = 0.808, p = 0.01), and PM raw difference and limb asymmetry in males (AUC = 0.958, p = 0.02).

CONCLUSION

Specific components of the mYBT can help predict the risk of developing a running overuse injury over one Division I XC season.

LEVEL OF EVIDENCE

Screening, Level 3.

A preliminary analysis of physical therapist agreement regarding the perceived impairments in cases of runners with knee pain

Background: There is a scarcity of evidence describing how physical therapists use data from clinical examinations to inform the treatment of runners with knee pain.Objective: Our purpose was to examine the between physical therapist agreement on the selection of perceived impairments in runners with knee pain.Methods: Twelve physical therapists reviewed two cases of runners with knee pain. The cases included clinical subjective information, objective data, and review of videos of each participant running. Each rater selected up to three perceived impairments (from a list of eight) that each physical therapist would address at the next physical therapy session. Percent agreement was calculated to determine the between rater agreement on each individual perceived impairment selection and Fleiss Kappa was calculated for each unique combination of three perceived impairments per case.Results: Twelve raters with 51 (18-156) months of clinical experience participated. Percent agreement ranged from 8%-100% for both cases for individual impairments. When assessing the unique combination of three impairments selected, inter-rater agreement was less than what is expected due to chance alone (κ = -0.09, p = .92; κ = -0.09, p = .98) for both cases.Conclusion: The 12 physical therapists demonstrated poor to excellent levels of agreement when selecting an individual perceived impairment. Agreement was worse than chance when selecting a combination of three unique impairments.

Increased Contact Time and Strength Deficits in Runners With Exercise-Related Lower Leg Pain

CONTEXT

Exercise-related lower leg pain (ERLLP) is common in runners.

OBJECTIVE

To compare biomechanical (kinematic, kinetic, and spatiotemporal) measures obtained from wearable sensors as well as lower extremity alignment, range of motion, and strength during running between runners with and those without ERLLP.

DESIGN

Case-control study.

SETTING

Field and laboratory.

PATIENTS OR OTHER PARTICIPANTS

Of 32 young adults who had been running regularly (>10 mi [16 km] per week) for ≥3 months, 16 had ERLLP for ≥2 weeks and 16 were healthy control participants.

MAIN OUTCOME MEASURE(S)

Both field and laboratory measures were collected at the initial visit. The laboratory measures consisted of alignment (arch height index, foot posture index, navicular drop, tibial torsion, Q-angle, and hip anteversion), range of motion (great toe, ankle, knee, and hip), and strength. Participants then completed a 1.67-mi (2.69-km) run along a predetermined route to calibrate the RunScribe devices. The RunScribe wearable sensors collected kinematic (pronation excursion and maximum pronation velocity), kinetic (impact g and braking g), and spatiotemporal (stride length, step length, contact time, stride pace, and flight ratio) measures. Participants then wore the sensors during at least 3 training runs in the next week.

RESULTS

The ERLLP group had a slower stride pace than the healthy group, which was accounted for as a covariate in subsequent analyses. The ERLLP group had a longer contact time during the stance phase of running (mean difference [MD] = 18.00 ± 8.27 milliseconds) and decreased stride length (MD = -0.11 ± 0.05 m) than the control group. For the clinical measures, the ERLLP group demonstrated increased range of motion for great-toe flexion (MD = 13.9 ± 4.6°) and ankle eversion (MD = 6.3 ± 2.7°) and decreased strength for ankle inversion (MD = -0.49 ± 0.23 N/kg), ankle eversion (MD = -0.57 ± 0.27 N/kg), and hip flexion (MD = -0.99 ± 0.39 N/kg).

CONCLUSIONS

The ERLLP group exhibited a longer contact time and decreased stride length during running as well as strength deficits at the ankle and hip. Gait retraining and lower extremity strengthening may be warranted as clinical interventions in runners with ERLLP.

Factors Associated With Self-Selected Step Rate in High School Cross Country Runners

ABSTRACT

Luedke, LE, Heiderscheit, BC, Williams, DSB, and Rauh, MJ. Factors associated with self-selected step rate in high school cross country runners. J Strength Cond Res 35(4): 1141-1148, 2021-Recommendations for step rate, or cadence, during distance running come from varying perspectives including performance, running economy, and injury risk. Studies of adult runners suggest that running experience and leg length may influence step rate, but limited evidence is available on factors that influence adolescent runner step rates. The purpose was to evaluate relationships between running experience, anthropometric factors, and lower extremity muscle strength with self-selected step rate in adolescent runners. Sixty-eight high school cross country runners (47 young women; age 16.2 ± 1.3 years) reported height, body mass, and running experience. Mean step rate was assessed at 3.3 m·s-1 and self-selected (mean 3.8 ± 0.5 m·s-1) speeds. Leg length and peak isometric strength of the hip abductors, knee extensors, and flexors were also measured. Step rates at 3.3 m·s-1 {r (95% confidence interval [CI]) = 0.44 [0.22, 0.61], p < 0.001} and self-selected (r [95% CI] = 0.45 [0.20, 0.66], p < 0.001) speeds were correlated with running experience. Step rates at 3.3 m·s-1 and self-selected speeds were inversely associated with body mass (r [95% CI] = -0.32 [-0.52, -0.09], p = 0.007 and r [95% CI] = -0.34 [-0.53, -0.11], p = 0.005, respectively), height (r [95% CI] = -0.40 [-0.58, -0.18], p = 0.01 and r [95% CI] = -0.32 [-0.52, -0.09], p = 0.008, respectively), and leg length (r [95% CI] = -0.48 [-0.64, -0.27], p < 0.001 and r [95% CI] = -0.35 [-0.52, -0.12], p = 0.004, respectively). No significant relationships were found between isometric strength values and step rate at either speed (p > 0.05). Adolescent runners with greater running experience displayed higher step rates. Hence, the lower step rates in runners with less experience may factor in the higher injury risk previously reported in novice runners. Runners with shorter leg length displayed higher step rates. Step rate recommendations should consider runner experience and anthropometrics.

Predicting Temporal Gait Kinematics: Anthropometric Characteristics and Global Running Pattern Matter

Equations predicting stride frequency (SF) and duty factor (DF) solely based on running speed have been proposed. However, for a given speed, kinematics vary depending on the global running pattern (GRP), i.e., the overall individual movement while running, which depends on the vertical oscillation of the head, antero-posterior motion of the elbows, vertical pelvis position at ground contact, antero-posterior foot position at ground contact, and strike pattern. Hence, we first verified the validity of the aforementioned equations while accounting for GRP. Kinematics during three 50-m runs on a track (n = 20) were used with curve fitting and linear mixed effects models. The percentage of explained variance was increased by ≥133% for DF when taking into account GRP. GRP was negatively related to DF (p = 0.004) but not to SF (p = 0.08), invalidating DF equation. Second, we assessed which parameters among anthropometric characteristics, sex, training volume, and GRP could relate to SF and DF in addition to speed, using kinematic data during five 30-s runs on a treadmill (n = 54). SF and DF linearly increased and quadratically decreased with speed (p < 0.001), respectively. However, on an individual level, SF was best described using a second-order polynomial equation. SF and DF showed a non-negligible percentage of variance explained by random effects (≥28%). Age and height were positively and negatively related to SF (p ≤ 0.05), respectively, while GRP was negatively related to DF (p < 0.001), making them key parameters to estimate SF and DF, respectively, in addition to speed.

Effects of Wearable Devices with Biofeedback on Biomechanical Performance of Running-A Systematic Review

This present review includes a systematic search for peer-reviewed articles published between March 2009 and March 2020 that evaluated the effects of wearable devices with biofeedback on the biomechanics of running. The included articles did not focus on physiological and metabolic metrics. Articles with patients, animals, orthoses, exoskeletons and virtual reality were not included. Following the PRISMA guidelines, 417 articles were first identified, and nineteen were selected following the removal of duplicates and articles which did not meet the inclusion criteria. Most reviewed articles reported a significant reduction in positive peak acceleration, which was found to be related to tibial stress fractures in running. Some previous studies provided biofeedback aiming to increase stride frequencies. They produced some positive effects on running, as they reduced vertical load in knee and ankle joints and vertical displacement of the body and increased knee flexion. Some other parameters, including contact ground time and speed, were fed back by wearable devices for running. Such devices reduced running time and increased swing phase time. This article reviews challenges in this area and suggests future studies can evaluate the long-term effects in running biomechanics produced by wearable devices with biofeedback.

Risk of intra-articular hip injury in adolescent athletes: a five-year multicentre cohort study

PURPOSE

The purpose of the current study was to establish a risk stratification for hip injury by presenting the classification of sports among adolescent athletes undergoing hip arthroscopy.

METHODS

A multicentre registry was queried to examine the incidence of adolescent athletes undergoing hip arthroscopy. Patients were identified and grouped according to their sport-specific risk classification (level I-III). Chi-square analysis was performed to determine the relationship of classification of sport and gender in adolescent athletes to hip arthroscopy. A second chi-square analysis was performed to determine the relationship of classification of sport and number of sports the adolescent athlete was participating in prior to arthroscopic hip surgery.

RESULTS

A total of 297 adolescent athletes were included in the study with 129 (43.4%) participating in level I sports compared with 84 (28.3%) in level II and 84(28.3%) in level III sports. Chi-square testing demonstrated a significant effect on gender and sport classification, X2 (2, N = 297) = 31.18, p < 0.01. There was a greater percentage of athletes participating in a single sport (65.3%) compared with multiple sports (34.6%), but was not statistically significant, X2 (1, N = 297) = 1.88, p = 0.17.

CONCLUSION

The current study was successful in stratifying a large, multicentre cohort of adolescent athletes requiring hip arthroscopy based on classification levels of sport. There were more male athletes participating in level I sports, while more female athletes participated in level II and level III sports.

A warm-up performed with proper-weight sandbags on the leg improves the speed and RPE performance of 100 m sprint in collegiate male sprinters

BACKGROUND

Muscle performance can be notably improved following a preloading maximal or near maximal stimulus due to the induction of postactivation potentiation, but the success of a preloading exercise in generating a postactivation potentiation response depends on the balance between fatigue and potentiation. However, the optimal warm-up strategy for sprint runners before a match may be not well established until now.

METHODS

Fifteen well-trained male sprint runners performed four different warm-up protocols: warm-up with 0% body mass; warm-up with 2% body mass; warm-up with 4% body mass; warm-up with 8% body mass. The weight-bearing sandbag was tied about 3~5 cm above each ankle joint. During the 100-meter test, the time and rating of perceived exertion (RPE) in the first 30 meters, time in the first 60 meters, and time in the 100 meters were recorded, respectively. Two-high-speed digital video cameras were separately set in the sagittal planes on the left side of a line drawn at a distance of 30 m and 60 m from the start line to record the sprint motion.

RESULTS

A warm-up performed with a sandbag weighted 4% of body mass could significantly improve the time and the RPE score of 100 m sprint by improving average velocity, stride frequency, average stride length, and average accelerated velocity during the sections of 0~30 m, 30~60 m and 60~100 m. This positive effect was better than that of 2% body-weigh effect. However, a warm-up performed with a sandbag weighted 8% of body mass had no significant influence on the performance of a 100 m sprint.

CONCLUSIONS

Current results indicated that a warm-up performed with proper-weight(4% body mass) sandbags on the leg was beneficial to the improvement of 100 m sprint performance, and the mechanism might be that it effectively activated the main muscles and neuromuscular regulation of running and produced a better postactivation potentiation.

Relationship among maximum hip isometric strength, hip kinematics, and peak gluteal muscle force during running

OBJECTIVE

To determine if there is a relationship among isometric hip strength, hip kinematics, and peak gluteal muscle forces in cross-country runners during running.

DESIGN

Cross Sectional.

SETTING

University Biomechanics Laboratory.

PARTICIPANTS

Forty-six NCAA Division III collegiate cross-country runners (18 males, 28 females).

MAIN OUTCOME MEASURES

Pearson correlation coefficients were used to describe relationships among isometric hip strength, hip kinematics, and peak gluteal muscle forces during the stance phase of running. Strength of correlations were interpreted as little to no relationship (r < 0.25), fair relationship (0.25 ≤ r < 0.5), moderate relationship (0.5 ≤ r < 0.75), and strong relationship (r ≥ 0.75). Correlations were considered significant if p < 0.05.

RESULTS

Little to no relationships were found among isometric hip strength and gluteal muscle forces during running (r < 0.25). A fair relationship was present between prone external rotation isometric hip strength and peak hip adduction (0.25 <r < 0.5). Little to no relationship was shown between gluteus medius force and hip internal rotation. Moderate relationships were present among peak gluteus medius and minimus muscle forces and peak hip adduction (0.5 <r < 0.75).

CONCLUSION

Isometric hip strength does not appear to be related to gluteal muscle forces and hip kinematics during the stance phase of running while gluteal muscle force was moderately related to hip adduction. Factors other than strength may be related to muscle force production and hip kinematics during running.

Do hip strength, flexibility and running biomechanics predict dynamic valgus in female recreational runners?

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.

IS STEP RATE ASSOCIATED WITH RUNNING INJURY INCIDENCE? AN OBSERVATIONAL STUDY WITH 9- MONTH FOLLOW UP

BACKGROUND

Several strategies have been proposed to reduce loading of the lower extremity while running including step rate manipulation. It is unclear however, whether step rate influences the incidence of lower extremity injuries.

PURPOSE

To examine the association between step rate and risk of injury in an adult recreational runner population.

STUDY DESIGN

Prospective Cohort.

METHODS

A total of 381 runners were prospectively followed for an average of nine months. Two-dimensional video was used to assess preferred step rate during a timed two-mile run or a 5K race. Injury surveillance to record sub-clinical injuries (those for which medical treatment was not sought) was performed via semi-monthly email surveys over the course of one year. Injury surveillance for clinical injuries (those for which medical treatment was sought) was performed via a full medical record review using the Armed Forces Health Longitudinal Technology Application. Clinical, sub-clinical and combined clinical and sub-clinical injury incidence were assessed in separate analyses. Injury was operationally defined as seven or more days of reduced activity due to pain. To assess the predictive validity of running step rate, the step rate of participants who did not develop a musculoskeletal injury during the observation period were compared with the running step rate of participants who did develop an injury during the observation period.

RESULTS

Out of 381 runners, 16 sustained a clinical overuse injury for which medical treatment was sought. Mean step rate for clinically un-injured runners was 172 steps/min and mean step rate for clinically injured runners was 173 steps/min which was not statistically significantly different (p = 0.77.) Out of 381 runners, 95 completed all four sub-clinical injury surveys (95/381 = 25%). Out of those 95 runners, 19 sustained a clinical (n=4) or sub-clinical injury (n=15). The step rate of sub-clinically injured and non-injured runners in this sub-sample was also not statistically significantly different (p = 0.08), with a mean of 174 steps/min for the uninjured group and a mean step rate of 170 steps/min for those in the sub-clinical injured group.

CONCLUSION

Preferred step rate was not associated with lower extremity injury rates in this sample of DoD runners. Additional research is needed to justify preferred step rate manipulation as a means to reduce lower extremity injury risk.

LEVEL OF EVIDENCE

Level 3.

How do Amateur Endurance Runners Alter Spatiotemporal Parameters and Step Variability as Running Velocity Increases? a Sex Comparison

This study aimed to analyse the effects of running velocity on spatiotemporal parameters and step variability in amateur endurance runners, according to sex. A group of 51 males and 46 females performed an incremental running test on a treadmill (10-16 km/h). Spatiotemporal parameters (contact and flight time, step length, step frequency and step angle [CT, FT, SL, SF, SA]) and step variability, in terms of within-participant standard deviation (SD), were recorded through the OptoGait System. The ANOVA showed significant differences in the magnitude of the spatiotemporal parameters as running velocity increased (p < 0.001). It also revealed significant differences in step variability (p < 0.005) over the entire running protocol. Between-sex differences in CT, SL, SL-normalized and SF (p < 0.05, ES = 0.4-0.8) were found. Differences were also found in step variability at high velocities (15-16 km/h), with males showing a greater SD than females. In conclusion, increasing running velocity makes CT shorter, FT and SL longer, and SF and SA greater in amateur endurance runners, changing step variability, regardless of sex. Additionally, some between-sex differences were found in spatiotemporal parameters and step variability.

Relationship between iliotibial band syndrome and hip neuromechanics in women runners

BACKGROUND

Atypical frontal plane hip kinematics are associated with iliotibial band syndrome in women runners. Gluteus medius is the primary muscle controlling the hip adduction angle during the loading response of stance. It is unclear if differences exist in gluteus medius activity magnitude and activity duration between runners with previous iliotibial band syndrome and controls. Furthermore, hip neuromechanics may change after a prolonged run.

RESEARCH QUESTION

Do differences exist in the hip adduction angle and gluteus medius activity between women with previous iliotibial band syndrome and controls at the beginning and end of a 30-minute moderate paced treadmill run?

METHODS

Thirty women participated (n = 15 controls). Lower extremity kinematics and gluteus medius activity were recorded at the start and end of a 30-minute treadmill run at participants' self-selected pace. Hip kinematics and gluteus medius activity were analyzed via separate two-way (group x time) mixed-model analysis of variance with time as the repeated measure.

RESULTS

Hip neuromechanics were similar at the start and end of a 30-minute treadmill run in women with previous iliotibial band syndrome and controls. However, hip adduction excursion was less in women with previous iliotibial band syndrome compared to controls. Average gluteus medius activity magnitude and activity duration were not significantly different between groups.

SIGNIFICANCE

These findings support the growing body of literature that smaller hip adduction motion is related to previous iliotibial band syndrome in women. Regardless of injury history, gluteus medius activity was similar between groups during the loading phase of stance.

Kinematics and muscle activity when running in partial minimalist, traditional, and maximalist shoes

While several studies have examined kinematic and kinetic differences between maximalist (MAX), traditional (TRAD), or partial minimalist (PMIN) shoes, to date it is unknown how MAX shoes influence muscle activity. This study compared lower extremity kinematics and muscle activity when running in PMIN, TRAD, and MAX shoes. Thirteen participants ran in each shoe while whole body kinematics were recorded using motion capture and electromyography was recorded from seven leg muscles. Differences in kinematics and root mean square amplitudes (RMS) were compared between shoe conditions. There were small differences in sagittal and frontal plane ankle kinematics between shoe conditions, with the MAX shoes resulting in less dorsiflexion at foot strike (p = .002) and less peak dorsiflexion (p < .001), and the PMIN shoes resulting in greater peak eversion (p = .012). Gluteus medius (p.006) and peroneus longus (p = .007) RMS amplitudes were greater in the MAX shoe then the TRAD or PMIN shoes while tibialis anterior RMS amplitudes were higher in the PMIN shoes (p = .005) than either the TRAD or MAX shoes. Consistent with previous findings, these results suggest there are small differences in kinematics when running in these three shoe types. This may partly be explained by the changes in muscle activity, which may be a response in order to maintain a preferred or habitual movement path. Implications for these difference in muscle activity in terms of fatigue or injury remain to be determined.

How Do Spatiotemporal Parameters and Lower-Body Stiffness Change with Increased Running Velocity? A Comparison Between Novice and Elite Level Runners

This study aimed to examine the effect of running velocity on spatiotemporal parameters and lower-body stiffness of endurance runners, and the influence of the performance level on those adaptations. Twenty-two male runners (novice [NR], n = 12, and elite runners [ER], n = 10) performed an incremental running test with a total of 5 different running velocities (10, 12, 14, 16, 18 km/h). Each condition lasted 1 min (30 s acclimatization period, and 30 s recording period). Spatiotemporal parameters were measured using the OptoGait system. Vertical (Kvert) and leg (Kleg) stiffness were calculated according to the sine-wave method. A repeated measures ANOVA (2 x 5, group x velocities) revealed significant adaptations (p < 0.05) to increased velocity in all spatiotemporal parameters and Kvert in both NR and ER. ER showed a greater flight time (FT) and step angle (at 18 km/h) (p < 0.05), longer step length (SL) and lower step frequency (SF) (p < 0.05), whereas no between-group differences were found in contact time (CT) nor in the sub-phases during CT at any speed (p ≥ 0.05). ER also showed lower Kvert values at every running velocity (p < 0.05), and no differences in Kleg (p ≥ 0.05). In conclusion, lower SF and Kvert and, thereby, longer FT and SL, seem to be the main spatiotemporal characteristics of high-level runners compared to their low-level counterparts.

Effects of medially wedged insoles on the biomechanics of the lower limbs of runners with excessive foot pronation and foot varus alignment

BACKGROUND

Excessive foot pronation during running in individuals with foot varus alignment may be reduced by medially wedged insoles.

RESEARCH QUESTION

This study investigated the effects of a medially wedged insole at the forefoot and at the rearfoot on the lower limbs angles and internal moments of runners with excessive foot pronation and foot varus alignment.

METHODS

Kinematic and kinetic data of 19 runners (11 females and 8 males) were collected while they ran wearing flat (control condition) and medially wedged insoles (insole condition). Both insoles had arch support. We used principal component analysis for data reduction and dependent t-test to compare differences between conditions.

RESULTS

The insole condition reduced ankle eversion (p = 0.003; effect size = 0.63); reduced knee range of motion in the transverse plane (p = 0.012; effect size = 0.55); increased knee range of motion in the frontal plane in early stance and had earlier knee adduction peak (p = 0.018; effect size = 0.52); reduced hip range of motion in the transverse plane (p = 0.031; effect size = 0.48); reduced hip adduction (p = 0.024; effect size = 0.50); reduced ankle inversion moment (p = 0.012; effect size = 0.55); and increased the difference between the knee internal rotation moment in early stance and midstance (p = 0.012; effect size = 0.55).

SIGNIFICANCE

Insoles with 7˚ medial wedges at the forefoot and rearfoot are able to modify motion and moments patterns that are related to lower limb injuries in runners with increased foot pronation and foot varus alignment with some non-desired effects on the knee motion in the frontal plane.

Years of running experience influences stride-to-stride fluctuations and adaptive response during step frequency perturbations in healthy distance runners

RESEARCH QUESTION

The current study investigated stride-to-stride fluctuations of step rate and contact time in response to enforced step frequency perturbations as well as adaptation and de-adaptation behavior.

METHODS

Forty distance runners ran at a self-selected speed and were asked to match five different enforced step frequencies (150, 160, 170, 180, and 190 beats per min). The influence of experience was explored, because running is a skill that presumably gets better with practice, and increased years of running experience is protective against injury. Detrended fluctuation analysis was used to determine the strength of long-range correlations in gait fluctuations at baseline, during the perturbation, and post-perturbation. Adaptive response was measured by the ability to match, rate of matching, and aftereffect of step frequency perturbations.

RESULTS

The structure of stride-to-stride fluctuations for step rate and contact time did not change during the perturbation or post-perturbation compared to baseline. However, fluctuations in step rate were affected by the level of perturbation. Runners with the most experience had a less persistent structural gait pattern for both step rate and contact time at baseline. Highly experienced runners also demonstrated the best adaptive response. They better matched the enforced step frequency, reached the enforced step frequency sooner, and returned to preferred step frequency more quickly following removal of the perturbation.

SIGNIFICANCE

These findings indicate baseline locomotor flexibility may be beneficial to achieve task demands and return to a stable state once the task is complete. Increased locomotor flexibility may also be a contributing factor for reduced injury risk in experienced runners.

Sex differences in gluteal muscle forces during running

Sex differences in common sports injuries to the lower extremity have been reported. Biomechanical factors of the hip have been investigated between sexes with regard to running-related injury. This study investigates gluteal muscle forces between sexes to aid in our understanding of sex-related biomechanical factors in running. Twenty-one healthy male and female runners were participants. Each ran at a controlled speed of 3.52-3.89 m/s down a 20-m runway. Kinetic and kinematic data were utilised to estimate muscle forces. Multivariate analysis of variance tests were utilised to detect differences in gluteal and hamstring muscle forces, hip and pelvic kinematics, and hip kinetic variables between sexes. Males produced greater peak gluteus maximus force, but lesser peak gluteus medius, minimus, and hamstring force than females during running. Males also demonstrated less hip adduction and greater hip flexion and anterior pelvic tilt than females. Finally, males produced lesser peak hip abduction and external rotation moments than females. Males and females demonstrate differences in gluteal muscle forces and hip kinetics and kinematics during running. Further understanding of underlying muscle forces may offer further insight into biomechanical differences in running between males and females.

Validity and reliability of evaluating hip abductor strength using different normalization methods in a functional electromechanical device

The hip abductor muscles are vitally important for pelvis stability, and common strength deficits can negatively affect functionality. The muscle strength can be measured using different dynamometers and be evaluated in three positions (side-lying, standing, and supine). Obtained strength data can be expressed in different ways, with data normalization providing more objective and comparable results. The aim of this study was to establish the validity and reliability of three protocols in evaluating the isometric strength of the hip abductor muscles. A new functional electromechanical dynamometer assessed strength in three positions, with findings subjected to three data normalization methods. In two identical sessions, the hip abductor strengths of 29 subjects were recorded in the side-lying, standing, and supine positions. Peak force was recorded in absolute terms and normalized against body mass, fat-free mass, and an allometric technique. The peak force recorded in the side-lying position was 30% and 27% higher than in the standing and supine positions, respectively, independent of data normalization methodology. High inter-protocol correlations were found (r: 0.72 to 0.98, p ≤ 0.001). The supine position with allometric data normalization had the highest test-retest reliability (0.94 intraclass correlation coefficient and 5.64% coefficient of variation). In contrast, the side-lying position with body mass data normalization had a 0.66 intraclass correlation coefficient and 9.8% coefficient of variation. In conclusion, the functional electromechanical dynamometer is a valid device for measuring isometric strength in the hip abductor muscles. The three assessed positions are reliable, although the supine position with allometric data normalization provided the best results.

Lack of Influence of Muscular Performance Parameters on Spatiotemporal Adaptations With Increased Running Velocity

Roche-Seruendo, LE, García-Pinillos, F, Haicaguerre, J, Bataller-Cervero, AV, Soto-Hermoso, VM, and Latorre-Román, PÁ. Lack of influence of muscular performance parameters on spatiotemporal adaptations with increased running velocity. J Strength Cond Res 32(2): 409-415, 2018-This study aimed to analyze the influence of muscular performance parameters on spatiotemporal gait characteristics during running when gradually increasing speed. Fifty-one recreationally trained male endurance runners (age, 28 ± 8 years) voluntarily participated in this study. Subjects performed a battery of jumping tests (squat jump, countermovement jump, and 20-cm drop jump), and after that, the subjects performed an incremental running test (10-20 km·h) on a motorized treadmill. Spatiotemporal parameters were measured using the OptoGait system. Cluster k-means analysis grouped subjects according to the jumping test performance, by obtaining a group of good jumpers (n = 19) and a group of bad jumpers (n = 32). With increased running velocity, contact time was shorter and flight time and step length were longer, whereas cadence and stride angle were greater (p < 0.001). No significant differences between groups (p ≥ 0.05) were found at any running speed. The results obtained indicate that increased running velocity produced no differences in spatiotemporal adaptations between those runners with good jumping ability and those with poor jumping ability. Based on that, it seems that muscular performance parameters do not play a key role in spatiotemporal adaptations experienced by recreational endurance runners with increased velocity. However, taken into consideration the well-known relationship between running performance and neuromuscular performance, the authors suggest that muscular performance parameters would be much more determinant in the presence of fatigue (exhausted condition) or in the case of considering other variables such as running economy or kinetic.

CLINICAL DECISION MAKING AND TREATMENT IN A RUNNER WITH HIP PAIN AND NEUROMUSCULAR CONTROL DYSFUNCTION: A CASE REPORT

BACKGROUND AND PURPOSE

The incidence of running related injuries remains high despite numerous efforts to understand the mechanical contributors to the etiology of these injuries. In light of continued running injury, theories of neuromuscular control, or movement patterns, have been suggested as possible contributors to running related injuries. However, the clinical decision making determining when altered neuromuscular control strategies may be affecting a runner's symptoms has not been described. Therefore, the purpose of this case report is to describe the clinical reasoning within the ICF framework for a runner with hip pain and neuromuscular control dysfunction.

CASE DESCRIPTION

A 47-year-old, experienced, female runner presented with posterior hip pain and radiating posterior thigh pain limiting her ability to participate in running and threatened her goal to run in an upcoming marathon. Several features of her examination indicated soft tissue muscular irritation of the posterior hip complex related to impaired balance and control of the lower quarter during functional movement and running activities consistent with a neuromuscular control dysfunction. Her initial Focus on Therapeutic Outcomes (FOTO) score was 69 with predicted change score of +7.

OUTCOMES

The subject was able to achieve her goals including a return to participation in her weekly running routine and competing in a marathon race. Objective examination features of range of motion, strength, and control of movement were all improved. Her reported function was greatly improved with a final FOTO score 98.

DISCUSSION

The diagnosis and treatment of running related injuries remains a clinical challenge. This case report describes the examination and clinical reasoning in diagnosing neuromuscular control dysfunction and proposes a treatment progression to address this functional limitation. The decision making scheme is also structured to follow the International Classification of Functioning, Disability, and Health.

LEVEL OF EVIDENCE

4.

Sex-Specific Relationships Between Hip Strength and Hip, Pelvis, and Trunk Kinematics in Healthy Runners

Weak hip muscle strength and excessive hip motion during running have been suggested as potential risk factors for developing patellofemoral pain syndrome (PFPS) in females, but not males. There is conflicting evidence on the relationship between hip strength and hip kinematics, which may be partly due to sex differences in the relationship between these parameters. Hip, pelvis, and trunk kinematics were collected while 60 healthy, habitual runners (23 females, 37 males) ran overground, and isometric hip abduction and external rotation strengths were measured bilaterally. Pearson correlation coefficients quantified sex-specific correlations between hip strength and kinematics, and unpaired t tests assessed sex differences in hip strength and kinematics. Hip abduction strength was moderately and inversely correlated to hip adduction excursion in females, and pelvic internal rotation excursion in males. Hip external rotation strength was moderately and inversely correlated to trunk flexion excursion in females. Finally, females displayed less hip external rotation strength and greater excursion at the hip and trunk during running compared to males. Despite the significant correlations, the relatively low r2 values suggest that additional factors outside of strength contribute to a substantial portion of the variance in trunk, pelvis, and hip kinematics.

Effects of different percentages of body weight support on spatiotemporal step characteristics during running

This study aimed to determine the effect of different percentages of body weight support (BWS) on spatiotemporal step characteristics during running. 26 endurance runners (age: 37 ± 9 years) completed a running treadmill protocol consisting of 6 different conditions (BWS combinations: 0-50%), with velocity maintained at 12 km/h. Each condition lasted 1 minute. Step angle, ground contact time (CT), flight time (FT), step length (SL) and frequency (SF), and duration of phases during stance time (phase1: initial contact; phase2: midstance; phase3: propulsion) were measured for every step during the test using a photoelectric cell system. Compared with the baseline condition (100% BW), FT was longer, CT was shorter, SL was longer, SF was lower, and the step angle was higher with each increase in BWS (p < 0.05). Also, some changes were observed in the duration of phases during stance time: phase1 did not experience changes across experimental conditions (p = 0.096), phase2 decreased and phase3 increased as BW was supported (p < 0.05). These results indicate that as BW was supported, runners showed longer FT and SL, shorter CT, lower SF, and greater step angle as well as some changes in the phases during the ground contact. Therefore, this study highlights the effect of different percentages of BWS on spatiotemporal parameters.

Changes in gluteal muscle forces with alteration of footstrike pattern during running

Gait retraining is a common form of treatment for running related injuries. Proximal factors at the hip have been postulated as having a role in the development of running related injuries. How altering footstrike affects hip muscles forces and kinematics has not been described. Thus, we aimed to quantify differences in hip muscle forces and hip kinematics that may occur when healthy runners are instructed to alter their foot strike pattern from their habitual rear-foot strike to a forefoot strike. This may gain insight on the potential etiology and treatment methods of running related lower extremity injury. Twenty-five healthy female runners completed a minimum of 10 running trials in a controlled laboratory setting under rear-foot strike and instructed forefoot strike conditions. Kinetic and kinematic data were used in an inverse dynamic based static optimization to estimate individual muscle forces during running. Within subject differences were investigated using a repeated measures multi-variate analysis of variance. Peak gluteus medius and minimus and hamstring forces were reduced while peak gluteus maximus force was increased when running with an instructed forefoot strike pattern. Peak hip adduction, hip internal rotation, and heel-COM distance were also reduced. Therefore, instructing habitual rearfoot strike runners to run with a forefoot strike pattern resulted in changes in peak gluteal and hamstring muscle forces and hip kinematics. These changes may be beneficial to the development and treatment of running related lower extremity injury.

A framework for the etiology of running-related injuries

The etiology of running-related injury is important to consider as the effectiveness of a given running-related injury prevention intervention is dependent on whether etiologic factors are readily modifiable and consistent with a biologically plausible causal mechanism. Therefore, the purpose of the present article was to present an evidence-informed conceptual framework outlining the multifactorial nature of running-related injury etiology. In the framework, four mutually exclusive parts are presented: (a) Structure-specific capacity when entering a running session; (b) structure-specific cumulative load per running session; (c) reduction in the structure-specific capacity during a running session; and (d) exceeding the structure-specific capacity. The framework can then be used to inform the design of future running-related injury prevention studies, including the formation of research questions and hypotheses, as well as the monitoring of participation-related and non-participation-related exposures. In addition, future research applications should focus on addressing how changes in one or more exposures influence the risk of running-related injury. This necessitates the investigation of how different factors affect the structure-specific load and/or the load capacity, and the dose-response relationship between running participation and injury risk. Ultimately, this direction allows researchers to move beyond traditional risk factor identification to produce research findings that are not only reliably reported in terms of the observed cause-effect association, but also translatable in practice.

Ischial Tuberosity Avulsion Stress Fracture after Short Period of Repetitive Training

Fatigue fracture of the pelvis is the form of fracture due to repetitive micro-stress accumulation, can be affected by a number of factors such as patient's nutritional status, biomechanics, social status and so on. Still there is no study about precise standard degree of external force that lead to stress fracture, but it may caused by compression force, traction force or complex force and others. Avulsion stress to ischial tuberosity or anterior superior iliac spine by attached muscle is known as the main factor for the avulsion fracture. This report will deal with 19 years old conscripted policeman who occurred ischial tuberosity avulsion fracture after training of 6-hour running for 5 days accompanying hip hyper-flexion motion. This reports aims to provide case study of stress fracture occurred after 5 days of exercise which is relatively short period who had no specific trauma history or pain.

Evaluation and Management of Hip and Pelvis Injuries

Injuries to the hip and pelvis among runners can be among the most challenging to treat. Advances in the understanding of running biomechanics as it pertains to the lumbopelvic and hip regions have improved the management of these conditions. Conservative management with an emphasis on activity modification and neuromuscular exercises should comprise the initial plan of care, with injection therapies used in a supportive manner.

THE EFFECT OF STEP RATE MANIPULATION ON FOOT STRIKE PATTERN OF LONG DISTANCE RUNNERS

PURPOSE/BACKGROUND

Running gait retraining to change foot strike pattern in runners from a heel strike pattern to a non heel- strike pattern has been shown to reduce impact forces and may help to reduce running related injuries. Step rate manipulation above preferred is known to help decrease step length, foot inclination angle, and vertical mass excursion, but has not yet been evaluated as a method to change foot strike pattern. The purpose of this study was to investigate the effect of step rate manipulation on foot strike pattern in shod recreational runners who run with a heel strike pattern. A secondary purpose was to describe the effect of step rate manipulation at specific percentages above preferred on foot inclination angle at initial contact.

METHODS

Forty volunteer runners, who were self-reported heel strikers and had a weekly running mileage of at least 10 miles, were recruited. Runners were confirmed to be heel strikers during the warm up period on the treadmill. The subject's step rate was determined at their preferred running pace. A metronome was used to increase step rate above the preferred step rate by 5%, 10% and 15%. 2D video motion analysis was utilized to determine foot strike pattern and to measure foot inclination angle at initial contact for each step rate condition.

RESULTS

There was a statistically significant change in foot strike pattern from a heel strike pattern to a mid-foot or forefoot strike pattern at both 10% and 15% step rates above preferred. Seven of the 40 subjects (17.5%) changed from a heel- strike pattern to a non- heel strike pattern at +10% and 12 of the 40 subjects (30%) changed to a non-heel strike pattern at +15%. Mean foot inclination angle at initial contact showed a statistically significant change (reduction) as step rate increased.

CONCLUSION

Step rate manipulation of 10% or greater may be enough to change foot strike pattern from a heel strike to a mid-foot or forefoot strike pattern in a small percentage of recreational runners who run in traditional running shoes. If changing the foot strike pattern is the main goal, other gait re-training methods may be needed to make a change from a heel strike to a non-heel strike pattern. Step rate manipulation shows a progressive reduction of foot inclination angle at 5%, 10%, and 15% above preferred step rate which reduces the severity of the heel strike at initial contact. Step rate manipulation of at least +10% above preferred may be an effective running gait retraining method for clinicians to decrease the severity of heel strike and possibly assist a runner to change to a non-heel strike pattern.

LEVEL OF EVIDENCE

3.

ASSOCIATION OF ISOMETRIC STRENGTH OF HIP AND KNEE MUSCLES WITH INJURY RISK IN HIGH SCHOOL CROSS COUNTRY RUNNERS

BACKGROUND

High school cross country runners have a high incidence of overuse injuries, particularly to the knee and shin. As lower extremity strength is modifiable, identification of strength attributes that contribute to anterior knee pain (AKP) and shin injuries may influence prevention and management of these injuries.

PURPOSE

To determine if a relationship existed between isometric hip abductor, knee extensor and flexor strength and the incidence of AKP and shin injury in high school cross country runners.

MATERIALS/METHODS

Sixty-eight high school cross country runners (47 girls, 21 boys) participated in the study. Isometric strength tests of hip abductors, knee extensors and flexors were performed with a handheld dynamometer. Runners were prospectively followed during the 2014 interscholastic cross country season for occurrences of AKP and shin injury. Bivariate logistic regression was used to examine risk relationships between strength values and occurrence of AKP and shin injury.

RESULTS

During the season, three (4.4%) runners experienced AKP and 13 (19.1%) runners incurred a shin injury. Runners in the tertiles indicating weakest hip abductor (chi-square = 6.140; p=0.046), knee extensor (chi-square = 6.562; p=0.038), and knee flexor (chi-square = 6.140; p=0.046) muscle strength had a significantly higher incidence of AKP. Hip and knee muscle strength was not significantly associated with shin injury.

CONCLUSIONS

High school cross country runners with weaker hip abductor, knee extensor and flexor muscle strength had a higher incidence of AKP. Increasing hip and knee muscle strength may reduce the likelihood of AKP in high school cross country runners.

LEVEL OF EVIDENCE

2b.

An Evidence-Based Videotaped Running Biomechanics Analysis

Running biomechanics play an important role in the development of injuries. Performing a running biomechanics analysis on injured runners can help to develop treatment strategies. This article provides a framework for a systematic video-based running biomechanics analysis plan based on the current evidence on running injuries, using 2-dimensional (2D) video and readily available tools. Fourteen measurements are proposed in this analysis plan from lateral and posterior video. Identifying simple 2D surrogates for 3D biomechanic variables of interest allows for widespread translation of best practices, and have the best opportunity to impact the highly prevalent problem of the injured runner.

Quadratus femoris: An EMG investigation during walking and running

Dysfunction of hip stabilizing muscles such as quadratus femoris (QF) is identified as a potential source of lower extremity injury during functional tasks like running. Despite these assumptions, there are currently no electromyography (EMG) data that establish the burst activity profile of QF during any functional task like walking or running. The objectives of this study were to characterize and compare the EMG activity profile of QF while walking and running (primary aim) and describe the direction specific action of QF (secondary aim). A bipolar fine-wire intramuscular electrode was inserted via ultrasound guidance into the QF of 10 healthy participants (4 females). Ensemble curves were generated from four walking and running trials, and normalized to maximum voluntary isometric contractions (MVICs). Paired t-tests compared the temporal and amplitude EMG variables. The relative activity of QF in the MVICs was calculated. The QF displayed moderate to high amplitude activity in the stance phase of walking and very high activity during stance in running. During swing, there was minimal QF activity recorded during walking and high amplitudes were present while running (run vs walk effect size=4.23, P<0.001). For the MVICs, external rotation and clam produced the greatest QF activity, with the hip in the anatomical position. This study provides an understanding of the activity demands placed on QF while walking and running. The high activity in late swing during running may signify a synergistic role with other posterior thigh muscles to control deceleration of the limb in preparation for stance.

Always on the run

With injury incidence ranging from 26% to 92%, runners are continually seeking the next great cure that will keep them injury free. And the information they receive is often conflicting: land on your heels, land on your toes; stretching makes you faster, stretching makes you slower; wear supportive shoes, do not wear shoes at all. As practitioners, we are often guilty of the same search for a common cause of all running injuries: foot pronation, impact forces, excessive hip motion, and so on. It is a confusing time for runners, as well as for those of us who treat them. By covering a diverse range of running topics, we hope this special running issue of JOSPT improves our understanding of what running is and takes us one step further toward having common answers for those on the run.