Progression in Running Intensity or Running Volume and the Development of Specific Injuries in Recreational Runners: Run Clever, a Randomized Trial Using Competing Risks

Week-to-week changes in training were not prospectively associated with injuries among Wisconsin high school cross-country runners

BACKGROUND

Training characteristics, such as volume and duration, have been studied in relation to running-related injury (RRI) risk, with mixed findings in adult runners. There is a lack of research assessing how training characteristics relate to RRI in youth runners, despite the high RRI rates observed in this population.

PURPOSE

To prospectively determine associations between (1) total weekly running volume and duration and (2) week-to-week changes in running volume, duration, intensity and training stress with in-season RRI among high school cross-country runners.

METHODS

Runners completed a preseason demographics and injury history survey and daily surveys regarding training distance, duration, intensity and current RRI. Values were summed weekly and change scores were calculated relative to the prior week. Runners completing ≥75% of daily surveys were analysed; sensitivity analyses for those completing ≥50% and ≥90% were conducted. Generalised estimating equations assessed associations between change in each predictor, including interactions with sex and RRI within the subsequent week, controlling for year in school, prior RRI and repeated observations.

RESULTS

434 runners enrolled in the study; 161 (37%) completed ≥75% of daily surveys. No associations between total volume, total duration or week-to-week change in training characteristics and in-season RRI were observed (p≥0.54). Sensitivity analyses did not detect any significant associations.

CONCLUSION

Total weekly running volume and duration and weekly changes in training were not associated with RRI. RRI are multifactorial and assessing the interaction between training characteristics and other lifestyle factors is likely necessary for determining RRI risk in youth runners.

Do we underestimate the frequency of ankle sprains in running? A systematic review and meta-analysis

OBJECTIVE

To provide a systematic review and meta-analysis of the proportion of ankle sprains in running practices.

DESIGN

Systematic review and meta-analysis.

MAIN OUTCOME MEASURES

We calculated the weighted summary proportion and conducted meta-analyses for runners, considering levels (elite/recreational) and disciplines (distance, track, cross-country, trail, and orienteering).

RESULTS

32 studies were included in the systematic review and 19 were included in the meta-analysis with a level of quality ranging from poor to good. Proportion of ankle sprains in runners was 13.69% (95%CI = 7.40-21.54; I2 = 98.58%) in global, 12.20% (95%CI = 5.24-21.53; I2 = 89.31%) in elite, 19.40% (95%CI = 10.05-30.90; I2 = 99.09%) in recreational, 8.51% (95%CI = 4.22-14.12; I2 = 96.15%) in distance, 67.42% (95%CI = 0.50-82.85; I2 = 99.36%) in track, 27.07% (95%CI = 12.48-44.81; I2 = 97.97%) in cross-country, and 25.70% (95%CI = 19.87-32.14; I2 = 0.00) in orienteering.

CONCLUSIONS

Running practice results in significant proportion rate of ankle sprains. Recreational runners exhibit higher proportion than elite. Running disciplines, especially track, cross-country, and orienteering, influence reported ankle sprain rates, surpassing those of distance runners.

Clinical and exercise professional opinion of return-to-running readiness after childbirth: an international Delphi study and consensus statement

Female athletes have identified a lack of guidance as a barrier to successfully returning to running postpartum, and existing guidelines are vague. Our aim was to define the current practice of determining postpartum run-readiness through a consensus survey of international clinicians and exercise professionals in postpartum exercise to assist clinicians and inform sport policy changes.A three-round Delphi approach was used to gain international consensus from clinicians and exercise professionals on run-readiness postpartum. Professionals who work with postpartum runners participated in an online survey to answer open-ended questions about the following postpartum return-to-running topics: definitions (runner and postpartum), key biopsychosocial milestones that runners need to meet, recommended screening, timeline to initiate running, support items, education topics and factors that contribute to advising against running. Consensus was defined as ≥75% participant agreement.One hundred and eighteen professionals participated in round I, 107 participated in round II (response rate 90.6%) and 95 participated in round III (response rate 80.5%). Responses indicated that, following a minimum 3-week period of rest and recovery, an individualised timeline and gradual return to running progression can be considered. Screening for medical and psychological concerns, current physical capacity, and prior training history is recommended prior to a return to running.This study proposes recommendations for the initial guidance on return-to-running postpartum, framed in the context of current research and consensus from professionals. Future research is needed to strengthen and validate specific recommendations and develop guidelines for best practice when returning-to-running after childbirth.

Clinical and exercise professional opinion on designing a postpartum return-to-running training programme: an international Delphi study and consensus statement

Returning to running postpartum presents challenges such as musculoskeletal pain and pelvic floor dysfunction for some females, but there is little guidance on developing and progressing postpartum training programmes. This study aims to establish expert consensus recommendations on designing and modifying a postpartum return-to-running training programme, highlight costs and access to qualified professionals as potential barriers and discuss clinical, research and sports policy implications.A three-round Delphi survey of clinical and exercise professionals working with postpartum runners was conducted. Round I consisted of open-ended questions related to designing the training plan, modifications based on biopsychosocial factors, key muscle groups to train and referral and payment sources. Rounds II and III involved Likert-scale voting to identify consensus (≥75% agreement).118 participants completed Round I, 107 completed Round II (response rate 90.6%) and 95 completed Round III (response rate 80.5%). Consensus was reached in 42/47 (89%) statements, including recommendations for a period of relative rest, gradual increases in duration and intensity, starting with a walk-run protocol and incorporating strength training. Training should be modified based on musculoskeletal or pelvic symptoms, sleep, mental health, lactation or energy availability concerns. Cost and access to experienced postpartum running professionals were identified as potential barriers for runners to receive care.Consensus recommendations for a postpartum return-to-running programme include an individualised exercise prescription, gradual increases in physical activity, walk-run protocols and targeted muscle strengthening. Further research and improved access to clinical and exercise professionals are needed to inform and facilitate best practices.

Risk Factors for Running-Related Injury in High School and Collegiate Cross-country Runners: A Systematic Review

OBJECTIVE: To summarize and describe risk factors for running-related injuries (RRIs) among high school and collegiate cross-country runners. DESIGN: Descriptive systematic review. LITERATURE SEARCH: Four databases (Scopus, SPORTDiscus, CINAHL, Cochrane) were searched from inception to August 2023. STUDY SELECTION CRITERIA: Studies assessing RRI risk factors in high school or collegiate runners using a prospective design with at least 1 season of follow-up were included. DATA SYNTHESIS: Results across each study for a given risk factor were summarized and described. The NOS and GRADE frameworks were used to evaluate quality of each study and certainty of evidence for each risk factor. RESULTS: Twenty-four studies were included. Overall, study quality and certainty of evidence were low to moderate. Females or runners with prior RRI or increased RED-S (relative energy deficiency in sport) risk factors were most at risk for RRI, as were runners with a quadriceps angle of >20° and lower step rates. Runners with weaker thigh muscle groups had increased risk of anterior knee pain. Certainty of evidence regarding training, sleep, and specialization was low, but suggests that changes in training volume, poorer sleep, and increased specialization may increase RRI risk. CONCLUSION: The strongest predictors of RRI in high school and collegiate cross-country runners were sex and RRI history, which are nonmodifiable. There was moderate certainty that increased RED-S risk factors increased RRI risk, particularly bone stress injuries. There was limited evidence that changes in training and sleep quality influenced RRI risk, but these are modifiable factors that should be studied further in this population. J Orthop Sports Phys Ther 2024;54(2):1-13. Epub 16 November 2023. doi:10.2519/jospt.2023.11550.

Strategies to prevent and manage running-related knee injuries: a systematic review of randomised controlled trials

OBJECTIVE

To evaluate the effectiveness of interventions to prevent and manage knee injuries in runners.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

MEDLINE, EMBASE, CINAHL, Web of Science and SPORTDiscus up to May 2022.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Randomised controlled trials (RCTs) with a primary aim of evaluating the effectiveness of intervention(s) to prevent or manage running-related knee injury.

RESULTS

Thirty RCTs (18 prevention, 12 management) analysed multiple interventions in novice and recreational running populations. Low-certainty evidence (one trial, 320 participants) indicated that running technique retraining (to land softer) reduced the risk of knee injury compared with control treadmill running (risk ratio (RR) 0.32, 95% CI 0.16 to 0.63). Very low-certainty to low-certainty evidence from 17 other prevention trials (participant range: 24 -3287) indicated that various footwear options, multicomponent exercise therapy, graduated running programmes and online and in person injury prevention education programmes did not influence knee injury risk (RR range: 0.55-1.06). In runners with patellofemoral pain, very low-certainty to low-certainty evidence indicated that running technique retraining strategies, medial-wedged foot orthoses, multicomponent exercise therapy and osteopathic manipulation can reduce knee pain in the short-term (standardised mean difference range: -4.96 to -0.90).

CONCLUSION

There is low-certainty evidence that running technique retraining to land softer may reduce knee injury risk by two-thirds. Very low-certainty to low-certainty evidence suggests that running-related patellofemoral pain may be effectively managed through a variety of active (eg, running technique retraining, multicomponent exercise therapy) and passive interventions (eg, foot orthoses, osteopathic manipulation).

PROSPERO REGISTRATION NUMBER

CRD42020150630.

Are models of plantar heel pain suitable for competitive runners? A narrative review

Background

Plantar heel pain (PHP), or plantar fasciopathy, is a common condition in active and sedentary populations, contributing to short- and long-term reductions in quality of life. The condition's aetiology and pathophysiology are the subjects of a significant body of research. However, much of this research has been conducted with sedentary participants, and comparatively little research exists in a population of highly-trained athletes focused on performance outcomes. Models for PHP and proposed mechanisms, such as high body mass index or systemic disease, are mostly absent from an athletic population. Even less is known about the origins of pain in PHP. Pain is believed to be a complex multifactorial process and may be experienced differently by sedentary and highly active populations, particularly endurance athletes. Consequently, conservative through to surgical treatment for athletes is informed by literature for a different population, potentially hindering treatment outcomes.

Aims

The aim of this review, therefore, is to summarise what is known about PHP in athletic populations and propose potential directions for future research.

Methods

Embase, PubMed, and Scopus using MeSH search terms for PHP and competitive sport and common synonyms.

Discussion

Two explanatory models for PHP were found. These primarily propose mechanical factors for PHP. It remains unclear how gait, body composition, and psychological factors may differ in an athletic population with and without PHP. Therefore, research in these three areas is needed to inform clinical and training interventions for this population.

Influence of the COVID-19 pandemic on running behaviors, motives, and running-related injury: A one-year follow-up survey

The purpose of this study was to compare running behaviors, motives, and injury during the first full year of the pandemic compared to the year prior, and month of eased restrictions. 466 runners responded to this follow-up survey. Paired t-tests were used to compare timepoints. Logistic regressions were used to assess demographic influences on behaviors. During the first full year of the pandemic, runners were more likely to increase their weekly runs (Mean Differences [MD]: 0.29±0.10, p < .001), yet had fewer motives (MD: -0.20±0.06, p = .02) compared to the month of eased restrictions. 18–25-year-olds were most likely to increase running volume (Odds Ratio [OR]: 2.79 [1.06, 7.32], p = .04) during the first full year of the pandemic compared to the year prior. Inexperienced runners reported fewer motives (OR: 3.00–4.41, p = .02-.04), and reduced sustained runs (OR: 2.36 [1.13, 4.96], p = .02) during the first full year of the pandemic compared to the year prior. Inexperienced runners and runners who lost access to preferred locations were at increased injury risk (OR: 1.98–2.63, p: .01-.04) during the first full year of the pandemic compared to the year prior. Our findings highlight pandemic-related changes among the running community that are likely to influence behaviors and injury risk.

The association between running injuries and training parameters: A systematic review

OBJECTIVE

To synthesise the current evidence on the incidence of running-related injuries (RRI) and their association with training parameters (distance, duration, frequency, intensity), as well as recent changes in training parameters.

DATA SOURCES

Searches were conducted in Medline/Ovid, CINAHL, Embase and SportDiscus up to July 7, 2020.

STUDY SELECTION

Included articles had to report prospective data on RRIs and training parameters, or any changes in parameters, and be published in English or French. Two reviewers independently screened titles, abstracts and full-texts.

DATA EXTRACTION

Data extraction and quality assessment (QualSyst) were performed by two independent raters.

DATA SYNTHESIS

Thirty-six articles totaling 23,047 runners were included. Overall, 6,043 runners (26.2%) sustained an RRI (incidence range: 8.8% to 91.3%). The incidence of RRI was 14.9% in novice runners (range: 9.4 to 94.9%), 26.1% in recreational runners (range: 17.9 to 79.3%) and 62.6% in competitive runners (range: 52.6 to 91.3%). The three most frequently injured body parts were the knee (25.8%), foot/ankle (24.4%) and lower leg (24.4%). Overall, there was conflicting evidence about the association between weekly running distance, duration, frequency, intensity or specific changes in training parameters and the onset of RRIs.

CONCLUSIONS

Despite high rates of RRIs, current evidence does not consistently link RRIs with specific training parameters or recent changes in training parameters. Therefore, caution should be taken when recommending optimal parameters or progressions. Given the multifactorial nature of RRIs, future studies also need to consider the interaction between training parameters, as well as psychosocial, hormonal, lifestyle and recovery outcomes to better understand the onset of RRIs.

Multidisciplinary, biopsychosocial factors contributing to return to running and running related stress urinary incontinence in postpartum women

OBJECTIVES

To examine contributory factors behind postpartum return-to-running and return to pre-pregnancy running level, in addition to risk factors for postpartum running-related stress urinary incontinence (SUI).

METHODS

881 postpartum women completed an online questionnaire. Clinically and empirically derived questions were created relating to running experiences and multidisciplinary, biopsychosocial contributory factors. Logistic regression was used to determine predictors for return-to-running, returning to pre-pregnancy level of running and running-related SUI.

RESULTS

Median time to first postpartum run was 12 weeks. Running during pregnancy (OR: 2.81 (1.90 to 4.15)), a high weekly running volume (OR: 1.79 (1.22 to 2.63)), lower fear of movement (OR: 0.53 (0.43 to 0.64)) and not suffering vaginal heaviness (OR: 0.52 (0.35-0.76)) increased the odds of return-to-running. Factors that increased the odds of returning to pre-pregnancy running level were a low weekly running volume (OR: 0.38 (0.26 to 0.56)), having more than one child (OR: 2.09 (1.43 to 3.05)), lower fear of movement (OR: 0.78 (0.65 to 0.94)), being younger (OR: 0.79 (0.65 to 0.96)) and shorter time to running after childbirth (OR: 0.74 (0.60 to 0.90)). Risk factors for running-related SUI were having returned to running (OR: 2.70 (1.51 to 4.76)) and suffering running-related SUI pre-pregnancy (OR: 4.01 (2.05 to 7.82)) and during pregnancy (OR: 4.49 (2.86 to 7.06)); having a caesarean delivery decreased the odds (OR: 0.39 (0.23 to 0.65)).

CONCLUSION

Running during pregnancy may assist women safely return-to-running postpartum. Fear of movement, the sensation of vaginal heaviness and running-related SUI before or during pregnancy should be addressed early by healthcare providers.

The Diagnostic Significance of Ultrasonographic Measurement of the Achilles Tendon Thickness for the Insertional Achilles Tendinopathy in Patients with Heel Pain

No consensus exists concerning the diagnostic role or cutoff value of the Achilles tendon thickness on ultrasonography (US) for the diagnosis of insertional Achilles tendinopathy. This study sought to assess the diagnostic utility of US measurement of the thickness and echogenicity of the Achilles tendon for the insertional Achilles tendinopathy in patients with heel pain, and to compare the results with those of the plantar fascia for the plantar fasciitis. We conducted US examinations in consecutive patients who presented with unilateral or bilateral heel pain at the foot clinic of a single tertiary hospital from February 2016 to December 2020. Each US evaluation assessed the thickness and echogenicity&nbsp;of the insertion area of the Achilles tendon and plantar fascia. We retrospectively compared these parameters between patients with insertional Achilles tendinopathy or plantar fasciitis and normal controls and analyzed the diagnostic utility of these parameters. Based on clinical diagnosis, 44 feet were diagnosed with insertional Achilles tendinopathy, 109 feet were diagnosed with plantar fasciitis, and 32 feet were classified as normal. There was a significant difference in the thickness of the plantar fascia between the plantar fasciitis and normal control groups (p = 0.032). There was also a significant difference in the echogenicity of the plantar fascia between the plantar fasciitis and normal groups (p < 0.001). However, there was no significant difference in the thickness of the insertional area of the Achilles tendon between the insertional Achilles tendinopathy and normal groups (p = 0.132). There was a significant difference in the echogenicity of the insertional area of the Achilles tendon between the insertional Achilles tendinopathy and normal groups (p < 0.001). US measurement of the thickness of the insertional area of the Achilles tendon might not reflect the clinical status of insertional Achilles tendinopathy, unlike that of plantar fasciitis.

The effect of speed on Achilles tendon forces and patellofemoral joint stresses in high-performing endurance runners

Achilles tendinopathy and patellofemoral pain are common running injuries associated with increased Achilles tendon (AT) forces and patellofemoral joint (PFJ) stresses. This study examined AT forces and PFJ stresses at different running speeds in high-performing endurance runners. Twenty runners ran overground at four running speeds (3.3, 3.9, 4.8, and 5.6 m/s). AT forces and PFJ stresses were estimated from kinematic and kinetic data. Repeated measures ANOVA with partial eta squared effect sizes was conducted to assess differences between running speeds. Increased peak AT forces (19.5%; p < 0.001) and loading rates (57.3%; p < 0.001) from 3.3 m/s to 5.6 m/s were observed. Cumulative AT loading was greater in the faster speeds compared to the slower speeds. Faster running speeds resulted in increased peak plantar flexor moments, increased peak plantar flexion angles, and a more flexed knee and an anterior center of pressure position at touchdown. Peak PFJ stress was lower in the slowest speed (3.3 m/s) compared to the faster running speeds (3.9-5.6 m/s; p = 0.005). PFJ stress loading rate significantly increased (43.6%; p < 0.001). Greater AT loading observed could be associated with strategies such as increased plantar flexor moments and altered lower body position at touchdown which are commonly employed to generate greater ground contact forces. Greater AT and PFJ loading rates were likely due to shorter ground contact times and therefore less time available to reach the peak. Running at faster speeds could increase the risk of developing Achilles tendinopathy and patellofemoral pain or limit recovery from these injuries without sufficient recovery.

Most Military Runners Report Recent Changes in Running Parameters Before Lower Limb Injury Onset

INTRODUCTION

While running is a popular activity because of the health and fitness benefits it provides, the yearly incidence of running-related injuries (RRI) is high across all populations of runners, including military members. The etiology of RRI is multifactorial, and despite the numerous studies on risk factors for RRI, there is no clear consensus in the literature on the relative contribution of several intrinsic or extrinsic risk factors to the development of RRI. Furthermore, little is known on RRI profile and running parameters among Canadian military members. The objectives of this study were to (1) describe the clinical presentation of lower limb RRI and running profile among military members and (2) explore any association between recent changes in running parameters (volume or intensity) and specific RRI diagnoses.

MATERIALS AND METHODS

This cross-sectional study was conducted in 107 military members from the Canadian Armed Forces (Valcartier Military Base) who presented with a restriction or interruption of running because of lower limb running-related pain. The following variables were collected during a physiotherapy evaluation: injury location and diagnosis, running kinematics (foot strike pattern and step rate), degree of minimalism of running shoes, running parameters in the last 3 months before consultation (volume, duration, frequency, and intensity), and recent changes in training before pain onset. Descriptive statistical analyses were conducted to describe the clinical presentation and running profile, while chi-square tests and multiple correspondence analysis were used to explore the association between recent changes in running parameters and diagnosis. This study was approved by the institutional ethics committee, and participants signed a detailed consent form.

RESULTS

Among the 107 participants included in the study (mean age: 30.7 ± 8.9 years; 13 females), the most common diagnoses were patellofemoral pain (26.2%), medial tibial stress syndrome (11.2%), plantar fasciopathy (9.3%), and sciatica (9.3%). The average Minimalist Index of running shoes was 27.6 ± 18.5%. Step rate was 161.7 ± 10.3 steps per minute, and 73.3% of the participants used a rearfoot strike pattern. The majority of military runners reported previous RRI, gradual onset of symptoms, and recent changes in their training parameters (75.7%) before injury onset. No association was found between recent changes in running volume ((χ2(4) = 2.849; P = .606)) or intensity ((χ2(4) = 1.381; P = .855)) and diagnosis.

CONCLUSION

This is the first study to specifically investigate RRI and running profile among Canadian military members. The most common injuries were located at the knee, and the most frequent diagnosis was patellofemoral pain. The majority of military runners reported previous RRI as well as recent changes in their running parameters before injury onset, but unique types of recent changes were not associated with specific diagnoses. This study illustrates the need to further investigate the impact of training loads on the development of RRI.

Is patellofemoral pain preventable? A systematic review and meta-analysis of randomised controlled trials

OBJECTIVE

To evaluate the effectiveness of interventions to reduce the risk of incident patellofemoral pain.

DESIGN

Systematic review and meta-analysis, with strength of evidence evaluated separately for each intervention type.

DATA SOURCES

MEDLINE, EMBASE, CINAHL, Web of Science and SPORTDiscus.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Randomised controlled trials evaluating the effectiveness of interventions to reduce patellofemoral pain risk compared with a control/non-exposed group.

RESULTS

Thirteen trials of mostly military recruits and young athletes analysed six different interventions. There was low certainty evidence from two trials (227 participants) that patellofemoral braces worn during physical activity (compared with no brace) effectively reduced the risk of patellofemoral pain (risk ratio (RR) 0.40, 95% CI 0.22 to 0.73; I2=24.0%). There was low certainty evidence from one trial (320 participants) that running technique retraining to (run softer) reduced patellofemoral pain risk (RR 0.21, 95% CI 0.07 to 0.60). There was low certainty evidence from four trials (3364 participants) that multicomponent (strengthening/neuromuscular) exercise programmes did not significantly reduce the risk of patellofemoral pain (RR 0.49, 95% CI 0.18 to 1.36; I2=64.9%), although broad CIs may reflect exercise dose variations among studies. There was very low certainty evidence from four trials (2314 participants) that foot orthoses (compared with flat inserts/no orthosis) did not significantly reduce the risk of patellofemoral pain (RR 0.63, 95% CI 0.35 to 1.13; I2=0.0%). Static stretching and a running programme that progressed intensity (compared with volume) did not significantly influence patellofemoral pain risk (single studies).

CONCLUSION

There is low-level evidence that patellofemoral braces and running technique retraining can reduce the risk of patellofemoral pain by 60%-79%.

Associations between biomechanical and clinical/anthropometrical factors and running-related injuries among recreational runners: a 52-week prospective cohort study

BACKGROUND

The purpose of this exploratory study was to investigate whether runners with certain biomechanical or clinical/anthropometrical characteristics sustain more running-related injuries than runners with other biomechanical or clinical/anthropometrical characteristics.

METHODS

The study was designed as a prospective cohort with 52-weeks follow-up. A total of 224 injury-free, recreational runners were recruited from the Gothenburg Half Marathon and tested at baseline. The primary exposure variables were biomechanical and clinical/anthropometrical measures, including strength, lower extremity kinematics, joint range of motion, muscle flexibility, and trigger points. The primary outcome measure was any running-related injury diagnosed by a medical practitioner. Cumulative risk difference was used as measure of association. A shared frailty approach was used with legs as the unit of interest. A total of 448 legs were included in the analyses.

RESULTS

The cumulative injury incidence proportion for legs was 29.0% (95%CI = 24.0%; 34.8%). A few biomechanical and clinical/anthropometrical factors influence the number of running-related injuries sustained in recreational runners. Runners with a late timing of maximal eversion sustained 20.7% (95%CI = 1.3; 40.0) more injuries, and runners with weak abductors in relation to adductors sustained 17.3% (95%CI = 0.8; 33.7) more injuries, compared with the corresponding reference group.

CONCLUSIONS

More injuries are likely to occur in runners with late timing of maximal eversion or weak hip abductors in relation to hip adductors.

The effects of marathon running on three-dimensional knee kinematics during walking and running in recreational runners

BACKGROUND

Running-related musculoskeletal injuries are common. Knee injuries are most frequent, and often occur during or shortly after marathons.

RESEARCH QUESTION

The effects of a marathon on runners' knee kinematics remain unclear. No studies have shown comprehensive three-dimensional (3D) knee kinematic changes following a marathon. This study aimed to observe the effects of running a marathon on 3D knee kinematics and identify the phases of walking and running gait in which significant changes occur.

METHODS

Based on an electronic survey, 10 healthy, recreational runners (20 knees) with similar running experience were included. Their 3D knee kinematics (during treadmill walking and running) were collected using a portable, optical motion capture system within 24 h before and within 6 h after running a marathon.

RESULTS

All measurements after the marathon were compared with pre-marathon measurements. (1) For walking post-marathon: varus rotation increased by 1.8° [95% confidence interval (CI) 0.1-3.4, P = 0.036] at peak knee extension during stance; anterior translation increased by 2.2 mm (95% CI 0.3-4.1, P = 0.025) at initial contact; range of motion (ROM) in internal-external rotation increased less than 1°, P = 0.023; ROM in anteroposterior translation increased by 3.8 mm, P = 0.048. (2) For running post-marathon: flexion rotation increased by 1.6° (95% CI 0.2-2.9, P = 0.025) at initial contact; varus rotation increased by 2.0° (95% CI 0.2-3.8, P = 0.031) at peak knee extension during stance.

SIGNIFICANCE

Significant differences in varus rotation and anterior translation were identified following a marathon, which could potentially contribute to injury. These results provide important information for runners and coaches about knee kinematic alterations following a marathon.

Low back pain and calf pain in a recreational runner masking peripheral artery disease: A case report

Background: Running is one of the most popular sports worldwide due to its low costs and its beneficial impact on health. Recent evidence suggests 11% to 85% of recreational runners experience at least one running-related injury each year and most of these are related to musculoskeletal conditions. The aim of this case report is to describe the clinical decision-making process that guided a physiotherapist to suspect a non-musculoskeletal cause in a recreational runner presenting with low back pain and calf pain secondary to Peripheral Artery Disease.Case Presentation: This case report describes the clinical history, clinical exam, laboratory and imaging tests, and surgical procedure of a 65 y.o. amateur runner suffering low back pain and left calf pain for 3 months. The patient's clinical findings suggested that referral to another health-care provider was required to explore potential non-musculoskeletal sources of pain. An angioplasty was necessary to solve the patient's clinical situation.Discussion and Conclusion: In this patient case, clinical findings along with a comprehensive family and personal history, ruled out a musculoskeletal condition and implicated a vascular condition.

Importance of screening in physical therapy: vertebral fracture of thoracolumbar junction in a recreational runner

Running is one of the most popular sports worldwide. Studies suggest that 11%-85% of recreational runners have at least one running-related injury (RRI) each year, resulting in a reduction or interruption in training. A high risk for running-related injuries (RRIs) represents an important inconvenience counterbalancing the beneficial effects of running. RRIs primarily affect the joints of the lower limb and lumbar spine. Noteworthy, in some cases, the clinical presentation of signs and symptoms is confusing and may hide serious conditions; thus, clinicians have to pay special attention when potential factors arise, such as the presence of red flags. As reported in this case report, patients can present with low back pain (LBP) as a primary problem, mimicking a red flag such as a fracture of the spine. The aim of this case report was to describe a case of a recreational runner presenting with LBP as the sole symptom of an underlying thoracolumbar fracture.

Anatomical variations of the plantar fascia's origin with respect to age and sex-an MRI based study

The plantar fascia (PF) plays a significant role in ankle movement and anatomical variations of this structure may significantly alter the biomechanical properties of the foot and lower extremity. The aim of this study was to evaluate the changes of the PF's origin point on the calcaneus (CB), and whether these changes are dependent on age and sex. Two independent observers evaluated two hundred and two foot and ankle MRIs and the following measurements was performed: (A) horizontal length of the AT insertion into the posterior aspect of the CB, (B) horizontal length of the CB and (C) horizontal distance from the most anterior point of the CB to the most posterior part of the PF. Statistical analysis was performed with the results obtained to evaluate both sex and age differences. Based on our results, we observed that: (1) changes of the PF's origin point on the CB is independent of age and sex and (2) the continuity between the PF and AT decreases during aging as a result from changes in the AT's insertion point into the CB. This study concludes that the PF's origin point does not change with respect to age or sex, but the continuity between the PF and AT decreases during aging. Knowledge regarding the biomechanical influences caused by changes in the relationship between the AT and PF may be important in terms of treatment and prophylaxis of both PF and AT pathologies. Clin. Anat. 32:597-602, 2019. © 2019 Wiley Periodicals, Inc.