Pre-injury Knee and Ankle Mechanics During Running are Reduced Among Collegiate Runners who Develop Achilles Tendinopathy.

Abstract

Achilles tendinopathies (AT) are common in runners, but prospective data assessing running mechanics associated with developing AT are limited. Asymmetry in running mechanics is also considered a risk factor for injury, though it is unknown if the problematic mechanics occur on the injured limb only or are present bilaterally. To prospectively identify differences in pre-injury running biomechanics in collegiate runners who did and did not develop AT and determine if between-limb asymmetries were associated with which limb developed AT. Running gait data were obtained pre-season on healthy collegiate cross country runners, and AT incidence was prospectively recorded each year. Spatiotemporal, ground reaction forces, and joint kinematics and kinetics were analyzed. Linear mixed effects models assessed differences in biomechanics between those who did and did not develop AT during the subsequent year. Generalized linear mixed effects models determined if the asymmetry direction was associated with which limb developed an AT, with odds ratios (OR) and 95% confidence intervals [95% CI] reported. Data from 106 runners were analyzed and 15 developed AT. Pre-injury biomechanics of runners who developed AT showed less peak knee flexion (non-injured: 45.9 degrees [45.2, 46.6], injured: 43.2 degrees [41.5, 44.9], p < 0.001), ankle dorsiflexion (non-injured: 28.7 degrees [28.0, 30.2], injured: 26.0 degrees [23.8, 28.3], p = 0.01), and knee extensor moment (non-injured: -2.18 Nm/kg [-2.24, -2.12], injured: -2.00 Nm/kg [-2.17, -1.84], p = 0.02). The limb demonstrating less peak knee flexion had a greater odds of sustaining an AT (OR = 1.29 [1.00, 1.65], p = 0.05). Knee and ankle kinematics, in addition to knee kinetics, were associated with developing an AT. Monitoring these mechanics may be useful for prospectively identifying runners at risk of developing AT.