Running Injuries Research Articles

Bone Stress Injuries in Runners: a Review for Raising Interest in Stress Fractures in Korea.

A bone stress injury (BSI) means that the bones cannot tolerate repeated mechanical loads, resulting in structural fatigue and local bone pain. A delay in BSI diagnosis can lead to more serious injuries, such as stress fractures that require longer treatment periods. Therefore, early detection of BSI is an essential part of management. Risk factors for BSI development include biological and biomechanical factors. Medical history and physical examination are the basics for a BSI diagnosis, and magnetic resonance imaging is helpful for confirming and grading. In this paper, the authors review the overall content of BSI and stress fractures which are common in runners. Through this review, we hope that interest in stress fractures will be raised in Korea and that active researches will be conducted.

Is There a Relationship Between Strike Pattern and Injury During Running: A Review

<strong>Object:</strong> Recently people have shown an interest in running barefoot or with minimalist shoes, which result in forefoot strike (FFS) patterns that are different from running in normal shod with the rearfoot strike (RFS). To date, there is a dispute whether runners’ footfall pattern has an important impact on running injuries. Therefore, the purpose of this review is to investigate whether there is a relationship between different strike patterns and running injuries by reviewing the literature. <strong>Materials and Methods:</strong> A database retrieval and reference search were carried out with PubMed, Scopus, Google Scholar, and ScienceDirect. In the final review, 10 papers were included by matching the inclusion criteria. <strong>Results:</strong> Barefoot running exhibited smaller impact forces, short stride length, higher strike frequency, and shorter contact times compared to the standard shod condition. The forefoot strike pattern showed an increase in the plantarflexed foot, more ankle compliance during impact, smaller loading at the knee and lowered vertical loading rate in the FFS pattern than RFS. <strong>Discussion:</strong> Although the running injury is driven by multi-factorial variables, our literature review did not show any scientific evidence to suggest that footfall patterns are directly related to running injury.

Shoe Cushioning Influences the Running Injury Risk According to Body Mass: A Randomized Controlled Trial Involving 848 Recreational Runners

Background: Shoe cushioning is expected to protect runners against repetitive loading of the musculoskeletal system and therefore running-related injuries. Also, it is a common belief that heavier runners should use footwear with increased shock absorption properties to prevent injuries. Purpose: The aim of this study was to determine if shoe cushioning influences the injury risk in recreational runners and whether the association depends on the runner’s body mass. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Healthy runners (n = 848) randomly received 1 of 2 shoe prototypes that only differed in their cushioning properties. Global stiffness was 61.3 ± 2.7 and 94.9 ± 5.9 N/mm in the soft and hard versions, respectively. Participants were classified as light or heavy according to their body mass using the median as a cut-off (78.2 and 62.8 kg in male and female runners, respectively). They were followed over 6 months regarding running activity and injury (any physical complaint reducing/interrupting running activity for at least 7 days). Data were analyzed through time-to-event models with the subhazard rate ratio (SHR) and their 95% confidence interval (CI) as measures of association. A stratified analysis was conducted to investigate the effect of shoe cushioning on the injury risk in lighter and heavier runners. Results: The runners who had received the hard shoes had a higher injury risk (SHR, 1.52 [95% CI, 1.07-2.16]), while body mass was not associated with the injury risk (SHR, 1.00 [95% CI, 0.99-1.01]). However, after stratification according to body mass, results showed that lighter runners had a higher injury risk in hard shoes (SHR, 1.80 [95% CI, 1.09-2.98]) while heavier runners did not (SHR, 1.23 [95% CI, 0.75-2.03]). Conclusion: The injury risk was higher in participants running in the hard shoes compared with those using the soft shoes. However, the relative protective effect of greater shoe cushioning was found only in lighter runners. Registration: NCT03115437 (ClinicalTrials.gov identifier)

Factors Associated With Half- and Full-Marathon Race-Related Injuries: A 3-Year Review.

To better evaluate the relationships between training, demographics, and injury, this study sought to define race-related injury risk factors for half- and full-marathon runners. This 3-year, observational cross-sectional study included adults who participated in a half or full marathon. Prerace and 2-week postrace surveys collected data on demographics, training factors, and injuries. This study took place during a nationally recognized marathon affiliated with a local hospital. Runners were recruited during the Expo in the days before the race. Postrace surveys were returned by 1043 half marathoners and 624 full marathoners (response rate, 83%). This was an observational study; independent variables included demographic data and race year. The primary outcome was race-related injury that occurred during the race or within 2 weeks after the race. Race-related injuries were reported by 24% of half marathoners and 30% of full marathoners. For half and full marathoners, respectively, significant factors for injuries were previous injury, lower peak weekly training mileage, and lower weekly mileage before race training. Factors significant for only half-marathon injuries were younger age, female sex, shorter distance of longest training run, and no formal training program. Factors significant for only full-marathon injuries were higher body mass index, fewer days running per week, and fewer years of running experience. Previous running injuries, undertraining, and inexperience increased race-related injury risk; women had higher risk than men. Decreased risk of injury was associated with training loads of greater than 23 miles/week for half marathoners and 40 miles/week for full marathoners.

ILIAC CREST HEIGHT DIFFERENCE AND OTHER RUNNING-RELATED VARIABLES’ RELATIONSHIP WITH RUNNING INJURY

Leg-length inequality (LLI) is a common condition that may contribute to various spinal, pelvic, and lower extremity dysfunctions. Iliac crest height difference (ICHD) has been demonstrated to be a good estimate for LLI and may be a useful measure for identifying individuals who are at risk for injury. To investigate the relationship between ICHD and other running-related variables with running injury. An observational retrospective case-control design was used. Data were collected via questionnaire and physical examination from a purposive sample of 100 runners and were analyzed using chi-squared tests of independence. The prevalence of ICHD ≥ 5mm reported by subjects via questionnaire was ∼40%. There was no difference in report of injury between subjects with ICHD >5mm and those with ICHD <5mm (χ2 = 0.02, p = 0.88); however, lifetime history of injury (χ2 = 15.68, p = 0.00) and the number of running events participated (χ2 = 3.09, p = 0.04) were significant factors associated with injury; although not significant, there was a trend towards relationship with gender (χ2 = 3.2, = 0.07). Small ICHD is not associated with running injury among recreational runners. There appears to be an increased risk of running injury among runners who participate in more than one running event annually and those that have had a past history of running injury. Also, males may be at slightly greater risk of sustaining a running injury compared to females. Therapy, level 3b.

Controlled trial to compare the Achilles tendon load during running in flatfeet participants using a customized arch support orthoses vs an orthotic heel lift

BackgroundAchilles tendinopathy is one of the most common overuse injuries in running, and forefoot pronation, seen in flatfeet participants, has been proposed to cause additional loading across the Achilles tendon. Foot orthoses are one of the common and effective conservative treatment prescribed for Achilles tendinopathy, it works by correcting the biomechanical malalignment and reducing tendon load. Previous studies have shown reduction of Achilles Tendon load (ATL) during running by using customized arch support orthosis (CASO) or an orthotic heel lift (HL). However, there are still little biomechanical evidence and comparative studies to guide orthotic prescriptions for Achilles tendinopathy management. Therefore, this study seeks to investigate the two currently employed orthotic treatment options for Achilles tendinopathy: CASO and HL for the reduction of ATL and Achilles tendon loading rate (ATLR) in recreational runners with flatfeet.MethodsTwelve participants were recruited and run along the runway in the laboratory for three conditions: (1) without orthoses, (2) with CASO (3) with HL. Kinematic and kinetic data were recorded by 3D motion capturing system and force platform. Ankle joint moments and ATL were computed and compared within the three conditions.ResultsParticipants who ran with CASO (p = 0.001, d = 0.43) or HL (p = 0.001, d = 0.48) associated with a significant reduction in ATL when compared to without orthotics while there was no significant difference between the two types of orthoses, the mean peak ATL of CASO was slightly lower than HL. Regarding the ATLR, both orthoses, CASO (p = 0.003, d = 0.93) and HL (p = 0.004, d = 0.78), exhibited significant lower value than the control but similarly, no significant difference was noted between them in which the use of CASO yielded a slightly lower loading rate than that of HL.ConclusionsBoth CASO and HL were able to cause a significant reduction in peak ATL and ATLR comparing to without orthotics condition. There were subtle but no statistically significant differences in the biomechanical effects between the two types of orthoses. The findings help to quantify the effect of CASO and HL on load reduction of Achilles tendon and suggests that foot orthoses may serve to prevent the incidence of Achilles tendon pathologies.Trial registrationNCT04003870 on clinicaltrials.gov 1 July 2019.

Injury frequency and characteristics (location, type, cause and severity) differed significantly among athletics (‘track and field’) disciplines during 14 international championships (2007–2018): implications for medical service planning

ObjectiveTo analyse differences between athletic disciplines in the frequency and characteristics of injuries during international athletics championships.MethodsStudy design, injury definition and data collection procedures were similar during the 14 international...

A Randomized Study of a Strength Training Program to Prevent Injuries in Runners of the New York City Marathon.

Lower extremity overuse injuries are common among runners, especially first-time marathoners. Hip abductor and quadriceps strengthening is often recommended to reduce running-related injuries. A 12-week strength training program would decrease the rate of overuse injuries resulting in marathon noncompletion and improve race finishing time. Randomized trial. Level 2. Twelve weeks before the New York City Marathon, first-time marathon runners age 18 years and older were randomized into a strength training group or an observation group. The strength training group was instructed to perform a 10-minute program 3 times weekly using written and video instruction. This program targeted the quadriceps, hip abductor, and core muscle groups. Injuries were self-reported through biweekly surveys, with major injuries being those that resulted in marathon noncompletion and minor injuries being those that impaired training or race performance. A total of 720 runners were enrolled (mean age, 35.9 ± 9.4 years; 69.4% female), of whom 583 runners started the marathon and 579 completed it. The incidence of major injury was 8.9% and minor injury was 48.5%. Fifty two of 64 major injuries were overuse, of which 20 were bone stress injuries. The incidence of overuse injury resulting in marathon noncompletion was 7.1% in the strength training group and 7.3% in the observation group (risk ratio, 0.97; 95% CI, 0.57-1.63; P = 0.90). The mean finishing time was 5 hours 1 ± 60 minutes in the strength training group and 4 hours 58 ± 55 minutes in the observation group (P = 0.35). There is a high prevalence of injury among first-time marathon runners, but this self-directed strength training program did not decrease overuse injury incidence resulting in marathon noncompletion. Prevention strategies such as strength training need to be developed and evaluated through clinical trials to reduce the high prevalence of overuse injuries in runners, especially for high-risk populations such as first-time marathon runners.

Association Between Temporal Spatial Parameters and Overuse Injury History in Runners: A Systematic Review and Meta-analysis.

Temporal spatial parameters during running are measurable outside of clinical and laboratory environments using wearable technology. Data from wearable technology may be useful for injury prevention, however the association of temporal spatial parameters with overuse injury in runners remains unclear. To identify the association between overuse injury and temporal spatial parameters during running. Electronic databases were searched using keywords related to temporal spatial parameters, running, and overuse injury, and authors' personal article collections through hand search. Articles included in this systematic review contained original data, and analytically compared at least one temporal spatial parameter (e.g. cadence) between uninjured and retrospectively or prospectively injured groups of runners. Articles were excluded from this review if they did not meet these criteria or measured temporal spatial parameters via survey. The internal validity of each article was assessed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Meta-analyses were conducted for temporal spatial parameters if data existed from at least three separate cohorts of the same prospective or retrospective design. Data were pooled and analyzed using an inverse variance fixed-effect model. Thirteen articles which tested a total of 24 temporal spatial parameters during running were included in the review. Meta-analyses were conducted on four temporal spatial parameters using data from eleven retrospective studies. Healthy runners and those with a history of overuse injury had a similar average stride time (mean difference: 0.00 s, 95% CI - 0.01 to 0.01 s), contact time (mean difference: 0.00 s, 95% CI 0.00 to 0.01 s), cadence (mean difference: 0.3 steps per minute (spm), 95% CI - 1.8 to 2.5 spm), and stride length (mean difference 0.00 m, 95% CI - 0.05 to 0.05 m) during running. Data pooled for meta-analyses were limited to retrospective design studies. Studies included in the systematic review had low methodological consistency. Based on pooled results from multiple studies, stride time, contact time, cadence, and stride length averages are not distinguishable between runners either with or without a history of overuse injury. More prospective studies are required to determine the association of temporal spatial parameters with overuse injury development in runners. CRD42018112290.

Evidence based treatment options for common knee injuries in runners.

The purpose of this paper is to review the current literature regarding conservative treatment options for the three most common knee injuries in runners including patellofemoral pain syndrome (PFPS), iliotibial band friction syndrome (ITBFS), and patellar tendinopathy (PT). Each diagnosis is discussed using current research to describe the pathophysiology, evaluation process, and evidence based effective treatment strategies including therapeutic exercise, manual therapy, neuromuscular re-education, and modalities. The result is a comprehensive overview of each diagnosis and a research-based approach to effectively evaluate and treat each condition for best outcomes.

External Workload Indicators of Muscle and Kidney Mechanical Injury in Endurance Trail Running.

Muscle and kidney injury in endurance athletes is worrying for health, and its relationship with physical external workload (eWL) needs to be explored. This study aimed to analyze which eWL indexes have more influence on muscle and kidney injury biomarkers. 20 well-trained trail runners (age = 38.95 ± 9.99 years) ran ~35.27 km (thermal-index = 23.2 ± 1.8 °C, cumulative-ascend = 1815 m) wearing inertial measurement units (IMU) in six different spots (malleolus peroneus [MPleft/MPright], vastus lateralis [VLleft/VLright], lumbar [L1–L3], thoracic [T2–T4]) for eWL measuring using a special suit. Muscle and kidney injury serum biomarkers (creatin-kinase [sCK], creatinine (sCr), ureic-nitrogen (sBUN), albumin [sALB]) were assessed pre-, -post0h and post24h. A principal component (PC) analysis was performed in each IMU spot to extract the main variables that could explain eWL variance. After extraction, PC factors were inputted in multiple regression analysis to explain biomarkers delta change percentage (Δ%). sCK, sCr, sBUN, sALB presented large differences (p < 0.05) between measurements (pre < post24h < post0h). PC’s explained 77.5–86.5% of total eWL variance. sCK Δ% was predicted in 40 to 47% by L1–L3 and MPleft; sCr Δ% in 27% to 45% by L1–L3 and MPleft; and sBUN Δ% in 38%-40% by MPright and MPleft. These findings could lead to a better comprehension of how eWL (impacts, player load and approximated entropy) could predict acute kidney and muscle injury. These findings support the new hypothesis of mechanical kidney injury during trail running based on L1–L3 external workload data.

Changes in running kinematics and kinetics after a 12-week running program for beginners

ABSTRACT The effect of running training on running kinematics and kinetics in novice runners has not yet been investigated. Previous studies have shown that novice runners are less economical and more prone to injury compared to well-trained runners. Since running economy (RE) and running injury risk have been associated with biomechanical variables that may be trainable, the purpose of this study was to determine the effect of a 12-week training program for beginners on running kinematics and kinetics. It was hypothesised that participants would evolve towards running kinematics and kinetics that have previously been associated with better RE and lower injury risk. 27 participants underwent a full-body, three-dimensional running analysis before and after a 12-week running program. Outcome variables included peak joint angles, joint moments, and ground reaction forces (GRF) in three planes. After training, hip external rotation moment increased significantly with 0.01 Nm/kg. Peak vertical GRF decreased with 0.9 N/kg (4.05%). There were no significant changes in peak joint angles. In conclusion, results show that a 12-week running program for beginners aimed to increase running endurance does not lead to changes in running kinematics or kinetics that have previously been associated with better RE and lower injury risk.

The Receptive and Propulsive Behavior of Human Foot Joints During Running With Different Striking Strategies.

Foot structure and kinematics have long been considered as risk factors for foot and lower-limb running injuries. The authors aimed at investigating foot joint kinetics to unravel their receptive and propulsive characteristics while running barefoot, both with rearfoot and with midfoot striking strategies. Power absorption and generation occurring at different joints of the foot in 6 asymptomatic adults were calculated using both a 3-segment and a 4-segment kinetic model. An inverse dynamic approach was used to quantify mechanical power. Major power absorption and generation characteristics were observed at the ankle joint complex as well as at the Chopart joint in both the rearfoot and the midfoot striking strategies. The power at the Lisfranc joint, quantified by the 4-segment kinetic model, was predominantly generated in both strategies, and at the toes, it was absorbed. The overall results show a large variability in the receptive and propulsive characteristics among the analyzed joints in both striking strategies. The present study may provide novel insight for clinical decision making to address foot and lower-limb injuries and to guide athletes in the adoption of different striking strategies during running.

Running injury prevention and treatment viewed from a causal lens: time to consider sudden changes?

Running injury prevention and treatment viewed from a causal lens: time to consider sudden changes?

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

BackgroundExcessive foot pronation during running in individuals with foot varus alignment may be reduced by medially wedged insoles. Research questionThis 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. MethodsKinematic 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. ResultsThe 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). SignificanceInsoles 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.

The Garmin-RUNSAFE Running Health Study on the aetiology of running-related injuries: rationale and design of an 18-month prospective cohort study including runners worldwide

IntroductionRunning injuries affect millions of persons every year and have become a substantial public health issue owing to the popularity of running. To ensure adherence to running, it is important...

Multi-segment foot kinematics during running and its association with striking patterns

ABSTRACT There is an ongoing debate regarding the advantages and harms of different running striking patterns. The purpose of this study was to explore the kinematic differences between running with a midfoot- and rearfoot striking (RFS) pattern. Multi-segment foot kinematics of 12 students were assessed while running barefoot at 3.3 m/s (±10%) using a passive optoelectronic motion analysis system. Participants performed multiple running trials while landing on the rearfoot and midfoot. Comparison of the kinematic waveforms was performed using one-dimensional statistical parametric mapping (1DSPM) (paired t-test). The inter-segment angle between the shank and calcaneus was found to be significantly more plantar-flexed, more inverted and more adducted in the midfoot striking (MFS) condition compared to the RFS pattern. The calcaneus-midfoot inter-segment angle was found to be more plantar-flexed in the MFS condition. The downward angulation of the metatarsals and the medial longitudinal arch angle in the late swing phase was found to be more pronounced during MFS. Differences between midfoot and RFS patterns occur in the first sub-phase of stance (0–50% of the stance phase). These findings may be of interest for the kinesiopathological or pathokinesiological reasoning processes when facing foot- and lower limb-related running injuries.

Lower Limb Biomechanical Factors Related to Running Injuries: A Review and Practical Recommendations

ABSTRACT The objective of this review is to analyze some of the biomechanical factors involved in the most common running injuries: anterior knee pain, iliotibial band syndrome, Achilles tendinopathy, and medial tibial stress syndrome/tibial stress fracture. Eighteen studies met all inclusion criteria. Results showed that there is little consistent evidence in the literature to connect any biomechanical anomaly to any given running injury, except for female runners with patellofemoral pain who have an increased peak hip adduction angle at stance phase. This review suggests that assessing and treating hip mechanics could help to prevent knee injuries in female runners.

Development of the University of Wisconsin Running Injury and Recovery Index.

Runners experience a high proportion of overuse injuries, with extended recovery periods involving a gradual, progressive return to preinjury status. A running-specific patient-reported outcome (PRO) measure does not exist, and a questionnaire assessing critical elements of runners' recovery processes may have excellent psychometric properties. To develop a valid, reliable, and responsive evaluative PRO measure to assess longitudinal change in running ability after running-related injury (RRI) for clinical practice and research applications. Self-identified runners and selected experts participated in an iterative, 6-step development process of the University of Wisconsin Running Injury and Recovery Index (UWRI) in this longitudinal clinical measurement study. Content-related validity was assessed using open comments. Reproducibility was assessed using Cronbach's alpha, the intraclass correlation coefficient (ICC), and standard error of measurement (SEM). An anchor-based construct validity assessment measured the association between the change in UWRI score and global rating of change (GROC). Responsiveness assessments included floor and ceiling effects. The 9-item UWRI assesses running ability following an RRI, with the maximum score of 36 indicating a return to preinjury running ability. The UWRI demonstrated acceptable internal consistency (α = .82), test-retest reliability (ICC = 0.93), and SEM (1.47 points). Change in UWRI score was moderately correlated with the GROC (r = 0.61; 95% confidence interval: 0.4, 0.76). Floor and ceiling effects were absent. Completion required 3 minutes 15 seconds. The UWRI is a reliable PRO measure and is responsive to changes in running function following an RRI, with minimal administrative burden. Therapy, level 2c. J Orthop Sports Phys Ther 2019;49(10):751-760. Epub 3 Aug 2019. doi:10.2519/jospt.2019.8868.

The efficacy of podological insoles - the attempt at proof

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