Running with injury: A study of UK novice and recreational runners and factors associated with running related injury

Objectives

To investigate the incidence and type of running related injuries in novice and recreational UK runners, and identify factors associated with injury.

ProjectRun21: Do running experience and running pace influence the risk of running injury—A 14-week prospective cohort study

Objectives

The health benefits from participation in half-marathon is challenged by a yearly running-related injury (RRI) incidence proportion exceeding 30%. Research in injury etiology is needed to successfully prevent injuries. The body’s load capacity is believed to play an essential role for injury development. Therefore, the purpose of ProjectRun21 was to investigate the association between load capacity defined as running experience and running pace, and RRI when following a specific half-marathon running schedule.

Reduced oxygen cost of running is related to alignment of the resultant GRF and leg axis vector: A pilot study

This pilot study investigated whether a 10‐week running program (10wkRP), which reduced the oxygen cost of running, affected resultant ground reaction force (GRF), leg axis alignment, joint moment characteristics, and gear ratios. Ten novice, female runners completed a 10wkRP. Running kinematics and kinetics, in addition to oxygen consumption () during steady‐state running, were recorded pre‐ and post‐10wkRP. decreased (8%) from pre‐10wkRP to post‐10wkRP. There was a better alignment of the resultant GRF and leg axis at peak propulsion post‐10wkRP compared with pre‐10wkRP (10.8 ± 4.9 vs 1.6 ± 1.2°), as the resultant GRF vector was applied 7 ± 0.6° (P = 0.008) more horizontally. There were shorter external ankle moment arms (24%) and smaller knee extensor moments (23%) at peak braking post‐10wkRP. The change in was associated with the change in alignment of the resultant GRF and leg axis (r_s = 0.88, P = 0.003). As runners became more economical, they exhibited a more aligned resultant GRF vector and leg axis at peak propulsion. This appears to be a self‐optimization strategy that may improve performance. Additionally, changes to external ankle moment arms indicated beneficial low gear ratios were achieved at the time of peak braking force.     

A drop landing screening approach to monitor an individual using functional data analysis: An ACL injury case study

ObjectivesTo explore the practicality of using functional principal components analysis (fPCA) and intra-athlete z-score changes for individual athlete monitoring post-ACL injury and surgery.DesignA single athlete case study using within-athlete repeated measures in the context of applied athlete monitoring.MethodsUsing single leg (left) drop landing (3 landings per session) onto a force plate, the athlete completed 6 sessions prior (healthy) and 3 sessions post-ACL injury/surgery. Maximum vertical ground reaction force (vGRF), time to stabilisation (TTS) and outputs from fPCA (fPC scores) for the healthy sessions were used to develop intra-athlete means and standard deviations for each variable. Post-surgery measures were given z-scores relative to the healthy mean and standard deviation for each variable. The standard normal deviate (z = 1.96) was used as a threshold to flag landings that could be indicative of changes in movement behaviour.ResultsMaximum vGRF revealed no post-surgery trials that exceeded the standard normal deviate threshold based on the healthy data. TTS identified one landing post-surgery that exceeded the threshold. Scores for fPC2, fPC3 and fPC4 revealed landings that exceeded the threshold, with fPC4 demonstrating landings greater than the threshold for every trial (except two) post-surgery.ConclusionsIncluding fPCA identified significant and stable changes to the landing strategy (particularly within fPC4). When used in conjunction with other measures such as maximum vGRF and TTS, fPCA has the potential to provide meaningful insights into athlete monitoring models regarding changes to movement characteristics after injury.     

Predicting gait events from tibial acceleration in rearfoot running: A structured machine learning approach

BackgroundGait event detection of the initial contact and toe off is essential for running gait analysis, allowing the derivation of parameters such as stance time. Heuristic-based methods exist to estimate these key gait events from tibial accelerometry. However, these methods are tailored to very specific acceleration profiles, which may offer complications when dealing with larger data sets and inherent biological variability.Research questionCan a structured machine learning approach achieve a more accurate prediction of running gait event timings from tibial accelerometry, compared to the previously utilised heuristic approaches?MethodsForce-based event detection acted as the criterion measure in order to assess the accuracy, repeatability and sensitivity of the predicted gait events. 3D tibial acceleration and ground reaction force data from 93 rearfoot runners were captured. A heuristic method and two structured machine learning methods were employed to derive initial contact, toe off and stance time from tibial acceleration signals.ResultsBoth a structured perceptron model (median absolute error of stance time estimation: 10.00 ± 8.73 ms) and a structured recurrent neural network model (median absolute error of stance time estimation: 6.50 ± 5.74 ms) significantly outperformed the existing heuristic approach (median absolute error of stance time estimation: 11.25 ± 9.52 ms). Thus, results indicate that a structured recurrent neural network machine learning model offers the most accurate and consistent estimation of the gait events and its derived stance time during level overground running.SignificanceThe machine learning methods seem less affected by intra- and inter-subject variation within the data, allowing for accurate and efficient automated data output during rearfoot overground running. Furthermore offering possibilities for real-time monitoring and biofeedback during prolonged measurements, even outside the laboratory.     

The biomechanics of running in athletes with previous hamstring injury: A case‐control study

Hamstring injury is prevalent with persistently high reinjury rates. We aim to inform hamstring rehabilitation by exploring the electromyographic and kinematic characteristics of running in athletes with previous hamstring injury. Nine elite male Gaelic games athletes who had returned to sport after hamstring injury and eight closely matched controls sprinted while lower limb kinematics and muscle activity of the previously injured biceps femoris, bilateral gluteus maximus, lumbar erector spinae, rectus femoris, and external oblique were recorded. Intergroup comparisons of muscle activation ratios and kinematics were performed. Previously injured athletes demonstrated significantly reduced biceps femoris muscle activation ratios with respect to ipsilateral gluteus maximus (maximum difference ?12.5%, P = 0.03), ipsilateral erector spinae (maximum difference ?12.5%, P = 0.01), ipsilateral external oblique (maximum difference ?23%, P = 0.01), and contralateral rectus femoris (maximum difference ?22%, P = 0.02) in the late swing phase. We also detected sagittal asymmetry in hip flexion (maximum 8°, P = 0.01), pelvic tilt (maximum 4°, P = 0.02), and medial rotation of the knee (maximum 6°, P = 0.03) effectively putting the hamstrings in a lengthened position just before heel strike. Previous hamstring injury is associated with altered biceps femoris associated muscle activity and potentially injurious kinematics. These deficits should be considered and addressed during rehabilitation.     

Plantar pressure measurements and running-related injury: A systematic review of methods and possible associations

Pressure-sensitive measuring devices have been identified as appropriate tools for measuring an array of parameters during running. It is unclear which biomechanical characteristics relate to running-related injury (RRI) and which data-processing techniques are most promising to detect this relationship. This systematic review aims to identify pertinent methodologies and characteristics measured using plantar pressure devices, and to summarise their associations with RRI. PubMed, Embase, CINAHL, ScienceDirect and Scopus were searched up until March 2015. Retrospective and prospective, biomechanical studies on running using any kind of pressure-sensitive device with RRI as an outcome were included. All studies involving regular or recreational runners were considered. The study quality was assessed and the measured parameters were summarised. One low quality, two moderate quality and five high quality studies were included. Five different subdivisions of plantar area were identified, as well as five instants and four phases of measurement during foot–ground contact. Overall many parameters were collated and subdivided as plantar pressure and force, plantar pressure and force location, contact area, timing and stride parameters. Differences between the injured and control group were found for mediolateral and anteroposterior displacement of force, contact area, velocity of force displacement, relative force–time integral, mediolateral force ratio, time to peak force and inter-stride correlative patterns. However, no consistent results were found between studies and no biomechanical risk patterns were apparent. Additionally, conflicting findings were reported for peak force in three studies. Based on these observations, we provide suggestions for improved methodology measurement of pertinent parameters for future studies.     

Reliability of a field-based drop vertical jump screening test for ACL injury risk assessment

Objectives: There is an epidemic of anterior cruciate ligament (ACL) injuries in youth athletes. Poor neuromuscular control is an easily modifiable risk factor for ACL injury, and can be screened for by observing dynamic knee valgus on landing in a drop vertical jump test. This study aims to validate a simple, clinically useful population-based screening test to identify at-risk athletes prior to participation in organized sports. We hypothesized that both physicians and allied health professionals would be accurate in subjectively assessing injury risk in real-time field and office conditions without motion analysis data and would be in agreement with each other. Methods: We evaluated the inter-rater reliability of risk assessment by various observer groups, including physicians and allied health professionals, commonly involved in the care of youth athletes. Fifteen athletes age 11–17 were filmed performing a drop vertical jump test. These videos were viewed by 242 observers including orthopaedic surgeons, orthopaedic residents/fellows, coaches, athletic trainers (ATCs), and physical therapists (PTs), with the observer asked to subjectively estimate the risk level of each jumper. Objective injury risk was calculated using normalized knee separation distance (measured using Dartfish, Alpharetta, GA), based on previously published studies. Risk assessments by observers were compared to each other to determine inter-rater reliability, and to the objectively calculated risk level to determine sensitivity and specificity. Seventy one observers repeated the test at a minimum of 6 weeks later to determine intra-rater reliability. Results: Between groups, the inter-rater reliability was high, κ = 0.92 (95% CI 0.829–0.969, p < 0.05), indicating that no single group gave better (or worse) assessments, including comparisons between physicians and allied health professionals. With a screening cutoff isolated to subjects identified by observers as “high risk”, the sensitivity was 63.06% and specificity 82.81%. Reducing the screening cutoff to also include jumpers identified as “medium risk” increased sensitivity to 95.04% and decreased the specificity to 46.07%. Intra-rater reliability was moderate, κ = 0.55 (95% CI 0.49–0.61, p < 0.05), indicating that individual observers made reproducible risk assessments. Conclusions: This study supports the use of a simple, field-based observational drop vertical jump screening test to identify athletes at risk for ACL injury. Our study shows good inter- and intra-rater reliability and high sensitivity and suggests that screening can be performed without significant training by physicians as well as allied health professionals, including: coaches, athletic trainers and physical therapists. Identification of these high-risk athletes may play a role in enrollment in appropriate preventative neuromuscular training programs, which have been shown to decrease the incidence of ACL injuries in this population.     

Subclassification of recreational runners with a running-related injury based on running kinematics evaluated with marker-based two-dimensional video analysis

ObjectivesTo explore whether homogeneous subgroups could be discriminated within a population of recreational runners with a running-related injury based on running kinematics evaluated with marker-based two-dimensional video analysis.DesignCross-sectional.SettingResearch laboratory.ParticipantsFifty-three recreational runners (15 males, 38 females) with a running-related injury.Main outcome measuresFoot and tibia inclination at initial contact, and hip adduction and knee flexion at midstance were measured in the frontal and sagittal plane with marker-based two-dimensional video analysis during shod running on a treadmill at preferred speed. The four outcome measures were clustered using K-means cluster analysis (n = 2–10). Silhouette coefficients were used to detect optimal clustering.ResultsThe cluster analysis led to the classification of two distinct subgroups (mean silhouette coefficient = 0.53). Subgroup 1 (n = 39) was characterized by significantly greater foot inclination and tibia inclination at initial contact compared to subgroup 2 (n = 14).ConclusionThe existence of different subgroups demonstrate that the same running-related injury can be represented by different kinematic presentations. A subclassification based on the kinematic presentation may help clinicians in their clinical reasoning process when evaluating runners with a running-related injury and could inform targeted intervention strategy development.     

Maximal oxygen consumption and energy cost of running after a long-lasting running race: the 100 km of Sahara

The purpose of this study was to investigate the effects of a 120 km desert running race (5 stages over 4 days) on the main physiologic parameters related to the individual aerobic work capacity. Incremental treadmill tests were carried out on 7 recreational long-distance runners (age: 50.4±11.8 years; body mass: 76.0±8.5 kg; mean±SD) before and 3–5 days after the competition. Maximal oxygen consumption (), ventilatory threshold and heart rate were obtained by standard methods; the mean energy cost of running (Cr) above resting was calculated during the same protocol from the slope of the oxygen consumption versus running speed. After the race, the subjects exhibited significant (p<0.05) reductions only in (averaging 7%; from 46.7±5.1 to 43.2±4.4 ml · kg⁻¹ · mm⁻¹) and in maximal heart rate (averaging 3%; from 172.4±14.1 to 166.7±14.5 beats · min⁻¹). Knowledge of Cr (3.78±0.31 J · kg⁻¹ · m⁻¹ and 3.74±0.48 J · kg⁻¹ · m⁻¹, before and after the race respectively) allowed us to estimate the overall daily energy requirement, about 20 850 kJ. and the maximal heart rate seem to be the main variables affected by prolonged strenuous runs followed by insufficient rest periods.     

The effect of running on knee joint cartilage: A systematic review and meta-analysis

ObjectiveAlthough running causes inevitable stress to the joints, data regarding its effect on the cartilage of the knee are conflicting. This systematic review and meta-analysis aimed to evaluate the effect of running on knee joint cartilage.MethodsPubMed, EMBASE, SportDiscus, and Cochrane Library databases were searched to identify randomized controlled trials (RCTs) and cohort studies. The outcome indicators were cartilage oligomeric matrix protein (COMP), cartilage volume and thickness, and T2.ResultsA total of two RCTs and 13 cohort studies were included. There was no significant difference in cartilage volume between the running and control groups (MD, −115.88 U/I; 95% CI, −320.03 to 88.27; p = 0.27). However, running would decrease cartilage thickness (MD, −0.09 mm; 95%CI, −0.18 to −0.01; p = 0.03) and T2 (MD, −2.78 ms; 95% CI, −4.12 to −1.45; p < 0.001). Subgroup analysis demonstrated that COMP immediately or at 0.5 h after running was significantly increased, but there were no significant changes at 1 h or 2 h.ConclusionsRunning has advantages in promoting nutrition penetrating into the cartilage as well as squeezing out the metabolic substance, such as water. Our study found that running had a short-term adverse effect on COMP and did not affect cartilage volume or thickness.     

Foot type classification: a critical review of current methods

Investigation into the effects of foot structure on foot function, and the risks of injury, has been at the core of many studies, sometimes with conflicting results. Often different methods of foot type classification have been used, making comparison of the results and drawing sound conclusions impossible. This article aims to critically review current methods of foot type classification. It is concluded that if a classification method combines data on structure with information on foot function in dynamic loading situations, it should relate more closely to the functional behaviour of the foot during locomotion.     

Reliability and validity of 2-dimensional video analysis for a running task: A systematic review

ObjectiveEvaluate the reliability and validity of 2-dimensional (2D) video-based motion analysis during running.MethodsA systematic search of MEDLINE, Cochrane Library, EMBASE, CINAHL, PEDro, SPORTDiscus, and IEEE Xplore was conducted in March 2020 and updated in May 2021. We included studies assessing reliability and/or validity of 2D video-based motion analysis (gold standard: 3D motion analysis) during running.Results11 studies (251 runners; mean age range: 18.7–37.0 years; 57.4% female; 63.7% injury-free) met inclusion criteria. Eight studies examined kinematics of the pelvis/hip, eight of the knee, and six of the ankle/foot. Low-to-moderate risk of bias was present in all studies. Heterogeneous study designs, measurement methods, and statistical approaches across studies precluded statistical synthesis. Intrarater reliability [Interclass correlation coefficient (ICC) range: 0.56–1.00; kappa range: 0.49–0.81] was better than interrater reliability (ICC range: 0.31–1.00; kappa range 0.00–0.85). ICC values for validity were poor to good (0.06–0.89). One study examining foot strike pattern found good to excellent validity (using Gwet AC statistics) when movement kinematics were categorized.ConclusionsA wide range of methods were reported in 2D video-based motion analysis of joint angular kinematics during a running task. Further research to develop standardized 2D video-based motion analysis for running is needed. Categorizing movement patterns may be more useful than angularly quantifying joint kinematics.     

Development of a preliminary evidence-based neuromusculoskeletal exercise guideline to reduce injury risk in the lower limb

Athletic participation growth has resulted in increased exposures and neuromusculoskeletal (NMSK) non-contact injuries. Based on current evidence, the primary objective of this literature review is to create a preliminary evidence-based NMSK exercise guideline, addressing these intrinsic modifiable risk factors. Systematic searches were conducted September 2014 prior to data extraction utilizing CINAHL Plus (1995 to September 2014), MEDLINE (1995 to September 2014), and Academic Search Premier (1995 to September 2014). A priori defined inclusion criteria were applied and included the following: (i) full text, (ii) published in English, (iii) peer-reviewed articles addressing injury risk of non-contact lower extremity injury, (iv) identified specific exercises aimed at reducing injury risk of non-contact lower extremity injury, were the key data extraction points of interest. 3163 potential articles were identified from the initial search, 3120 excluded with reason based on the exclusion criteria. Exclusion criteria was applied in the form of an eight item list summarized in table 2, 43 articles remained after search criteria were applied. Novel to the current body of knowledge, this review identified nine intrinsic modifiable risk factors of the NMSK system that were used as a foundation to create the exercise guideline consisting of 30 exercise techniques.     

Effects of a foot strengthening program on foot muscle morphology and running mechanics: A proof-of-concept,single-blind randomized controlled trial

ObjectivesTo investigate the effects of a foot training program on muscle morphology and strength as well as running biomechanics in healthy recreational runners.DesignProof-of-concept, single-blind randomized controlled trial.SettingsRunners were allocated to a control (CG) or an intervention (IG) group. The intervention focused on strengthening the intrinsic foot muscles and their activation during weight-bearing activities. All participants were assessed at baseline and after 8-weeks.ParticipantsTwenty-eight healthy recreational long-distance runners not habituated to minimalist running shoes or barefoot running.Main outcomes measuresOutcomes were hallux and toes strength; foot function, cross-sectional area and volume of the abductor hallucis (ABH), abductor digiti minimi (ABV), flexor digitorum brevis (FDB), and flexor hallucis brevis; medial longitudinal arch range of motion and stiffness; vertical and antero-posterior propulsive impulses during running.ResultsCompared to the CG, an increase was found in the IG for the volume of all muscles investigated and for vertical propulsive impulse during running. Correlations were found between vertical propulsive impulse and volume of ABH(r = 0.40), ABV(r = 0.41), and FDB(r = 0.69).ConclusionThe foot exercise protocol effectively increased intrinsic foot muscle volume and propulsive forces in recreational runners. This shows that intrinsic muscle strengthening affects running mechanics and suggests that it may improve running performance.     

The effects & mechanisms of increasing running step rate: A feasibility study in a mixed-sex group of runners with patellofemoral pain

ObjectivesTo explore feasibility of recruitment and retention of runners with patellofemoral pain (PFP), before delivering a step rate intervention.DesignFeasibility study.SettingHuman performance laboratory.ParticipantsA mixed-sex sample of runners with PFP (n = 11).Main outcome measuresAverage/worst pain and the Kujala Scale were recorded pre/post intervention, alongside lower limb kinematics and surface electromyography (sEMG), sampled during a 3 KM treadmill run.ResultsRecruitment and retention of a mixed-sex cohort was successful, losing one participant to public healthcare and with kinematic and sEMG data lost from single participants only. Clinically meaningful reductions in average (MD = 2.1, d = 1.7) and worst pain (MD = 3.9, d = 2.0) were observed. Reductions in both peak knee flexion (MD = 3.7°, d = 0.78) and peak hip internal rotation (MD = 5.1°, d = 0.96) were observed, which may provide some mechanistic explanation for the identified effects. An increase in both mean amplitude (d = 0.53) and integral (d = 0.58) were observed for the Vastus Medialis Obliqus (VMO) muscle only, of questionable clinical relevance.ConclusionsRecruitment and retention of a mixed sex PFP cohort to a step rate intervention involving detailed biomechanical measures is feasible. There are indications of both likely efficacy and associated mechanisms. Future studies comparing the efficacy of different running retraining approaches are warranted.     

Risk factors for lower extremity injuries among half marathon and marathon runners of the Lage Landen Marathon Eindhoven 2012: A prospective cohort study in the Netherlands

To determine risk factors for running injuries during the Lage Landen Marathon Eindhoven 2012. Prospective cohort study. Population‐based study. This study included 943 runners. Running injuries after the Lage Landen Marathon. Sociodemographic and training‐related factors as well as lifestyle factors were considered as potential risk factors and assessed in a questionnaire 1 month before the running event. The association between potential risk factors and injuries was determined, per running distance separately, using univariate and multivariate logistic regression analysis. In total, 154 respondents sustained a running injury. Among the marathon runners, in the univariate model, body mass index ≥ 26 kg/m², ≤ 5 years of running experience, and often performing interval training, were significantly associated with running injuries, whereas in the multivariate model only ≤ 5 years of running experience and not performing interval training on a regular basis were significantly associated with running injuries. Among marathon runners, no multivariate model could be created because of the low number of injuries and participants. This study indicates that interval training on a regular basis may be recommended to marathon runners to reduce the risk of injury.