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.

The Sprint Mechanics Assessment Score: A Qualitative Screening Tool for the In-field Assessment of Sprint Running Mechanics.

BACKGROUND: Qualitative movement screening tools provide a practical method of assessing mechanical patterns associated with potential injury development. Biomechanics play a role in hamstring strain injury and are recommended as a consideration within injury screening and rehabilitation programs. However, no methods are available for the in-field assessment of sprint running mechanics associated with hamstring strain injuries. PURPOSE: To investigate the intra- and interrater reliability of a novel screening tool assessing in-field sprint running mechanics titled the Sprint Mechanics Assessment Score (S-MAS) and present normative S-MAS data to facilitate the interpretation of performance standards for future assessment uses. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 3. METHODS: Maximal sprint running trials (35 m) were recorded from 136 elite soccer players using a slow-motion camera. All videos were scored using the S-MAS by a single assessor. Videos from 36 players (18 men and 18 women) were rated by 2 independent assessors blinded to each other's results to establish interrater reliability. One assessor scored all videos in a randomized order 1 week later to establish intrarater reliability. Intraclass correlation coefficients (ICCs) based on single measures using a 2-way mixed-effects model, with absolute agreement with 95% CI and kappa coefficients with percentage agreements, were used to assess the reliability of the overall score and individual score items, respectively. T-scores were calculated from the means and standard deviations of the male and female groups to present normative data values. The Mann-Whitney U test and the Wilcoxon signed-rank test were used to assess between-sex differences and between-limb differences, respectively. RESULTS: The S-MAS showed good intrarater (ICC, 0.828 [95% CI, 0.688-0.908]) and interrater (ICC, 0.799 [95% CI, 0.642-0.892]) reliability, with a standard error of measurement of 1 point. Kappa coefficients for individual score items demonstrated moderate to substantial intra- and interrater agreement for most parameters, with percentage agreements ranging from 75% to 88.8% for intrarater and 66.6% to 88.8% for interrater reliability. No significant sex differences were observed for overall scores, with mean values of 4.2 and 3.8 for men and women, respectively (P = .27). CONCLUSION: The S-MAS is a new tool developed for assessing sprint running mechanics associated with lower limb injuries in male and female soccer players. The reliable and easy-to-use nature of the S-MAS means that this method can be integrated into practice, potentially aiding future injury screening and research looking to identify athletes who may demonstrate mechanical patterns potentially associated with hamstring strain injuries.

Using wearable technology data to explain recreational running injury: A prospective longitudinal feasibility study.

OBJECTIVES: Investigate 1) if collecting and analysing wristwatch inertial measurement unit (IMU) and global positioning system (GPS) data using a commercially-available training platform was feasible in recreational runners and 2) which variables were associated with subsequent injury. DESIGN: Prospective longitudinal cohort. PARTICIPANTS: Healthy recreational runners. MAIN OUTCOME MEASURES: We set a priori feasibility thresholds for recruitment (maximum six-months), acceptance (minimum 80%), adherence (minimum 70%), and data collection (minimum 80%). Participants completed three patient-reported outcome measures (PROMS) detailing their psychological health, sleep quality, and intrinsic motivation to run. We extracted baseline anthropometric, biomechanical, metabolic, and training load data from their IMU/GPS wristwatch for analysis. Participants completed a weekly injury status surveillance questionnaire over the next 12-weeks. Feasibility outcomes were analysed descriptively and injured versus non-injured group differences with 95% confidence intervals were calculated for PROM/IMU/GPS data. RESULTS: 149 participants consented; 86 participants completed (55 men, 31 women); 21 developed an injury (0.46 injuries/1000km). Feasibility outcomes were satisfied (recruitment = 47 days; acceptance = 133/149 [89%]; adherence = 93/133 [70%]; data collection = 86/93 [92%]). Acute load by calculated effort was associated with subsequent injury (mean difference -562.14, 95% CI -1019.42, -21.53). CONCLUSION: Collecting and analysing wristwatch IMU/GPS data using a commercially-available training platform was feasible in recreational runners.

Exploring the Role of Sprint Biomechanics in Hamstring Strain Injuries: A Current Opinion on Existing Concepts and Evidence.

Hamstring strain injuries are one of the most common injuries in sprint-based sports with the mechanism of injury considered the result of an interaction between applied mechanical strain and the capacity of the muscle to tolerate strain. To date, injury prevention and rehabilitation strategies have frequently focused on enhancing the capacity of the hamstrings to tolerate strain, with little consideration of factors directly influencing mechanical strain. Sprint running biomechanics are one factor proposed to influence the mechanical strain applied to the hamstrings that may be modified (towards reduced strain) within rehabilitation and injury prevention programs. This article aims to explore the theoretical mechanistic link between sprint running mechanics and hamstring strain injury, along with the available supporting evidence. In doing so, it hopes to provide practitioners with an understanding of mechanical parameters that may influence hamstring strain injury whilst also identifying areas for further research exploration.

Force plate methodologies applied to injury profiling and rehabilitation in sport: A scoping review protocol.

Musculoskeletal injuries are a common health problem among sporting populations. Such injuries come with a high financial burden to the involved organisations and can have a detrimental impact on the career attainment of injured individuals. Force plates are now a common tool available to sport and exercise science and medicine professionals to enable them to profile injury risk predisposition and modulate the rehabilitation process within sporting environments. This is because contemporary force plate technology is portable and affordable and often comes with software that enables the automatic and immediate feedback of test variables to key stakeholders. However, to our knowledge, to date, there has been no comprehensive review of the scientific literature pertaining to clinical applications of force plate technology. Therefore, this article presents a protocol and a methodological framework to perform a scoping review to identify and map the available scientific literature in which force plates have been applied to the injury profiling and rehabilitation of athletes. The specific aims of the scoping review are 1) to identify and describe the force plate tests, methodologies, and metrics used to screen for injury risk and guide the return of injured athletes to full-time training and competition, 2) to identify potential trends and/or differences by participants' age, sex, and/or level of performance in tests, methodologies, and metrics selected, and 3) to identify key gaps in the existing evidence base and new questions that should be addressed in future research. The global aim of the scoping review is to improve practitioner decision-making around force plate test and variable selection when applied to the injury prevention and rehabilitation of sporting populations.

The Kneeling Isometric Plantar Flexor Test: Preliminary Reliability and Feasibility in Professional Youth Football.

Calf injuries are common in professional football; thus, the establishment of reliable and time-efficient methods of measuring the peak force capabilities of the plantar flexors with equipment that is accessible to football practitioners is valuable. In this study, we determined the preliminary reliability and feasibility of a new test, termed the kneeling isometric plantar flexion test (KIPFT), for footballers. Twenty-one male youth footballers (age = 17.8 ± 1.1 years, height = 182 ± 5 cm, weight = 77.6 ± 5.9 kg) from English League One football clubs completed three trials of the KIPFT on a wireless force plate at the end (2022-2023) and start (2023-2024) of the season. The within-session reliability of the peak force (relative to body weight) was good-excellent for both limbs and both occasions. On average, performance of the KIPFT took just over 1 min per limb and ~2 min to set up. The peak force values were larger for the non-dominant limbs only at the start versus the end of the season, but there were no between-limb differences. From these results, it was determined that (1) the KIPFT is feasible, (2) a minimum of 32 footballers would be required to establish its between-session reliability with ≥80% statistical power and (3) large-cohort normative data for the KIPFT may be best collected at the start of the football season.

Kinematic Characteristics of Male Runners With a History of Recurrent Calf Muscle Strain Injury.

BACKGROUND: Calf muscle strain injuries are a common running injury affecting male runners and are known to have high reoccurrence rates. Currently, limited evidence exists investigating factors associated with this injury with no previous study investigating the running kinematics of male runners with a history of repeat calf muscle strain injuries. PURPOSE: To investigate whether male runners with a history of repeat calf muscle strain injury demonstrate differences in stance phase running kinematics when compared to healthy controls. STUDY DESIGN: Case-control investigation. LEVEL OF EVIDENCE: 3b. METHODS: Stance phase kinematics were compared between 15 male runners with a history of calf muscle strain injury and 15 male control participants during treadmill running at 3.2m/s. Independent t-tests were used to compare differences in stance phase kinematic parameters between groups and effect sizes were calculated using Cohen's d. RESULTS: The group with a history of calf muscle strain injury demonstrated a significant 2.1° and 3.1° increase in contralateral pelvic drop and anterior pelvic tilt during mid stance. In addition, this group exhibited longer stance times and a more anterior tilted pelvis, flexed hip and a greater distance between the heel and centre of mass at initial contact. Large effect sizes, greater than 0.8, were observed for all differences. No significant differences were observed for ankle and knee joint kinematics between the groups. CONCLUSION: This is the first study to identify kinematic characteristics associated with recurrent calf muscle strain injury. While it is not possible to determine causality, the observed kinematic differences may contribute to recurrent nature of this injury. Specifically, it is possible that neuromuscular deficits of the hip and calf muscle complex may lead to increased strain on the calf complex. Rehabilitation interventions which focus on addressing pelvis and hip kinematics may reduce the demands placed upon the calf complex and could prove clinically effective.

The between-day repeatability, standard error of measurement and minimal detectable change for discrete kinematic parameters during treadmill running.

BACKGROUND: Kinematic parameters of the trunk, pelvis and lower limbs are frequently associated with both running injuries and performance, and the target of clinical interventions. Currently there is limited evidence reporting the between-day repeatability of discrete kinematic parameters of the trunk, pelvis and lower limbs during treadmill running. RESEARCH QUESTION: What is the between-day repeatability, standard error of measurement and minimal detectable change of discrete kinematic parameters of the trunk, pelvis and lower limbs during treadmill running? METHODS: 16 healthy participants attended two kinematic data collection sessions two weeks apart. Three-dimensional kinematic data were collected while participants ran on a motorised treadmill at 3.2 m/s. The interclass correlation coefficient, standard error of measurement and minimal detectable change were calculated for discrete kinematic parameters at initial contact, toe off, peak angles and joint excursions during the stance phase of running. RESULTS: Good to excellent repeatability with low standard error of measurement and minimal detectable change values were observed for sagittal and frontal plane kinematics at initial contact (Range: ICC, 0.829-0.941; SEM, 0.6°- 2.6°; MDC, 1.5°- 7.2) and peak angles during stance (Range: ICC, 0.799 - 0.946; SEM, 0.6°- 2.6°; MDC, 1.7°- 7.1°). Peak transverse plane kinematics of the hip (ICC, 0.783; SEM, 3.2°; MDC, 8.7°) and knee (ICC, 0.739; SEM, 3°; MDC, 8.4°) demonstrated moderate between-day repeatability with large SEM and MDC values. Kinematics at toe off demonstrated the lowest ICC values and largest measurement errors of all parameters (Range: ICC, 0.109 - 0.900; SEM, 0.8°- 5.7°; MDC, 2.5°- 15.7°). SIGNIFICANCE: This is the first study detailing the measurement error and minimal detectable change for discrete kinematic parameters of the trunk and pelvis during treadmill running. The reported values may provide a useful reference point for future studies investigating between-day differences in running kinematics.

The biomechanical characteristics of high-performance endurance running.

The biomechanical profile of high-level endurance runners may represent a useful model that could be used for developing training programmes designed to improve running style. This study, therefore, sought to compare the biomechanical characteristics of high-performance and recreational runners. Kinematic and kinetic measurements were taken during overground running from a cohort of 14 high-performance (8 male) and 14 recreational (8 male) runners, at four speeds ranging from 3.3 to 5.6 m s-1. Two-way ANOVA analysis was then used to explore group and speed effects and principal component analysis used to explore the interdependence of the tested variables. The data showed the high-performance runners to have a gait style characterised by an increased vertical velocity of the centre of mass and a flight time that was 11% longer than the recreational group. The high-performance group were also observed to adopt a forefoot strike pattern, to contact the ground with their foot closer to their body and to have a larger ankle moment. Importantly, although observed group differences were mostly independent of speed, the tested variables showed a high degree of interdependence suggesting an underlying unitary phenomenon. This is the first study to compare high-performance and recreational runners across a full range of kinematic and kinetic variables. The results suggest that high-performance runners maintain stride length with a prolonged aerial phase, rather than by landing with a more extended knee. These findings motivate future intervention studies that should investigate whether recreational runners could benefit from instruction to decrease shank inclination at foot contact.

A 10% Increase in Step Rate Improves Running Kinematics and Clinical Outcomes in Runners With Patellofemoral Pain at 4 Weeks and 3 Months.

BACKGROUND: Aberrant frontal-plane hip and pelvis kinematics have been frequently observed in runners with patellofemoral pain (PFP). Gait retaining interventions have been shown to improve running kinematics and may therefore be beneficial in runners with PFP. PURPOSE: To investigate whether a 10% increase in the running step rate influences frontal-plane kinematics of the hip and pelvis as well as clinical outcomes in runners with PFP. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Runners with PFP underwent a 3-dimensional gait analysis to confirm the presence of aberrant frontal-plane hip and/or pelvis kinematics at baseline. A total of 12 participants with frontal-plane hip and/or pelvis kinematics 1 standard deviation above a reference database were invited to undergo the gait retraining intervention. Running kinematics along with clinical outcomes of pain and functional outcomes were recorded at baseline, 4 weeks after retraining, and 3 months. Gait retraining consisted of a single session where step rate was increased by 10% using an audible metronome. Participants were asked to continue their normal running while self-monitoring their step rate using a global positioning system smartwatch and audible metronome. RESULTS: After gait retraining, significant improvements in running kinematics and clinical outcomes were observed at 4-week and 3-month follow-up. Repeated-measures analysis of variance with post hoc Bonferroni correction (P < .016) showed significant reductions in peak contralateral pelvic drop (mean difference [MD], 3.12° [95% CI, 1.88°-4.37°]), hip adduction (MD, 3.99° [95% CI, 2.01°-5.96°]), and knee flexion (MD, 4.09° [95% CI, 0.04°-8.15°]) as well as significant increases in self-reported weekly running volume (MD, 13.78 km [95% CI, 4.62-22.93 km]) and longest run pain-free (MD, 6.84 km [95% CI, 3.05-10.62 km]). Friedman test with a post hoc Wilcoxon signed-rank test showed significant improvements on a numerical rating scale for worst pain in the past week and the Lower Extremity Functional Scale. CONCLUSION: A single session of gait retraining using a 10% increase in step rate resulted in significant improvements in running kinematics, pain, and function in runners with PFP. These improvements were maintained at 3-month follow-up. It is important to assess for aberrant running kinematics at baseline to ensure that gait interventions are targeted appropriately. REGISTRATION: NCT03067545 (ClinicalTrials.gov identifier).

Is There a Pathological Gait Associated With Common Soft Tissue Running Injuries?

BACKGROUND: Previous research has demonstrated clear associations between specific running injuries and patterns of lower limb kinematics. However, there has been minimal research investigating whether the same kinematic patterns could underlie multiple different soft tissue running injuries. If they do, such kinematic patterns could be considered global contributors to running injuries. HYPOTHESIS: Injured runners will demonstrate differences in running kinematics when compared with injury-free controls. These kinematic patterns will be consistent among injured subgroups. STUDY DESIGN: Controlled laboratory study. METHODS: The authors studied 72 injured runners and 36 healthy controls. The injured group contained 4 subgroups of runners with either patellofemoral pain, iliotibial band syndrome, medial tibial stress syndrome, or Achilles tendinopathy (n = 18 each). Three-dimensional running kinematics were compared between injured and healthy runners and then between the 4 injured subgroups. A logistic regression model was used to determine which parameters could be used to identify injured runners. RESULTS: The injured runners demonstrated greater contralateral pelvic drop (CPD) and forward trunk lean at midstance and a more extended knee and dorsiflexed ankle at initial contact. The subgroup analysis of variance found that these kinematic patterns were consistent across each of the 4 injured subgroups. CPD was found to be the most important variable predicting the classification of participants as healthy or injured. Importantly, for every 1° increase in pelvic drop, there was an 80% increase in the odds of being classified as injured. CONCLUSION: This study identified a number of global kinematic contributors to common running injuries. In particular, we found injured runners to run with greater peak CPD and trunk forward lean as well as an extended knee and dorsiflexed ankle at initial contact. CPD appears to be the variable most strongly associated with common running-related injuries. CLINICAL RELEVANCE: The identified kinematic patterns may prove beneficial for clinicians when assessing for biomechanical contributors to running injuries.

Are the arms and head required to accurately estimate centre of mass motion during running?

Accurate measurement of centre of mass (CoM) motion can provide valuable insight into the biomechanics of human running. However, full-body kinematic measurement protocols can be time consuming and difficult to implement. Therefore, this study was performed to understand whether CoM motion during running could be estimated from a model incorporating only lower extremity, pelvic and trunk segments. Full-body kinematic data was collected whilst (n=12) participants ran on a treadmill at two speeds (3.1 and 3.9ms-1). CoM trajectories from a full-body model (16-segments) were compared to those estimated from a reduced model (excluding the head and arms). The data showed that, provided an offset was included, it was possible to accurately estimate CoM trajectory in both the anterior-posterior and vertical direction, with root mean square errors of 5mm in both directions and close matches in waveform similarity (r=0.975-1.000). However, in the ML direction, there was a considerable difference in the CoM trajectories of the two models (r=0.774-0.767). This finding suggests that a full-body model is required if CoM motions are to be measured in the ML direction. The mismatch between the reduced and full-body model highlights the important contribution of the arms to CoM motion in the ML direction. We suggest that this control strategy, of using the arms rather than the heavier trunk segments to generate CoM motion, may lead to less variability in CoM motion in the ML direction and subsequently less variability in step width during human running.

How do elite endurance runners alter movements of the spine and pelvis as running speed increases?

Elite endurance runners are characterised by their performance ability and higher running economy. However, there is relatively little research aimed at identifying the biomechanical characteristics of this group. This study aimed to understand how motions of the pelvis, lumbar spine and thorax change with speed in a cohort of elite endurance runners (n=14) and a cohort of recreational runners (n=14). Kinematic data were collected during over ground running at four speeds ranging from 3.3 to 5.6ms(-1) and a linear mixed model used to understand the effect of speed on both range of motion and mean sagittal inclination. The results showed the two groups to exhibit similar changes in range of motion as speed was increased, with the most pronounced increases being observed in the transverse plane. However, the adaptation of thorax inclination with speed differed between the two groups. Whereas the recreational runners increased thorax inclination as running speed was increased, elite endurance runners consistently maintained a more upright thorax position. This is the first study to identify specific differences in upper body motions between recreational and elite runners and the findings may have implications for training protocols aimed at improving running performance.

The coordinated movement of the spine and pelvis during running.

Previous research into running has demonstrated consistent patterns in pelvic, lumbar and thoracic motions between different human runners. However, to date, there has been limited attempt to explain why observed coordination patterns emerge and how they may relate to centre of mass (CoM) motion. In this study, kinematic data were collected from the thorax, lumbar spine, pelvis and lower limbs during over ground running in n=28 participants. These data was subsequently used to develop a theoretical understanding of the coordination of the spine and pelvis in all three body planes during the stance phase of running. In the sagittal plane, there appeared to be an antiphase coordinate pattern which may function to increase femoral inclination at toe off whilst minimising anterior-posterior accelerations of the CoM. In the medio-lateral direction, CoM motion appears to facilitate transition to the contralateral foot. However, an antiphase coordination pattern was also observed, most likely to minimise unnecessary accelerations of the CoM. In the transverse plane, motion of the pelvis was observed to lag slightly behind that of the thorax. However, it is possible that the close coupling between these two segments facilitates the thoracic rotation required to passively drive arm motion. This is the first study to provide a full biomechanical rationale for the coordination of the spine and pelvis during human running. This insight should help clinicians develop an improved understanding of how spinal and pelvic motions may contribute to, or result from, common running injuries.

A comparison of kinematic algorithms to estimate gait events during overground running.

The gait cycle is frequently divided into two distinct phases, stance and swing, which can be accurately determined from ground reaction force data. In the absence of such data, kinematic algorithms can be used to estimate footstrike and toe-off. The performance of previously published algorithms is not consistent between studies. Furthermore, previous algorithms have not been tested at higher running speeds nor used to estimate ground contact times. Therefore the purpose of this study was to both develop a new, custom-designed, event detection algorithm and compare its performance with four previously tested algorithms at higher running speeds. Kinematic and force data were collected on twenty runners during overground running at 5.6m/s. The five algorithms were then implemented and estimated times for footstrike, toe-off and contact time were compared to ground reaction force data. There were large differences in the performance of each algorithm. The custom-designed algorithm provided the most accurate estimation of footstrike (True Error 1.2 ± 17.1 ms) and contact time (True Error 3.5 ± 18.2 ms). Compared to the other tested algorithms, the custom-designed algorithm provided an accurate estimation of footstrike and toe-off across different footstrike patterns. The custom-designed algorithm provides a simple but effective method to accurately estimate footstrike, toe-off and contact time from kinematic data.