A 2-Year Prospective Cohort Study of Overuse Running Injuries: The Runners and Injury Longitudinal Study (TRAILS).

BACKGROUND: The National Center for Injury Prevention and Control, noting flaws in previous running injury research, called for more rigorous prospective designs and comprehensive analyses to define the origin of running injuries. PURPOSE: To determine the risk factors that differentiate recreational runners who remain uninjured from those diagnosed with an overuse running injury during a 2-year observational period. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Inclusion criteria were running a minimum of 5 miles per week and being injury free for at least the past 6 months. Data were collected at baseline on training, medical and injury histories, demographics, anthropometrics, strength, gait biomechanics, and psychosocial variables. Injuries occurring over the 2-year observation period were diagnosed by an orthopaedic surgeon on the basis of predetermined definitions. RESULTS: Of the 300 runners who entered the study, 199 (66%) sustained at least 1 injury, including 73% of women and 62% of men. Of the injured runners, 111 (56%) sustained injuries more than once. In bivariate analyses, significant ( P ≤ .05) factors at baseline that predicted injury were as follows: Short Form Health Survey-12 mental component score (lower mental health-related quality of life), Positive and Negative Affect Scale negative affect score (more negative emotions), sex (higher percentage of women were injured), and knee stiffness (greater stiffness was associated with injury); subsequently, knee stiffness was the lone significant predictor of injury (odds ratio = 1.18) in a multivariable analysis. Flexibility, quadriceps angle, arch height, rearfoot motion, strength, footwear, and previous injury were not significant risk factors for injury. CONCLUSION: The results of this study indicate the following: (1) among recreational runners, women sustain injuries at a higher rate than men; (2) greater knee stiffness, more common in runners with higher body weights (≥80 kg), significantly increases the odds of sustaining an overuse running injury; and (3) contrary to several long-held beliefs, flexibility, arch height, quadriceps angle, rearfoot motion, lower extremity strength, weekly mileage, footwear, and previous injury are not significant etiologic factors across all overuse running injuries.

Temporal changes in the required shoe-floor friction when walking following an induced slip.

Biomechanical aspects of slips and falls have been widely studied to facilitate fall prevention strategies. Prior studies have shown changes in gait after an induced slipping event. As such, most researchers only slip participants one time to avoid such changes that would otherwise reduce the external validity of experimental results. The ability to slip participants more than once, after allowing gait to return to a natural baseline, would improve the experimental efficiency of such studies. Therefore, the goal of this study was to characterize the temporal changes in required shoe-floor friction when walking following an induced slip. Two experiments were completed, and each employed a different potential strategy to promote the return of gait to a natural baseline after slipping. In the first experiment, extended time away from the laboratory was used to promote the return of gait to baseline. We measured required coefficient-of-friction among 36 young adult male participants over four sessions. The first three sessions provided measurements during baseline (i.e., natural gait) both prior to slipping and immediately after slipping. The fourth session provided a measurement 1-12 weeks after slipping. In the second experiment, an extensive number of walking trials was used to promote the return of gait to baseline. We measured required coefficient-of-friction among 10 young adult male participants in a single session. Measurements were collected during 10 baseline walking trials, immediately after slipping, and during 50-55 additional trials. In both experiments, required coefficient-of-friction decreased 12-16% immediately after a single slip, increased toward baseline levels over subsequent weeks/walking trials, but remained statistically different from baseline at the end of the experiments. Based on these results, experiments involving slipping participants multiple times may not have a high level of external validity, and researchers are encouraged to continue to limit experimental protocols to a single induced slip per participant.