Running Injury Paradigms and Their Influence on Footwear Design Features and Runner Assessment Methods: A Focused Review to Advance Evidence-Based Practice for Running Medicine Clinicians.

Many runners seek health professional advice regarding footwear recommendations to reduce injury risk. Unfortunately, many clinicians, as well as runners, have ideas about how to select running footwear that are not scientifically supported. This is likely because much of the research on running footwear has not been highly accessible outside of the technical footwear research circle. Therefore, the purpose of this narrative review is to update clinical readers on the state of the science for assessing runners and recommending running footwear that facilitate the goals of the runner. We begin with a review of basic footwear construction and the features thought to influence biomechanics relevant to the running medicine practitioner. Subsequently, we review the four main paradigms that have driven footwear design and recommendation with respect to injury risk reduction: Pronation Control, Impact Force Modification, Habitual Joint (Motion) Path, and Comfort Filter. We find that evidence in support of any paradigm is generally limited. In the absence of a clearly supported paradigm, we propose that in general clinicians should recommend footwear that is lightweight, comfortable, and has minimal pronation control technology. We further encourage clinicians to arm themselves with the basic understanding of the known effects of specific footwear features on biomechanics in order to better recommend footwear on a patient-by-patient basis.

Youth running consensus statement: minimising risk of injury and illness in youth runners.

Despite the worldwide popularity of running as a sport for children, relatively little is known about its impact on injury and illness. Available studies have focused on adolescent athletes, but these findings may not be applicable to preadolescent and pubescent athletes. To date, there are no evidence or consensus-based guidelines identifying risk factors for injury and illness in youth runners, and current recommendations regarding suitable running distances for youth runners at different ages are opinion based. The International Committee Consensus Work Group convened to evaluate the current science, identify knowledge gaps, categorise risk factors for injury/illness and provide recommendations regarding training, nutrition and participation for youth runners.

Running Dose and Risk of Developing Lower-Extremity Osteoarthritis.

Whether or not running leads to the development of knee and hip osteoarthritis has been a much-debated topic and is often a question patients pose to their physicians. Recent literature adds to a growing body of evidence suggesting that lower-dose running may be protective against the development of osteoarthritis, whereas higher-dose running may increase one's risk of developing lower-extremity osteoarthritis. However, running dose remains challenging to define, leading to difficulty in providing firm recommendations to patients regarding the degree of running which may be safe. Furthermore, when counseling patients regarding their risk of developing lower-extremity osteoarthritis secondary to running, clinicians must consider many additional factors, such as the numerous health benefits from running and individual risk factors for developing osteoarthritis.

Medical encounters (including injury and illness) at mass community-based endurance sports events: an international consensus statement on definitions and methods of data recording and reporting.

Mass participation endurance sports events are popular but a large number of participants are older and may be at risk of medical complications during events. Medical encounters (defined fully in the statement) include those traditionally considered 'musculoskeletal' (eg, strains) and those due to 'illness' (eg, cardiac, respiratory, endocrine). The rate of sudden death during mass endurance events (running, cycling and triathlon) is between 0.4 and 3.3 per 100 000 entrants. The rate of other serious medical encounters (eg, exertional heat stroke, hyponatraemia) is rarely reported; in runners it can be up to 100 times higher than that of sudden death, that is, between 16 and 155 per 100 000 race entrants. This consensus statement has two goals. It (1) defines terms for injury and illness-related medical encounters, severity and timing of medical encounters, and diagnostic categories of medical encounters, and (2) describes the methods for recording data at mass participation endurance sports events and reporting results to authorities and for publication. This unifying consensus statement will allow data from various events to be compared and aggregated. This will inform athlete/patient management, and thus make endurance events safer.

Youth Distance Running: Strategies for Training and Injury Reduction.

Running is a popular sport for children in the United States. However, review of available literature on health effects and safety recommendations for youth running has not been previously conducted. Unique factors for injury include periods of growth during puberty and potential for growth plate injury. Youth runners may benefit from activities that incorporate high-impact loading and multidirectional movement for optimal bone maturation, exercises to strengthen tendons and muscles, and strategies aimed at improving running biomechanics to reduce risk of injury. In addition, addressing lifestyle factors, including nutrition and sleep is essential for a runner's general health. Similar to other sports, sports specialization should not be encouraged in youth runners. Reducing running-related injury in growing children and assessing readiness for running should be based on a combination of physical, emotional, psychological, social, and cognitive factors. Youth runners require individualized training and competition to safely participate in the sport.

A Descriptive Study of Self-Reported Injury in Non-elite Adaptive Athletes.

BACKGROUND: Adaptive sports programs are increasing across the country and there is a paucity of research investigating the epidemiology and sports injury risk factors in non-elite athletes. OBJECTIVE: To assess the demographics, training regime, and injuries incurred by adaptive athletes participating in local adaptive sports clubs and to assess the athletes' type of medical care and prevalence of those with spasticity. DESIGN: Descriptive cross-sectional study. SETTING: Local area adaptive sports teams and programs. PARTICIPANTS: Sixty-one athletes participating in wheelchair basketball, wheelchair rugby, sled hockey, and adaptive rowing were surveyed, with a response rate of 70.5%. INTERVENTIONS: Completion of self-report survey. OUTCOME: Report of injury prevalence, injury characteristics, type of medical care, and assessment of frequency and severity of spasticity using the Penn Spasm Frequency Scale. RESULTS: Most athletes (86%) trained or competed in their main sport 9-12 months per year. Most athletes (79.1%) trained at least 4 hours per week. In the past 12 months, 39.5% of athletes surveyed sustained an injury that required them to miss practice or a competition, with 58.8% of these athletes having sustained a significant injury. Many of those injured (64.7%) had never participated in an injury prevention or conditioning program. Injury prevalence by sport was 42.9% in wheelchair rugby, 60% in sled hockey, 44% wheelchair basketball, and 0% in adaptive rowing. The most commonly injured body parts were the shoulder (52.9%) and wrist (52.9%). CONCLUSIONS: This study shows that non-elite adaptive sports athletes sustain similar types of injuries as noted in published reports of elite athletes but could be provided with less injury prevention education and access to medical care. This area will require future study, especially investigating injury risk factors within specific sports and diagnoses. LEVEL OF EVIDENCE: III.

Optimal Running Dose and Cardiovascular Risk.

The cardiovascular benefits of regular exercise are well established. A mortality benefit has clearly been demonstrated for those that participate in light and moderate exercise. Less is known regarding the long-term effects of vigorous regular running over an extended period. In recent years, myocardial fibrosis, arrhythmias, and coronary artery calcium have been demonstrated in high-intensity exercisers. However, the prognostic implication of these findings remains unknown, and thus, there is insufficient evidence, and potentially not a need, to recommend a maximal running dose or limit for healthy individuals who already train intensively. For those otherwise healthy individuals who wish to run for cardiovascular health benefits, following the standard guidelines of 150 min of moderate-intensity exercise or 75 min of vigorous exercise weekly is recommended. Prevention and screening remain as key to lowering morbidity and mortality in all individuals.

Medial foot pain in a runner: a case presentation.

A 27-year-old runner presented to our sports medicine clinic with 4 months of medial foot pain after an eversion ankle sprain. Initial radiographs were negative for fracture. Her symptoms improved but plateaued after 1 month. She was unable to continue running and noticed a new prominence at her right medial foot. Results of a physical examination showed pes planus, a prominent navicular in her right foot and mild weakness of inversion at the right ankle. Magnetic resonance imaging showed bone edema adjacent to a navicular synchondrosis, which confirmed a diagnosis of type 2 accessory navicular with synchondrosis injury. The patient was treated conservatively with a progressive rehabilitation course.

Rehabilitation and return to running after lower limb stress fractures.

Lower limb stress fractures are common injuries in runners. In terms of treatment, much of the medical literature has focused primarily on rest and cessation of running, but little has been written about the rehabilitation and functional progression of runners following a lower limb stress fracture. This article reviews the scientific evidence behind common rehabilitation concepts used for runners recovering from these injuries and also discusses sport-specific training modalities such as deep water running and antigravity treadmill training. Overall this article is intended to be a practical resource for clinicians to guide runners in functional rehabilitation and return to running following lower limb stress injury.

Exercise in the older adult: from the sedentary elderly to the masters athlete.

The diverse exercise goals of the aging population present several challenges to physicians. Whereas some Masters athletes aim to set personal time records, sedentary elderly persons may look to exercise to help maintain independence and combat functional decline. This review article examines the common cardiovascular and neuromuscular physiological changes associated with aging and how regular exercise is used to improve physiological parameters and functional abilities. Exercise precautions specific to the elderly population are discussed. Exercise recommendations for persons with osteoarthritis and after joint arthroplasty also are presented.

Overview of spinal interventions.

Athletes represent a specific subgroup of highly motivated patients with a unique set of social and psychological incentives. Demands placed on the lumbosacral system are high, and athletes may be particularly prone to the pathology discussed above. For this reason, it is crucial to consider the athlete as a functional whole operating in concert with intrinsic and extrinsic factors and to consider the lumbosacral system within the context of the complete kinetic chain. Spinal interventions should never be considered in isolation but rather as part of a comprehensive rehabilitation program targeting psychosocial as well as biomechanical opportunities. When interventional procedures are warranted, they should be performed according to existing guidelines regarding indication, patient selection, and technique where possible and with systems in place to maximize patient safety and to consistently monitor for response. Each of the interventions discussed above should be performed with fluoroscopic guidance, given the lack of accuracy without fluoroscopy, and generally be reserved for athletes not responding to conservative care. When returning an athlete to play after ESI, we recommend careful serial evaluation as well as involvement of appropriate family members, athletic trainers, and coaches in the decision-making process. Athletes should not return to play with any significant objective neurologic deficits. In appropriate athletes, return to play should occur with graduated and comprehensive rehabilitation as discussed above. Because evidence concerning the interventions discussed in this article is often lacking, clinical judgment is paramount regarding their allocation. The interventions explored above likely do provide viable treatment adjuncts in the carefully selected athlete but are not without risk. Athlete safety and global well being should guide any decision to pursue interventional treatment options.

Radiating upper limb pain in the contact sport athlete: an update on transient quadriparesis and stingers.

Participation in contact sports exposes the athlete to a risk of cervical spine injury. Temporary neurological injuries manifesting as radiating arm pain or paresthesias, such as transient quadriparesis and stingers, present unique challenges for the sports medicine physician and will be reviewed in detail. The initial management of these conditions must recognize signs and symptoms of spinal cord injury and prevent further neurological sequelae. Evaluation will often include advanced imaging of the cervical spine in addition to serial neurological examinations. This review concludes with rational return-to-play guidelines for contact sport athletes.

Stress fractures in runners.

Running has many beneficial effects, including cardiovascular and skeletal health. Poor training technique and a variety of risk factors may predispose runners to lower-limb overuse injuries affecting muscle, tendon, and bone. Injuries to the bone include stress reactions to full-fledged stress fractures. This article is designed to provide an understanding of the general concepts involving bone strain, risk factor assessment, and evaluation and treatment strategies for the runner with a stress fracture. The second half of the article presents more detail regarding each specific fracture seen in runners. The ultimate goal of this article is to provide the basics regarding stress fractures in runners from pathophysiology and general guidelines of evaluation and treatment and provide a quick reference regarding the details of each specific fracture encountered in clinical practice.

Lumbar epidural steroid injections: indications, contraindications, risks, and benefits.

The clinical use of lumbar epidural steroid injections has increased dramatically. Although there are certainly beneficial effects to using epidural steroid injections in a treatment regimen for lumbar radicular pain, there is a lack of well designed, placebo-controlled studies to define conclusively specific indications and techniques for different spinal diagnoses. This article reviews the pathophysiology of lumbar radiculopathy and the use of epidural steroid injections as one treatment option, as well as describes their risks and benefits. Based on current literature, we offer an evidence-based perspective regarding rational use of lumbar epidural steroid injections for certain indications and treatment goals.

Sports and performing arts medicine: 1. Upper extremity injuries.

OBJECTIVE: This self-directed learning module highlights upper limb sports and performing arts injuries. It is part of the study guide on sports and performing arts medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. Using a case vignette format, this article specifically focuses on shoulder, elbow and finger pain in athletes and wrist pain in musicians. The goal of this article is to enhance the learner's understanding on how to approach common upper limb pain conditions and injuries in these populations.

Sports and performing arts medicine: 2. Lower extremity injuries.

OBJECTIVE: This self-directed learning module highlights lower limb sports and performing arts injuries. It is part of the study guide on sports and performing arts medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. Using a case vignette format, this article specifically focuses on hip, knee and ankle pain in athletes and performing artists. The goal of this article is to influence the learner's existing practice techniques for evaluating and managing common lower limb injuries in these populations.