Health and Economic Burden of Running-Related Injuries in Dutch Trailrunners: A Prospective Cohort Study.

BACKGROUND: Trailrunning is becoming very popular. However, the risk and burden of running-related injuries (RRI) in trailrunning is not well established. OBJECTIVE: To investigate the prevalence, injury rate, severity, nature, and economic burden of RRIs in Dutch trailrunners. METHODS: This prospective cohort study included 228 trailrunners aged 18 years or over (range 23-67), and was conducted between October 2013 and December 2014. After completing the baseline questionnaire, the Oslo Sports Trauma Research Center Questionnaire on Health Problems was administered every 2 weeks to collect data on RRIs. Participants who reported RRIs were asked about healthcare utilization (direct costs) and absenteeism from paid work (indirect costs). RRI was defined as disorders of the musculoskeletal system or concussions experienced or sustained during participation in running. RESULTS: The mean prevalence of RRIs measured over time was 22.4 % [95 % confidence interval (CI) 20.9-24.0], and the injury rate was 10.7 RRIs per 1000 h of running (95 % CI 9.4-12.1). The prevalence was higher for overuse (17.7 %; 95 % CI 15.9-19.5) than for acute (4.1 %; 95 % CI 3.3-5.0) RRIs. Also, the injury rate was higher for overuse (8.1; 95 % CI 6.9-9.3) than for acute (2.7; 95 % CI 2.0-3.4) RRIs. The median of the severity score was 35.0 [25-75 %, interquartile range (IQR) 22.0-55.7], and the median of the duration of RRIs was 2.0 weeks (IQR 2.0-6.0) during the study. The total economic burden of RRIs was estimated at €172.22 (95 % CI 117.10-271.74) per RRI, and €1849.49 (95 % CI 1180.62-3058.91) per 1000 h of running. An RRI was estimated to have a direct cost of €60.92 (95 % CI 45.11-94.90) and an indirect cost of €111.30 (95 % CI 61.02-192.75). CONCLUSIONS: The health and economic burden of RRIs presented in this study are significant for trailrunners and for society. Therefore, efforts should be made in order to prevent RRIs in trailrunners.

Lower limb alignment characteristics are not associated with running injuries in runners: Prospective cohort study.

There is conflicting evidence on the association between lower limb alignment characteristics and the incidence of running-related injury (RRI). Therefore, the primary aim of this study was to investigate the association between lower limb alignment characteristics and the incidence proportion of RRI in a convenience sample of recreational runners. A total of 89 recreational runners were included in this prospective cohort study. These participants had been running for at least six months and were injury-free at baseline. Lower limb alignment measurements were conducted in order to calculate lower limb discrepancy, Q-angle, subtalar angle and plantar index. All participants also answered a baseline and biweekly online surveys about their running routine, history of RRI and newly developed RRI over a period of 12 weeks. The prevalence of previous RRI and the 12-week incidence proportion of new RRI were calculated. Logistic regression analysis was performed to estimate the association between lower limb length discrepancy, Q-angle, subtalar angle and plantar ach index with the incidence proportion of RRI. The prevalence of previous RRI was 55.1% (n = 49). The 12-week incidence proportion of new RRI was 27.0% (n = 24). Muscle injuries and tendinopathies were the main types of RRI identified. The lower leg and the knee were the main anatomical regions affected. We did not find significant associations between lower limb length discrepancy, Q-angle, subtalar angle and plantar arch index and injury occurrence.

Meta-Analyses of the Effects of Habitual Running on Indices of Health in Physically Inactive Adults.

BACKGROUND: In order to implement running to promote physical activity, it is essential to quantify the extent to which running improves health. OBJECTIVE: The aim was to summarise the literature on the effects of endurance running on biomedical indices of health in physically inactive adults. DATA SOURCES: Electronic searches were conducted in October 2014 on PubMed, Embase, CINAHL, SPORTDiscus, PEDro, the Cochrane Library and LILACS, with no limits of date and language of publication. STUDY SELECTION: Randomised controlled trials (with a minimum of 8 weeks of running training) that included physically inactive but healthy adults (18-65 years) were selected. The studies needed to compare intervention (i.e. endurance running) and control (i.e., no intervention) groups. STUDY APPRAISAL AND SYNTHESIS METHODS: Two authors evaluated study eligibility, extracted data, and assessed risk of bias; a third author resolved any uncertainties. Random-effects meta-analyses were performed to summarise the estimates for length of training and sex. A dose-response analysis was performed with random-effects meta-regression in order to investigate the relationship between running characteristics and effect sizes. RESULTS: After screening 22,380 records, 49 articles were included, of which 35 were used to combine data on ten biomedical indices of health. On average the running programs were composed of 3.7 ± 0.9 sessions/week, 2.3 ± 1.0 h/week, 14.4 ± 5.4 km/week, at 60-90% of the maximum heart rate, and lasted 21.5 ± 16.8 weeks. After 1 year of training, running was effective in reducing body mass by 3.3 kg [95% confidence interval (CI) 4.1-2.5], body fat by 2.7% (95% CI 5.1-0.2), resting heart rate by 6.7 min(-1) (95% CI 10.3-3.0) and triglycerides by 16.9 mg dl(-1) (95% CI 28.1-5.6). Also, running significantly increased maximal oxygen uptake (VO2max) by 7.1 ml min(-1) kg(-1) (95% CI 5.0-9.1) and high-density lipoprotein (HDL) cholesterol by 3.3 mg dl(-1) (95% CI 1.2-5.4). No significant effect was found for lean body mass, body mass index, total cholesterol and low-density lipoprotein cholesterol after 1 year of training. In the dose-response analysis, larger effect sizes were found for longer length of training. LIMITATIONS: It was only possible to combine the data of ten out the 161 outcome measures identified. Lack of information on training characteristics precluded a multivariate model in the dose-response analysis. CONCLUSIONS: Endurance running was effective in providing substantial beneficial effects on body mass, body fat, resting heart rate, VO2max, triglycerides and HDL cholesterol in physically inactive adults. The longer the length of training, the larger the achieved health benefits. Clinicians and health authorities can use this information to advise individuals to run, and to support policies towards investing in running programs.

Descriptors used to define running-related musculoskeletal injury: a systematic review.

STUDY DESIGN: Systematic review. OBJECTIVES: To systematically review the descriptors used to define running-related musculoskeletal injury and to analyze the implications of different definitions on the results of studies. BACKGROUND: Studies have developed their own definitions of running-related musculoskeletal injuries based on different criteria. This may affect the rates of injury, which can be overestimated or underestimated due to the lack of a standard definition. METHODS: Searches were conducted in the Embase, PubMed, CINAHL, SPORTDiscus, LILACS, and SciELO databases, without limits on date of publication and language. Only articles that reported a definition of running-related injury were included. The definitions were classified according to 3 domains and subcategories: (1) presence of physical complaint (symptom, body system involved, region), (2) interruption of training or competition (primary sports involved, extent of injury, extent of limitation, interruption, period of injury), and (3) need for medical assistance. Spearman rank correlation was performed to evaluate the correlation between the completeness of definitions and the rates of injury reported in the studies. RESULTS: A total of 48 articles were included. Most studies described more than half of the subcategories, but with no standardization between the terms used within each category, showing that there is no consensus for a definition. The injury rates ranged between 3% and 85%, and tended to increase with less specific definitions. CONCLUSION: The descriptors commonly used by researchers to define a running-related injury vary between studies and may affect the rates of injuries. The lack of a standardized definition hinders comparison between studies and rates of injuries.

Kinesio taping to generate skin convolutions is not better than sham taping for people with chronic non-specific low back pain: a randomised trial.

QUESTION: For people with chronic low back pain, does Kinesio Taping, applied according to the treatment manual to create skin convolutions, reduce pain and disability more than a simple application without convolutions? DESIGN: Randomised trial with concealed allocation, intention-to-treat analysis and blinded assessment of some outcomes. PARTICIPANTS: 148 participants with chronic non-specific low back pain. INTERVENTION: Experimental group participants received eight sessions (over four weeks) of Kinesio Taping applied according to the Kinesio Taping Method treatment manual (ie, 10 to 15% tension applied in flexion to create skin convolutions in neutral). Control group participants received eight sessions (over four weeks) of Kinesio Taping with no tension, creating no convolutions. OUTCOME MEASURES: The primary outcome measures were pain intensity and disability after the four-week intervention. Secondary outcomes were pain intensity and disability 12 weeks after randomisation, and global perceived effect at both four and 12 weeks after randomisation. RESULTS: Applying Kinesio Tape to create convolutions in the skin did not significantly change its effect on pain (MD-0.4 points, 95% CI-1.3 to 0.4) or disability (MD-0.3 points, 95% CI-1.9 to 1.3) at four weeks. There was a small difference in favour of the experimental group for the secondary outcome of global perceived effect (MD 1.4 points, 95% CI 0.3 to 2.5) at four weeks. No significant between-group differences were observed for the other secondary outcomes. CONCLUSION: Kinesio Taping applied with stretch to generate convolutions in the skin was no more effective than simple application of the tape without tension for the outcomes measured. These results challenge the proposed mechanism of action of this therapy. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials, RBR-7ggfkv.

What are the main risk factors for running-related injuries?

BACKGROUND: Despite several studies that have been conducted on running injuries, the risk factors for running-related injuries are still not clear in the literature. OBJECTIVE: The aim of this study was to systematically review prospective cohort studies that investigated the risk factors for running injuries in general. DATA SOURCES: We conducted electronic searches without restriction of language on EMBASE (1980 to Dec 2012), PUBMED (1946 to Dec 2012), CINAHL (1988 to Dec 2012) SPORTDiscus (1977 to Dec 2012), Latin American and Caribbean Centre on Health Sciences Information (1985 to Dec 2012) and Scientific Electronic Library Online (1998 to Dec 2012) databases, using subject headings, synonyms, relevant terms and variant spellings for each database. STUDY SELECTION: Only prospective cohort studies investigating the risk factors for running-related musculoskeletal injuries were included in this review. Two independent reviewers screened each article and, if they did not reach a consensus, a third reviewer decided whether or not the article should be included. STUDY APPRAISAL AND SYNTHESIS METHODS: Year of publication, type of runners, sample size, definition of running-related musculoskeletal injury, baseline characteristics, reported risk factors and the statistical measurement of risk or protection association were extracted from the articles. A scale adapted by the authors evaluated the risk of bias of the articles. RESULTS: A total of 11 articles were considered eligible in this systematic review. A total of 4,671 pooled participants were analysed and 60 different predictive factors were investigated. The main risk factor reported was previous injury (last 12 months), reported in 5 of the 8 studies that investigated previous injuries as a risk factor. Only one article met the criteria for random selection of the sample and only six articles included a follow-up of 6 months or more. There was no association between gender and running injuries in most of the studies. LIMITATIONS: It is possible that eligible articles for this review were published in journals that were not indexed in any of the searched databases. We found a great heterogeneity of statistical methods between studies, which prevented us from performing a meta-analysis. CONCLUSIONS: The main risk factor identified in this review was previous injury in the last 12 months, although many risk factors had been investigated in the literature. Relatively few prospective studies were identified in this review, reducing the overall ability to detect risk factors. This highlights the need for more, well designed prospective studies in order to fully appreciate the risk factors associated with running.

Previous injuries and some training characteristics predict running-related injuries in recreational runners: a prospective cohort study.

QUESTIONS: What is the incidence of running-related injuries (RRIs) in recreational runners? Which personal and training characteristics predict RRIs in recreational runners? DESIGN: Prospective cohort study. PARTICIPANTS: A total of 200 recreational runners answered a fortnightly online survey containing questions about their running routine, races, and presence of RRI. These runners were followed-up for a period of 12 weeks. OUTCOME MEASURES: The primary outcome of this study was running-related injury. The incidence of injuries was calculated taking into account the exposure to running and was expressed by RRI/1000 hours. The association between potential predictive factors and RRIs was estimated using generalised estimating equation models. RESULTS: A total of 84 RRIs were registered in 60 (31%) of the 191 recreational runners who completed all follow-up surveys. Of the injured runners 30% (n=18/60) developed two or more RRIs, with 5/18 (28%) being recurrences. The incidence of RRI was 10 RRI/1000 hours of running exposure. The main type of RRI observed was muscle injuries (30%, n=25/84). The knee was the most commonly affected anatomical region (19%, n=16/84). The variables associated with RRI were: previous RRI (OR 1.88, 95% CI 1.01 to 3.51), duration of training although the effect was very small (OR 1.01, 95% CI 1.00 to 1.02), speed training (OR 1.46, 95% CI 1.02 to 2.10), and interval training (OR 0.61, 95% CI 0.43 to 0.88). CONCLUSIONS: Physiotherapists should be aware and advise runners that past RRI and speed training are associated with increased risk of further RRI, while interval training is associated with lower risk, although these associations may not be causative.

Translation, cross-cultural adaptation, and clinimetric testing of instruments used to assess patients with patellofemoral pain syndrome in the Brazilian population.

STUDY DESIGN: Clinical measurement study. OBJECTIVES: To cross-culturally adapt the Anterior Knee Pain Scale (AKPS), the Functional Index Questionnaire (FIQ), and the Pain Severity Scale (PSS) for patellofemoral pain syndrome (PFPS) into Brazilian Portuguese. This study also aimed to test the measurement properties of the AKPS, the FIQ, and the PSS, and the existing Brazilian Portuguese versions of the numeric pain rating scale (NPRS) and the Global Perceived Effect scale in a group with PFPS. BACKGROUND: PFPS is a common condition. Therefore, translated, culturally adapted, and clinimetrically tested instruments for measuring PFPS are needed. METHODS: The AKPS, FIQ, and PSS instruments were cross-culturally adapted into Brazilian Portuguese. The measurement properties of the AKPS, FIQ, PSS, NPRS, and Global Perceived Effect scale (internal consistency, ceiling and floor effects, and construct validity) were tested in 83 patients with PFPS. The reproducibility and responsiveness were tested in 52 patients with PFPS in a test-retest design, with follow-up testing at 48 to 72 hours and at 4 weeks after baseline. RESULTS: The AKPS, the FIQ, and the PSS yielded adequate internal consistency (Cronbach alpha ranging from .75 to .87) and excellent reliability (intraclass correlation coefficients [model 2,1] ranging from 0.90 to 0.97). The AKPS and the PSS yielded very good agreement (standard error of measurement, 2.9% and 3.5%, respectively). The highest correlations were observed among the AKPS, the FIQ, and the PSS (Pearson r>0.60, P<.05). No floor or ceiling effects were observed for any of the instruments. Effect sizes used for measuring internal responsiveness ranged from moderate to high for all measures. The NPRS and the AKPS were the measures with the highest external responsiveness. CONCLUSION: The Brazilian Portuguese versions of the AKPS, FIQ, PSS, NPRS, and Global Perceived Effect scale have acceptable measurement properties.

Do convolutions in Kinesio Taping matter? Comparison of two Kinesio Taping approaches in patients with chronic non-specific low back pain: protocol of a randomised trial.

INTRODUCTION: Chronic low back pain is a common condition. A new intervention that is popular in sports has been used in patients with low back pain. This technique is based on the use of elastic tapes that are fixed on the skin of patients using different tensions and is named Kinesio Taping Method. Although this intervention has been widely used, to date the evidence of its effectiveness is lacking. RESEARCH QUESTION: Is the application of the Kinesio Taping Method according to the treatment manual (with convolutions in neutral position) more efficacious than a simple application without convolutions in patients with chronic low back pain? DESIGN: Two-arm randomised controlled trial with a blinded assessor. PARTICIPANTS AND SETTING: 148 patients with chronic low back pain from two outpatient physiotherapy clinics in Brazil. INTERVENTION: 8 sessions of Kinesio Taping according to the Kinesio Taping Method treatment manual (ie, 10-15% tension with the treated muscles in stretching position and with convolutions in neutral). CONTROL: 8 sessions of Kinesio Taping having no convolutions in neutral (0% tension) with the treated muscles in resting position. MEASUREMENTS: Clinical outcomes (pain intensity, disability and global impression of recovery) will be obtained in assessments that will be performed at 4 weeks and 3 months after randomisation. ANALYSIS: The effects of the intervention will be calculated through linear mixed models following intention-to-treat principles. DISCUSSION: This is the largest study aimed to investigate the hypothesised mechanism behind the Kinesio Taping application in patients with chronic low back pain. The results of this study will contribute to a better understanding about the mechanisms of action of this widely applied therapeutic modality. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials. REGISTRATION NUMBER: RBR-7ggfkv. PROSPECTIVE REGISTRATION: Yes. FUNDED BY: Fundação de Amparo a Pesquisa do Estado de São Paulo (FAPESP), and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil. APPROVAL NUMBER: FAPESP number 2011/12926-0; CNPq number 470652/2011-0. ANTICIPATED COMPLETION: February 2013. CORRESPONDENCE: Leonardo Oliveira Pena Costa, Rua Cesário Galeno 448, Tatuapé, São Paulo/SP, Brazil 03071-000 Email: lcos3060@gmail.com FULL PROTOCOL: Available on the eAddenda at jop.physiotherapy.asn.au.

Principais gestos esportivos executados por jogadores de handebol / Main sporting gestures performed by handball players / Principales gestos deportivos realizados por jugadores de balonmano

Este estudo teve como objetivo quantificar os principais gestos esportivos executados por jogadores profissionais de handebol. Para a mensuração quantitativa dos principais movimentos executados por cada jogador de handebol avaliado foram realizadas gravações de vídeo em todos os jogos. Foram realizados em média 1288,0 (DP = 190,7) gestos esportivos por jogo. Os armadores centrais realizaram em média 375,0 (DP = 83,7) gestos esportivos, e a posição de pivô 63,3 (DP = 21,2) gestos por jogo. As recepções e os passes foram os gestos mais executados, e a posição que mais realizou gestos esportivos na equipe de handebol avaliada foi o armador central, seguido do armador esquerdo e direito. O pivô foi a posição que menos realizou gestos esportivos.

This study aimed to quantify the main sporting gestures performed by professional handball players. For the quantitative measurements of the main movements performed by each player, video recordings were made for all games. It was recorded a mean of 1.288.0 (SD = 190.7) sporting gestures per game. The central ship-owners did a mean of 375.0 (SD = 83.7) gestures and the pivot position perform 63.3 (SD = 21.2) gestures per game. The receptions and passes were the main sporting gestures performed by the handball team. The central ship-owner was the position that performed more gestures, followed by the left and right ship-owner. The pivot was the position that performed less sporting gestures by the handball team evaluated.

Este estudio tuvo como objetivo cuantificar los principales gestos deportivos realizados por los jugadores de balonmano. Para la cuantificación de los principales movimientos realizados se hizo grabaciones de vídeo y el análisis se realizó para cada jugador. En promedio los jugadores de balonmano realizaron 1.288,0 (DP = 190,7) gestos deportivos por juego. Los armadores centrales realizaron promedio de 375,0 (DP = 83,7) y la posición de pivote hizo 63,3 (DP = 21,2) gestos. Las recepciones y los pases fueron los gestos deportivos más ejecutados, e los armadores centrales realizaron más gestos deportivos en el equipo de balonmano, seguido por los armadores izquierdos y derechos. La posición que menos ejecuto gestos deportivos fue lo pivote.

What are the main running-related musculoskeletal injuries? A Systematic Review.

BACKGROUND: Musculoskeletal injuries occur frequently in runners and despite many studies about running injuries conducted over the past decades it is not clear in the literature what are the main running-related musculoskeletal injuries (RRMIs). OBJECTIVE: The aim of this study is to systematically review studies on the incidence and prevalence of the main specific RRMIs. METHODS: An electronic database search was conducted using EMBASE (1947 to October 2011), MEDLINE (1966 to October 2011), SPORTDiscus(1975 to October 2011), the Latin American and Caribbean Center on Health Sciences Information (LILACS) [1982 to October 2011] and the Scientific Electronic Library Online (SciELO) [1998 to October 2011] with no limits of date or language of publication. Articles that described the incidence or prevalence rates of RRMIs were considered eligible. Studies that reported only the type of injury, anatomical region or incomplete data that precluded interpretation of the incidence or prevalence rates of RRMIs were excluded. We extracted data regarding bibliometric characteristics, study design, description of the population of runners, RRMI definition, how the data of RRMIs were collected and the name of each RRMI with their rates of incidence or prevalence. Separate analysis for ultra-marathoners was performed. Among 2924 potentially eligible titles, eight studies (pooled n = 3500 runners) were considered eligible for the review. In general, the articles had moderate risk of bias and only one fulfilled less than half of the quality criteria established. RESULTS: A total of 28 RRMIs were found and the main general RRMIs were medial tibial stress syndrome (incidence ranging from 13.6% to 20.0%; prevalence of 9.5%), Achilles tendinopathy (incidence ranging from 9.1% to 10.9%; prevalence ranging from 6.2% to 9.5%) and plantar fasciitis (incidence ranging from 4.5% to 10.0%; prevalence ranging from 5.2% to 17.5%). The main ultra-marathon RRMIs were Achilles tendinopathy (prevalence ranging from 2.0% to 18.5%) and patellofemoral syndrome (prevalence ranging from 7.4% to 15.6%). CONCLUSION: This systematic review provides evidence that medial tibia stress syndrome, Achilles tendinopathy and plantar fasciitis were the main general RRMIs, while Achilles tendinopathy and patellofemoral syndrome were the most common RRMIs for runners who participated in ultra-marathon races.

Reproducibility of the Portuguese version of the PEDro Scale.

The objective of this study was to test the inter-rater reproducibility of the Portuguese version of the PEDro Scale. Seven physiotherapists rated the methodological quality of 50 reports of randomized controlled trials written in Portuguese indexed on the PEDro database. Each report was also rated using the English version of the PEDro Scale. Reproducibility was evaluated by comparing two separate ratings of reports written in Portuguese and comparing the Portuguese PEDro score with the English version of the scale. Kappa coefficients ranged from 0.53 to 1.00 for individual item and an intraclass correlation coefficient (ICC) of 0.82 for the total PEDro score was observed. The standard error of the measurement of the scale was 0.58. The Portuguese version of the scale was comparable with the English version, with an ICC of 0.78. The inter-rater reproducibility of the Brazilian Portuguese PEDro Scale is adequate and similar to the original English version.

Reproducibility of the Portuguese version of the PEDro Scale / Reprodutibilidade da Escala de Qualidade PEDro em português

The objective of this study was to test the inter-rater reproducibility of the Portuguese version of the PEDro Scale. Seven physiotherapists rated the methodological quality of 50 reports of randomized controlled trials written in Portuguese indexed on the PEDro database. Each report was also rated using the English version of the PEDro Scale. Reproducibility was evaluated by comparing two separate ratings of reports written in Portuguese and comparing the Portuguese PEDro score with the English version of the scale. Kappa coefficients ranged from 0.53 to 1.00 for individual item and an intraclass correlation coefficient (ICC) of 0.82 for the total PEDro score was observed. The standard error of the measurement of the scale was 0.58. The Portuguese version of the scale was comparable with the English version, with an ICC of 0.78. The inter-rater reproducibility of the Brazilian Portuguese PEDro Scale is adequate and similar to the original English version.

O objetivo foi testar a reprodutibilidade da versão em português da Escala de Qualidade PEDro. Sete fisioterapeutas avaliaram a qualidade metodológica de 50 estudos controlados aleatorizados em português, indexados na base de dados PEDro. Cada artigo já possuía sua respectiva avaliação nessa base de dados, utilizando a versão em inglês da escala PEDro. Foi calculada a confiabilidade da escala, assim como foi comparada a pontuação total de consenso com a pontuação das avaliações utilizando a escala em inglês. Os coeficientes kappa variaram entre 0,53 e 1,00 para itens individuais, e um coeficiente de correlação intraclasse (CCI) de 0,82 foi obtido para a pontuação total. O erro-padrão de medida foi de 0,58 ponto. A versão em português da escala foi comparada com a versão em inglês e foi observado um CCI de 0,78. A reprodutibilidade da versão em língua portuguesa da Escala de Qualidade PEDro foi adequada e similar à versão em inglês.