A Simplified Prediction Model for Lower Extremity Long Bone Stress Injuries in Male Endurance Running Athletes.

OBJECTIVE: Develop a prediction model for lower extremity long bone injuries (LBIs) in male endurance running athletes using dual-energy x-ray absorptiometry (DEXA). DESIGN: Retrospective. SETTING: Sports medicine department in a university athletic setting. PARTICIPANTS: National Collegiate Athletic Association (NCAA) Division 1 white male endurance athletes (n = 27). INDEPENDENT VARIABLES: Backward stepwise elimination was used to achieve a model that predicts LBI, by removing noncontributory variables (P > 0.10), using binary logistic regression. Independent prediction variables analyzed for model were as follows: (1) height (cm), body mass index (BMI) (kg/m), and total mass (kg); and (2) regional and total lean mass, fat mass, and bone density assessed using DEXA. MAIN OUTCOME MEASURES: Dichotomous dependent variable was LBI. RESULTS: Final constructed model predicted 96.3% of athletes with and without LBI. Prediction model were as follows: predict lower extremity long bone stress injury = 23.465 - 0.896 BMI + 1.043 (total upper-body mass) TUB - 34.536 leg bone mineral density (BMD). Predict lower extremity long bone stress injury is the LBI prediction, and TUB (kg) is total fat, muscle, and bone weight in trunk and arms. CONCLUSIONS: These preliminary data suggest that Division 1 white male endurance running athletes are at risk of LBI with higher relative TUB and lower BMI in combination with a lower leg BMD.

The effect of pain on hip and knee kinematics during running in females with chronic patellofemoral pain.

PURPOSE: Despite the growing recognition of the role of abnormal hip and knee mechanics in patellofemoral pain (PFP), few studies have assessed if or how these mechanics change when the person experiences pain while running. Therefore, the purpose of this study was to determine if the development of pain while running resulted in altered hip and knee kinematics in female runners with PFP as compared to healthy female runners. METHODS: Thirty female runners (15 PFP, 15 controls) participated in an instrumented gait analysis while running for 30 min at a self-selected pace. Pain and fatigue were recorded every minute while participants ran. Variables of interest included peak hip adduction, hip internal rotation, knee abduction, knee external rotation, pain, and fatigue. RESULTS: There were significant group by pain interactions for hip adduction (p<0.01) and hip internal rotation (p<0.01). The healthy group, who did not develop pain had significant increases in both motions compared to the PFP group, who did develop pain. There was also a trend toward less knee external rotation in the PFP group in presence of pain (p=0.059). No differences were found for knee abduction (p=0.32). A group main effect was found for hip internal rotation (p=0.008) in which the PFP group had significantly larger values. CONCLUSION: Runners with PFP did not alter their hip mechanics over the course of the run. This may have resulted in repetitive stress to the same aspect of the patellofemoral joint and contributed to the initial development of pain. However, the PFP group did attempt to make a compensation once in pain by reducing knee external rotation.

Proximal and distal kinematics in female runners with patellofemoral pain.

BACKGROUND: Female runners have a high incidence of developing patellofemoral pain. Abnormal mechanics are thought to be an important contributing factor to patellofemoral pain. However, the contribution of abnormal trunk, hip, and foot mechanics to the development of patellofemoral pain within this cohort remains elusive. Therefore the aim of this study was to determine if significant differences during running exist in hip, trunk and foot kinematics between females with and without patellofemoral pain. METHODS: 32 female runners (16 patellofemoral pain, 16 healthy control) participated in this study. All individuals underwent an instrumented gait analysis. Between-group comparisons were made for hip adduction, hip internal rotation, contra-lateral pelvic drop, contra-lateral trunk lean, rearfoot eversion, tibial internal rotation, as well as forefoot dorsiflexion and abduction FINDINGS: The patellofemoral pain group had significantly greater peak hip adduction and hip internal rotation. No differences in contra-lateral pelvic drop were found. A trend towards reduced contra-lateral trunk lean was found in the patellofemoral pain group. No significant differences were found in any of the rearfoot or forefoot variables but significantly greater shank internal rotation was found in the patellofemoral pain group. INTERPRETATION: We found greater hip adduction, hip internal rotation and shank internal rotation in female runners with patellofemoral pain. We also found less contra-lateral trunk lean in the patellofemoral pain group. This may be a potential compensatory mechanism for the poor hip control seen. Rehabilitation programs that correct abnormal hip and shank kinematics are warranted in this population.