Co-creation of injury prevention measures for competitive adolescent distance runners: knowledge, behavior, and needs of athletes and coaches enrolled on England Athletics' Youth Talent Programme.

This study assessed the knowledge, behavior, and needs of competitive adolescent (16-18 years) distance runners and distance running coaches enrolled as part of England Athletics' Youth Talent Programme in relation to the prevention of running-related injury (RRI). Two online surveys were developed and distributed to the distance runners (survey one) and coaches (survey two). Both surveys included sections related to: (1) current knowledge; (2) current behavior; (3) need and support for RRI prevention measures; and (4) possible content and form of RRI prevention measures. A total of 39 distance runners (36% of total possible sample) completed survey 1, and 29 coaches (32% of total possible sample) completed survey 2. Key findings included that the majority of distance runners and coaches: (1) agreed that it is 'very important' to try to prevent RRI; (2) are currently implementing something in practice (e.g., strength training) to prevent RRI; and (3) view the creation of RRI prevention measures as an important initiative. Differences between distance runners and coaches were identified in relation to their understanding of the most common causes of RRI. Interestingly, distance runners identified a modifiable cause of RRI (i.e., too much training) as the most common cause of RRI, while coaches selected a non-modifiable cause of RRI (i.e., growth and maturation). These key findings were supplemented by competitive adolescent runners and distance running coaches detailing their delivery preferences for such RRI prevention measures. Results from this study will help inform subsequent steps of the larger co-creation process, with an emphasis on developing multifaceted and context-specific RRI prevention measures that are deemed to be feasible and acceptable for real-world implementation.

The majority of competitive adolescent distance runners and distance running coaches who took part in this study agreed that it is 'very important' to try to prevent RRI and view the creation of RRI prevention measures as an important initiative.Alongside this support, interesting differences between the distance runners and coaches were also identified, including, for example: (1) their understanding of the most common causes of RRI and (2) their preferences about where and when to complete RRI prevention measures.Results from this study will help inform subsequent steps of the larger co-creation process, with an emphasis on developing multifaceted and context-specific RRI prevention measures that are deemed to be feasible and acceptable for real-world implementation.

Bone health and the masters runner.

Masters runners are often defined as those ages 35 years and older who train and compete in running events. These runners represent a growing population of the overall running community and experience running-related injuries including bone stress injuries (BSIs). Similar to younger runners, health considerations in masters runners include the goal to optimize bone health with focus on mitigating age-associated loss of bone strength and preventing BSIs through a combination of ensuring appropriate physical activity, optimizing nutrition, and correcting faulty biomechanics. Importantly, BSIs in masters runners may include characteristics of both overuse injury from insufficient recovery and failure of bone weakened by age-related loss of bone (insufficiency fractures). This narrative review covers the limited available research on strategies to optimize bone health in masters runners. Applying knowledge on masters athletes and extrapolating from other populations, we propose strategies on treatment and prevention of BSIs. Finally, the review highlights gaps in knowledge that require further age-specific discoveries to advance treatment and prevention.

Per-step and cumulative load at three common running injury locations: The effect of speed, surface gradient, and cadence.

Understanding how loading and damage on common running injury locations changes across speeds, surface gradients, and step frequencies may inform training programs and help guide progression/rehabilitation after injuries. However, research investigating tissue loading and damage in running is limited and fragmented across different studies, thereby impairing comparison between conditions and injury locations. This study examined per-step peak load and impulse, cumulative impulse, and cumulative weighted impulse (hereafter referred to as cumulative damage) on three common injury locations (patellofemoral joint, tibia, and Achilles tendon) across different speeds, surface gradients, and cadences. We also explored how cumulative damage in the different tissues changed across conditions relative to each other. Nineteen runners ran at five speeds (2.78, 3.0, 3.33, 4.0, 5.0 m s-1 ), and four gradients (-6, -3, +3, +6°), and three cadences (preferred, ±10 steps min-1 ) each at one speed. Patellofemoral, tibial, and Achilles tendon loading and damage were estimated from kinematic and kinetic data and compared between conditions using a linear mixed model. Increases in running speed increased patellofemoral cumulative damage, with nonsignificant increases for the tibia and Achilles tendon. Increases in cadence reduced damage to all tissues. Uphill running increased tibial and Achilles tendon, but decreased patellofemoral damage, while downhill running showed the reverse pattern. Per-step and cumulative loading, and cumulative loading and cumulative damage indices diverged across conditions. Moreover, changes in running speed, surface gradient, and step frequency lead to disproportional changes in relative cumulative damage on different structures. Methodological and practical implications for researchers and practitioners are discussed.

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.

Assessing the effects of foot strike patterns and shoe types on the control of leg length and orientation in running.

This research investigates the stabilization of leg length and orientation during the landing phase of running, examining the effects of different footwear and foot strike patterns. Analyzing kinematic data from twenty male long-distance runners, both rearfoot and forefoot strikers, we utilized the Uncontrolled Manifold approach to assess stability. Findings reveal that both leg length and orientation are indeed stabilized during landing, challenging the hypothesis that rearfoot strikers exhibit less variance in deviations than forefoot strikers, and that increased footwear assistance would reduce these deviations. Surprisingly, footwear with a lower minimalist index enhanced post-landing stability, suggesting that cushioning contributes to both force dissipation and leg length stability. The study indicates that both foot strike patterns are capable of effectively reducing task-relevant variance, with no inherent restriction on flexibility for rearfoot strikers. However, there is an indication of potential reliance on footwear for stability. These insights advance our understanding of the biomechanics of running, highlighting the role of footwear in stabilizing leg length and orientation, which has significant implications for running efficiency and injury prevention.

Speed and surface steepness affect internal tibial loading during running.

BACKGROUND: Internal tibial loading is influenced by modifiable factors with implications for the risk of stress injury. Runners encounter varied surface steepness (gradients) when running outdoors and may adapt their speed according to the gradient. This study aimed to quantify tibial bending moments and stress at the anterior and posterior peripheries when running at different speeds on surfaces of different gradients. METHODS: Twenty recreational runners ran on a treadmill at 3 different speeds (2.5 m/s, 3.0 m/s, and 3.5 m/s) and gradients (level: 0%; uphill: +5%, +10%, and +15%; downhill: -5%, -10%, and -15%). Force and marker data were collected synchronously throughout. Bending moments were estimated at the distal third centroid of the tibia about the medial-lateral axis by ensuring static equilibrium at each 1% of stance. Stress was derived from bending moments at the anterior and posterior peripheries by modeling the tibia as a hollow ellipse. Two-way repeated-measures analysis of variance were conducted using both functional and discrete statistical analyses. RESULTS: There were significant main effects for running speed and gradient on peak bending moments and peak anterior and posterior stress. Higher running speeds resulted in greater tibial loading. Running uphill at +10% and +15% resulted in greater tibial loading than level running. Running downhill at -10% and -15% resulted in reduced tibial loading compared to level running. There was no difference between +5% or -5% and level running. CONCLUSION: Running at faster speeds and uphill on gradients ≥+10% increased internal tibial loading, whereas slower running and downhill running on gradients ≥-10% reduced internal loading. Adapting running speed according to the gradient could be a protective mechanism, providing runners with a strategy to minimize the risk of tibial stress injuries.

The interaction effect of different footwear types and static navicular drop or dynamic ankle pronation on the joint stiffness of the lower limb during running.

BACKGROUND: Although the effects of footwear type on joint stiffness have previously been investigated, researchers did not consider foot flexibility. Thus, the present investigation aimed to determine the interaction effects of footwear type, static navicular drop and dynamic ankle pronation on dynamic joint stiffness in running. RESEARCH QUESTION: Does the footwear types in interaction with the foot posture affect the stiffness of the joints of the lower limb? METHODS: Forty-seven male individuals participated in this study. Firstly, they were divided into the high navicular, low navicular, and normal navicular drop. Secondly, they were divided into the high dynamic ankle pronation, low dynamic ankle pronation, and normal dynamic ankle pronation groups. Participants performed three running trials at 3 ± 0.2 m/s at minimalist footwear, conventional footwear, and barefoot conditions. We collected the ground reaction forces and three-dimensional kinematic data and calculated joint stiffness over the stance phase. RESULTS: There was no significant main effect of navicular drop or dynamic ankle pronation on dynamic joint stiffness for the ankle, knee, and hip (p > 0.05). However, footwear type significantly affected dynamic joint stiffness. The pairwise comparison revealed that the ankle and hip dynamic joint stiffness magnitudes in the conventional footwear condition were greater than in the barefoot and minimalist footwear conditions (p 0.001). In contrast, the knee dynamic joint stiffness magnitude in the conventional footwear condition was lesser than in barefoot and minimalist footwear conditions (p 0.001). SIGNIFICANCE: The navicular drop or dynamic ankle pronation did not influence lower limb joint stiffness, and there was no significant interaction between navicular drop or dynamic ankle pronation and footwear on lower limb dynamic joint stiffness. However, conventional footwear increased the ankle and hip dynamic joint stiffness while reducing knee dynamic joint stiffness, leading to changes in transfer energy, which could have implications for relative injury risk.

Risk Factors for Running-Related Injury in High School and Collegiate Cross-country Runners: A Systematic Review.

OBJECTIVE: To summarize and describe risk factors for running-related injuries (RRIs) among high school and collegiate cross-country runners. DESIGN: Descriptive systematic review. LITERATURE SEARCH: Four databases (Scopus, SPORTDiscus, CINAHL, Cochrane) were searched from inception to August 2023. STUDY SELECTION CRITERIA: Studies assessing RRI risk factors in high school or collegiate runners using a prospective design with at least 1 season of follow-up were included. DATA SYNTHESIS: Results across each study for a given risk factor were summarized and described. The NOS and GRADE frameworks were used to evaluate quality of each study and certainty of evidence for each risk factor. RESULTS: Twenty-four studies were included. Overall, study quality and certainty of evidence were low to moderate. Females or runners with prior RRI or increased RED-S (relative energy deficiency in sport) risk factors were most at risk for RRI, as were runners with a quadriceps angle of >20° and lower step rates. Runners with weaker thigh muscle groups had increased risk of anterior knee pain. Certainty of evidence regarding training, sleep, and specialization was low, but suggests that changes in training volume, poorer sleep, and increased specialization may increase RRI risk. CONCLUSION: The strongest predictors of RRI in high school and collegiate cross-country runners were sex and RRI history, which are nonmodifiable. There was moderate certainty that increased RED-S risk factors increased RRI risk, particularly bone stress injuries. There was limited evidence that changes in training and sleep quality influenced RRI risk, but these are modifiable factors that should be studied further in this population. J Orthop Sports Phys Ther 2024;54(2):1-13. Epub 16 November 2023. doi:10.2519/jospt.2023.11550.

Running-Related Injuries Among More Than 7000 Runners in 87 Different Countries: The Garmin-RUNSAFE Running Health Study.

OBJECTIVE: To describe the cumulative injury proportion after 1000 and 2000 km of running among runners from 87 countries worldwide using wearable devices. Secondly, examine if the cumulative injury proportion differed between runners from different countries. DESIGN: Cohort study with an 18-month follow-up. METHODS: Runners aged ≥18 years who were familiar with the English language, and who were using a Garmin sports watch that supported tracking of running were eligible for inclusion. The exposure was residential country; self-reported running-related injury was the primary outcome. A generalized linear model was used to estimate the cumulative injury proportion for each country and the cumulative risk difference between the countries (country with the lowest risk used as reference). Data were analyzed at 1000 and 2000 km. RESULTS: The proportions of injured runners among the 7605 included runners from 87 different countries were 57.6% [95% CI: 56.9%, 59.0%] at 1000 km and 69.8% [95% CI: 68.3%, 71.4%] at 2000 km. Runners from the Czech Republic (40.3% [95% CI: 28.7%, 51.9%]), Austria (41.1% [95% CI: 25.9%, 52.2%]), and Germany (41.9% [95% CI: 36.0%, 47.9%]) had the lowest cumulative injury proportions at 1000 km, whereas Ireland (75.4% [95% CI: 60.4%, 90.4%]), Great Britain and Northern Ireland (73.2% [95% CI: 69.3%, 77.1%]), and Finland (67.5% [95% CI: 47.2%, 87.7%]) had the highest proportions. At 2000 km, Poland (47.7% [95% CI: 36.0%, 59.4%]), Slovenia (52.2% [95% CI: 28.5%, 75.8%]), and Croatia (54.2% [95% CI: 35.6%, 72.7%]) had the lowest proportions of injured runners. The highest cumulative injury proportions were reported in Great Britain and Northern Ireland (83.6% [95% CI: 79.6%, 87.6%]) and the Netherlands (78.3% [95% CI: 70.6%, 85.9%]). CONCLUSION: More than half of the population of adult runners from 87 countries using wearable devices sustained a running-related injury during follow-up. There were considerable between-country differences in injury proportions. J Orthop Sports Phys Ther 2024;54(2):1-9. Epub 16 November 2023. doi:10.2519/jospt.2023.11959.

Preinjury Knee and Ankle Mechanics during Running Are Reduced among Collegiate Runners Who Develop Achilles Tendinopathy.

INTRODUCTION: Achilles tendinopathies (AT) are common in runners, but prospective data assessing running mechanics associated with developing AT are limited. Asymmetry in running mechanics is also considered a risk factor for injury, although it is unknown if the problematic mechanics occur on the injured limb only or are present bilaterally. PURPOSE: This study aimed to prospectively identify differences in preinjury running biomechanics in collegiate runners who did and did not develop AT and determine if between-limb asymmetries were associated with which limb developed AT. METHODS: Running gait data were obtained preseason on healthy collegiate cross-country runners, and AT incidence was prospectively recorded each year. Spatiotemporal, ground reaction forces, and joint kinematics and kinetics were analyzed. Linear mixed-effects models assessed differences in biomechanics between those who did and did not develop AT during the subsequent year. Generalized linear mixed-effects models determined if the asymmetry direction was associated with which limb developed an AT, with odds ratios (OR) and 95% confidence intervals (95% CI) reported. RESULTS: Data from 106 runners were analyzed and 15 developed AT. Preinjury biomechanics of runners who developed AT showed less peak knee flexion (noninjured: 45.9° (45.2°-46.6°), injured: 43.2° (41.5°-44.9°), P < 0.001), ankle dorsiflexion (noninjured: 28.7° (28.0°-30.2°), injured: 26.0° (23.8°-28.3°), P = 0.01), and knee extensor moment (noninjured: -2.18 (N·m)·kg -1 (-2.24 to -2.12 (N·m)·kg -1 ), injured: -2.00 (N·m)·kg -1 (-2.17 to -1.84 (N·m)·kg -1 ), P = 0.02). The limb demonstrating less peak knee flexion had greater odds of sustaining an AT (OR, 1.29 (1.00-1.65), P = 0.05). CONCLUSIONS: Knee and ankle kinematics, in addition to knee kinetics, were associated with developing an AT. Monitoring these mechanics may be useful for prospectively identifying runners at risk of developing AT.

Changes in Sleep, Stress, and Fatigue Were Not Prospectively Associated With Running-Related Injuries Among High School Cross Country Runners.

BACKGROUND: Running-related injuries (RRI) are common among adolescent runners; however, our understanding of RRI risk factors in this population is limited. Sleep, stress, and fatigue are risk factors in other youth sports but have not been studied in high school runners. This study prospectively assessed the effect of changes in sleep duration and quality, stress, and fatigue on RRI among high school cross country runners. HYPOTHESIS: Less and poorer quality sleep and greater stress and fatigue, compared with the previous week, would be associated with RRI. STUDY DESIGN: Prospective, observational study. LEVEL OF EVIDENCE: Level 2b. METHODS: Runners completed a preseason demographics and injury history survey and daily surveys regarding sleep duration and quality, stress, fatigue, and current RRI. Values were summed within each week, and change scores were calculated relative to the previous week. Runners completing ≥75% of daily surveys were analyzed; sensitivity analyses for those completing ≥50% and ≥90% were also conducted. Generalized estimating equations assessed the association between change in each predictor, including its interaction with sex, and RRI, controlling for year in school, previous RRI, and repeated observations. RESULTS: A total of 434 runners enrolled in the study; 161 (37%) completed ≥75% of daily surveys. No associations between change in sleep duration, sleep quality, or fatigue and RRI were observed (P values ≥0.24). A significant change in stress × sex interaction with RRI was observed (P < 0.01). Associations among boys (P = 0.06) and girls (P = 0.07) were marginally significant. Sensitivity results were similar. CONCLUSION: Short-term changes in sleep duration, quality, and fatigue were not associated with RRI, but a significant interaction between change in stress and sex suggests that stress may influence RRI risk in high school cross country runners. CLINICAL RELEVANCE: Large changes in stress levels should be monitored throughout the season, as these changes may precede RRI occurrence in this population.

Exploring running styles in the field through cadence and duty factor modulation.

According to the dual-axis model, running styles can be defined by cadence and duty factor, variables that have been associated with running performance, economy and injury risk. To guide runners in exploring different running styles, effective instructions to modulate cadence and duty factor are needed. Such instructions have been established for treadmill running, but not for overground running, during which speed can be varied. In this study, five participants completed eight field training sessions over a 4-week training period with acoustic instructions to modulate cadence, duty factor, and, in combination, running style. Instructions were provided via audio files. Running data were collected with sports watches. Participants' experiences with guided-exploration training were evaluated with the user experience questionnaire. Data analysis revealed acoustic pacing and verbal instructions to be effective in respectively modulating cadence and duty factor, albeit with co-varying effects on speed and the non-targeted variable (i.e. duty factor or cadence). Combining acoustic pacing and verbal instructions mitigated these co-varying effects considerably, allowing for running-style modulations in intended directions (particularly towards the styles with increased cadence and increased duty factor). User experience of this form of guided-exploration training was overall positive, but could be improved in terms of autonomy (dependability). In conclusion, combining acoustic pacing and verbal instructions for running-style modulation is effective in overground running.

Predicting Tissue Loads in Running from Inertial Measurement Units.

BACKGROUND: Runners have high incidence of repetitive load injuries, and habitual runners often use smartwatches with embedded IMU sensors to track their performance and training. If accelerometer information from such IMUs can provide information about individual tissue loads, then running watches may be used to prevent injuries. METHODS: We investigate a combined physics-based simulation and data-based method. A total of 285 running trials from 76 real runners are subjected to physics-based simulation to recover forces in the Achilles tendon and patella ligament, and the collected data are used to train and test a data-based model using elastic net and gradient boosting methods. RESULTS: Correlations of up to 0.95 and 0.71 for the patella ligament and Achilles tendon forces, respectively, are obtained, but no single best predictive algorithm can be identified. CONCLUSIONS: Prediction of tissues loads based on body-mounted IMUs appears promising but requires further investigation before deployment as a general option for users of running watches to reduce running-related injuries.

Preseason Vertical Center of Mass Displacement During Running and Bone Mineral Density Z-Score Are Risk Factors for Bone Stress Injury Risk in Collegiate Cross-country Runners.

OBJECTIVES: To (1) assess relationships between running biomechanics, bone health, and bone stress injuries (BSIs), and (2) determine which variables constitute the most parsimonious BSI risk model among collegiate cross-country runners. DESIGN: Prospective, observational cohort study. METHODS: Running gait and bone mineral density (BMD) data from healthy collegiate cross-country runners were collected at preseason over 6 seasons. A generalized estimating equation model with backward selection was used to develop the most parsimonious model for estimating BSI risk, controlling for sex, running speed, and prior BSI. The variables assessed were spatiotemporal, ground reaction force, and joint kinematics, based on previous literature. Quasi-likelihood under the independence model criterion values and R2 values were used to select the best-fitting model. RESULTS: Data from 103 runners were included in the analysis. The best-fitting model included vertical center of mass (COM) displacement and BMD z-score. Injury risk increased with greater vertical COM displacement (unit = 0.5 cm; relative risk [RR] = 1.14; 95% confidence interval [CI]: 1.01, 1.29; P = .04) and decreased with greater BMD z-score (unit = 0.5; RR = 0.83; 95% CI: 0.72, 0.95; P = .007). The model performed similarly when step rate was included instead of vertical COM displacement. CONCLUSION: Vertical COM displacement and BMD z-score contributed to the best model for estimating risk the risk of bone stress injury in cross-country runners. Step rate was also an important variable for assessing injury risk. J Orthop Sports Phys Ther 2023;53(12):1-8. Epub 20 October 2023. doi:10.2519/jospt.2023.11860.

Frontal plane pelvic kinematics during high velocity running: Association with hamstring injury history.

INTRODUCTION: Hamstring injuries are the most prevalent non-contact soft tissue injury in sports, with a larger portion of injuries being recurrent. The sagittal plane running kinematics correlated to hamstring injury history has been well documented. However, analysis of frontal plane kinematics allows for observation of stability and symmetry. This study aimed to examine the frontal plane running kinematics of elite collegiate level sprinters, with and without previous hamstring injury, compared to healthy counterparts. METHODS: Thirty-nine participants performed three 50-m sprints, with three inertial measurement unit sensors placed on the pelvis: one on each iliac crest and one on the sacrum. Participants were classified based on sex, competitive status, and injury history. To investigate differences based on group classification, the data were used to analyze mediolateral motion (relative magnitude of mediolateral acceleration) and asymmetry (difference in acceleration between right and left iliac crests) during each stance phase throughout the run. RESULTS: Injured sprinters displayed significantly greater mediolateral motion and asymmetry during stances than healthy counterparts. CONCLUSIONS: This study demonstrates that frontal plane running stance dynamics are different in athletes with previous hamstring injury than healthy athletes. These athletes may benefit from rehabilitation strategies targeting postural control and stability during dynamic tasks.

Are alterations in running biomechanics associated with running injuries? A systematic review with meta-analysis.

BACKGROUND: No systematic review has investigated the main biomechanical variables as predictors of running-related injuries. OBJECTIVE: To investigate the main biomechanical variables associated with running-related injuries. METHODS: Medline via PubMed, EMBASE, SPORTDiscus, Web of Science, and CINAHL were searched from inception until 1 November 2021. Each study included must have investigated the association of at least one biomechanical variable (kinetics, kinematics, electromyography, or pressure distribution) with running injuries. The meta-analysis was conducted, and a modified version of the Downs and Black Quality Index was used for methodological quality evaluation. RESULTS: Across the 82 studies included, 5465 runners were investigated. The meta-analysis was conducted with 11 biomechanical variables from 51 articles (n=2395). The peak hip adduction angle was the sole biomechanical variable associated with running injury and was found to be higher in injured runners (0.57, 95% CI 0.21, 0.94) compared to uninjured runners. However, this result was highly influenced by two studies (out of five studies) conducted by the same group of authors. CONCLUSION: Clinicians, coaches, and runners should be aware that minimal evidence supports that alterations of running biomechanics are associated with running-related injuries. Heterogeneity in evaluation conditions and inconsistency in the naming and definitions of biomechanical variables make definitive conclusions challenging. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO, CRD42017068839.

Gender differences in footwear characteristics between half and full marathons in China: a cross-sectional survey.

There are concerns about the risk of injuries caused by marathons in China. Since male and female runners have different injury risks, gender differences in running shoe functionality should be further complemented. A supervised questionnaire survey of 626 marathon runners was collected. The questionnaire was categorized into four sections: (1) participant profile, (2) importance of shoe properties, (3) functional evaluation of shoe properties and (4) importance ranking of shoe properties. The Mann-Whitney U test, Fisher's exact test of cross tabulation and Chi-square test, and two-way ANOVA were used to analyze the results of this survey. The significance level was set at P < 0.05. The full marathon participants were older than the half marathon participants. There was no gender difference in the importance of shoe features to elite runners. In addition, women are more concerned about upper elasticity and have higher requirements for running shoes than men. Women were more focused on injury prevention, while men were more focused on running performance. Heel cushioning was identified by all participants as the most important running shoe feature. There were no gender differences between elite players' demand for running shoes, but significant gender differences were found between genders at other running levels.

Outpatient Runners Clinic Visit Trends and Injury Characteristics Among 392 Child and Adolescent Patients: A 10-year Chart Review.

OBJECTIVE: To evaluate clinic visits and running-related injury (RRI) characteristics among child and adolescent runners seeking care at an outpatient clinic over a 10-year time frame. DESIGN: Retrospective chart review. SETTING: Outpatient hospital-affiliated Injured Runners Clinic. PATIENTS: Children and adolescent runners (6-17 years) with RRIs. INDEPENDENT VARIABLES: We examined electronic medical records (EMRs) among child and adolescent patients in the hospital database from 2011 to 2021 to obtain RRI characteristics and key demographic factors. MAIN OUTCOME MEASURES: We assessed volume and frequency of patient visits to the clinic by RRI characteristics. Chi square analyses were used to compare the proportion of clinic visits over time and injury trends by body region and diagnosis. RESULTS: There were 392 patients (sex: 277 F; mean age: 16.1 ± 1.3 years) and an average of 5 clinic visits per diagnosis (5 ± 4 visits; min: 1 visit, max: 31 visits). Number of visits generally increased over time up to 2016 but declined most drastically during the years of the pandemic (2020-2021; χ 2 = 644, P < 0 .001). Of the 654 new injury diagnoses, 77.68% were attributed to repetitive stress. Bone stress injuries to the tibia were the most common RRI (χ 2 = 1940, P < 0 .001; N = 132; 20.2% of all injuries) and constituted most of the clinic visits (χ 2 = 9271, P < 0 .001; N = 591; 25.4% of all visits). CONCLUSION: We identified that adolescents with overuse injuries, particularly bone stress injuries to the tibia, constituted most of the visits to the outpatient healthcare setting. Clinicians should emphasize injury prevention efforts in clinical practice to reduce RRI burden.

Running-Related Achilles Tendon Injury: A Prospective Biomechanical Study in Recreational Runners.

There are relatively few running studies that have attempted to prospectively identify biomechanical risk factors associated with Achilles tendon (AT) injuries. Therefore, the aim was to prospectively determine potential running biomechanical risk factors associated with the development of AT injuries in recreational, healthy runners. At study entry, 108 participants completed a set of questionnaires. They underwent an analysis of their running biomechanics at self-selected running speed. The incidence of AT running-related injuries (RRI) was assessed after 1-year using a weekly questionnaire standardized for RRI. Potential biomechanical risk factors for the development of AT RRI injury were identified using multivariable logistic regression. Of the 103 participants, 25% of the sample (15 males and 11 females) reported an AT RRI on the right lower limb during the 1-year evaluation period. A more flexed knee at initial contact (odds ratio = 1.146, P = .034) and at the midstance phase (odds ratio = 1.143, P = .037) were significant predictors for developing AT RRI. The results suggested that a 1-degree increase in knee flexion at initial contact and midstance was associated with a 15% increase in the risk of an AT RRI, thus causing a limitation of training or a stoppage of running in runners.

Foot kinematics in runners with plantar heel pain during running gait.

BACKGROUND: Plantar heel pain associated with plantar fascia pathology (PHP) is one of the most common running overuse injuries. Degeneration and changes in the mechanical properties of the plantar fascia associated with PHP can result in changes in foot kinematics during gait. RESEARCH QUESTION: How do running gait foot kinematics differ between female and male runners with and without PHP? METHODS: Retrospective study of 13 runners with PHP (7 female, 6 male) and a matched group of 13 uninjured runners (6 female, 7 male). A seven-segment foot model was used to quantify six functional articulations (rearfoot complex, lateral and medial midfoot, lateral and medial forefoot, and first metatarsophalangeal). Functional articulation ROM during early, mid, and propulsion running stance subphases was assessed. Two-way ANOVAs and Friedman's two-way ANOVA for ranks tests were conducted for normally distributed variables and non-normally distributed variables, respectively. RESULTS: During early stance, PHP runners demonstrated significantly increased lateral midfoot eversion ROM compared to uninjured runners. During the propulsion phase, male runners with PHP demonstrated increased medial midfoot eversion and dorsiflexion ROM and increased medial forefoot plantar flexion compared to uninjured male runners. Also during propulsion, females with PHP went through significantly less medial forefoot plantar flexion ROM compared to uninjured female runners. SIGNIFICANCE: Given the function of the plantar fascia to assist foot supination, the differences in runners with PHP, which were consistent with increased pronation or inadequate supination, may be the result of insufficient tension during the stance phase of running gait caused by degeneration of the plantar fascia. Further, the significant medial midfoot and medial forefoot group by sex interactions during propulsion suggest that PHP may affect male and female runners differently. Understanding the effect of PHP on foot function during running may aid in the development of future rehabilitation programs and/or treatment outcome assessments.