Sports Medicine Research: In the Lab & In the Field: Possible Keys For Running Away From Injury (Sports Med Res)


Wednesday, March 29, 2017

Possible Keys For Running Away From Injury

A Prospective Comparison of Lower Extremity Kinematics and Kinetics Between Injured and Non-Injured Collegiate Cross Country Runners

Dudley RI, Pamukoff DN, Lynn SK, Kersey RD, & Noffal GJ. Human Movement Science. 2017; 52:197-202. doi: 10.1016/j.humov.2017.0.007

Take Home Message: Cross country runners who developed a running-related injury during a season had greater knee valgus and ankle eversion velocity before the season started compared with runners who remained injury free. 

Running is generally considered to have many positive benefits; however, runners are at greater risk for injury due to the repetitive loads associated with running.  It remains unclear if a runner’s biomechanics may predispose them to a running-related injury. Hence, the researchers in this specific prospective study followed collegiate cross country runners with a goal to identify factors related to a new running-related injury.  The researchers followed 32 cross county athletes on the same team, who would have similar training practices and loads, over a 14-week cross country season.  At the start of the season, all athletes had no running-related injuries within the previous 6 months.  The researchers assessed each athlete’s navicular drop and then their running gait with a motion analysis system. A certified athletic trainer documented any running-related injuries that caused an athlete to miss at least one full practice session.  Twelve (39%) athletes suffered an injury over the course of the season.  The researchers reported that runners who suffered an injury had greater knee adduction moment and ankle eversion velocity than runners who remained injury free. 

The findings of this study are interesting because they potentially identify 2 variables that contribute to running-related injury risk.  This is one of the first studies to prospectively follow runners with similar training patterns. This allowed the authors to control for many factors that could cause false findings.  These findings are interesting and support other previous research that shows that knee adduction moment or knee valgus is linked with injury risk.  Rehabilitation and preventative programs could specifically target hip abduction musculature to try to limit the amount of adduction that occurs during running to try to mitigate injury risk.  It would have been interesting if these authors re-assessed running gaits during various time points in the season.  Many athletes start to develop soreness and pain, but might not report an injury to their athletic trainer.  Compensatory patterns may start to develop and could serve as an early identifier of impending injury, and an opportunity for earlier intervention.  Also – as fatigue sets in, there are variables that change.  Ultimately, there are were couple of biomechanical attributes that were linked with increased running-related injury risk.  While most clinicians cannot perform a complex gait analysis, we can utilize this information to try to look at eccentric hip and ankle muscular control and prescribe appropriate preventative strengthening exercises.

Questions for Discussion:  What do you use for injury risk assessments in runners?  Are there any other clinical evaluations that you commonly use for injury risk in athletes?    

Written by: Nicole Cattano
Reviewed by: Jeffrey Driban

Related Posts:

Dudley RI, Pamukoff DN, Lynn SK, Kersey RD, & Noffal GJ (2017). A prospective comparison of lower extremity kinematics and kinetics between injured and non-injured collegiate cross country runners. Human Movement Science, 52, 197-202 PMID: 28237655


Ryan Duffy said...

I find the results of the study to be significant because it is yet another study that highlights the consequences of having a greater amount of knee valgus/KAM in athletes. An interesting question to asked based on the findings of this article is: does one cause the other? Does an increased ankle dorsiflexion moment cause the increased KAM, or vice versa?

Based on the plentiful amount of evidence supporting the relationship between KAM/decreased eccentric control and injury, injury prevention programs that address this issues really should be considered for most athletes at all levels.

Nicole Cattano said...

Thanks for your comment Ryan. I agree, it would be interesting to see if one prospectively caused the other. I think you bring up a great point about looking at the entire lower kinetic chain with the ankle dorsiflexion moments.

But I absolutely agree with you that we have ample evidence to address in our injury prevention programming.

What injury prevention programming do you currently use or plan to use?

Christopher Gregory said...

I think this article is a good first step on drawing relationships between anatomy and injury risk, but I do have some questions about the article. When they state that 39% of the followed runners who suffered injury had knee valgus, is this dynamic or static? Also, are these athletes with knee valgus at risk for injury because of the condition or because of this specific training pattern? I understand that these findings line up with the current literature on knee valgus shows increased injury risk but it is difficult to apply these results to the current literature if we don't know if that this particular training these runners were exposed to may be more detrimental to those with knee valgus.

Kyle Hernden said...

Being an athletic trainer that works with a cross country/ track & field team, the findings of this study are very relatable to me. First, I think it’s remarkable that only 12 of 32 athletes suffered an injury during the season. In long-distance runners, anecdotally it seems that they are generally at a high risk of injury. The comments on this article suggest it would be interesting if the researchers would have assessed gait patterns throughout the season, and I strongly agree that this study could have included additional, valuable measurements and results. As most collegiate cross country runners are running at least 60 miles per week, gait patterns could change over time as athletes get fatigued towards the end of the season. If gait was assessed each month throughout the season and a general decline in lower extremity kinetics and kinematics were present, this information could be useful to both healthcare professionals and coaches in being able to keep their athletes at an optimal level of competition and at a low injury risk during the most important part of the season. I also think it would be interesting to see how gait patterns changed in the injured athletes when they returned from injury. Were they doing anything different that put them at a higher or lower risk of injury? Although possibly outside the scope of this study, an additional study using EMG to look at lower extremity muscle activation patterns in this population could supplement the results of this study well to provide a greater idea of what puts long-distance runners at risk of lower-extremity injury.

Jeffrey Driban said...

Christopher, the authors are referring to a dynamic valgus (knee adduction moment). You are correct that it would be interesting to see this study replicated with multiple teams to see if these findings are generalizable to other teams. There could be an interaction between dynamic valgus and training type or load.

Kyle, thanks for your insight from working with cross-country. Have you noticed changes in gait patterns over the course of a season?

Amy Virostek said...

In my undergraduate clinical experience, I have not seen athletic trainers use injury risk assessments for the cross country and track and field teams. Since these are individual and non-contact sports, I feel that they are sometimes overlooked by athletic training staff when they also have more intensive sports like football to take care of. As an athlete myself in college, I have also experienced this first hand and recognize the need for more attention in the injury risk assessment before the season. The Functional Movement Screen is a comprehensive test but often takes too much time and resources to be practical for use with every athlete. I think this study was very insightful and may help provide a shorter and easier way of addressing these risks. Since knee adduction moment and knee valgus seem to predispose a runner to injury, a screening test could be done to address those specifically. The strength and conditioning staff could be alerted to these issues as well and have all athletes performing exercises to strengthen hip abduction and hopefully prevent more of these injuries. Thank you for your article!

Nicole Cattano said...

Thanks Amy! I think your are right that we need to be sure to pay attention to all sports from a preventative and screening standpoint. It is unfortunate that we get so busy that it sometimes turns into triage. Hopefully we can shift some time into prevention which may seem time intensive upon start up, but will hopefully help in the long run with less injuries and not feeling spread so thin.

The authors in this study used motion analysis- which we might not all have access to. But hopefully researchers are working on finding a clinical tool to assess this during a walking or running gait as well. The FMS is only one tool, but there are many out there. Hopefully you can find one that works for your needs.

While this is more subjective- I like to video the athletes that I work with while walking and then running on a treadmill. That way I can watch it back in slow motion. This seems to work well for linear athletes (such as runners). But it is has proven to ve very difficult to get buy-in from athletes who dont have any current problems as well as to create changes in their gait- even with intensive rehabilitation.

Does anyone have any advice for how to make gait changes?

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