Sports Medicine Research: In the Lab & In the Field: Female Runners Should Watch Their Step (Sports Med Res)

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Tuesday, July 31, 2018

Female Runners Should Watch Their Step

Kinetic Risk Factor of Running-Related Injuries in Female Recreational Runners.

Napier C, MacLean CL, Maurer J, Taunton, JE, Hunt, MA. Scand J Med Sci Sports. 2018 May. https://doi.org/10.1111/sms.13228
Text Freely Available

Take Home Message: A female recreational runner with greater peak braking force is more likely to get an injury during a 15-week half-marathon training program.

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Authors of a recent systematic review showed that gait retraining can address abnormal biomechanics that may increase the risk of running-related injuries. However, it is unclear if these proposed biomechanical risk factors are present before an injury and if they predict who will get an injury. Thus, the purpose of this study was to determine if several biomechanical factors are associated with the onset of running-related injuries among female recreational runners. The authors assessed 74 female novice recreational runners (history of < 2 half marathons) who then completed a 15-week half-marathon training program. Researchers collected kinematic and kinetic data while participants ran on a treadmill at a self-selected moderate intensity pace. The two primary kinetic variables of interest were average vertical loading rate and peak braking force (PBF), which is the force in the opposite direction of running. The authors used these variables to separate runners into three levels: Low, Medium, or High. Hours of running exposure were collected from beginning of training until a participant was injured, lost to follow-up, or finished the program. Any lower extremity or low back overuse injury due to training and resulting in 3 missed training days counted as an injury. Twenty-two participants (34%) sustained a running-related injury after an average of 17 hours of running.  Another 33 runners remained uninjured after an average training time of 43 hours (10 runners dropped out due to unrelated circumstances). Overall, PBF was the only kinetic variable that predicted a running-related injury. Specifically, runners with the highest PBF were 5 times more likely to sustain an injury than those with medium PBF, and 8 times more likely than those runners with the lowest PBF.

This study is interesting because the authors assessed biomechanical factors that may predict any running-related injury. In contrast, previous researchers studying biomechanical variables concentrated on one injury diagnosis (e.g., tibial stress fractures or patellofemoral pain). Finding a common risk factor across injury types is important for clinicians and researchers when performing a baseline assessment since there is no way to predict which injury, if any, will develop during training. While biomechanical abnormalities may influence risk of running-related injuries among novice runners, they are difficult to assess in most clinical settings. However, these studies are vital for future research to explore interventions that can target PBF and in turn reduce the risk of running-related injuries. A noteworthy secondary analysis revealed foot strike pattern (e.g., heel strike vs midfoot strike) did not differ between runners who did or did not develop an injury. Furthermore, they found no relationship between PBF and foot strike pattern. This may suggest foot strike pattern does not influence running-related injury risk as much as previously assumed. Interestingly, these results differ from previous studies that found lower BPF among injured runners compared with healthy runners. This should prompt clinicians and researchers to be cautious when assuming that differences between healthy and injured athletes may help us identify risk factors. We saw this in a recent post on a prospective study of runners that found many of the long-established factors believed to contribute to running-related injuries (e.g., arch height, Q-angle) failed to predict new injuries. We need to remember that interventions aimed to prevent injuries should be based on prospective findings, whereas our rehabilitative programs should focus on abnormalities found during an injury assessment.

Questions for Discussion: If you perform a biomechanical assessment on runners, what are you looking for? Do you incorporate gait retaining into your rehabilitation programs for injured runners with a biomechanical abnormality?

Written by: Danielle M. Torp
Reviewed by: Jeffrey Driban

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