Sports Medicine Research: In the Lab & In the Field: Hip and Knee Strength Are Not Related to Injury in Female Runners (Sports Med Res)


Wednesday, September 26, 2018

Hip and Knee Strength Are Not Related to Injury in Female Runners

No baseline strength differences between female recreational runners who developed an injury and injury free runners during a 16-week formalized training program

Torp DM, Donovan L, Gribble PA, Thomas AC, Bazett-Jones DM, Beard MQ. Phys Ther Sport. 2018 Aug 6; 34:1-7. doi: 10.1016/j.ptsp.2018.08.001. [Epub ahead of print]

Take Home Message: Female recreational runners who sustained a running-related injury during a 16-week training program typically do not differ at baseline in hip or knee strength measures from peers who remained uninjured.
Female runners are at risk for injuries during running training. Although previous research has identified extrinsic risk factors such as training volume that may predispose females for running-related injury, intrinsic risk factors are not well understood. Therefore, the authors conducted a prospective cohort study to examine if hip and knee strength measures prior to a 16-week training protocol was associated with new running-related injuries among 54 healthy female runners. Prior to starting the running protocol, a runner first warmed up on a treadmill for 5 minutes, and then the investigators tested isometric hip flexion, extension, abduction, and external rotation, as well as knee flexion and extension strength using hand-held dynamometry. Following laboratory testing, each runner performed bi-weekly training sessions for 16 weeks specific to their goals (half vs. full marathon) and skill level (beginner vs. advanced). A physical therapist attended all sessions to document running-related musculoskeletal injury. The authors defined a running-related injury as any limb or back injury that occurred because of running, and required running modifications, activity modifications, and/or full removal from training. At the end of the program, 30% of the female participants (15 runners) sustained a running-related injury, and the majority occurred in the final 3 weeks of training (7 runners). These injury rates align with other work examining injuries in runners. On average, females who sustained a running-related injury and those who remained healthy never differed in baseline strength, previous injury history, running experience, and weekly mileage prior to training.

Overall, isometric hip and knee strength measures were unrelated to the onset of running-related injuries among these female runners. These findings complement another recent study where the authors found that many long-established factors (e.g., abnormal rear foot motion, flexibility, strength) had no relation with new overuse running-related injuries. This information is important because these factors, including strength deficits, are frequently reported among female runners with patellofemoral pain and other overuse running-related injuries. Therefore, these results suggest that factors like isometric weakness may develop as a result of injury rather than contribute to the onset of injury. However, the authors acknowledged that they only considered static strength measures while running requires dynamic muscle action. It would be interesting to understand the relationship between eccentric/concentric muscle strength in relation to running-related injury, and to expand these evaluations to other major lower extremity muscles. Other intrinsic factors, such as postural control, may also be important to examine in this population. In all, hip and knee strength measures did not differ between female runners who did or did not develop injuries during a structured running protocol. Clinicians should monitor and address strength alterations following running-related injury, and monitor runners for other modifiable factors over the course of running training.

Questions for Discussion: Do you test your running athletes before they begin a structured training program? What extrinsic and intrinsic factors do you monitor over time in your female running athletes?

Written By: Alexandra F. DeJong
Reviewed By: Jeffrey Driban

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