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

Questions for
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

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

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