Ida Buist

Incidence and risk factors of running-related injuries during preparation for a 4-mile recreational running event

Objective In this study, the incidence and the sex-specific predictors of running-related injury (RRI) among a group of recreational runners training for a 4-mile running event were determined and identified, respectively. Design Prospective cohort study. Methods Several potential risk factors were prospectively measured in 629 novice and recreational runners. They were observed during an 8-week training period for any running-related musculoskeletal injuries of the lower limbs and back. A running-related injury was defined as any musculoskeletal pain of the lower limb or back causing a restriction of running for at least 1 day. Results At least one RRI was reported by 25.9% of the runners during the 8-week observation period. The incidence of RRI was 30.1 (95% CI 25.4 to 34.7) per 1000 h of running exposure. Multivariate Cox regression showed that male participants were more prone to sustain a RRI than female participants (HR 1.4; 95% CI 1.0 to 2.0). No previous running experience was the most important risk factor in male (HR 2.6; 95% CI 1.2 to 5.5) and female (HR 2.1; 95% CI 1.2 to 3.7) participants. Conclusions The incidence of running-related injuries in recreational runners preparing for a 4-mile running event is substantially high. Male and female participants have different risk profiles. Furthermore, the findings suggest that novice runners may benefit the most out of preventive interventions for RRI.

Predictors of Running-Related Injuries in Novice Runners Enrolled in a Systematic Training Program A Prospective Cohort Study

Background The popularity of running is still growing. As participation increases, running-related injuries also increase. Until now, little is known about the predictors for injuries in novice runners. Hypothesis Predictors for running-related injuries (RRIs) will differ between male and female novice runners. Study Design Cohort study; Level of evidence, 2. Methods Participants were 532 novice runners (226 men, 306 women) preparing for a recreational 4-mile (6.7-km) running event. After completing a baseline questionnaire and undergoing an orthopaedic examination, they were followed during the training period of 13 weeks. An RRI was defined as any self-reported running-related musculoskeletal pain of the lower extremity or back causing a restriction of running for at least 1 week. Results Twenty-one percent of the novice runners had at least one RRI during follow-up. The multivariate adjusted Cox regression model for male participants showed that body mass index (BMI) (hazard ratio [HR], 1.15; 95% confidence interval [CI], 1.05-1.26), previous injury in the past year (HR, 2.7; 95% CI, 1.36-5.55), and previous participation in sports without axial load (HR, 2.05; 95% CI, 1.03-4.11) were associated with RRI. In female participants, only navicular drop (HR, 0.85; 95% CI, 0.75-0.97) remained a significant predictor for RRI in the multivariate Cox regression modeling. Type A behavior and range of motion (ROM) of the hip and ankle did not affect risk. Conclusion Male and female novice runners have different risk profiles. Higher BMI, previous injury, and previous sports participation without axial loading are important predictors for RRI in male participants. Further research is needed to detect more predictors for female novice runners.

No Effect of a Graded Training Program on the Number of Running-Related Injuries in Novice Runners: A Randomized Controlled Trial

Background Although running has positive effects on health and fitness, the incidence of a running-related injury (RRI) is high. Research on prevention of RRI is scarce; to date, no studies have involved novice runners. Hypothesis A graded training program for novice runners will lead to a decrease in the absolute number of RRIs compared with a standard training program. Study Design Randomized controlled trial; Level of evidence, 1. Methods GRONORUN (Groningen Novice Running) is a 2-armed randomized controlled trial comparing a standard 8-week training program (control group) and an adapted, graded, 13-week training program (intervention group), on the risk of sustaining an RRI. Participants were novice runners (N = 532) preparing for a recreational 4-mile (6.7-km) running event. The graded 13-week training program was based on the 10% training rule. Both groups registered information on running characteristics and RRI using an Internet-based running log. The primary outcome measure was RRIs per 100 participants. An RRI was defined as any musculoskeletal complaint of the lower extremity or back causing a restriction of running for at least 1 week. Results The graded training program was not preventive for sustaining an RRI (χ 2 = 0.016, df = 1, P = .90). The incidence of RRI was 20.8% in the graded training program group and 20.3% in the standard training program group. Conclusions This randomized controlled trial showed no effect of a graded training program (13 weeks) in novice runners, applying the 10% rule, on the incidence of RRI compared with a standard 8-week training program.

Foot pronation is not associated with increased injury risk in novice runners wearing a neutral shoe: a 1-year prospective cohort study

Objective To investigate if running distance to first running-related injury varies between foot postures in novice runners wearing neutral shoes. Design A 1-year epidemiological observational prospective cohort study. Setting Denmark. Participants A total of 927 novice runners equivalent to 1854 feet were included. At baseline, foot posture on each foot was evaluated using the foot-posture index and categorised into highly supinated (n=53), supinated (n=369), neutral (n=1292), pronated (n=122) or highly pronated (n=18). Participants then had to start running in a neutral running shoe and to use global positioning system watch to quantify the running distance in every training session. Main outcome measure A running-related injury was defined as any musculoskeletal complaint of the lower extremity or back caused by running, which restricted the amount of running for at least 1 week. Results During 1 year of follow-up, the 1854 feet included in the analyses ran a total of 326 803 km until injury or censoring. A total of 252 participants sustained a running-related injury. Of these, 63 were bilateral injuries. Compared with a neutral foot posture, no significant body mass index-adjusted cumulative risk differences (RD) were found after 250 km of running for highly supinated feet (RD=11.0% (−10% to 32.1%), p=0.30), supinated feet (RD=−1.4% (−8.4% to 5.5%), p=0.69), pronated feet (RD=−8.1% (−17.6% to 1.3%), p=0.09) and highly pronated feet (RD=9.8% (−19.3% to 38.8%), p=0.51). In addition, the incidence-rate difference/1000 km of running, revealed that pronators had a significantly lower number of injuries/1000 km of running of −0.37 (−0.03 to −0.70), p=0.03 than neutrals. Conclusions The results of the present study contradict the widespread belief that moderate foot pronation is associated with an increased risk of injury among novice runners taking up running in a neutral running shoe. More work is needed to ascertain if highly pronated feet face a higher risk of injury than neutral feet.

Comparison of vertical ground reaction forces during overground and treadmill running. A validation study

BackgroundOne major drawback in measuring ground-reaction forces during running is that it is time consuming to get representative ground-reaction force (GRF) values with a traditional force platform. An instrumented force measuring treadmill can overcome the shortcomings inherent to overground testing. The purpose of the current study was to determine the validity of an instrumented force measuring treadmill for measuring vertical ground-reaction force parameters during running.MethodsVertical ground-reaction forces of experienced runners (12 male, 12 female) were obtained during overground and treadmill running at slow, preferred and fast self-selected running speeds. For each runner, 7 mean vertical ground-reaction force parameters of the right leg were calculated based on five successful overground steps and 30 seconds of treadmill running data. Intraclass correlations (ICC(3,1)) and ratio limits of agreement (RLOA) were used for further analysis.ResultsQualitatively, the overground and treadmill ground-reaction force curves for heelstrike runners and non-heelstrike runners were very similar. Quantitatively, the time-related parameters and active peak showed excellent agreement (ICCs between 0.76 and 0.95, RLOA between 5.7% and 15.5%). Impact peak showed modest agreement (ICCs between 0.71 and 0.76, RLOA between 19.9% and 28.8%). The maximal and average loading-rate showed modest to excellent ICCs (between 0.70 and 0.89), but RLOA were higher (between 34.3% and 45.4%).ConclusionsThe results of this study demonstrated that the treadmill is a moderate to highly valid tool for the assessment of vertical ground-reaction forces during running for runners who showed a consistent landing strategy during overground and treadmill running. The high stride-to-stride variance during both overground and treadmill running demonstrates the importance of measuring sufficient steps for representative ground-reaction force values. Therefore, an instrumented treadmill seems to be suitable for measuring representative vertical ground-reaction forces during running.

The effectiveness of a preconditioning programme on preventing running-related injuries in novice runners: a randomised controlled trial

Objectives There is no consensus on the aetiology and prevention of running-related injuries in runners. Preconditioning studies among different athlete populations show positive effects on the incidence of sports injuries. Hypothesis A 4-week preconditioning programme in novice runners will reduce the incidence of running-related injuries. Study design Randomised controlled clinical trial; level of evidence, 1. Methods Novice runners (N=432) prepared for a four-mile recreational running event. Participants were allocated to the 4-week preconditioning (PRECON) group (N=211) or the control group (N=221). The PRECON group started a 4-week training programme, prior to the running programme, with walking and hopping exercises. After the 4-week period both groups started a 9-week running programme. In both groups information was registered on running exposure and running-related injuries (RRIs) using an internet-based running log. Primary outcome measure was RRIs per 100 runners. An RRI was defined as any musculoskeletal complaint of the lower extremity or lower back causing restriction of running for at least a week. Results The incidence of RRIs was 15.2% in the PRECON group and 16.8% in the control group. The difference in RRIs between the groups was not significant (χ2=0.161, df=1, p=0.69). Conclusion This prospective study demonstrated that a 4-week PRECON programme with walking and hopping exercises had no influence on the incidence of RRIs in novice runners.

Can GPS Be Used to Detect Deleterious Progression in Training Volume Among Runners

Abstract Nielsen, RO, Cederholm, P, Buist, I, Sørensen, H, Lind, M, and Rasmussen, S. Can GPS be used to detect deleterious progression in training volume among runners? J Strength Cond Res 27(6): 1471–1478, 2013—There is a need to ascertain if an association exists between excessive progression in weekly volume and development of running-related injuries (RRI). The purpose of this study was to investigate if GPS can be used to detect deleterious progression in weekly training volume among 60 novice runners included in a 10-week prospective study. All participants used GPS to quantify training volume while running. In case of injury, participants attended a clinical examination. The 13 runners who sustained injuries during follow-up had a significantly higher weekly progression in total training volume in the week before the injury origin (86% [95% confidence interval: 12.9–159.9], p = 0.026) compared with other weeks. Although not significant, participants with injuries had an increase in weekly training volume of 31.6% compared with a 22.1% increase among the healthy participants. The error of the GPS measurements in open landscape, forest, and urban area of volume was ⩽6.2%. To conclude, no clinically relevant measurement errors of the GPS devices were found for training volume. Based on this, GPS has a potential to detect errors in training volume, which may be associated with development of RRI. Based on the results from the current study, increases in weekly training progression may become deleterious at a weekly increase above 30%, which is more than the 10% rule currently used as a guideline for correct progression in weekly volume by runners and coaches. Still, no clear evidence for safe progression of weekly volume exists. But it seems likely that some individuals may tolerate weekly progressions around 20–25%, at least for a short period of time.

Differences in kinetic variables between injured and noninjured novice runners: A prospective cohort study

OBJECTIVES This prospective study examined differences in kinetic variables between injured and noninjured novice female and male runners and their potential contribution to RRIs. DESIGN A prospective cohort study. METHODS At baseline vertical ground reaction forces were assessed with an instrumented treadmill equipped with three force measuring transducers. Female participants ran at 8 and 9kmh(-1) and male runners ran at 9 and 10kmh(-1). Primary outcome measure was a running related injury (RRI). Participants were novice female and male recreational runners and were followed during a 9-week running program with three running sessions a week. RESULTS One hundred thirty three female and seventy seven male runners participated in this study. Mean age was 37.2years and the BMI was 23.9kgm(-2). During the nine week running program 16.2% of the participants sustained an injury and no difference in incidence between female and male runners was seen. In injured male runners loading rate was significantly higher compared to noninjured male runners at both running speeds and contact time in the injured male group was significantly shorter at 9kmh(-1). In the group of female injured and noninjured runners no differences on kinetic or spatio-temporal variables were observed. Female runners had significantly higher loading rates compared to male runners but this did not have an effect on the incidence of RRIs. CONCLUSIONS This study showed that male injured runners had higher loading rates and shorter contact times than noninjured male runners. In female runners, however, no differences in kinetic or spatio-temporal variables were observed between injured and noninjured novice runners.

Predictors of Running-Related Injuries Among 930 Novice Runners A 1-Year Prospective Follow-up Study

Background: To identify persons at high risk of sustaining running-related injuries, an evidence-based understanding of the risk factors associated with injury is needed. Purpose: To identify demographic and behavioral risk factors associated with running-related injuries. Study Design: Observational prospective cohort study with a 1-year follow-up. Methods: Exposures including sex, age, body mass index (BMI), behavior (Type A Self-Rating Inventory [TASRI]), running experience, other sports activity, previous running-related injuries, and other injuries not related to running were assessed prior to or at baseline. The outcome of interest was a running-related injury, defined as any musculoskeletal complaint of the lower extremity or back caused by running that restricted the amount of running (volume, duration, pace, or frequency) for at least 1 week. All participants quantified their running volume by global positioning system (GPS) and used a neutral running shoe. Time to first injury for each exposure variable was analyzed using a generalized linear model, with cumulative kilometers of the training sessions as the time scale. Results: A total of 930 individuals were included in the study, of which 254 sustained a running-related injury during a total of 155.318 km of running. By calculating the cumulative injury risk differences (cIRDs) [95% confidence intervals] after 500 km of running, the TASRI Type B behavior (cIRD, 11.9% [−0.5%; 23.3%]; P = .04) was found to be a significant predictor of injury, while age between 45 and 65 years (cIRD, 14.7% [−2.1%; 31.5%]; P = .08) and previous injuries not related to running (cIRD, 11.1% [−0.2%; 22.4%]; P = .05) were considered clinically interesting, although not statistically significant. In addition, χ2 test results across 4 BMI groups also revealed a borderline significant relationship (P = .06). No significant or clinically relevant relationships were found for sex (P = .42), previous running-related injury (P = .47), running experience (P = .30), and other sports activities (P = .30). Conclusion: The findings of the present study suggest BMI >30 kg/m2, age between 45 and 65 years, noncompetitive behavior, and previous injuries not related to running are associated with increased risk of injury among novice runners, while BMI <20 kg/m2 was protective. Still, the role of the risk factors in the causal mechanism leading to injury needs to be investigated.

The GRONORUN 2 study: effectiveness of a preconditioning program on preventing running related injuries in novice runners. The design of a randomized controlled trial

BackgroundDistance running is a popular recreational exercise. It is a beneficial activity for health and well being. However, running may also cause injuries, especially of the lower extremities. In literature there is no agreement what intrinsic and extrinsic factors cause running related injuries (RRIs). In theory, most RRIs are elicited by training errors, this too much, too soon. In a preconditioning program runners can adapt more gradually to the high mechanical loads of running and will be less susceptible to RRIs. In this study the effectiveness of a 4-week preconditioning program on the incidence of RRIs in novice runners prior to a training program will be studied.Methods/DesignThe GRONORUN 2 (Groningen Novice Running) study is a two arm randomized controlled trial studying the effect of a 4-week preconditioning (PRECON) program in a group of novice runners. All participants wanted to train for the recreational Groningen 4-Mile running event. The PRECON group started a 4-week preconditioning program with walking and hopping exercises 4 weeks before the start of the training program. The control (CON) and PRECON group started a frequently used 9-week training program in preparation for the Groningen 4-Mile running event.During the follow up period participants registered their running exposure, other sporting activities and running related injuries in an Internet based running log. The primary outcome measure was the number of RRIs. RRI was defined as a musculoskeletal ailment or complaint of the lower extremities or back causing a restriction on running for at least three training sessions.DiscussionThe GRONORUN 2 study will add important information to the existing running science. The concept of preconditioning is easy to implement in existing training programs and will hopefully prevent RRIs especially in novice runners.Trial registrationThe Netherlands National Trial Register NTR1906. The NTR is part of the WHO Primary Registries.