Risk Factors for Injuries in Runners: A Systematic Review of Foot Strike Technique and Its Classification at Impact.
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ABSTRACT: Background
It has been suggested that foot strike technique (FST) at initial contact is related to running-related injuries (RRIs).Purpose
To explore the relationship between FST and RRIs.Study design
Systematic review; Level of evidence, 3.Methods
A systematic electronic search was performed using MEDLINE, PubMed, SPORTDiscus, Scopus, and Web of Science databases. Included were studies published in the English language that explored the relationship between FST and RRIs between January 1960 and November 2020. Results were extracted and collated. The Grading of Recommendations, Assessment, Development and Evaluation approach was applied to synthesize the quality of evidence.Results
We reviewed 13 studies exploring the relationship between FST and RRIs. Of these, 6 studies reported FST categorically (foot strike pattern [FSP]), and 7 reported continuous measures (foot contact angle, ankle flexion angle, and strike index). Three of the 6 studies looking at categorical FSP found rearfoot strikers have a significantly greater retrospective injury rate than do non- rearfoot strikers, with 1 other study noting a greater risk associated with midfoot and forefoot strike. Regarding the continuous measures of FST, only 1 of the 7 studies reported a significant relationship with RRIs.Conclusion
There was low evidence to suggest a relationship between FST (or its subcategories of categorical FSP and continuous measures) and RRIs. While two-thirds of the categorical studies found a relationship between FSP and RRIs, these studies were very low quality, with limitations such as retrospective study design, low participant numbers, and poor FSP assessment methods. More large-scale prospective studies are required.
SUBMITTER: Burke A
PROVIDER: S-EPMC8436320 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BACKGROUND:The popularity of running continues to increase, which means that the incidence of running-related injuries will probably also continue to increase. Little is known about risk factors for running injuries and whether they are sex-specific. OBJECTIVES:The aim of this study was to review information about risk factors and sex-specific differences for running-induced injuries in adults. SEARCH STRATEGY:The databases PubMed, EMBASE, CINAHL and Psych-INFO were searched for relevant articles. SELECTION CRITERIA:Longitudinal cohort studies with a minimal follow-up of 1 month that investigated the association between risk factors (personal factors, running/training factors and/or health and lifestyle factors) and the occurrence of lower limb injuries in runners were included. DATA COLLECTION AND ANALYSIS:Two reviewers' independently selected relevant articles from those identified by the systematic search and assessed the risk of bias of the included studies. The strength of the evidence was determined using a best-evidence rating system. Sex differences in risk were determined by calculating the sex ratio for risk factors (the risk factor for women divided by the risk factor for men). MAIN RESULTS:Of 400 articles retrieved, 15 longitudinal studies were included, of which 11 were considered high-quality studies and 4 moderate-quality studies. Overall, women were at lower risk than men for sustaining running-related injuries. Strong and moderate evidence was found that a history of previous injury and of having used orthotics/inserts was associated with an increased risk of running injuries. Age, previous sports activity, running on a concrete surface, participating in a marathon, weekly running distance (30-39 miles) and wearing running shoes for 4 to 6 months were associated with a greater risk of injury in women than in men. A history of previous injuries, having a running experience of 0-2 years, restarting running, weekly running distance (20-29 miles) and having a running distance of more than 40 miles per week were associated with a greater risk of running-related injury in men than in women. CONCLUSIONS:Previous injury and use of orthotic/inserts are risk factors for running injuries. There appeared to be differences in the risk profile of men and women, but as few studies presented results for men and women separately, the results should be interpreted with caution. Further research should attempt to minimize methodological bias by paying attention to recall bias for running injuries, follow-up time, and the participation rate of the identified target group.
| S-EPMC4338213 | biostudies-literature
Project description:Runners are often categorized as forefoot, midfoot or rearfoot strikers, but how much and why do individuals vary in foot strike patterns when running on level terrain? This study used general linear mixed-effects models to explore both intra- and inter-individual variations in foot strike pattern among 48 Kalenjin-speaking participants from Kenya who varied in age, sex, body mass, height, running history, and habitual use of footwear. High speed video was used to measure lower extremity kinematics at ground contact in the sagittal plane while participants ran down 13 meter-long tracks with three variables independently controlled: speed, track stiffness, and step frequency. 72% of the habitually barefoot and 32% of the habitually shod participants used multiple strike types, with significantly higher levels of foot strike variation among individuals who ran less frequently and who used lower step frequencies. There was no effect of sex, age, height or weight on foot strike angle, but individuals were more likely to midfoot or forefoot strike when they ran on a stiff surface, had a high preferred stride frequency, were habitually barefoot, and had more experience running. It is hypothesized that strike type variation during running, including a more frequent use of forefoot and midfoot strikes, used to be greater before the introduction of cushioned shoes and paved surfaces.
| S-EPMC4495985 | biostudies-literature
Project description:ObjectiveRunning-related musculoskeletal injuries (RRMIs), especially stemming from overuse, frequently occur in runners. This study aimed to systematically review the literature and determine the incidence and prevalence proportion of RRMIs by anatomic location and specific pathology.MethodsAn electronic database search with no date beginning restrictions was performed in SPORTDiscus, PubMed, and MEDLINE up to June 2020. Prospective studies were used to find the anatomic location and the incidence proportion of each RRMI, whereas retrospective or cross-sectional studies were used to find the prevalence proportion of each RRMI. A separate analysis for ultramarathon runners was performed.ResultsThe overall injury incidence and prevalence were 40.2% ± 18.8% and 44.6% ± 18.4% (mean ± SD), respectively. The knee, ankle, and lower leg accounted for the highest proportion of injury incidence, whereas the knee, lower leg, and foot/toes had the highest proportion of injury prevalence. Achilles tendinopathy (10.3%), medial tibial stress syndrome (9.4%), patellofemoral pain syndrome (6.3%), plantar fasciitis (6.1%), and ankle sprains (5.8%) accounted for the highest proportion of injury incidence, whereas patellofemoral pain syndrome (16.7%), medial tibial stress syndrome (9.1%), plantar fasciitis (7.9%), iliotibial band syndrome (7.9%), and Achilles tendinopathy (6.6%) had the highest proportion of injury prevalence. The ankle (34.5%), knee (28.1%), and lower leg (12.9%) were the 3 most frequently injured sites among ultramarathoners.ConclusionThe injury incidence proportions by anatomic location between ultramarathoners and non-ultramarathoners were not significantly different (p = 0.798). The pathologies with the highest incidence proportion of injuries were anterior compartment tendinopathy (19.4%), patellofemoral pain syndrome (15.8%), and Achilles tendinopathy (13.7%). The interpretation of epidemiological data in RRMIs is limited due to several methodological issues encountered.
| S-EPMC8500811 | biostudies-literature
Project description:BackgroundInvestigations of foot strike patterns during overground distance running have foci on prevalence, performance and change in foot strike pattern with increased distance. To date, synthesised analyses of these findings are scarce.ObjectiveThe key objectives of this review were to quantify the prevalence of foot strike patterns, assess the impact of increased running distance on foot strike pattern change and investigate the potential impact of foot strike pattern on performance.MethodsRelevant peer-reviewed literature was obtained by searching EBSCOhost CINAHL, Ovid Medline, EMBASE and SPORTDiscus (inception-2021) for studies investigating foot strike patterns in overground distance running settings (> 10 km). Random effects meta-analyses of prevalence data were performed where possible.ResultsThe initial search identified 2210 unique articles. After removal of duplicates and excluded articles, 12 articles were included in the review. Meta-analysis of prevalence data revealed that 79% of long-distance overground runners rearfoot strike early, with prevalence rising to 86% with increased distance. In total, 11% of runners changed foot strike pattern with increased distance and of those, the vast majority (84%) do so in one direction, being non-rearfoot strike to rearfoot strike. Analysis of the relationship between foot strike pattern and performance revealed that 5 studies reported a performance benefit to non-rearfoot strike, 1 study reported a performance benefit to non-rearfoot strike in women but not men, 4 studies reported no benefit to non-rearfoot strike or rearfoot strike, and no studies reported a performance benefit of rearfoot strike over non-rearfoot strike.ConclusionMost overground distance runners rearfoot strike early, and the prevalence of this pattern increases with distance. Of those that do change foot strike pattern, the majority transition from non-rearfoot to rearfoot. The current literature provides inconclusive evidence of a competitive advantage being associated with long-distance runners who use a non-rearfoot strike pattern in favour of a rearfoot strike pattern.
| S-EPMC8581084 | biostudies-literature
Project description:ContentDistance running is one of the most popular physical activities, and running-related injuries (RRIs) are also common. Foot strike patterns have been suggested to affect biomechanical variables related to RRI risks.ObjectiveTo determine the effects of foot strike techniques on running biomechanics.Data sourcesThe databases of Web of Science, PubMed, EMBASE, and EBSCO were searched from database inception through November 2018.Study selectionThe initial electronic search found 723 studies. Of these, 26 studies with a total of 472 participants were eligible for inclusion in this meta-analysis.Study designSystematic review and meta-analysis.Level of evidenceLevel 4.Data extractionMeans, standard deviations, and sample sizes were extracted from the eligible studies, and the standard mean differences (SMDs) were obtained for biomechanical variables between forefoot strike (FFS) and rearfoot strike (RFS) groups using a random-effects model.ResultsFFS showed significantly smaller magnitude (SMD, -1.84; 95% CI, -2.29 to -1.38; P < 0.001) and loading rate (mean: SMD, -2.1; 95% CI, -3.18 to -1.01; P < 0.001; peak: SMD, -1.77; 95% CI, -2.21 to -1.33; P < 0.001) of impact force, ankle stiffness (SMD, -1.69; 95% CI, -2.46 to -0.92; P < 0.001), knee extension moment (SMD, -0.64; 95% CI, -0.98 to -0.3; P < 0.001), knee eccentric power (SMD, -2.03; 95% CI, -2.51 to -1.54; P < 0.001), knee negative work (SMD, -1.56; 95% CI, -2.11 to -1.00; P < 0.001), and patellofemoral joint stress (peak: SMD, -0.71; 95% CI, -1.28 to -0.14; P = 0.01; integral: SMD, -0.63; 95% CI, -1.11 to -0.15; P = 0.01) compared with RFS. However, FFS significantly increased ankle plantarflexion moment (SMD, 1.31; 95% CI, 0.66 to 1.96; P < 0.001), eccentric power (SMD, 1.63; 95% CI, 1.18 to 2.08;P < 0.001), negative work (SMD, 2.60; 95% CI, 1.02 to 4.18; P = 0.001), and axial contact force (SMD, 1.26; 95% CI, 0.93 to 1.6; P < 0.001) compared with RFS.ConclusionRunning with RFS imposed higher biomechanical loads on overall ground impact and knee and patellofemoral joints, whereas FFS imposed higher biomechanical loads on the ankle joint and Achilles tendon. The modification of strike techniques may affect the specific biomechanical loads experienced on relevant structures or tissues during running.
| S-EPMC7734358 | biostudies-literature
Project description:This study aimed to assess the validity and reliability of the three-dimensional joint kinematic outcomes obtained by the inertial measurement units (IMUs) for runners with rearfoot strike pattern (RFS) and non-rearfoot strike pattern (NRFS). The IMUs system and optical motion capture system were used to simultaneous collect 3D kinematic of lower extremity joint data from participants running at 12 km/h. The joint angle waveforms showed a high correlation between the two systems after the offset correction in the sagittal plane (NRFS: coefficient of multiple correlation (CMC) = 0.924–0.968, root mean square error (RMSE) = 4.6°–13.7°; RFS: CMC = 0.930–0.965, RMSE = 3.1°–7.7°), but revealed high variability in the frontal and transverse planes (NRFS: CMC = 0.924–0.968, RMSE = 4.6°–13.7°; RFS: CMC = 0.930–0.965, RMSE = 3.1°–7.7°). The between-rater and between-day reliability were shown to be very good to excellent in the sagittal plane (between-rater: NRFS: CMC = 0.967–0.975, RMSE = 1.9°–2.9°, RFS: CMC = 0.922–0.989, RMSE = 1.0°–2.5°; between-day: NRFS: CMC = 0.950–0.978, RMSE = 1.6°–2.7°, RFS: CMC = 0.920–0.989, RMSE = 1.7°–2.2°), whereas the reliability was weak to very good (between-rater: NRFS: CMC = 0.480–0.947, RMSE = 1.1°–2.7°, RFS: CMC = 0.646–0.873, RMSE = 0.7°–2.4°; between-day: NRFS: CMC = 0.666–0.867, RMSE = 0.7°–2.8°, RFS: CMC = 0.321–0.805, RMSE = 0.9°–5.0°) in the frontal and transverse planes across all joints in both types of runners. The IMUs system was a feasible tool for measuring lower extremity joint kinematics in the sagittal plane during running, especially for RFS runners. However, the joint kinematics data in frontal and transverse planes derived by the IMUs system need to be used with caution.
| S-EPMC9793257 | biostudies-literature
Project description:BackgroundRunning overuse injuries (ROIs) occur within a complex, partly injury-specific interplay between training loads and extrinsic and intrinsic risk factors. Biomechanical risk factors (BRFs) are related to the individual running style. While BRFs have been reviewed regarding general ROI risk, no systematic review has addressed BRFs for specific ROIs using a standardized methodology.ObjectiveTo identify and evaluate the evidence for the most relevant BRFs for ROIs determined during running and to suggest future research directions.DesignSystematic review considering prospective and retrospective studies. (PROSPERO_ID: 236,832).Data sourcesPubMed. Connected Papers. The search was performed in February 2021.Eligibility criteriaEnglish language. Studies on participants whose primary sport is running addressing the risk for the seven most common ROIs and at least one kinematic, kinetic (including pressure measurements), or electromyographic BRF. A BRF needed to be identified in at least one prospective or two independent retrospective studies. BRFs needed to be determined during running.ResultsSixty-six articles fulfilled our eligibility criteria. Levels of evidence for specific ROIs ranged from conflicting to moderate evidence. Running populations and methods applied varied considerably between studies. While some BRFs appeared for several ROIs, most BRFs were specific for a particular ROI. Most BRFs derived from lower-extremity joint kinematics and kinetics were located in the frontal and transverse planes of motion. Further, plantar pressure, vertical ground reaction force loading rate and free moment-related parameters were identified as kinetic BRFs.ConclusionThis study offers a comprehensive overview of BRFs for the most common ROIs, which might serve as a starting point to develop ROI-specific risk profiles of individual runners. We identified limited evidence for most ROI-specific risk factors, highlighting the need for performing further high-quality studies in the future. However, consensus on data collection standards (including the quantification of workload and stress tolerance variables and the reporting of injuries) is warranted.
| S-EPMC9325808 | biostudies-literature
Project description:PurposeThis umbrella systematic review (SR) of SRs and meta-analysis seeks to comprehensively synthesize existing literature to identify and consolidate the diverse range of risk factors contributing to running-related injuries (RRIs).MethodsSystematic searches were conducted on June 28, 2023, across Web of Science, SPORTDiscus, Scopus, PubMed, and Cochrane Library. We included SRs, whether accompanied by meta-analyses or not, that focused on investigating risk factors for RRIs within observational studies. The methodological quality of the SRs was evaluated using the Assessing the Methodological Quality of Systematic Reviews II. To assess the extent of overlap across reviews, the corrected covered area metric was calculated.ResultsFrom 1509 records retrieved, 13 SRs were included. The degree of overlap between SRs was low (4%), and quality varied from critically low (n = 8) to low (n = 5). Two hundred seven outcomes assessed in 148 primary studies were identified as being associated with the occurrence of RRIs. The effect sizes of the associations for which risk measures were reported (n = 131) were classified as large (n = 30, 23%), medium (n = 38, 29%), small (n = 48, 37%) or no effect (n = 15, 11%). Running/training characteristics, health and lifestyle factors, along with morphological and biomechanical aspects, exhibit large effect sizes in increasing the risk for RRIs.ConclusionDrawing from the outcomes of the low-quality SRs and associations with large effect sizes, our findings indicate that running/training characteristics and health and lifestyle factors, as well as morphological and biomechanical aspects, are all implicated in elevating the risk of RRIs, emphasizing the multifactorial basis of injury incidence in running. Given the low quality and heterogeneity of SR, individual findings warrant cautious interpretation.
| S-EPMC11336318 | biostudies-literature
Project description:BackgroundMarathons are the most challenging form of running, and amateur athletes may be more prone to injury due to a lack of professional knowledge and instruction in running.PurposeTo analyze the MRI manifestations of and factors related to knee injuries in amateur marathon runners.SubjectsData were collected from a hospital database of 105 qualified amateur marathon athletes (65 males,40 females), between May 2018 and December 2021.Field strength/sequence1.5T MR: sagittal fs-PDWI, sagittal T1WI and sagittal 3D-DESS sequence.AssessmentThe MRI manifestations of knee joint injury were analyzed and evaluated by two radiologists.Statistical testsThe inter-observer agreement on MRI readings was analyzed using the kappa coefficient, and binary logistic regression analysis was employed to identify factors associated with knee injuries.ResultsThe overall prevalence of knee cartilage lesions, meniscus lesions and bone marrow edema among amateur marathon runners was 45.7%, 72.4%, and 49.5% respectively. Our analysis revealed that older age (OR = 1.135, P<0.001), higher BMI (OR = 1.236, P = 0.044), and slower pace (OR = 2.305, P = 0.017) were associated with increased risk of articular cartilage disease. Furthermore, older age (OR = 1.425, P<0.001) was identified as a risk factor for meniscal lesions, while older age (OR = 1.088, P = 0.002) was bone marrow edema. Notably, no significant correlation was observed between knee joint injuries of amateur marathon athletes and gender or the monthly running distance (P>0.05).ConclusionsThe occurrence of knee injuries among amateur marathon athletes was highly prevalent, with the patellofemoral joint cartilage and posterior horn of medial meniscus being frequently affected areas. Moreover, age, BMI, running years and pace were significant risk factors of knee joint injury.
| S-EPMC11232983 | biostudies-literature
Project description:ObjectivesThis study aimed to compare the plantar loads between habitual rearfoot strike (RFS) and non-RFS (NRFS) during running under the participant's preferred speed.MethodsA total of 66 (36 RFS, 30 NRFS) healthy amateur male runners were included in our study. In-shoe pressure sensors were utilised to the test plantar loads when participants were running using their preferred foot strike pattern and running speed (RFS: 3.2 ± 0.3 m/s; NRFS: 3.4 ± 0.4 m/s).ResultsResults indicated that running speed has a significant effect on the total contact area [F (1, 64) = 7.061, P = 0.01, η 2 = 0.101], which also affects midfoot and forefoot regions. No significant difference was found on the total maximum force, force-time-integral, peak pressure (PP) and pressure-time-integral (PTI), but the total contact area of RFS was higher than that of NRFS runners [F (1, 64) = 77.406, P < 0.001, η 2 = 0.551]. Plantar loads were mainly focused on the heel and midfoot for RFS runners in all variables, and NRFS runners experienced increased PP and PTI in medial forefoot regions.ConclusionHabitual runners tend to adjust their contact area according to the running speed through midfoot and forefoot regions. RFS runners remain susceptible to high impact force on the heel and midfoot, and NRFS runners experience high impact force in the first metatarsal regions. Therefore, runners should note this situation to avoid running-related injuries.
| S-EPMC7327771 | biostudies-literature