Running-Related Biomechanical Risk Factors for Overuse Injuries in Distance Runners: A Systematic Review Considering Injury Specificity and the Potentials for Future Research

Abstract

Background Running 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. Objective To identify and evaluate the evidence for the most relevant BRFs for ROIs determined during running and to suggest future research directions. Design Systematic review considering prospective and retrospective studies. (PROSPERO_ID: 236,832). Data Sources PubMed. Connected Papers. The search was performed in February 2021. Eligibility Criteria English 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. Results Sixty-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. Conclusion This 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.

Shock Acceleration and Attenuation during Running with Minimalist and Maximalist Shoes: A Time- and Frequency-Domain Analysis of Tibial Acceleration

“…However, it was quantified in the whole lower limb from a time dimension [ 33 ]. Shin and knee injuries are predominant in running-related injuries, for instance, patellofemoral pain [ 34 ] and bone stress injuries [ 35 ]. It is essential to explore the transmission of impact loading from the ankle and distal tibia to the proximal tibia and knee.…”

A machine learning approach to identify risk factors for running-related injuries: study protocol for a prospective longitudinal cohort trial

“…To prevent such pathologies a detailed analysis of the risk factors is necessary. Among others, significant risk factors in running are: previous injuries, higher body mass index, low vitamin D status, impaired bone health [ 16 , 17 ], higher age, sex, no previous running experience, lower running volume and biomechanical factors [ 8 , 9 , 43 ]. All of these risk factors are in some way attributable to a mismatch of loading and loading capacity.…”

“…From the assessments, relevant kinematic, kinetic, and spatiotemporal parameters will be calculated (Table 1 ) based on two recent systematic reviews [ 8 , 43 ] investigating possible biomechanical risk factors for running-related injuries.…”

Clinical Application of Gait Retraining in the Injured Runner

“…A recent systemic review examined biomechanical risk factors for several common RRIs including hamstring tendinopathy, patellofemoral pain syndrome (PFPS), patellar tendinopathy, iliotibial band syndrome, medial tibial stress syndrome, tibial stress fractures, Achilles tendinopathy, and plantar fasciitis [ 27 ]. Criteria for inclusion of a biomechanical risk factor in the study was a significant difference from a control group in one prospective study or two retrospective studies [ 27 ]. Levels of evidence for biomechanical risk factors for specific RRIs varied from conflicting evidence to moderate evidence.…”

“…While the literature supporting hip adduction as a risk factor for PFPS is inconsistent [ 27 ], two studies have reported beneficial outcomes related to reduced hip adduction in runners with PFPS [ 8 , 9 ]. One study used a real time display generated by motion capture technology to display hip adduction [ 8 ], while the other study used visual feedback with a full-length mirror [ 9 ].…”