Lower Extremity Complaints in Runners and Other Athletes

Running is one of the most accessible sports, and probably for this reason, is practiced by many persons all over the world. However, besides the positive health effects of running there are some concerns about the high incidence of running injuries, especially to the lower extremities. The results of a systematic review on lower extremity injuries of long-distance runners showed an incidence of running injuries ranging from 19.4% to 79.3%. The results of the Rotterdam marathon revealed a one-year prevalence of 48.3%. The incidence of lower extremity injuries occurring during the marathon was 18.2%; most of these injuries occurred in the calf, knee and thigh. The following factors were associated with the occurrence of lower extremity injuries: participating more than six times in a race in the previous 12 months (OR 1.66), a history of running injuries (OR 2.62), high education level (OR 0.73) and daily smoking (OR 0.23). Among the modifiable risk factors studied, a training distance less than 40 kilometres a week is a strong protective factor of future calf injuries, and regular interval training is a strong protective factor for knee injuries. At 3-months follow-up, 25.5% of th

Physical Activity and Features of Knee Osteoarthritis on Magnetic Resonance Imaging in Individuals Without Osteoarthritis:A Systematic Review

Objective: To systematically review all studies that have evaluated the association between physical activity (PA) levels and features of knee osteoarthritis (OA) on magnetic resonance imaging (MRI) for subjects without OA. Methods: The inclusion criteria for prospective studies were as follows: 1) subjects without OA; 2) average age 35–80 years; and 3) any self-reported PA or objective measurement of PA. The eligible MRI outcomes were OA-related measures of intraarticular knee joint structures. Exclusion criteria were evaluations of instant associations with transient structural changes after PA. Results: Two randomized controlled trials and 16 observational studies were included. One of 11 studies found that PA was harmfully related to cartilage volume or thickness, but 4 studies found a significant protective association. Four of 10 studies found that PA was harmfully related to cartilage defects, while others showed no significant associations. Two of 3 studies reported a significantly increased cartilage T2 value in individuals with more PA. All 3 studies reported no significant association between PA and bone marrow lesions. Two studies assessed the association between PA and meniscus pathology, in which only occupational PA involving knee bending was associated with a greater risk of progression. Conclusion: Within the sparse and diverse evidence available, no strong evidence was found for the presence or absence of an association between PA and the presence or progression of features of OA on MRI among subjects without OA. Therefore, more research is required before PA in general and also specific forms of PA can be deemed safe for knee joint structures.</p

Sex-Differences in Characteristics and Factors Associated With New Running-Related Injuries Among Recreational Runners

Previous findings of sex-differences in type, location, consequences, and risk factors of running-related injuries (RRIs) are contradictory. We aim to clarify these potential sex-differences. This cohort study analyzed prospective RRIs among recreational runners participating in running events (5–42 km) by combining data of two RCTs, including all intervention arms. Participants received a baseline questionnaire at registration and three follow-up questionnaires (before and up to 1 month after the event) detailing runners characteristics, injury characteristics (location, type [muscle and tendon], joint injury, etc.), and consequences (medication use, pain scores [0–10]). A predetermined injury definition was used to register RRIs. Data analysis was performed using descriptive statistics and univariate and multivariable logistic regression analysis of risk factors for a new RRI (demographics, training characteristics, event distance, and RRI-history), using separate models per sex. We analyzed 6428 participants with an average follow-up time of 4.8 months, 82% finished at least one follow-up questionnaire. During follow-up, 2133 (33%) participants (33% men, 34% women) suffered one or more RRIs. We found no sex-differences in injury location and type of injury. Men used less medication (13% vs. 15%, p = 0.01) and had lower pain scores while running (4.2 [SD2.9] vs. 4.5 [SD 2.8], p = 0.04) compared to women. A history of RRIs was associated with a new RRI in both men (OR 1.9 [95% CI: 1.6–2.2]) and women (OR 1.7 [95% CI: 1.4–2.0]). No relevant sex-differences were found between middle-aged runners. Our findings do not support accounting for sex-specific factors, specifically with regard to training characteristics, injury history, or injury consequences, in the development of personalized RRI risk reduction. Trial Registration: The INSPIRE trial (NTR5998) and SPRINT study (NL7694) were prospectively registered in the Dutch Trial Register.</p

The socio-economic impact of running-related injuries:A large prospective cohort study

OBJECTIVES: To evaluate the impact of running‐related injuries (RRIs) on activities of daily living (ADL), work, healthcare utilization, and estimated costs. DESIGN: Prospective cohort study with data from a randomized controlled trial. METHODS: Adult recreational runners who registered for a running event (distances 5 to 42 km) were included in this study. Minimum follow‐up duration was 3 months (preparation, event participation, and post‐race period). Injuries were registered using a standardized definition. Primary outcome measure was a standardized 5‐item survey on limitations in ADL. The survey data were categorized to the number of injured runners with complete/moderate/no limitations. This outcome was expressed as the percentage of injured runners with any limitation (complete or moderate limitations amalgamated). Secondary outcomes were work absenteeism, the number of healthcare visits per injured runner, and estimated direct medical and indirect costs per participant and per RRI. RESULTS: 1929 runners (mean [SD] age 41 [12] years, 53% men) were included in this study and 883 runners (46%) sustained a RRI during the course of the study. Injured runners reported the highest limitations (% with any limitation) of RRIs during the first week of injury on sports and leisure activities (70%) and transportation activities (23%). 39% of the injured runners visited a healthcare professional. Work absenteeism due to the RRI was reported in 5% of the injured runners. The total mean estimated costs were €74 per RRI and €35 per participant. CONCLUSIONS: Injured runners are mainly limited in their transportation activities and during sports and leisure. While the estimated costs of RRIs are not high when expressed per participant, the absolute costs may be substantial due to the popularity of running

What are the Differences in Injury Proportions Between Different Populations of Runners?:A Systematic Review and Meta-Analysis

_Background:_ Many runners suffer from injuries. No information on high-risk populations is available so far though. _Objectives:_ The aims of this study were to systematically review injury proportions in different populations of runners and to compare injury locations between these populations. _Data Sources:_ An electronic search with no date restrictions was conducted up to February 2014 in the PubMed, Embase, SPORTDiscus and Web of Science databases. The search was limited to original articles written in English. The reference lists of the included articles were checked for potentially relevant studies. _Study Eligibility Criteria:_ Studies were eligible when the proportion of running injuries was reported and the participants belonged to one or more homogeneous populations of runners that were clearly described. Study selection was conducted by two independent reviewers, and disagreements were resolved in a consensus meeting. _Study Appraisal and Synthesis Methods:_ Details of the study design, population of runners, sample size, injury definition, method of injury assessment, number of injuries and injury locations were extracted from the articles. The risk of bias was assessed with a scale consisting of eight items, which was specifically developed for studies focusing on musculoskeletal complaints. _Results:_ A total of 86 articles were included in this review. Where possible, injury proportions were pooled for each identified population of runners, using a random-effects model. Injury proportions were affected by injury definitions and durations of follow-up. Large differences between populations existed. The number of medical-attention injuries during an event was small for most populations of runners, except for ultra-marathon runners, in which the pooled estimate was 65.6 %. Time-loss injury proportions between different populations of runners ranged from 3.2 % in cross-country runners to 84.9 % in novice runners. Overall, the proportions were highest among short-distance track runners and ultra-marathon runners. _Limitations:_ The results were pooled by stratification of studies according to the population, injury definition and follow-up/recall period; however, heterogeneity was high. _Conclusions:_ Large differences in injury proportions between different populations of runners existed. Injury proportions were affected by the duration of follow-up. A U-shaped pattern between the running distance and the time-loss injury proportion seemed to exist. Future prospective studies of injury surveillance are highly recommended to take running exposure and censoring into account

No differences in physical activity between children with overweight and children of normal-weight

BACKGROUND: The aim of this study was to investigate the differences in objectively measured physical activity and in self-reported physical activity between overweight and normal-weight children. METHODS: Data from a prospective cohort study including children, presenting at the participating general practices in the south-west of the Netherlands, were used. Children (aged 4-15 years) were categorized as normal-weight or overweight using age- and sex specific cut-off points. They wore an ActiGraph accelerometer for one week to register physical activity, and filled out a diary for one week about physical activity. RESULTS: A total of 57 children were included in this study. Overweight children spent significantly less percentage time per day in sedentary behavior (β - 1.68 (95%CI -3.129, - 0.07)). There were no significant differences in percentage time per day spent in moderate to vigorous physical activity (β 0.33 (- 0.11, 0.78)). No significant differences were found between children of normal-weight and overweight in self-reported measures of physical activity. CONCLUSIONS: Overweight children are not less physically active than normal-weight children, which may be associated with the risen awareness towards overweight/obesity and with implemented interventions for children with overweight/obesity

Patients' Perspectives on Participation in an Effectiveness Study on Footwear Modification for the First Metatarsophalangeal Joint Osteoarthritis:A Qualitative Study

Background: The effectiveness of footwear modifications for the first metatarsophalangeal (MTP) joint osteoarthritis (OA) compared to usual general practitioner (GP) care has never been studied. Understanding patients' perspectives is essential for assessing the feasibility of a randomized controlled trial (RCT) on this topic. Our objective is to explore experiences, expectations, beliefs, and opinions of patients with the first MTP joint OA regarding symptoms and limitations, healthcare management, footwear intervention, and research participation for designing a successful future effectiveness trial. Method: A qualitative research design was embedded within a feasibility pilot study for the recruitment of participants diagnosed with the first MTP joint OA. Qualitative data from semistructured interviews were categorized analyzed. Results: All participants (n = 10) experienced limitations on the activity and participation level due to pain symptoms in the first MTP joint. Patients experienced varying approaches and treatment outcomes in primary and secondary healthcare, leading to both positive and negative perspectives. Most participants highlighted the importance of the cosmetic appearance of modified footwear, indicating that this is crucial for compliance with the intervention. Participants showed willingness to participate in an RCT, with strong preference for randomization into an intervention group with a modified footwear alongside usual GP care rather than GP care alone. Conclusion: Our study identified key considerations for designing a successful future trial, including recruiting incident cases, offering the deferred footwear intervention to the control group, providing clear information during recruitment and randomization phase, and the significance of the cosmetic appearance of modified footwear for patients with the first MTP joint OA.</p