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Excellent study just published in Gait and Posture:
A prospective study of gait related risk factors for exercise-related lower leg pain
T.M. Willems, D. De Clercq, K. Delbaere, G. Vanderstraeten, A. De Cock and E. Witvrouw
Abstract
The purpose of this study was to determine prospectively gait related risk factors for exercise-related lower leg pain (ERLLP) in 400 physical education students. Static lower leg alignment was determined, and 3D gait kinematics combined with plantar pressure profiles were collected. After this evaluation, all sports injuries were registered by the same sports physician during the duration of the study. Forty six subjects developed ERLLP and 29 of them developed bilateral symptoms thus giving 75 symptomatic lower legs. Bilateral lower legs of 167 subjects who developed no injuries in the lower extremities served as controls. Cox regression analysis revealed that subjects who developed ERLLP had an altered running pattern before the injury compared to the controls and included (1) a significantly more central heel-strike, (2) a significantly increased pronation, accompanied with more pressure underneath the medial side of the foot, and (3) a significantly more lateral roll-off. These findings suggest that altered biomechanics play a role in the genesis of ERLLP and thus should be considered in prevention and rehabilitation.
They got the Nike award at Cleveland ISB conference for that work.
__________________ Craig Payne
__________________________________________________ ___________________________________ Follow me on Twitter | Run Junkie God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
OBJECTIVES:: This study (1) examined the occurrence of exercise-related leg pain (ERLP) in collegiate cross-country athletes and (2) compared structural factors in runners with and without ERLP history.
STUDY DESIGN:: Cross-sectional design comparing 2 groups of cross-country athletes (with and without ERLP history).
SETTING:: Intercollegiate athletics.
PARTICIPANTS:: A total of 63 athletes (30 males, 33 females) representing 2 cross-country teams consented to participate.
MEASURES:: Athlete examination included self-report of ERLP history, active ankle dorsiflexion with knee extended and flexed, navicular drop (ND), and 1st ray length. ND index was calculated by dividing ND by 1st ray length. Athletes on 1 team (n = 32) were followed through 1 season to identify incidence of ERLP over the course of 1 season. Independent t tests were used to compare structural measures of those with and without ERLP history, and chi was used to examine frequencies.
RESULTS:: Of the 63 athletes, 33 (52%) reported ERLP history; most reported medial leg pain and also bilateral symptoms. No differences in structural measures were found between those with and without ERLP history. Ten of 32 athletes (31%) reported the occurrence of ERLP during the fall season, 8 of whom had a history of ERLP.
CONCLUSIONS:: Exercise-related leg pain was a common complaint among these athletes, usually occurring bilaterally and located along the medial leg. Athletes with ERLP history did not have a greater foot pronation as measured by ND, nor was there limited ankle range of motion as compared with those without ERLP history. Further research is needed to identify factors associated with the development of ERLP.
Here is a challenge for any students reading this...
Look at the abstracts for the two studies above...what is the fundamental methodological design difference between them that substantially weakens the conclusions from one of them? (PS - its not sample size)
__________________ Craig Payne
__________________________________________________ ___________________________________ Follow me on Twitter | Run Junkie God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
Last edited by Craig Payne : 9th January 2006 at 03:18 PM.
Reason: typo
Re: Risk factors for exercise-related lower leg pain
Another one from the same authors:
Gait-Related Risk Factors for Exercise-Related Lower-Leg Pain during Shod Running. Med Sci Sports Exerc. 2007 Feb;39(2):330-9
Willems TM, Witvrouw E, DE Cock A, DE Clercq D
Quote:
PURPOSE:: Exercise-related lower-leg pain (ERLLP) is a common chronic sports injury. In clinical practice, deviant gait biomechanics are frequently considered to play a role in the development of ERLLP, although there is scarce scientific evidence that gait-related variables predispose athletes to this injury. The purpose of this study was to examine prospectively the gait-related risk factors for ERLLP during shod running in a young, physically active population.
METHODS:: The gait pattern during shod running of 400 physical education students was evaluated at the beginning of their academic study. This was accomplished by means of plantar pressure measurements and 3D gait kinematics. After this evaluation, the same sports physician registered all sports injuries during this study.
RESULTS:: During the follow-up period, 46 subjects developed ERLLP, of whom 29 subjects had bilateral complaints. Thus, 75 symptomatic lower legs (35 left and 40 right) were classified into the ERLLP group. Bilateral feet of 167 subjects who sustained no injuries at the lower extremities served as the referent group. Cox regression analysis revealed that subjects who will develop ERLLP have an altered running pattern compared with the referent subjects. More specifically, these subjects showed a significantly increased pronation excursion, accompanied by more pressure underneath the medial side of the foot, a delayed maximal eversion, and an accelerated reinversion.
CONCLUSION:: The findings of this study suggest that altered gait biomechanics during shod running play a role in the genesis of ERLLP and, thus, should be considered in prevention and rehabilitation of this pathology.
STUDY DESIGN: Prospective cohort design. OBJECTIVES: To determine in a sample of collegiate cross-country athletes (1) the percentage of athletes with history of exercise-related leg pain (ERLP) associated with running, (2) the incidence of ERLP during 1 season, (3) if factors including years of collegiate running, training distance, and gender are associated with ERLP, and (4) if there is a relationship between foot type and ERLP. BACKGROUND: ERLP is a common overuse pain syndrome, but little evidence exists regarding the prevalence, incidence, and risk factors.
METHODS AND MEASURES: Eighty-eight collegiate cross-country athletes (44 male, 44 female) from 5 Midwest universities consented to participate. Prior to the season, athletes completed a questionnaire and 3 measures of foot type were performed: navicular drop, medial longitudinal arch angle, and visual assessment of foot type. Athletes completed a postseason questionnaire regarding the season incidence of ERLP. Statistical analyses of differences (t test, proportion test) and relationships (chi-square, relative risk) were conducted.
RESULTS: Prior to the season, 60 of the 88 athletes (68%) reported a history of ERLP with bilateral medial leg pain the most common ERLP presentation. Over 50% of the athletes with a history of ERLP reported the pain had interfered with cross-country participation. Of the 67 postseason respondents, 38.8% reported ERLP incidence during the season. Most athletes (80.8%) who reported season incidence of ERLP had a previous history of ERLP. There were no differences between athletes with and without a history of ERLP or season incidence of ERLP regarding years of collegiate running, training distance, gender, and foot measures.
CONCLUSION: ERLP history and season incidence was common among these cross-country athletes. The only risk factor identified for season incidence of ERLP was a history of ERLP
Re: Risk factors for exercise-related lower leg pain
Hi Hylton Menz,
the study seems good to me (Willems et al), however is it correct to attribute a group as a control after finding the pathologies? is that still considered randomised?
Re: Risk factors for exercise-related lower leg pain
Risk factors for self-reported exercise-related leg pain in high school cross-country athletes.
Reinking MF, Austin TM, Hayes AM. J Athl Train. 2010 Jan-Feb;45(1):51-7.
Quote:
Context: Prevention of exercise-related leg pain (ERLP) has not been successful because ERLP risk factors are not well known.
Objective: To determine the percentage of high school cross-country (XC) athletes who reported a history of ERLP in their running careers, to identify the percentage of athletes who reported an occurrence of ERLP during 1 XC season, and to investigate the association of selected factors (age, high school year, years of high school running, sex, ERLP history, body mass index [BMI], foot type, and training distance) and the occurrence of ERLP.
Design: Prospective cohort study. Setting: Six local high schools. Patients or Other Participants: One hundred twenty-five high school XC athletes (62 females, 63 males). Main
Outcome Measure(s): All athletes completed an initial ERLP questionnaire, and foot type was visually assessed. After the season, athletes were asked to complete a Web-based questionnaire regarding the seasonal occurrence of ERLP. Statistical analyses of differences (t tests) and associations (chi(2), relative risk) were conducted.
Results: A total of 103 of the 125 athletes (82.4%) reported a history of ERLP, with 81 athletes reporting ERLP occurrence within the month preceding completion of the initial questionnaire. Bilateral medial leg pain was the most common ERLP presentation. More than half of the athletes (58.4%) with an ERLP history reported that the pain had interfered with XC participation. Ninety-three athletes responded to the postseason questionnaire, and 45 (48.0%) reported ERLP seasonal occurrence. Most athletes (97.8%) who experienced the seasonal occurrence of ERLP had a history of ERLP. No associations were noted between ERLP history or seasonal occurrence and age, high school year, years of high school running, sex, BMI, foot type, or training distance.
Conclusions: Both a history of ERLP and the seasonal occurrence of ERLP were common among these XC athletes. The only risk factor identified for ERLP season occurrence was ERLP history.
Re: Risk factors for exercise-related lower leg pain
Quote:
Originally Posted by NewsBot
Risk factors for self-reported exercise-related leg pain in high school cross-country athletes.
Reinking MF, Austin TM, Hayes AM. J Athl Train. 2010 Jan-Feb;45(1):51-7.
Anyone know what model of foot type classification they used?
Re: Risk factors for exercise-related lower leg pain
I used the Willems articles pretty extensively for my dissertation and if I remember correctly I'm pretty sure that they pooled their left and right foot results from subjects including using bilateral "injured" feet as 2 separate incidences. That obviously has some problems. But as my advisor always said "there are NO perfect studies.."
Still 2 good articles and I applaud their efforts - I did a prospective study for my dissertation with a much smaller sample than they did and I know how flippin' hard it is to keep track of people over a time course.
Re: Risk factors for exercise-related lower leg pain
The relationship between isotonic plantar flexor endurance, navicular drop, and exercise-related leg pain in a cohort of collegiate cross-country runners.
Bennett JE, Reinking MF, Rauh MJ. Int J Sports Phys Ther. 2012 Jun;7(3):267-78.
Quote:
PURPOSE:
The purpose of this study was to examine the relationships between isotonic ankle plantar flexor endurance (PFE), foot pronation as measured by navicular drop, and exercise-related leg pain (ERLP).
BACKGROUND:
Exercise-related leg pain is a common occurrence in competitive and recreational runners. The identification of factors contributing to the development of ERLP may help guide methods for the prevention and management of overuse injuries.
METHODS:
Seventy-seven (44 males, 33 females) competitive runners from five collegiate cross-country (XC) teams consented to participate in the study. Isotonic ankle PFE and foot pronation were measured using the standing heel-rise and navicular drop (ND) tests, respectively. Demographic information, anthropometric measurements, and ERLP history were also recorded. Subjects were then prospectively tracked for occurrence of ERLP during the 2009 intercollegiate cross-country season. Multivariate logistic regression analysis was used to examine the relationships between isotonic ankle joint PFE and ND and the occurrence of ERLP.
RESULTS:
While no significant differences were identified for isotonic ankle PFE between groups of collegiate XC runners with and without ERLP, runners with a ND >10 mm were almost 7 times (OR=6.6, 95% CI=1.2-38.0) more likely to incur medial ERLP than runners with ND <10 mm. Runners with a history of ERLP in the month previous to the start of the XC season were 12 times (OR=12.3, 95% CI=3.1-48.9) more likely to develop an in-season occurrence of ERLP.
CONCLUSION:
While PFE did not appear to be a risk factor in the development of ERLP in this group of collegiate XC runners, those with a ND greater than 10 mm may be at greater odds of incurring medial ERLP.
PURPOSE:
Medial tibial stress syndrome (MTSS) and tibial stress fracture (SF) are common lower leg disorders in runners. A prospective study was done to identify the incidence of MTSS and SF in high school runners and to determine risk factors.
METHODS:
A total of 230 runners participating in high school running teams were evaluated. All runners aged 15 years as first grade of high school were involved in the study. They were followed up for 3 years. The measured items included height, weight, body mass index (BMI), range of hip and ankle motion, straight leg raising (SLR), intercondylar and intermalleolar interval, Q-angle, navicular drop test, hip abductor strength and physical conditioning. Each runner was followed for 3 years to report occurrence of MTSS and SF.
RESULTS:
A total number of 102 MTSS (0.29 athlete exposures) and 21 SF (0.06 athlete exposures) were identified. In females, BMI significantly increased the risk of MTSS after adjustment for the other variables in this study (adjusted odds ratio, 0.51; 95 % confidence interval, 0.31-0.86). Increased internal rotation of the hip significantly increased the risk of MTSS (adjusted odds ratio, 0.91; 95 % confidence interval, 0.85-0.99). In males, limited SLR also significantly increased the risk of SF with adjustment for the other variables in this study (adjusted odds ratio, 1.38; 95 % confidence interval, 1.04-1.83).
CONCLUSION:
A significant relationship was found between BMI, internal hip rotation angle and MTSS in females, and between limited SLR and SF in males.
Risk factors for exercise-related lower leg pain
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