Gait variability and overuse injury in runners

NewsBot · Mar 13, 2014

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FLUCTUATIONS IN STRIKE INDEX AND SPATIOTEMPORAL PARAMETERS IN PREVIOUSLY INJURED VS UNINJURED RUNNERS
R Mann, K Meijer, L Malisoux, R Brunner, A Urhausen1, C Nuehrenboerger, D Theisen
Br J Sports Med 2014;48:632-633 doi:10.1136/bjsports-2014-093494.196
Abstracts from the IOC World Conference on Prevention of Injury & Illness in Sport, Monaco 2014

Background: Long-range correlations in running stride interval have been proposed as an indicator of running-related injury (RRI) and found to change with running speed. They have not yet been used to distinguish running style between runners having previously sustained a RRI or not.

Objectives: To compare long-range correlations and stride-to-stride variability of strike index (SI) and spatiotemporal parameters in previously injured and uninjured runners over various running speeds. We hypothesized significant effects of groups and running speed for these parameters.

Design: Retrospective, case-control study.

Setting: Recreational runners.

Participants: 69 regular male and female runners (currently asymptomatic) either having sustained a RRI during the previous year (n=26) or not (n=43).

Risk factor assessment: Five 2-minute incremental running intervals were performed at 80, 90, 100, 110 and 120% of the individual typical running speed on a treadmill. SI, contact time (CT), flight time (FT), stride time (ST), duty factor (CT/ST), stride length (SL) and frequency were measured using an insole-based system. Coefficient of variance (CV) and the scaling exponent α of the detrended fluctuation analysis were calculated, and effects were analysed using repeated measures analyses of variance.

Main outcome measurements: RRI, defined as a pain or complaint to the lower limbs, progressive in nature and influencing running activity for >1 week.

Results: The RRI group displayed lower CV than the controls for CT (P=.01) and FT (P=.027). Significant differences in α between normalised speeds were found for all variables (P<.048) except SL. CV differed significantly between normalised speeds for ST and SL. No significant interactions were found.

Conclusions: Previously uninjured runners display significantly greater CV in CT and FT. Long-range correlations of SI and spatiotemporal parameters change according to running speed, but are not significantly different between previously injured and uninjured runners. Further prospective study to confirm these findings is warranted.
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Admin2 · Mar 13, 2014

Related Threads:
Other threads tagged with variability
Variability and overuse injury
Variability and chronic achilles tendon injury

NewsBot · May 3, 2017

Quantifying sources of variability in gait analysis
Kohleth Chia et al
Gait and Posture; Article in Press

Highlights
•We proposed corrected methods to estimate variance components.
•We showed that ICC and CMC can be derived from variance components.
•We discussed methods to estimate variability on the curve level.
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Measurements from gait analysis are affected by many sources of variability. Schwartz et al. [1] illustrated an experimental design and methods to estimate these variance components. However, the derivation contains errors which could severely bias the estimation of some components. Therefore, in this paper, we presented correction to this method using ANOVA and Likelihood methods. Furthermore, we demonstrated how commonly used reliability indices like CMC and ICC may be derived from the variance components. We advocate the use of the variance components, in preference to reliability indices, because the variance components are easier to interpret, with understandable units.
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NewsBot · Nov 22, 2017

Differences in pattern of variability for lower extremity kinematics between walking and running
Amanda Estep et al
Gait and Posture; Article in Press

Highlights
•Linear analyses of gait may not be representative of the full gait task.
•ApEn depicts the ability to provide insight into the system organization.
•ApEn analyses revealed that running presents greater complexity than walking.
•ApEn is more sensitive to detect changes between gait conditions than SD & CV.
•Running exhibit increased complexity compared to walking.
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This study characterizes walking and running patterns in healthy individuals using linear and nonlinear methods Seventeen individuals (12 males, 5 females) volunteered for the study. 3D kinematic data during walking (WA) and running (RU) on a motorized treadmill were captured using reflective markers placed on lower body (200 Hz). A single 25 s trial (5,000 data points) was collected for each gait task. WA speed was 1.39 ± 0.12 m/s, whereas RU speed was 2.56 ± 0.27 m/s. Variables of interest included ankle plantar/dorsi flexion, knee flexion/extension, knee abduction/adduction, hip flexion/extension, and hip abduction/adduction angles. For linear analysis, standard deviation (SD) and coefficient of variation (CV) were calculated for the entire time series for both conditions. Nonlinear analysis included assessing pattern of regularity of respective kinematic time series using approximate entropy (ApEn). Inferential analyses were conducted using MANOVA to compare selected dependent measures (p < 0.05). SD for knee flexion/extension angle (WA = 23.34 ± 4.17, RU = 27.51 ± 5.25) and ankle plantar/dorsi flexion angle (WA = 9.24 ± 2.37, RU = 12.88 ± 2.00) were both greater during running. For all other variables, there were no significant differences in degree of variability between walking and running (p’s > 0.05). Running ApEn values were greater than walking ApEn values for knee flexion/extension (WA = 0.14 ± 0.02, RU = 0.23 ± 0.04), knee abduction/adduction (WA = 0.18 ± 0.07, RU = 0.24 ± 0.07), hip flexion/extension (WA = 0.09 ± 0.02, RU = 0.17 ± 0.04), and hip abduction/adduction (WA = 0.12 ± 0.03, RU = 0.21 ± 0.05). Greater variability was demonstrated during running across all joints compared to walking. This suggests that ApEn is more sensitive to detecting changes between different gait conditions than standard discrete measures of variability (SD).
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NewsBot · Dec 14, 2017

Does the amount of lower extremity movement variability differ between injured and uninjured populations? A systematic review
Samuel R. Baida, Shane J. Gore ,Andrew D. Franklyn-Miller, Kieran A. Moran
Scandinavian Journal of Medicine & Science in Sports; 14 December 2017

Movement variability during repetitive performance of a dynamic activity (e.g. running, jumping, kicking) is considered an integral characteristic of optimal movement execution, however, it's relationship with musculoskeletal injury is not known. The primary aim of this paper was to review published comparison trials to determine if movement variability differs between uninjured controls and subjects with a lower limb musculoskeletal injury.

A systematic search of online databases; Medline, Sports Discus, Scopus and Web of Science was conducted from July to November 2016. Studies were selected if they: (1) included participants with a lower limb injury, (2) compared injured participants to uninjured controls, (3) examined movement variability for at least one dependent variable, and (4) provided a statistical between-group comparison when comparing measures of movement variability. Studies were excluded if they: (1) investigated neurological disorders, (2) examined musculoskeletal injury in the upper extremity or spine, and (3) used non-linear measures to examine variability (i.e. complexity). A significant difference between injured and uninjured populations was reported in 73% of the included studies and of these, 64% reported greater movement variability in the injured group. This is the first systematic review with a best-evidence synthesis investigating the association between movement variability and musculoskeletal injury. Findings suggest that movement variability in those with a musculoskeletal injury differs from uninjured individuals. Interestingly, there was an overall trend towards greater movement variability being associated with the injured groups; although it should be noted that this trend was not consistent across all sub-categories (e.g. injury type).

For a clearer insight into the clinical application of variability greater methodological homogeneity is required and prospective research is recommended.
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NewsBot · May 20, 2018

Stride-to-stride variability and complexity between novice and experienced runners during a prolonged run at anaerobic threshold speed
Shiwei Mo, Daniel H.K. Chow
Gait and Posture; Article in Press

Highlights
•Stride variability and complexity of runners with different experience was compared.
•Stride variability varied greatly for experienced runners.
•Both experienced and novice runners adopted a U-shape trend in stride complexity.
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Background
Motor control, related to running performance and running related injuries, is affected by progression of fatigue during a prolonged run. Distance runners are usually recommended to train at or slightly above anaerobic threshold (AT) speed for improving performance. However, running at AT speed may result in accelerated fatigue. It is not clear how one adapts running gait pattern during a prolonged run at AT speed and if there are differences between runners with different training experience.

Purposes
To compare characteristics of stride-to-stride variability and complexity during a prolonged run at AT speed between novice runners (NR) and experienced runners (ER).

Methods
Both NR (n = 17) and ER (n = 17) performed a treadmill run for 31 minutes at his/her AT speed. Stride interval dynamics was obtained throughout the run with the middle 30 minutes equally divided into six time intervals (denoted as T1, T2, T3, T4, T5 and T6). Mean, coefficient of variation (CV) and scaling exponent alpha of stride intervals were calculated for each interval of each group.

Results
This study revealed mean stride interval significantly increased with running time in a non-linear trend (p<0.001). The stride interval variability (CV) maintained relatively constant for NR (p = 0.22) and changed nonlinearly for ER (p = 0.023) throughout the run. Alpha was significantly different between groups at T2, T5 and T6, and nonlinearly changed with running time for both groups with slight differences.

Significance
These findings provided insights into how the motor control system adapts to progression of fatigue and evidences that long-term training enhances motor control. Although both ER and NR could regulate gait complexity to maintain AT speed throughout the prolonged run, ER also regulated stride interval variability to achieve the goal.
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NewsBot · Jan 28, 2019

Segment Coordination Variability Differs by Years of Running Experience
Hafer, Jocelyn F. et al
Medicine & Science in Sports & Exercise: January 24, 2019 - Volume Publish Ahead of Print - Issue - p

Running is a popular activity that results in high rates of overuse injury, with less-experienced runners becoming injured at higher rates than their more-experienced peers. While measures of joint kinematics and kinetics and ground reaction forces have been associated with overuse running injuries, similar differences across levels of running experience have not been found. As running is a motor skill that may develop with experience, an analysis of segment coordination and its variability could provide additional insight into why injury incidence decreases with increasing experience.

Purpose The purpose of this study was to determine if less-experienced runners have different segment coordination and lower segment coordination variability compared to their more-experienced peers.

Methods This retrospective analysis included 20 more-experienced (≥10 years running) and 21 less-experienced (≤2 years running) runners. Sagittal thigh vs. shank and shank vs. foot segment coordination and coordination variability were calculated using a modified vector coding approach as individuals ran on a treadmill at preferred pace. Coordination and its variability were compared between groups during terminal swing and early, mid, and late stance for both segment couples.

Results Segment coordination was similar between less- and more-experienced runners. Less-experienced runners had lower segment coordination variability compared to more-experienced runners for both the thigh vs. shank and shank vs. foot couples. This lower variability occurred during early and mid stance.

Conclusion Runners appeared to attain stable segment coordination patterns within 2 years of consistent running, but had lower coordination variability compared to individuals who had been running for 10 or more years. These results suggest that assessment of movement patterns and their flexibility may help inform injury prevention or treatment strategies for less-experienced runners.
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NewsBot · May 17, 2019

Differences in Lower Extremity Kinematic Variability
between Healthy Runners Classied as Low or High
Mileage
Amanda Estep et al
ACSM ANNUAL MEETING
May 28 – June 1, 2019 – Orlando, Florida

Evidence suggests that running mechanics may differ between runners based on their
weekly mileage; greater weekly mileage (WM) may act as a protective mechanism
against injury. While the interaction between coordination patterns and WM has been
investigated, interaction between lower extremity (LE) kinematic variability and WM
has not. PURPOSE: To compare changes in LE kinematic variability between low
(LM) and high mileage (HM) healthy runners after a prolonged run. METHODS:
23 healthy participants (27.4±7.7 yrs., 1.70±0.11 m, 67.9±15.4 kg, 16.3±5.6 km/
week) were included in the LM group, while 12 participants (25.1±6.3 years, 1.71±0.1
m, 65.8±9.4 kg, 46.9±14.5 km/week) were included in the HM group. Participants
ran on a treadmill for 30 minutes at a self-selected training pace. 3D kinematic data
were collected after 5 minutes of running and again at the end of run at 200Hz using
reflective markers placed on the lower body with 6 infrared cameras. Variables of
interest included ankle, knee and hip sagittal and frontal plane angles. Standard
deviation (SD) and coefficient of variation (CV) were calculated for each dependent
variable (DV) at the beginning and end of the run. Approximate entropy (ApEn) was
also calculated for each DV at both time intervals. Two repeated measures ANOVAs
with time and joint as the within-subject factors and group as the between-subject
factor, were used to compare kinematic variability. Post-hoc analyses were conducted
for significant interactions. Alpha level was set at 0.05. RESULTS: Average running
speed for the LM and HM group were 2.5±.3 m/s and 2.9±.4 m/s, respectively. In the
sagittal plane, a significant interaction was found between joint and group (F2,62=5.5,
p=.006). Specifically, the HM group demonstrated greater amounts of variability (SD)
than the LM group (LM=25.7±3.0; HM=29.5±3.7). No other statistically significant
differences were attained.
CONCLUSIONS: Kinematic variability differed between the LM and HM groups,
but only for the knee in the sagittal plane. Ankle and hip sagittal plane movement was
comparable between the LM and HM groups. This may suggest that movement of the
ankle and the hip do not differ in response to having to control variability at the knee.
When assessing kinematic variability, it is important to consider the weekly mileage of
each runner.
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NewsBot · Jun 7, 2019

The effect of running speed on joint coupling coordination and its variability in recreational runners
PabloFloría et al
Human Movement Science; Volume 66, August 2019, Pages 449-458

Highlights
•Coordination during running at different speeds was quantified using modified vector coding technique.
•The classification of coordination pattern did not change across running speeds.
•Differences in the percentage of time of each coordination pattern were found mainly in early stance.
•Coordination variability was not sensitive to changes in running speed.
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The purpose of this study was to examine the effect of speed on coordination and its variability in running gait using vector coding analysis. Lower extremity kinematic data were collected for thirteen recreational runners while running at three different speeds in random order: preferred speed, 15% faster and 15% lower than preferred speed. A dynamical systems approach, using vector coding and circular statistics, were used to quantify coordination and its variability for selected hip-knee and knee-ankle joint couplings. The influence of running speed was calculated from the continuous data sets of the running cycle, allowing for the identification of time percentages where differences existed. Results indicate that increases in running speed produced moderate alterations in the frequency of movement patterns which were not enough to alter classification of coordination. No effects of speed on coordination variability were observed. This study has demonstrated that coordination and coordination variability is generally stable in the range of ±15% around of preferred speed in recreational runners.
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NewsBot · Jun 12, 2019

Predicting running injury using kinematic and kinetic parameters generated by an optical motion capture system
Sinan OnalMitchell LeefersBryan SmithSohyung Cho
SN Applied Sciences; 2019, 1:675

Although runners are at high risk of back and lower extremity injuries, available tools detect only current injury. Here, a model was developed to analyze kinetic and kinematic running gait data collected by an optical motion capture system to predict future injuries based on an individual’s running gait pattern. The two key points, when the joints are most vulnerable because internal forces are the greatest, in the continuous running gait cycle were used to extract average parameter values to create predictive models: the heel strike, and when one leg supports the body weight. Three different prediction models—logistic regression, random forest, and boosting—were built using 10 significant parameters identified in a two-step feature selection approach. All collected metric data were normalized before building the predictive models to avoid outlier values and redundancy. The three models were tested to determine whether they could predict that a participant would incur chronic running injuries in the future based on their current running gait pattern. The logistic regression model had the highest prediction accuracy: the area under the curve was 0.9016 [95% confidence interval (CI) 0.8808–0.9369] for logistic regression, 0.8892 (95% CI 0.8463–0.9152) for the random forest, and 0.8732 (95% CI 0.8401–0.9178) for boosting. Further model development may not only enable clinicians to integrate injury intervention into running programs but also lead to predictive models that recognize patterns associated with neurological disorders, such as Parkinson’s disease, autism, and multiple sclerosis, in which gait and balance deficiencies may be symptoms or even predictors of disease.
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NewsBot · Apr 29, 2020

Subclassification of recreational runners with a running-related injury based on running kinematics evaluated with marker-based two-dimensional video analysis
BartDingenen et al
Physical Therapy in Sport; 28 April 2020

Highlights
•Two homogeneous subgroups were identified in runners with running-related injuries.
•Foot and tibia inclination were significantly different between subgroups.
•The same injury can be represented by different kinematic presentations.
•Similar kinematic presentations can be related to different injuries.
•Marker-based 2D video analysis can be used to assist clinical reasoning.
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Objectives
To explore whether homogeneous subgroups could be discriminated within a population of recreational runners with a running-related injury based on running kinematics evaluated with marker-based two-dimensional video analysis.

Design
Cross-sectional.

Setting
Research laboratory.

Participants
Fifty-three recreational runners (15 males, 38 females) with a running-related injury.

Main outcome measures
Foot and tibia inclination at initial contact, and hip adduction and knee flexion at midstance were measured in the frontal and sagittal plane with marker-based two-dimensional video analysis during shod running on a treadmill at preferred speed. The four outcome measures were clustered using K-means cluster analysis (n = 2–10). Silhouette coefficients were used to detect optimal clustering.

Results
The cluster analysis led to the classification of two distinct subgroups (mean silhouette coefficient = 0.53). Subgroup 1 (n = 39) was characterized by significantly greater foot inclination and tibia inclination at initial contact compared to subgroup 2 (n = 14).

Conclusion
The existence of different subgroups demonstrate that the same running-related injury can be represented by different kinematic presentations. A subclassification based on the kinematic presentation may help clinicians in their clinical reasoning process when evaluating runners with a running-related injury and could inform targeted intervention strategy development.
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NewsBot · Aug 29, 2020

Segment coordination and variability among prospectively injured and uninjured runners
Gauri A. Desai & Allison H. Gruber
Journal of Sports Sciences: 14 Aug 2020

Coordinative variability (CAV) and underlying coordinative patterns are potential running-related overuse injury (RROI) mechanisms, but prospective analyses are needed. This study compared lower limb CAV and coordinative patterns between prospectively injured and uninjured runners. Knee, shank, and ankle kinematics were collected for 39 recreational runners at the beginning of a 6-month follow-up period. Subjects were classified as injured (n=21) or controls (n=18) based on RROI incidence during follow-up. CAV was quantified using modified vector coding. Time spent in each coordinative pattern category was quantified using binning frequency analysis. Coordinative patterns were classified as mechanically unsound if underlying joint/segment motions opposed anatomically allowable running motion. Wilcoxon Rank-Sum tests compared CAV and binning frequencies between groups within different stance portions for knee-shank, shank-ankle, and knee-ankle couplings (α≤0.05). During initial-stance, the injured group displayed significantly greater knee-ankle CAV (effect size (ES)=1.1), knee-shank CAV (ES=0.97), and greater frequency of mechanically unsound knee-shank (ES=0.72) and shank-ankle (ES=0.63) motion. During mid-stance, the injured group displayed lower frequency of mechanically sound knee-ankle motion (ES=0.31). In late-stance, the injured group displayed greater shank-ankle CAV (ES=0.11). Mechanically unsound coordinative patterns along with greater knee-ankle and shank-ankle CAV potentially lead to RROI.
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NewsBot · Oct 3, 2020

Changes in segment coordination variability and the impacts of the lower limb across running mileages in half marathons: Implications for running injuries
Tony Lin-WeiChen et al
Journal of Sport and Health Science; 28 September 2020

Highlights
•The vertical loading rate was not influenced by running mileages during half marathons.
•Changes in coordination variabilities occurred at the early stance phase of running gaits.
•As the half marathon progressed, coordination variabilities increased in the couplings of pelvis frontal vs. thigh frontal and shank transverse vs. rearfoot frontal.
•The increased coordination variabilities on the frontal/transverse planes of motion could be associated with fatigue and indicate injury potential.
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Background
Segment coordination variability (CV) is a movement pattern associated with running-related injuries. It can also be adversely affected by a prolonged run. However, research on this topic is currently limited. The purpose of this study was to investigate the effects of a prolonged run on segment CV and vertical loading rates during a treadmill half marathon.

Methods
Fifteen healthy runners ran a half marathon on an instrumental treadmill in a biomechanical laboratory. Synchronized kinematic and kinetic data were collected every 2 km (from 2 km until 20 km), and the data were processed by musculoskeletal modeling. Segment CVs were computed from the angle-angle plots of selected pelvis-thigh, thigh-shank, and shank-rearfoot couplings using a modified vector coding technique. The loading rate of vertical ground reaction force was also calculated. A 1-way MANOVA with repeated measures was performed on each of the outcome variables to examine the main effect of running mileage.

Results
Significant effects of running mileage were found on segment CVs (p = 0.004–0.010) but not on loading rate (p = 0.881). Notably, during the early stance phase, the CV of pelvis frontal vs. thigh frontal was significantly increased at 20 km compared with the CV at 8 km (g = 0.59, p = 0.022). The CV of shank transverse vs. rearfoot frontal decreased from 2 km to 8 km (g = 0.30, p = 0.020) but then significantly increased at both 18 km (g = 0.05, p < 0.001) and 20 km (g = 0.36, p < 0.001).

Conclusion
At the early stance, runners maintained stable CVs on the sagittal plane, which could explain the unchanged loading rate throughout the half marathon. However, increased CVs on the frontal/transverse plane may be an early sign of fatigue and indicative of possible injury risk. Further studies are necessary for conclusive statements in this regard.
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NewsBot · Oct 5, 2020

Long-range correlations and stride pattern variability in recreational and elite distance runners during a prolonged run
C Markus Brahms et al
Gait Posture. 2020 Aug 17;S0966-6362(20)30498-7

Background: Although movement variability and long-range correlations (LRCs) have been assessed in relation to neuropathology and aging during walking, to date only a few studies have investigated these aspects in subjects of different skill levels during prolonged overground running.

Research question: What effect does skill level and run duration have on different stride parameters, measures of variability and long-range correlations?

Methods: Using a between-subject repeated measures design, we assessed stride mechanics, variability and LRCs in recreational and elite runners over the course of a continuous exhaustive run. All subjects ran at a fixed, pre-determined running speed relative to their maximal performance. Stride parameters were continually recorded using a single foot-mounted inertial measurement unit. It was hypothesized that a significant reduction in the strength of the LRCs would occur over the course of the run and that the observed changes would be more pronounced in the group of recreational runners.

Results: Runners maintained a consistent stride length (SL), stride time (ST) and contact time (CT) during the run, while peak impact acceleration increased. Across groups, long-range correlations significantly decreased over the course of the run, while the magnitude of the variability remained constant. LRCs did not differ significantly between groups.

Significance: This is the first study to simultaneously investigate the effects of prolonged running and skill level on a range of stride parameters as well as stride-to-stride variability. Generally, long-range correlations were shown to be sensitive to run duration, while the magnitude of the variability did not differ between earlier and later stages of the run. The lack of a group effect on LRCs supports the idea that the mechanisms responsible for the emergence of temporal patterns in the stride pattern are not influenced by skill level.
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NewsBot · Jun 21, 2021

Runners with a history of injury have greater lower limb movement regularity than runners without a history of injury
Juliana Quirino et al
Sports Biomechanics: 14 Jun 2021

This study aimed to investigate the regularity of the lower limb joint kinematics in runners with and without a history of running-related injuries. The second aim was to verify if the movement pattern regularities are different among the lower limb joints. Eighteen asymptomatic recreational runners with and without a history of running-related injury participated in this study. Lower limb kinematics in the sagittal plane were recorded during running on a treadmill at a self-selected speed. The regularities of the time series of hip, knee, and ankle were analysed using sample entropy (SampEn). A mixed analysis of variance was used to investigate differences between groups and among joints. Runners with a history of injury had lower SampEn values than runners without a history of injury. Ankle kinematics SampEn was higher than that of the knee and hip. Knee kinematics had higher values of SampEn than that of the hip. Runners with a history of running-related injury had greater joint kinematic’s regularity. This result suggests that, even in asymptomatic runners, previous injuries could influence the movement pattern regularity. Also, the regularity was different among joints. The ankle demonstrated the lowest regularity, reinforcing the different functions that lower limb joints perform during running.
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NewsBot · Aug 19, 2021

Association between movement patterns and risk of musculoskeletal injuries in navy cadets: A cohort study
Priscila dos SantosBunn et al
Physical Therapy in Sport; 18 August 2021

Highlights
•There is no association between between movement patterns evaluated by Dynamic Movement Assessment and the occurrence of musculoskeletal injuries in navy cadets.
•Attendance of a non-military high school increases from 3.14 to 4.57 times the chance of developing an injury of any kind (acute or overuse).
•History of injuries prior to the course increases the chance of acute injuries.
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Objective
To investigate the association of movement patterns evaluated by the Dynamic Movement Assessment (DMA) with the occurrence of musculoskeletal injuries in navy cadets.

Design
Cohort study.

Setting
Participants were filmed performing the six functional tests of the DMA(deep squat, step up, single-leg squat, hop, plank and side-plank tests).

Participants
240 navy cadets.

Main outcome measurements
Depending on the number of certain movement patterns on the Dynamic Movement Assessment(DMA), participants were classified as high, moderate, medium or low risk of developing injuries. Predictive associations between injuries and risk classification were examined using logistic regression analysis.

Results
Considering sex, previous injuries and the type of secondary school as covariates, participants who were classified as high risk were not more likely to develop injuries. Non-military high school was an independent risk factor for any injuries (OR = 3.14, 95%CI[1.43,6.91]; OR = 4.57, 95%CI[1.92,10.83]), overuse injuries (OR = 2.58, 95%CI[1.05,6.30]; OR = 2.55, 95%CI [1.06, 6.14]) and acute injuries (OR = 4.88, 95%CI [1.19,19.99]), respectively. Previous musculoskeletal symptoms also increased the chance of AI (OR = 4.45, 95% CI [1.15,17.18]; OR = 5.91, 95% CI [1.13,30.88]).

Conclusions
Movement patterns evaluated by DMA are not associated with an increased risk of injuries. However, attendance of a non-military high school and previous musculoskeletal symptoms are associated with musculoskeletal injuries.
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NewsBot · Jan 25, 2022

Bilateral differences in coordination variability among injured and uninjured runners: A prospective study
Gauri A.DesaiAllison H.Gruber
Journal of Biomechanics; Volume 132, February 2022, 110938

This prospective cohort study aimed to identify bilateral differences in coordination variability (CAV) to determine if limb-specific CAV or CAV asymmetry is associated with running-related overuse injury (RRI) development in recreational runners. Lower limb kinematics were collected at enrollment. Runners were classified as injured (n = 14) or controls (n = 17) based on RRI incidence during a ≥ 6-month follow-up. Pelvis-thigh, knee-shank, knee-ankle, and shank-ankle CAV was quantified bilaterally within thirds of stance using modified vector coding. Wilcoxon Signed-Rank tests compared CAV between limbs within each group, and Wilcoxon Rank-Sum tests compared CAV asymmetry between groups (α ≤ 0.05). Injured runners displayed elevated injured versus uninjured limb CAV during initial-stance for all couplings (p < 0.010,d(effect size) = 0.51–1.31) except pelvis-thigh (p = 0.060,d = 0.36). During mid-stance, the injured limb exhibited restricted knee-ankle CAV (p < 0.010,d = 0.413) and elevated pelvis-thigh CAV (p < 0.010,d = 0.23). Controls also displayed bilateral differences specifically in pelvis-thigh CAV across stance, shank-ankle CAV during initial-stance, in all couplings during mid-stance, and shank-ankle CAV during late-stance (p < 0.010–0.025,d = 0.09–0.63). Comparing CAV asymmetry between groups revealed lower asymmetry among injured runners compared with controls for knee-ankle coupling in mid-stance and all couplings except pelvis-thigh during late-stance (p < 0.010,d = 0.85–1.87). Injured runners also displayed greater knee-shank CAV asymmetry in mid-stance versus controls (p < 0.010,d = 0.85). Logistic regression (α ≤ 0.05) revealed that between-limb CAV asymmetry did not predict RRI (p = 0.161), however, the odds of RRI were > 20% in the limb with either elevated shank-ankle CAV in initial-stance (p = 0.020) or elevated knee-ankle CAV in mid-stance (p = 0.043) than the contralateral limb. Therefore, limb-specific CAV rather than degree of CAV asymmetry may influence risk of RRI.
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NewsBot · Feb 7, 2022

Comparisons of Gait Variability and Symmetry in Healthy Runners, Runners with a History of Lower Limb Injuries, and Runners with a Current Lower Limb Injury.
Tenriwulan, A. F., Sinsurin, K., Areerak, K., Nanta, P., Kong-oun, S., Sakunkaruna, Y., Wattananon, P. and Richards, James
Asian Journal of Sports Medicine . e114922. ISSN 2008-000X (In Press)

Background: Running is a cyclic movement and requires a bilateral symmetry between the lower limbs to reduce injury risk, and the assessment of side-to-side differences is often performed to detect functional deficits.
Objectives: The purpose was to study side-to-side differences using clinical and running performance assessments in healthy runners (HR), runners with a history of lower limb injuries (RHI), and runners with a current lower limb injury.
Methods: Forty-three runners were recruited with 14 participants being allocated to the HR group, 13 to the RHI group, and 16 to the RLI group. Peak vertical ground reaction force (GRF), midfoot pressure, foot rotation, and gait variability were recorded using a Zebris FDM-T treadmill analysis system, and participants were also assessed using the navicular drop test. Dependent t-tests were used to determine if any differences existed between the lower limbs within each group. One-way ANOVAs were then used to investigate the side-to-side differences between the three groups.
Results: Significant differences were seen in navicular drop height between lower limbs within both the HR (p=0.02) and RHI (p=0.009) groups, and side-to-side differences in foot rotation were greatest in the RLI group (~34%) compared to both the RHI (~30.5%) and HR (~24%) groups. The lateral variability of the centre of pressure was greatest in the RLI group (37.1mm) compared to the RHI (28.9mm) and HR (22.2mm) groups.
Conclusion: Centre of pressure variability may help identify runners at a greater risk of lower limb injury. Side-to-side differences should be expected to progressively decrease from the injured stage, through the recovery and return to sport phases. Target goals of less than 34% side-to-side difference for foot rotation and 37.1mm for lateral centre of pressure variability may be used to help the decision making process when considering a return to running practice.
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NewsBot · Mar 14, 2022

Inter-strides variability affects internal foot tissue loadings during running
Coline Van Waerbeke et al
Sci Rep. 2022 Mar 10;12(1):4227

Running overuse injuries result from an imbalance between repetitive loadings on the anatomical structures and their ability to adapt to these loadings. Unfortunately, the measure of these in-vivo loadings is not easily accessible. An optimal amount of movement variability is thought to decrease the running overuse injury risk, but the influence of movement variability on local tissue loading is still not known. A 3D dynamic finite element foot model driven by extrinsic muscle forces was developed to estimate the stress undergone by the different internal foot structures during the stance phase. The boundary conditions of different trials with similar running speed were used as input. Variability in bone stress (10%) and cartilage pressure (16%) can be expected while keeping the overall running speed constant. Bone and cartilage stress were mainly influenced by the muscle force profiles rather than by ground reaction force. These findings suggest, first, that the analysis of a single trial only is not representative of the internal tissue loadings distribution in the foot and second, that muscle forces must be considered when estimating bone and cartilage loadings at the foot level. This model could be applied to an optimal clinical management of the overuse injury.
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NewsBot · Nov 22, 2022

Differences in the coordination and its variability among foot joints during running in neutral foot and flatfoot
Tomoya Takabayashi, Mutsuaki Edama, Takuma Inai Masayoshi Kubo
Scand J Med Sci Sports. 2022 Nov 8

Flatfoot is a well-known foot deformity, with a prevalence of 11.2%-29.0% among adults. Running injuries can occur in individuals with flatfoot; however, the underlying mechanism remains unknown. We investigated the coordination pattern and variability among foot joints while running by comparing participants with neutral foot and with flatfoot. Participants with neutral foot (n = 15) and flatfoot (n = 15) were asked to run at their preferred speed. Using the modified vector coding technique, the coupling angle between the foot joints, representing interjoint coordination, was calculated and categorized into four coordination patterns. The standard deviation of the coupling angle was computed to measure the coordination variability during the stance phase. There were no differences in the spatiotemporal parameters (speed, step length, and cadence) between the groups. In the sagittal rearfoot and sagittal midfoot coordination patterns, the flatfoot group showed a significantly greater proportion of anti-phase with proximal dominancy and a lower proportion of in-phase with proximal dominancy than the neutral foot group during early stance. Coordination variabilities between the sagittal rearfoot and sagittal midfoot (midstance), between the sagittal midfoot and sagittal forefoot (early stance), and between the frontal rearfoot and sagittal midfoot (midstance) were greater in the flatfoot group than in the neutral foot group. This may explain why those with flatfoot are likely to experience running injuries.
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NewsBot · Feb 6, 2023

The impact of previous musculoskeletal injury on running gait variability: a systematic review
Sarah J Blyton et al
Gait & Posture 4 February 2023

Highlights
•Individuals who run with injury-related symptoms employ altered gait variability
•Pain or ligamentous instability may underly injurious adjustments in gait
•Knee-ankle/foot coupling variability commonly altered among runners with injury
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Background
Growing evidence suggests that identifying movement variability alterations in pathological vs. healthy gait may further understanding of injury mechanisms related to gait biomechanics; however, in the context of running and musculoskeletal injuries the role of movement variability remains unclear.

Research question
What is the impact of a previous musculoskeletal injury on running gait variability?

Methods
Medline, CINAHL, Embase, Cochrane library and SPORTDiscus were searched from inception until February 2022. Eligibility criteria were (a) included a musculoskeletal injury group, (b) compared running biomechanics data to a control group, (c) measured movement variability for at least one dependent variable, (d) provided a statistical between-group comparison of variability outcomes. Exclusion criteria were neurological conditions impacting gait, upper body musculoskeletal injuries and age <18 years old. A summative synthesis was performed instead of a meta-analysis due to methodological heterogeneity.

Results
Seventeen case-control studies were included. The most common deviations in variability observed among the injured groups were: (1) high and low knee-ankle/foot coupling variability and (2) low trunk-pelvis coupling variability. Significant (p<0.05) between-group differences in movement variability were identified in 8 of 11; 73% of studies of runners with injury-related symptoms, and 3 of 7; 43% of studies of recovered or asymptomatic populations.

Significance
This review identified limited to strong evidence that running variability is altered in adults with a recent history of injury for particular joint couplings. Individuals with ankle instability or pain employed altered running strategies more often than those who have recovered from injury. Altered variability strategies have been proposed to contribute to future running-related injuries, therefore these findings are relevant to clinicians managing active populations.
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NewsBot · Apr 4, 2023

Running Gait Produces Long Range Correlations: A Systematic Review
Taylor J. Wilson, Aaron D. Likens
Gait & Posture 3 April 2023

Background
Walking and running are common forms of locomotion, both of which exhibit variability over many gait cycles. Many studies have investigated the patterns generated from that ebb and flow, and a large proportion suggests human gait exhibits Long Range Correlations (LRCs). LRCs refer to the observation that healthy gait characteristic, like stride times, are positively correlated to themselves over time. Literature on LRCs in walking gait is well known but less attention has been given to LRCs in running gait.

Research Question
What is the state of the art concerning LRCs in running gait?

Methods
We conducted a systematic review to identify the typical LRC patterns present in human running gait, in addition to disease, injury, and running surface effects on LRCs. Inclusion criteria were human subjects, running related experiments, computed LRCs, and experimental design. Exclusion criteria were studies on animals, non-humans, walking only, non-running, non-LRC analysis, and non-experiments.

Results
The initial search returned 536 articles. After review and deliberation, our review included 26 articles. Almost every article produced strong evidence for LRCs apparent in running gait and in all running surfaces. Additionally, LRCs tended to decrease due to fatigue, past injury, increased load carriage and seem to be lowest at preferred running speed on a treadmill. No studies investigated disease effects on LRCs in running gait.

Significance
LRCs seem to increase with deviations away from preferred running speed. Previously injured runners produced decreased LRCs compared to non-injured runners. LRCs also tended to decrease due to an increase in fatigue rate, which has been associated with increased injury rate. Lastly, there is a need for research on the typical LRCs in an overground environment, for which the typical LRCs found in a treadmill environment may or may not transfer.
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NewsBot · May 23, 2023

Pre-Pubertal Runners Demonstrate Greater Variability in Running Kinematics than Post-Pubertal Runners
Eryn L. Close, Micah C. Garcia, David M. Bazett-Jones
Gait & Posture; 22 May 2023

Background
Adolescents undergo a period of motor incoordination during puberty characterized by high movement variability. It is unknown if differences in running kinematics variability exist among adolescent long-distance runners.

Research Question
Is kinematic variability different among male and female adolescent long-distance runners of different stages of physical maturation?

Methods
We enrolled 114 adolescent long-distance runners (ages 8-19, F = 55, M = 59) in this secondary analysis of a larger cross-sectional study. Participants completed a three-dimensional overground running analysis at a comfortable self-selected speed. Peak frontal, sagittal, and transverse plane hip, knee, and ankle/shoe joint angles from the right leg were identified during stance phase for at least five trials. Variability in running kinematics was quantified as the standard deviation of the peak joint angles among the running trials for each participant. Participants were stratified by sex and stage of physical maturation (pre-, mid-, post-pubertal) and two-way ANOVAs compared between-subjects variability among groups (p ≤.05).

Results
Significant sex by maturation interactions were observed for hip external rotation and ankle external rotation variability. Sex differences were observed for hip internal rotation, with males demonstrating greater variability, and ankle internal rotation, with females demonstrating greater variability. Pre-pubertal runners demonstrated significantly greater variability than mid-pubertal runners for hip flexion, and greater variability than post-pubertal runners for hip flexion, hip adduction, hip internal rotation, and knee flexion.

Significance
Pre-pubertal adolescent long-distance runners demonstrate greater stance phase variability in running kinematics than post-pubertal adolescent long-distance runners, while adolescent males and females demonstrate similar variability. Anthropometric and neuromuscular changes that occur during puberty likely influence running patterns and may contribute to more consistent kinematic patterns for post-pubertal runners.
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