How (not) to interpret a non-causal association in sports injury science

NewsBot · May 11, 2018

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How (not) to interpret a non-causal association in sports injury science
Mette Hjerrild et al
Phys Ther Sport; Article in Press

Highlights
•A non-causal association identifies athletes at higher or lower risk of injury.
•In sports science, a non-causal association excludes information on training load.
•Training load (e.g. running) is a necessary cause to injury in causal associations.
•Training load is needed to determine why injury develops.
•Effective interventions to reduce injury risk is likely to include training load.
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Objective
To discuss the interpretability of non-causal associations to sports injury development exemplified via the relationship between navicular drop (ND) and running-related injury (RRI) in novice runners using neutral shoes.

Design
1-year prospective cohort study.

Setting
Denmark.

Participants
926 novice runners, representing 1852 feet, were included.

Main outcome measure
The outcome was “a musculoskeletal complaint of the lower extremity or back caused by running, which restricted the amount of running for at least a week”.

Results
Fewer feet with small ND than those feet with a reference ND sustained injuries at 50 (risk difference (RD) = −4.1% [95%CI = −7.9%;-0.4%]) and 100 km (RD = −5.3% [95%CI = −9.9%;-0.7%]). Similarly, fewer feet with a large ND sustained injuries than the feet with a reference drop at 250 (RD = −7.6% [95%CI = −14.9%;-0.3%]) and 500 km (RD = −9.8% [95%CI = −19.1%;-0.4%]).

Conclusion
The results suggest that the sub-groups of novice runners with a small or large navicular drop sustain fewer injuries than those with a reference drop. However, navicular drop per se does not cause RRIs, but may influence the relationship between training load, the necessary cause, and RRI. This illustrates that non-causal associations are able to identify certain runners at high risk of injury but unsuitable to respond to the questions: (i) Why do running injury develop?, and (ii) is foot posture a suitable target for interventions to reduce injury risk?
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