Background: Running biomechanics may play a role in running-related injury development, but to date, only a few modifiable factors have been prospectively associated with injury risk. Purpose: To identify risk factors among spatiotemporal and ground-reaction force characteristics in recreational runners and to investigate whether shoe cushioning modifies the association between running biomechanics and injury risk. Study Design: Case-control study; Level of evidence, 3. Methods: Recreational runners (N = 848) were tested on an instrumented treadmill at their preferred running speed in randomly allocated, standardized running shoes (with either hard or soft cushioning). Typical kinetic and spatiotemporal metrics were derived from ground-reaction force recordings. Participants were subsequently followed up for 6 months regarding running activity and injury. Cox regression models for competing risk were used to investigate the association between biomechanical risk factors and injury risk, including stratified analyses by shoe version. Results: In the crude analysis, greater injury risk was found for greater step length (subhazard rate ratio [SHR], 1.01; 95% CI, 1.00-1.02; P = .038), longer flight time (SHR, 1.00; 95% CI, 1.00-1.01; P = .028), shorter contact time (SHR, 0.99; 95% CI, 0.99-1.00; P = .030), and lower duty factor (defined as the ratio between contact time and stride time; SHR, 0.95; 95% CI, 0.91-0.98; P = .005). In the stratified analyses by shoe version, adjusted for previous injury and running speed, lower duty factor was associated with greater injury risk in those using the soft shoes (SHR, 0.92; 95% CI, 0.85-0.99; P = .042) but not in those using the hard shoes (SHR, 0.97; 95% CI, 0.91-1.04; P = .348). Conclusion: Lower duty factor is an injury risk factor, especially for softer shoe use. Contrary to widespread beliefs, vertical impact peak, loading rate, and step rate were not injury risk factors in recreational runners. Registration: NCT03115437 (ClinicalTrials.gov identifier).

Spatiotemporal and Ground-Reaction Force Characteristics as Risk Factors for Running-Related Injury: A Secondary Analysis of a Randomized Trial Including 800+ Recreational Runners

Although reference values in healthy subjects have been published for both the International Knee Documentation Committee 2000 subjective knee form (IKDC 2000) and the Knee injury and Osteoarthritis Outcome Score (KOOS), data obtained during the first year after anterior cruciate ligament reconstruction (ACL-R) are sparse. The aim was to establish patient reference values for both questionnaires at different time points and depending on nine individual patient characteristics during the first year after ACL-R. Prospectively recorded data from a hospital-based registry were retrospectively extracted from the database. IKDC 2000 and KOOS questionnaires were self-administered pre-operatively and 6 weeks, 3 months, and 6 and 12 months following primary ACL-R. Score values were compared according to nine individual patient criteria: gender, age, body mass index, level of activity, involvement in competition, previous contralateral knee injury and/or surgery, graft type, meniscal repair and/or cartilage lesions. The feature which had a significant and consistent impact on the outcomes was considered as main reference. Two-hundred and nighty-eight patients met the inclusion criteria. Overall, the score values increased over time after ACL-R. At 12 months, they were significantly greater than at any other time point (p < 0.05). The main individual feature influencing the IKDC 2000 score was age. Patients below 30 years of age had up to 9 points higher IKDC 2000 score values at all time points (p < 0.05). The main individual characteristic influencing the KOOS score was graft type. Patients with hamstring tendon grafts (STGR) had up to 15 points higher KOOS score values than patients with bone–patellar tendon–bone (BPTB) grafts during the first months after ACL-R (p < 0.05). At 12 months, no differences in KOOS score values could be identified anymore. Younger age (< 30 years) and STGR grafts were related to higher IKDC 2000 and KOOS score values within the first year after primary ACL-R. The patient reference values adjusted to age and graft provided in this study may help to identify patients with lower outcomes within the first year after ACL-R. Level III.

Younger age and hamstring tendon graft are associated with higher IKDC 2000 and KOOS scores during the first year after ACL reconstruction.

Leisure-time running is one of the most popular forms of physical activity around the world. It can be practiced almost everywhere and requires mainly a pair of "appropriate" running shoes. However, the term appropriate is ambiguous, and the properties of running footwear have always generated hot debates among clinicians, coaches, and athletes, whatever the level of practice. As the main interface between the runner's foot and the ground, the shoe potentially plays an important role in managing repetitive external mechanical loads applied to the musculoskeletal system and, thus, in injury prevention. Consequently, over the last decades, running shoes have been prescribed based on matching shoe features to foot morphology. This strategy aligns with the popular belief that footwear is one of the main extrinsic factors influencing running-related injury risk. Despite a seemingly sound strategy for shoe prescription and constant progress in running-footwear technology, the injury rate remains high. Therefore, our aim in this narrative literature review is to clarify whether the prescription of appropriate footwear to prevent injury in running is evidence based, the result of logical fallacy, or just a myth. The literature presented in this review is based on a nonsystematic search of the MEDLINE database and focuses on work investigating the effect of shoe features on injury risk in runners. In addition, key elements for a proper understanding of the literature on running footwear and injury risk are addressed. In this literature review, we outline (1) the main risk factors and the mechanisms underlying the occurrence of running-related injury, (2) important methodologic considerations for generating high-level evidence, (3) the evidence regarding the influence of running-shoe features on injury risk, (4) future directions for research, and (5) final general recommendations.

/pdf/can-the-appropriate-footwear-prevent-injury-in-leisure-time-ulf761iiya.pdf

Can the "Appropriate" Footwear Prevent Injury in Leisure-Time Running? Evidence Versus Beliefs.

In a recent randomized trial including 800+ recreational runners, injury risk was lower in those who received the Soft shoe version compared to those using the Hard version (Hazard ratio = 1.52; 95...

Effect of shoe cushioning on landing impact forces and spatiotemporal parameters during running: results from a randomized trial including 800+ recreational runners.

Boots are often used in sports, occupations, and rehabilitation. However, there are few studies on the biomechanical alterations after wearing boots. The current study aimed to compare the effects of running shoes and boots on running biomechanics. Kinematics and ground reaction forces were recorded from 17 healthy males during running at 3.3 m/s with shoe and boot conditions. Temporal distance gait variables, ground reaction force components as well as lower limb joints angle, moment, and power were compared using Paired t-test and Statistical Parametric Mapping package for time-series analysis. Running with boots was associated with greater stride, step, flight, and swing times, greater flight length, and smaller cadence (p<0.05). The only effect of boots on lower limb joints kinematics during running was a reduction in ankle range of motion (p<0.05). Significantly greater hip flexor, abductor, and internal rotator moments, greater knee extensor and abductor moments, and ankle plantar flexor moments were observed at push-off phase of running as well as greater ankle dorsiflexor moment at early-stance in boot condition (p<0.05). Also, knee joint positive power was greater with a significant temporal shift in boot condition, suggesting a compensatory mechanism in response to limited ankle range of motion and the inability of the ankle joint to generate the required power. Our findings showed that running with boots is physically more demanding and is associated with a greater net contribution of muscles spanning hip and knee joints in order to generate more power and compensate for the ankle joint limitations, consequently, may increase the risk of both musculoskeletal injuries and degenerative joint diseases.

/pdf/biomechanics-of-running-a-special-reference-to-the-17j8j1j3.pdf

Biomechanics of running: A special reference to the comparisons of wearing boots and running shoes

Summary Purpose: To systematically record preand post-operative clinical data after ACL reconstruction in an institutional clinical pathway. Material and methods: From 2011 to 2014, 285 patients had an ACL reconstruction with a bone patellar tendon bone (BPTB) (n = 123) or a hamstring (HS) (n = 162) auto-graft. Isokinetic quadriceps and hamstrings force, anterior and rotational knee laxity, hop tests and subjective knee function were evaluated. Results:All outcomes improved significantly throughout the follow-up. Anterior knee laxity was significantly improved by ACL reconstruction (p < 0.01). Quadriceps force deficit was significantly greater in BPTB group compared to HS group at all time points (p < 0.01). The same holds true for functional performance (p < 0.05). Discussion and conclusion: The present study highlighted the progression of ACL-reconstructed patients throughout their rehabilitation. The results of this institutional clinical pathway may serve as an internal and external benchmark, as well as a potential baseline to individualize patient care including return-to-sports.

ORIGINAL PAPER / SPECIAL ISSUE The anterior cruciate ligament clinical pathway: Towards a systematic evaluation of ACL injured patients

Summary We report a case of a 47-year-old male handball player who sustained a direct trauma in competition of his right lateral knee against the hinges of a braced defensive player. The trauma resulted in a split fracture of the lateral tibial plateau. There is a high probability that the hinged brace might have caused or at least aggravated the injury and that the rules of handball should be more detailed on the topic of protective gear.

CASE REPORT / SPECIAL ISSUE Unusual injury mechanism of a tibial plateau fracture in relation with a knee brace in handball - A case study

REVIEW / SPECIAL ISSUE Knieverletzungen im Handball

Summary The aim of this contribution is to present and discuss recent research findings on the relationship between shoe technology, running biomechanics and running-related injury risk. This association has long been inferred based on biomechanical studies, but this inference is not always scientifically sound, given that the study outcome is seldom injury itself. Epidemiological studies such as prospective cohort or intervention studies focusing on running-related injuries provide more conclusive evidence. However, the underlying mechanisms in the relationship between shoe design features and injury can generally not be established. Comparisons of healthy and injured runners have revealed subtle differences in their running mechanics, especially when certain injury types are considered. However, there is no evidence today that a particular footgear is able to induce a less injury-prone running style in general.

REVIEW / SPECIAL ISSUE Footwear and running-related injuries - Running on faith?

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ORIGINAL PAPER / SPECIAL ISSUE The anterior cruciate ligament clinical pathway: Towards a systematic evaluation of ACL injured patients

CASE REPORT / SPECIAL ISSUE Unusual injury mechanism of a tibial plateau fracture in relation with a knee brace in handball - A case study

REVIEW / SPECIAL ISSUE Knieverletzungen im Handball

REVIEW / SPECIAL ISSUE Footwear and running-related injuries - Running on faith?