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Purpose of Review Running-related injuries (RRIs) are a common cause of dysfunction among runners. Foot and ankle injuries are among the most common RRIs. The purpose of this review is to detail current concepts in the pathophysiology, evaluation, management, and prevention of foot and ankle RRIs. Recent Findings Running gait analyses are helpful in identifying biomechanical and kinematic abnormalities that can be targeted in rehabilitation. Musculoskeletal ultrasonography is now being used to both qualitatively and quantitatively assess tissue integrity to guide diagnosis, prognosis, and return to run decision-making. Recent treatment analyses have demonstrated that rehabilitation exercises are vital for restoring tissue function. The effectiveness of gait retraining and shoe modification is unclear. There is emerging evidence that training the foot core muscles is preventative against RRIs. Although injections such as orthobiologics have recently gained popularity, their long-term effectiveness in the management of foot and ankle RRIs remains inconclusive. Summary A comprehensive review of RRI risk factors and a thorough physical examination are vital for identifying RRIs. Ultrasonography is an emerging diagnostic modality for RRIs. Treatment should center around extrinsic risk factor reduction, activity modification, rehabilitative exercise, and a gradual return to run progression. Caution should be used when considering injections, particularly orthobiologics, for the management of RRIs. Future research should be performed to investigate the effectiveness of gait modification and the effectiveness of orthobiologics in the treatment of RRIs.

Achilles tendinopathy is a painful overuse injury that is extremely common in athletes, especially those who participate in running and jumping sports. In addition to pain, Achilles tendinopathy is accompanied by alterations in the tendon's structure and mechanical properties, altered lower extremity function, and fear of movement. Cumulatively, these impairments limit sport participation and performance. A thorough evaluation and comprehensive treatment plan, centered on progressive tendon loading, is required to ensure full recovery of tendon health and to minimize the risk of reinjury. In this review, we will provide an update on the evidence-based evaluation, outcome assessment, treatment, and return-to-sport planning for Achilles tendinopathy. Furthermore, we will provide the strength of evidence for these recommendations using the Strength of Recommendation Taxonomy system.

Sports injuries pose significant challenges in athlete welfare and team dynamics, particularly in high-intensity sports like soccer. This study used machine learning algorithms to assess non-contact injury risk in professional male soccer players from physiological and mechanical load variables. Twenty-five professional male soccer players with a first-time, non-contact muscle injury were included in this study. Recordings of external load (speed, distance, and acceleration/deceleration data) and internal load (heart rate) were obtained during all training sessions and official matches over a 4-year period. Machine learning model training and evaluation features were calculated for each of nine different metrics for a 28-day period prior to the injury and an equal-length baseline epoch. The acute surge in the values of each workload metric was quantified by the deviation of maximum values from the average, while the variations of cumulative workload over the last four weeks preceding injury were also calculated. Seven features were selected by the model as prominent estimators of injury incidence. Three of the features concerned acute load deviations (number of sprints, training load score-incorporating heart rate and muscle load- and time of heart rate at the 90-100% of maximum). The four cumulative load features were (total distance, high speed and sprint running distance and training load score). The accuracy of the muscle injury risk assessment model was 0.78, with a sensitivity of 0.73 and specificity of 0.85. Our model achieved high performance in injury risk detection using a limited number of training load variables. The inclusion, for the first time, of heart rate related variables in an injury risk assessment model highlights the importance of physiological overload as a contributor to muscle injuries in soccer. By identifying the important parameters, coaches may prevent muscle injuries by controlling surges of training load during training and competition.

Medical personnel may find it challenging to distinguish severe Exertional Heat Illness (EHI), with attendant risks of organ-injury and longer-term sequalae, from lesser forms of incapacity associated with strenuous physical exertion. Early evidence for injury at point-of-incapacity could aid the development and application of targeted interventions to improve outcomes. We aimed to investigate whether biomarker surrogates for end-organ damage sampled at point-of-care (POC) could discriminate EHI versus successful marathon performance. Eight runners diagnosed as EHI cases upon reception to medical treatment facilities and 30 successful finishers of the same cool weather marathon (ambient temperature 8 rising to 12 ºC) were recruited. Emerging clinical markers associated with injury affecting the brain (neuron specific enolase, NSE; S100 calcium-binding protein B, S100β) and renal system (cystatin C, cysC; kidney-injury molecule-1, KIM-1; neutrophil gelatinase-associated lipocalin, NGAL), plus copeptin as a surrogate for fluid-regulatory stress, were sampled in blood upon marathon collapse/completion, as well as beforehand at rest (successful finishers only). Versus successful finishers, EHI showed significantly higher NSE (10.33 [6.37, 20.00] vs. 3.17 [2.71, 3.92] ug.L-1, P<0.0001), cysC (1.48 [1.10, 1.67] vs. 1.10 [0.95, 1.21] mg.L-1, P = 0.0092) and copeptin (339.4 [77.0, 943] vs. 18.7 [7.1, 67.9] pmol.L-1, P = 0.0050). Discrimination of EHI by ROC (Area-Under-the-Curve) showed performance that was outstanding for NSE (0.97, P<0.0001) and excellent for copeptin (AUC = 0.83, P = 0.0066). As novel biomarker candidates for EHI outcomes in cool-weather endurance exercise, early elevations in NSE and copeptin provided sufficient discrimination to suggest utility at point-of-incapacity. Further investigation is warranted in patients exposed to greater thermal insult, followed up over a more extended period.

Traumatic brain injury (TBI) leads to disturbed brain discharge rhythm, elevated excitability, anxiety-like behaviors, and decreased learning and memory capabilities. Cognitive dysfunctions severely affect the quality of life and prognosis of TBI patients, requiring effective rehabilitation treatment. Evidence indicates that moderate exercise after brain injury decreases TBI-induced cognitive decline. However, the underlying mechanism remains unelucidated. Our results demonstrate that TBI causes cognitive impairment behavior abnormalities and overexpression of Nav1.1, Nav1.3 and Nav1.6 proteins inside the hippocampus of mice models. Three weeks of voluntary running wheel (RW) exercise treatments before or/and post-injury effectively redressed the aberrant changes caused by TBI. Additionally, a 10% exercise-conditioned medium helped recover cell viability, neuronal sodium current and expressions of Nav1.1, Nav1.3 and Nav1.6 proteins across cultured neurons after injury. Therefore, the results validate the neuroprotection induced by voluntary RW exercise treatment before or/and post-TBI. The RW exercise-induced improvement in cognitive behaviors and neuronal excitability could be associated with correcting the Nav1.1, Nav1.3, and Nav1.6 expression levels. The current study proves that voluntary exercise is an effective treatment strategy against TBI. The study also highlights novel potential targets for rehabilitating TBI, including the Navs proteins.

Background and Objectives: Patellofemoral pain (PFP) is the most prevalent running-related injury due to underlying biomechanical factors, particularly among female runners. Although instrument-assisted soft tissue mobilization (IASTM) is a popular therapeutic technique, the optimal application site for the short-and long-term outcomes of PFP has not been well established. This aim of this study was to compare the immediate and short-term (1-week) effects of a single IASTM treatment applied to the hip and knee versus the knee alone on running-related pain. Range of motion (ROM), muscle strength, and functional performance were also assessed to compare change between the two treatment conditions. Materials and Methods: Twenty-eight female runners with PFP were randomly assigned to either the Hip and Knee (HK) group (n = 14) or the knee-only (K) group (n = 14). The HK group received a 7-min IASTM treatment targeting the quadriceps, patella, iliotibial band (ITB), and gluteus medius, whereas the K group received a 3-min treatment targeting the quadriceps and patella. Visual analog scale (VAS), hip adduction ROM, hip abduction/external rotation strength, and step-down test scores were measured at baseline, immediately post-intervention, and 1 week later. Results: Running-related pain significantly decreased in both groups (main effect of time, p < 0.001) from baseline (HK: 5.49 ± 2.14 [95% CI: 4.78–6.68]; K: 5.30 ± 1.45 [95% CI: 4.69–5.91]) to week 1 (HK: 1.30 ± 1.08 [95%CI: 0.69–1.90]; K: 1.57 ± 1.20 [95%CI: 0.93–2.21]). However, no significant difference was found between the groups. Significant improvement was also observed in hip adduction ROM (p < 0.001), hip abduction strength (p = 0.02), step-down pain (p < 0.001), and patellofemoral function (p < 0.001) immediately after the intervention, which was sustained at the 1-week follow-up. However, no significant difference was found between the groups. Also, hip external rotation strength showed no significant change over time or between groups (p = 0.737). Conclusions: A single IASTM session effectively reduced pain and improved function in female runners with PFP. However, the hip treatment did not show a significant additional benefit compared with knee treatment alone. IASTM can provide immediate and short-term relief of pain and functional limitations.

Objective To investigate the effect of a structured warm-up programme designed to reduce the incidence of knee and ankle injuries in young people participating in sports. Design Cluster randomised controlled trial with clubs as the unit of randomisation. Setting 120 team handball clubs from central and eastern Norway (61 clubs in the intervention group, 59 in the control group) followed for one league season (eight months). Participants 1837 players aged 15-17 years; 958 players (808 female and 150 male) in the intervention group; 879 players (778 female and 101 male) in the control group. Intervention A structured warm-up programme to improve running, cutting, and landing technique as well as neuromuscular control, balance, and strength. Main outcome measure The rate of acute injuries to the knee or ankle. Results During the season, 129 acute knee or ankle injuries occurred, 81 injuries in the control group (0.9 (SE 0.09) injuries per 1000 player hours; 0.3 (SE 0.17) in training v 5.3 (SE 0.06) during matches) and 48 injuries in the intervention group (0.5 (SE 0.11) injuries per 1000 player hours; 0.2 (SE 0.18) in training v 2.5 (SE 0.06) during matches). Fewer injured players were in the intervention group than in the control group (46 (4.8%) v (76 (8.6%); relative risk intervention group v control group 0.53, 95% confidence interval 0.35 to 0.81). Conclusion A structured programme of warm-up exercises can prevent knee and ankle injuries in young people playing sports. Preventive training should therefore be introduced as an integral part of youth sports programmes.

Objectives There is no consensus on the aetiology and prevention of running-related injuries in runners. Preconditioning studies among different athlete populations show positive effects on the incidence of sports injuries. Hypothesis A 4-week preconditioning programme in novice runners will reduce the incidence of running-related injuries. Study design Randomised controlled clinical trial; level of evidence, 1. Methods Novice runners (N=432) prepared for a four-mile recreational running event. Participants were allocated to the 4-week preconditioning (PRECON) group (N=211) or the control group (N=221). The PRECON group started a 4-week training programme, prior to the running programme, with walking and hopping exercises. After the 4-week period both groups started a 9-week running programme. In both groups information was registered on running exposure and running-related injuries (RRIs) using an internet-based running log. Primary outcome measure was RRIs per 100 runners. An RRI was defined as any musculoskeletal complaint of the lower extremity or lower back causing restriction of running for at least a week. Results The incidence of RRIs was 15.2% in the PRECON group and 16.8% in the control group. The difference in RRIs between the groups was not significant (χ2=0.161, df=1, p=0.69). Conclusion This prospective study demonstrated that a 4-week PRECON programme with walking and hopping exercises had no influence on the incidence of RRIs in novice runners.

Side cutting involves mechanical loading of the knee which has been associated with anterior cruciate ligament injury risk. Despite a fast growing body of research, the relationship between loading mechanisms and running speed is still unclear. The aim of this study was to investigate how running speed determines a likely trade-off between task achievement and actual mechanical loading. Fourteen female participants (mean age=20.6±0.7yr, height=1.66±0.05m, mass=57.5±6.9kg) performed 45° side cutting manoeuvres at 2, 3, 4 and 5ms−1 approach speeds. Three dimensional motion and ground reaction forces were recorded to calculate whole body centre of mass (CoM) velocity and lower limb kinematics and kinetics, focusing on knee flexion angle at touch-down and peak knee valgus loading during weight acceptance. One-way repeated measures ANOVA and one-dimensional statistical parametric mapping were used to identify significant speed effects on task achievement and mechanical loading. Analysis of CoM velocities revealed that side cutting manoeuvres at higher running speeds matched the task requirements to a lesser extent. Despite a gradual increase of anterior–posterior deceleration and medio-lateral acceleration with running speed, knee loading mechanisms only reached meaningful levels from a 4ms−1 running speed. Our results confirmed a trade-off between task achievement and actual mechanical loading. This identified a need for standardisation of reporting running speeds. Taking into account also safety considerations, standardisation of a 4ms−1 running speed is proposed for female athletes.