Explore the vast range of titles available.

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.

AimTo investigate the association of daily clinical measures and the progression of rehabilitation and perceived running effort.MethodsA cohort of 131 athletes with an MRI-confirmed acute hamstring injury underwent a standardised criteria-based rehabilitation protocol. Descriptive and inferential statistics were used to investigate the association between daily clinical subjective and objective measures and both the progression of rehabilitation and perceived running effort. These measures included different strength, palpation, flexibility and functional tests. Inter-rater and intrarater reliability and minimal detectable change were established for the clinical measures of strength and flexibility by examining measures taken on consecutive days for the uninjured leg.ResultsThe progression of the daily measures was seen to be non-linear and varied according to the measure. Intra-rater reliability for the strength and flexibility measures were excellent (95% CI ≥0.85 for all measures). Strength (in the outer range position) and flexibility (in maximum hip flexion with active knee extension (MHFAKE) in supine) were best associated with rehabilitation progression and perceived running effort. Additionally, length of pain on palpation was usefully associated with rehabilitation progression. At lower perceived running effort there was a large variation in actual running speed.ConclusionDaily physical measures of palpation pain, outer range strength, MHFAKE and reported pain during daily activity are useful to inform the progression of rehabilitation.Trial registration numberNCT01812564 and NCT02104258.

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.

Background Hamstring strain is a common injury in sprinters and jumpers, and therefore time to return to sport and secondary prevention become of particular concern. Objective To compare the effectiveness of two rehabilitation protocols after acute hamstring injury in Swedish elite sprinters and jumpers by evaluating time needed to return to full participation in the training process. Study design Prospective randomised comparison of two rehabilitation protocols. Methods Fifty-six Swedish elite sprinters and jumpers with acute hamstring injury, verified by MRI, were randomly assigned to one of two rehabilitation protocols. Twenty-eight athletes were assigned to a protocol emphasising lengthening exercises, L-protocol, and 28 athletes to a protocol consisting of conventional exercises, C-protocol. The outcome measure was the number of days to return to full training. Re-injuries were registered during a period of 12 months after return. Results Time to return was significantly shorter for the athletes in the L-protocol, mean 49 days (1SD±26, range 18–107 days), compared with the C-protocol, mean 86 days (1SD±34, range 26–140 days). Irrespective of protocol, hamstring injuries where the proximal free tendon was involved took a significantly longer time to return than injuries that did not involve the free tendon, L-protocol: mean 73 vs 31 days and C-protocol: mean 116 vs 63 days, respectively. Two reinjuries were registered, both in the C-protocol. Conclusions A rehabilitation protocol emphasising lengthening type of exercises is more effective than a protocol containing conventional exercises in promoting time to return in Swedish elite sprinters and jumpers.

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.

Running-related stress fractures have been associated with the overall impact intensity, which has recently been described through the loading rate (LR). Our purpose was to evaluate the effects of four acute interventions with specific focus on LR: wearing racing shoes (RACE), increasing step frequency by 10 % (FREQ), adopting a midfoot strike pattern (MIDFOOT) and combining these three interventions (COMBI). Nine rearfoot-strike subjects performed five 5-min trials during which running kinetics, kinematics and spring-mass behavior were measured for ten consecutive steps on an instrumented treadmill. Electromyographic activity of gastrocnemius lateralis , tibialis anterior , biceps femoris and vastus lateralis muscles was quantified over different phases of the stride cycle. LR was significantly and similarly reduced in MIDFOOT (37.4 ± 7.20 BW s −1 , −56.9 ± 50.0 %) and COMBI (36.8 ± 7.15 BW s −1 , −55.6 ± 29.2 %) conditions compared to NORM (56.3 ± 11.5 BW s −1 , both P  < 0.001). RACE (51.1 ± 9.81 BW s −1 ) and FREQ (52.7 ± 11.0 BW s −1 ) conditions had no significant effects on LR. Running with a midfoot strike pattern resulted in a significant increase in gastrocnemius lateralis pre-activation (208 ± 97.4 %, P  < 0.05) and in a significant decrease in tibialis anterior EMG activity (56.2 ± 15.5 %, P  < 0.05) averaged over the entire stride cycle. The acute attenuation of foot–ground impact seems to be mostly related to the use of a midfoot strike pattern and to a higher pre-activation of the gastrocnemius lateralis . Further studies are needed to test these results in prolonged running exercises and in the long term.

Background Risk factors have been proposed for running injuries including (a) reduced muscular strength, (b) excessive joint movements and (c) excessive joint moments in the frontal and transverse planes. To date, many running injury prevention programs have focused on a “top down” approach to strengthen the hip musculature in the attempt to reduce movements and moments at the hip, knee, and/or ankle joints. However, running mechanics did not change when hip muscle strength increased. It could be speculated that emphasis should be placed on increasing the strength of the ankle joint for a “ground up” approach. Strengthening of the large and small muscles crossing the ankle joint is assumed to change the force distribution for these muscles and to increase the use of smaller muscles. This would be associated with a reduction of joint and insertion forces, which could have a beneficial effect on injury prevention. However, training of the ankle joint as an injury prevention strategy has not been studied. Ankle strengthening techniques include isolated strengthening or movement-related strengthening such as functional balance training. There is little knowledge about the efficacy of such training programs on strength alteration, gait or injury reduction. Methods/Design Novice runners will be randomly assigned to one of three groups: an isolated ankle strengthening group (strength, n = 40), a functional balance training group (balance, n = 40) or an activity-matched control group (control, n = 40). Isokinetic strength will be measured using a Biodex System 3 dynamometer. Running kinematics and kinetics will be assessed using 3D motion analysis and a force platform. Postural control will be assessed by quantifying the magnitude and temporal structure of the center of pressure trace during single leg stance on a force platform. The change pre- and post-training in isokinetic strength, running mechanics, and postural control variables will be compared following the interventions. Injuries rates will be compared between groups over 6 months. Discussion Avoiding injury will allow individuals to enjoy the benefits of participating in aerobic activities and reduce the healthcare costs associated with running injuries. Trial registration Current Controlled Trial NCT01900262 .

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.

Patellofemoral pain (PFP) is the most common injury in running and jumping athletes. Randomized controlled trials suggest that incorporating hip and core strengthening (HIP) with knee-focused rehabilitation (KNEE) improves PFP outcomes. However, no randomized controlled trials have, to our knowledge, directly compared HIP and KNEE programs. To compare PFP pain, function, hip- and knee-muscle strength, and core endurance between KNEE and HIP protocols after 6 weeks of rehabilitation. We hypothesized greater improvements in (1) pain and function, (2) hip strength and core endurance for patients with PFP involved in the HIP protocol, and (3) knee strength for patients involved in the KNEE protocol. Randomized controlled clinical trial. Four clinical research laboratories in Calgary, Alberta; Chicago, Illinois; Milwaukee, Wisconsin; and Augusta, Georgia. Of 721 patients with PFP screened, 199 (27.6%) met the inclusion criteria (66 men [31.2%], 133 women [66.8%], age = 29.0 ± 7.1 years, height = 170.4 ± 9.4 cm, weight = 67.6 ± 13.5 kg). Patients with PFP were randomly assigned to a 6-week KNEE or HIP protocol. Primary variables were self-reported visual analog scale and Anterior Knee Pain Scale measures, which were conducted weekly. Secondary variables were muscle strength and core endurance measured at baseline and at 6 weeks. Compared with baseline, both the visual analog scale and the Anterior Knee Pain Scale improved for patients with PFP in both the HIP and KNEE protocols (P < .001), but the visual analog scale scores for those in the HIP protocol were reduced 1 week earlier than in the KNEE group. Both groups increased in strength (P < .001), but those in the HIP protocol gained more in hip-abductor (P = .01) and -extensor (P = .01) strength and posterior core endurance (P = .05) compared with the KNEE group. Both the HIP and KNEE rehabilitation protocols produced improvements in PFP, function, and strength over 6 weeks. Although outcomes were similar, the HIP protocol resulted in earlier resolution of pain and greater overall gains in strength compared with the KNEE protocol.