The association between running kinematics and common overuse injuries in runners : implications for injury and rehabilitation

Bramah, CA

Abstract

Background: Running related injuries are influenced by a complex interaction between multiple factors. Running kinematic patterns represent one such factor which will influence the load applied to musculoskeletal structures during each foot contact of a run. When combined with an increase in external training load, a cumulative tissue load may result that exceeds tissue capacity, resulting in injury development.

Aim: This thesis aimed to identify kinematic parameters associated with common running related injuries, explore whether such factors are influenced by training load exposure and investigate whether gait retraining, aimed at improving to running kinematics, may represent a clinically effective intervention.

Methods: A narrative literature review was conducted to identify gaps within the literature and formulate specific research questions. An initial study was performed to investigate the between day repeatability and quantify the standard error of measurement for discrete kinematic parameters during running. A case control study of 108 runners was then undertaken to investigate whether similar kinematic parameters are associated with multiple different common running related injuries. Following identification of kinematic parameters associated with running injuries, a cross sectional study investigated whether kinematic parameters associated with injury are associated with training load exposure. Finally, a case series study investigated whether gait retraining, in the form of a step rate intervention, improves running kinematics and clinical outcomes amongst a group of 12 injured runners with patellofemoral pain.

Findings: The repeatability study demonstrated good to excellent repeatability with low measurement errors for several kinematic parameters during treadmill running. The second study found several kinematic parameters to be associated with multiple different running related injuries, including increased contralateral pelvic drop, hip adduction and forward trunk lean, as well as reduced knee flexion and increased ankle dorsiflexion at initial contact. Within this study, a logistic regression analysis found peak contralateral pelvic drop to be the kinematic parameter most strongly associated with common running injuries. Data from this study was used to set a critical threshold for peak contralateral pelvic drop, above which runners were deemed more likely to be at risk of injury. Building on this idea, the third study, highlighted an association between training load exposure and running kinematics. Specifically, amongst injury-free high-mileage runners, a significantly lower proportion of runners exhibited “high-risk” kinematics than in a group of injury-free low-mileage runners. Finally, the case series study found a single session of gait retraining, via a 10% increase in step rate, resulted in significant reductions in peak contralateral pelvic drop, hip adduction and knee flexion, as well as significant improvements in clinical and functional outcomes amongst runners with patellofemoral pain.

Implications: Several kinematic parameters appear to be associated with multiple different running related injuries, suggesting similar kinematic patterns may increase tissue load on multiple different anatomical locations. Interestingly, there appears to be a complex interaction between kinematics and training load exposure highlighting that kinematics alone may be unlikely to explain injury development. In such instances where runners have become injured and possess kinematic parameters which increase tissue load, increasing step rate appears to be an effective gait intervention which can be easily integrated into clinical practise and a runner’s normal routine.

Citation

Bramah, C. The association between running kinematics and common overuse injuries in runners : implications for injury and rehabilitation. (Thesis). University of Salford

• Thesis Type: Thesis
• Deposit Date: Dec 17, 2020
• Publicly Available Date: Dec 17, 2020
• Award Date: Oct 29, 2020