HVORFOR OPSTÅR LØBESKADER?

PT, MHSc, PhD Post Doc at Section for Sport Science, Department of Public Health, Aarhus Universitet. Idrætsskader, epidemiologi og statistik

OUR RESEARCH GROUP: Research coordinator in RUNSAFE A multi-disciplinary research group with particular interest within the running-related injury thematic Conflicts of interests: None!

CONTENT RUNNING INJURIES A PUBLIC HEALTH BURDEN? CSES TO RUNNING-RELATED INJURIES RUNNING SHOES

POPULARITY OF RUNNING 35 30 25 20 15 10 5 0 1975 1993 1998 2004 2007 2011 2016 Percentage of the adult Danish population engaged in running from 1975 to 2016. Data used to compute this graph is based on reports from IDAN (http://www.idan.dk/).

WHAT IS A RUNNING-RELATED INJURY? Yamato et al J Orthop Sports Phys Ther. 2015 May;45(5):375-80. consensus-baseret definition: Running-related (training or competition) musculoskeletal pain in the lower limbs that causes a restriction on or stoppage of running (distance, speed, duration, or training) for at least 7 days or 3 consecutive scheduled training sessions, or that requires the runner to consult a physician or other health professional Mange andre eksisterer

SPORTS INJURIES IN DENMARK 2016

SPORTS INJURIES AMONGST ADULTS Respondents Number injured Percent All 3.498 642 18,4 % Males 1.719 396 23,0 % Females 1.779 246 13,8 %

INJURIES PREVALENCE PROPORTION 50 40 30 20 10 0

INJURY PREVALENCE 250 200 150 100 50 0

Videbæk et al. 2015, Sports Med; Novices sustain a greater number of injuries than others 14

DIAGNOSES Ref: Nielsen et al. PLOS One, 2014, Jun; 9(6): e99877. Ref: Taunton et al. BJSM, 2002, 36: 95-101

WHO DO RECREATIONALS SEEK? 175 Injured runners What did they do? 122 Healthy runners What would they do? GP N = 42 24% N = 37 30% Physiotherapist N= 40 23% N = 7 6% Sports clinic N = 35 20% N = 41 34% Chiropractor N = 4 2% N = 3 2% Speciallæge N = 7 4% N = 2 2% Other N = 10 6% N = 6 5% Nothing N = 22 13% N = 0 0% Multiple of the above N = 15 9% N = 26 21% Reference: Furman, S. SAMJ 1986; 69(1): 108-110

SATISFACTION

SOCIO-ECONOMIC COSTS Novice runners - Economic burden per running injury 83.22 Euro (95% CI = 50.42; 116.02) Trail runners - Economic burden per running injury 172.22 Euro (95% CI = 117.10; 271.74)

CONSEQUENCES Reference: Nielsen et al, PLOS one 2014; 9(6): e99877

ARE INJURIES IN RUNNERS A PUBLIC HEALTH BURDEN?

CONTENT RUNNING INJURIES A PUBLIC HEALTH BURDEN? CSES TO RUNNING-RELATED INJURIES RUNNING SHOES

IN CLINICAL PRACTICE RUNNERS ASK What causes injury How do I prevent injuries What are my treatment options 22

IMPORTANT TAKE HOME MESSAGE! PREVENTION AND TREATMENT Identify factors leading to injury! 1) van Mechelen W, et al. Sports Med. 1992;14(2):82-99 2) Finch, C. J Sci Med Sport. 2006;9(1-2):3-9

WHERE IS THE LINK? The preoccupation with risk factor identification, albeit necessary, has run its course for the last 45 years with moderate success.

IMPORTANT SLIDE Risk factors Risk factors RUN INJURY RUNNING IS A NECESSARY CSE TO INJURY DEVELOPMENT 25

WE NEED TO CONCEPTUALISE CSALITY PARTICIPATION IN RUNNING IS A NECESSARY CSE TO RUNNING INJURY

WHERE IS THE LINK? SUDDEN CHANGES MAY BE THE LINK

CONSENSUS STATEMENT

AVERAGE VERSUS SUDDEN 25 20 15 10 5 Runner A Runner B 0 Week 1 Week 2 Week 3 Week 4 The average weekly distances are similar

MAJOR PROBLEM Little research has investigated exposure to injury using time-varying exposures and/or outcomes.

THE CONCEPT OF SUDDEN CHANGES? WE BELIEVE CHANGES ARE IMPORTANT! You must change something to sustain a running-related overuse injury

MAJOR QUESTION: WHAT CAN CHANGE? ABSOLUTE NUMBER OF STRIDES MAGNITUDE OF THE LOAD PER STRIDE LOAD DISTRIBUTION LOAD CAPACITY

WHERE IS THE LINK? It is not there yet Sudden changes may reveal important

CASES 34

CASE 1 You diagnose the injured runner as the important first step In this case: Achilles tendinopathy (3-4 cm above the insertion) Using shoes or video analyses you identify this runner as a rear foot striker

CHANGES THAT MAY LEAD TO ACHILLES TENDINOPATHY SOME THEORETICAL CHANGES THAT INCREASE THE LOAD ANAMNESIS Increasing running speed Change to a forefoot strike Via technique Via shoes Via running up hill I sprinted towards the finish line during the DHL relay race!!

HOW SHOULD CASE 1 WITH ACHILLES TENDINOPATHY TAKE UP RUNNING? Run at a slow pace Do not practice technique Run in shoes with greater heel toe drop Run in flat terrain

CASE 2: EXCESSIVE RUNNING DISTANCE Risk factors constant Risk factors constant RUN Excessive distance INJURY How do runners usually do this? Most would run slowly 38

WHAT HAPPENS WHEN YOU RUN SLOWLY? The cumulative stress at the medial side of the lower leg, anterior part of the knee and lateral part of the hip is increased. Does this mean, that these structures are more vulnerable to injury if running distance is excessively increased?

YES IT SEEMS SO CONCLUSION A sudden increase in weekly running distance of greater than 30% over a 2- week period may lead to the development of 1) patellofemoral pain, 2) iliotibial band syndrome, 3) medial tibial stress syndrome, 4) patellar tendinopathy 5) gluteus medius injury 6) greater trochanteric bursitis 7) injury to the tensor fascia latae.

HOW TO USE THIS INFORMATION? TREATMENT Runners with injuries at the anterior part of the knee, medial part of the lower leg and lateral part of the hip may be advised to take up running at a fast pace (but at a short distance). PREVENTION Injuries at the anterior part of the knee, medial part of the lower leg and lateral part of the hip may be prevented by running faster.

CASE 3: EXCESSIVE RUNNING PACE Risk factors constant Risk factors constant RUN Excessive pace INJURY How do runners usually do this? Intervals / short-distance runs 42

WHAT HAPPENS WHEN YOU RUN FAST? Progressing running speed from jogging to sprinting is mostly dependent on ankle and hip muscle performance (achillestendon, calf muscles, iliopsoas) Does this mean, that these structures are more vulnerable to injury if running speed is excessively increased?

WE DO NOT KNOW YET BUT IT SEEMS PLSIBLE

CLINICIANS / COACHES / STUDENTS HOW TO USE THIS INFORMATION TREATMENT Runners with injuries in the achilles tendon, calf muscles, hamstrings and iliopsoas may be advised to take up running at a slow pace (but distance is ok). PREVENTION Injuries at the achilles tendon, calf muscles, hamstrings and iliopsoas may be prevented by running slowly.

SUMMARY CASE 2 + 3 GREY = Excessive pace Pain is located Achillestendon /Calf Plantar fascia Hamstings Iliopsoas RED = Excessive distance Pain is located Knee (Anterior and lateral), Lower leg medial par Hip (lateral part)

CASE 4: CHANGE A RISK FACTOR Shoe change Risk factors constant RUN constant INJURY Modifiable risk factors: Shoes, terrain, surface, BMI, insoles and many more 47

IMPORTANT SLIDE Risk factors Risk factors RUN INJURY WHAT IS RUNNING?. The model is too simple 48

WHAT DO WE WANT TO MEASURE? DISTANCE? TIME-SPENT-RUNNING? SPEED / PACE? STEPS / STRIDES? OTHER?

NOVEL CSAL FRAMEWORK Online soon in:

CONCLUSION SUDDEN CHANGES ARE IMPORTANT INJURIES OCCUR VIA THE RUNNING PARTICIPATION USE THE ANAMNESIS!!! IT IS OF OUTMOST IMPORTANCE!! THE CHALLENGE IS: WHAT IS RUNNING? THIS QUESTION REMAINS UNCERTAIN

REMEMBER Runners do NOT sustain injuries just because they Have a high BMI Have a certain running style Run in a wrong shoe Run on a wrong surface 52

CONTENT RUNNING INJURIES A PUBLIC HEALTH BURDEN? CSES TO RUNNING-RELATED INJURIES RUNNING SHOES

THE MEDIA LOVES SHOE-RELATED NEWS 54

SCIENTISTS ACCEPTED THE SHOE-SHOP THEORY Old shoes were examined to evaluate any one-sided wear due to excessive pronation. Proper individually fitted running shoes were used 55

DANO-RUN

LUXEMBOURGISH TRIALS 57

RUNNING SHOES IN A CSAL PERSPECTIVE We do not know. It seems plausible to assume that runners sustained overuse injury because they ran too much in a specific shoe.

ACKNOWLEDGEMENTS

CONTACT RASMUS NIELSEN ROEN@PH..DK http://runsafe.au.dk/