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

Abstract

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).