Published online: January 30, 2021 (Accepted for publication January 22, 2021)
Abstract
Problem statement: The street running practice has grown substantially in the last decades. Some musculoskeletal injuries from this running can cause prolonged periods of absence from this activity. Aim: To estimate the occurrence of running-related injuries and to analyze their association with sociodemographic characteristics, training variables, and characteristics of the primary type of competition in adult street runners from Curitiba, Brazil. Material and methods: A observational and cross-sectional design study was conducted in 2017. The 195 participants (60.5% male) were recreational street runners, intentionally selected among clients of four running consultancy companies or approached after a race competition. Injury occurrence was self-reported and measured with a dichotomous answer to the question: In the last six months, have you suffered any type of injury to your lower limbs as a result of running? The independent variables included sociodemographic characteristics (sex, age group, body mass, height, Body Mass Index), training variables (weekly frequency, volume, place, professional monitoring), and characteristics of the primary type of competition (main running types, distance, and years of practice). Data were analyzed using a multivariate Poisson regression in SPSS 26.0. Results: The prevalence of injury was 16.9% and was positively associated only with five or more years of run practices (PR: 2.11; 95% CI: 1.07-4.17; p = 0.032). The most injured site was the leg (49%), while the least common was the thigh (3%). Tibial periostitis (47%) and muscle strain (3%) were the most and least reported types of injury, respectively. Conclusion: These results may help professionals develop preventive injury strategies with adequate exercise and periodization to preserve long-time street runners' health. Keywords: recreational runners; running; sports medicine; sports injuries; musculoskeletal injuries; running-related Injuries
Introduction
Regular physical activity is associated with essential health benefits such as reduced mortality, the incidence of hypertension, type II diabetes, anxiety, depression, overweight, and improved cardiorespiratory fitness (Ding et al., 2016). Among the various physical activities, street running is one of the most popular and accessible activities and has shown substantial growth in the last decades (Bueno et al., 2020; Lima et al., 2017; Torres et al., 2020).
However, musculoskeletal injuries are common among runners (Bueno et al., 2018; Saragiotto et al., 2014). These injuries can be related to intrinsic factors (sex, age, experience) and extrinsic factors (such as place of training, type of race, and professional monitoring), which may lead to a reduction in the practice of running (Benca et al., 2020; Hino et al., 2009; Hollander et al., 2021). In some cases, injuries require a lengthy recovery period and are often reported as the reason for giving up the physical activity (Bueno et al., 2018; Hespanhol Junior et al., 2012; Kluitenberg et al., 2015).
Despite the evidence showing an increase in the number of injuries among street runners, there is still some disagreement on the factors that can influence these injuries. Still, there is a relative lack of epidemiological studies in street runners in Brazil. These findings make it difficult to carry out interventions that can prevent injuries in this modality and help maintain and improve its practitioners' health and increase their performance (Borel et al., 2019; Hino et al., 2009; Torres et al., 2020).
In this context, a recent study (Borel et al., 2019) reported the prevalence of injuries ranging between 21-65% and an international study between 20-79% (Van der Worp et al., 2015). These variations in results may be due to divergences in the definition of injury related to street running (Yamato et al., 2015). For example, Purim et al. (2014) classified an injury as "any pain, or condition that has limited or removed for one or more days the athlete's participation in training andor competitions in the last six months" and found a prevalence of 65%. On the other hand, Hespanhol Junior et al., classified injury as "any musculoskeletal pain related to running practice severe enough to prevent training" and found a prevalence of 31% (Hespanhol Junior et al., 2013).
There seems to be a lack of studies using a standardized concept of injury suffered by street runners, presenting a difficulty in comparing the data, with low consistency of results in the prevalence of injuries (Yamato et al., 2015). This characteristic may, in part, make it difficult to understand the primary injuries and the factors associated with them, thus limiting prevention and treatment strategies (Torres et al., 2020; Van der Worp et al., 2015). In this context, the aim of this study was 1) to estimate the occurrence of running-related injuries in adult street runners in Curitiba, Brazil, and 2) to analyze the association of their injuries with sociodemographic characteristics, training variables, and characteristic the primary type of competition.
Material & methods
Design, research location, and ethical aspects
Between August and September 2017, an observational study with a cross-sectional design was conducted to identify aspects related to injuries in street racing practitioners, both recreational and long-distance (Kluitenberg et al., 2015).
The study was conducted in Curitiba, Parana State, in the south of Brazil. The city has a diversified calendar of traditional street races or relay events, children's circuit, in addition to regional and international races, such as a half-marathon and a marathon, promoted by the Municipal Secretariat for Sport, Leisure and Youth (PMC, 2020). Private companies and sports entities promote other events during the year. In 2017, it was estimated that there were 92 street racing events in the city (PMC, 2020). These characteristics can contribute to the popularization of this type of physical/sports activity and, consequently, increase practitioners' number in recent years. For example, it estimated that about 4% of men and 2% of women in Curitiba city are runners (Lima et al., 2017).
The Research Ethics Committee approved the study of Federal University of Technology - Paraná (# 2,533,719), and the participants signed informed consent.
Participants and sample power
Participants were non-probabilistic selected among the clients of four street running consultancy companies and participants in three street running events. As an inclusion criterion, they had to be adults and to have practiced street racing for at least a year.
Running advisors were intentionally selected as they offer their services in public parks in the city. Ninety-five individuals (61% men) were invited to study before or after the training sessions. Acceptance rate was 100% (n=95). A street race competition was also selected, given its proximity to the place of the data collection. One hundred and forty-three individuals (60% men) were approached after a race competition and invited to participate in the study; the acceptance rate was 70% (n=100). The final number of participants was 195 street runners, 85% of those invited to participate.
The sample power was calculated posterior using the software G*Power 3.1.1 and show power of 92% for an alpha value of 5%.
Dependent variable
The injuries' characteristics were assessed using a self-reported morbidity survey, enabling collecting information on the frequency of health problems and their possible risk factors (Pastre et al., 2004). Injury occurrence was assessed with a dichotomous response with a question: In the last six months, have you suffered any type of injury to your lower limbs as a result of running? (no, yes).Self-reporting is commonly used in similar studies to verify the occurrence of injuries resulting from the practice of running (Hino et al., 2009; Van der Worp et al., 2015; Hespanhol Junior et al., 2016; Torres et al., 2020).
The injury was considered any musculoskeletal pain or condition that caused restriction and withdrawal from running for a) at least seven days; or b) three consecutive training sessions; or c) made it necessary to consult a doctor/health professional. After a consensus of researchers on injuries in recreational and amateur street runners, this operational definition was established for an adequate comparison between studies (Yamato et al., 2015). The type of injury was assessed with series of questions, in which participants were asked about the location of the injury, point to the region on a sex-specific figure of the human body (e. g.: right or left leg, knee), as well as to give the characteristics of the moment of the injury occurrence (training, competition), the time off (number of days), the use of medications (no, yes) and the need for surgical intervention (no, yes) (Kasimov et al., 2018).
Independent variables Sociodemographic characteristics
Sex was observed, and age wasclassified into two age groups (= 39.9 years, = 40 years). Body mass (kg) and height (m) were self-reported and classified by the median according to the parameters of the Brazilian Institute of Geography and Statistics for the adult population of southern Brazil (below and above) (IBGE, 2010). The body mass index (BMI) was categorized in = 24.9 kg/m2 and = 25kg/m2.
Training characteristics
The weekly frequency of training was assessed with the question: How many times a week do you train street running?This continuous variable was classified as 1-3 times/week and = 4 times/week for analysis purposes. Training volume was assessed with the question: On average, how many kilometers per week do you run in your training? The variable was categorized as = 19.9 km/wk, 20-39.9 km/wk, and = 40 km/wk.
The training place was assessed with the question: What is the predominantly used place for your training? (urban street, rural street, park, treadmill, trail). The response options were grouped into three categories according to their potential for injuries: urban street, rural street or trail, and park (Kluitenberg et al., 2015). Finally, professional monitoring was assessed with the question: Do you have any monitoring during training?(no, trainer, personal trainer, and sports advisor). The variable was classified into three categories for analysis purposes: no, trainer/personal trainer, and sports advisor).
Characteristics of running practice
The primary type of race was evaluated with the question: What is the primary type of race you practice? (street race, trail run, mountain race, obstacle race, and triathlon). This variable was grouped according to injuries' potential into two types: street race and trail run/mountain race/obstacle race/triathlon (Kluitenberg et al., 2015). The primary type of race's distance was assessed with four answer options (5 km, 10 km, 21 km, and 42 km) and categorized in = 10 km and = 11 km. Finally, the experience in years of practice was evaluated with four options (< 1 yrs, 1-4.9 yrs, 5-9.9 yrs and = 10 yrs) and classified into two categories (= 4.9 yrs and = 5 yrs).
Statistical analysis
The absolute and relative frequency distribution was used to describe the categorical variables of the participants' characteristics, while the mean and standard deviation described the quantitative variables. The occurrence of injuries was described for the different independent variables, and the association between the variables was analyzed with Poisson regression. After bivariate analysis, all the same or higher-level variables presented a p-value <0.10 and were selected for adjustment in the multivariate model. The final model was carried out following multiple models elaborated from the hierarchical structure with the following levels and variables: level 1 - sociodemographic characteristics; level 2 - training characteristics; and level 3 - running characteristics. The analyses were performed using SPSS 26 software, and the significance level was maintained at 5%.
Results
Most participants were male (60.5%), aged = 39.9 yrs (59.0%), had body mass below the median (52.8%), height above the median (57.4%) and BMI = 24.9 kg / m2 (60.0%) (Table 1).
Regarding training characteristics, there was a more proportion of participants who performed between 1-3 training sessions per week (60.0%), with a volume between 20-39.9 km/week (39.0%), trained in parks (52.1%), and had professional support of sports advice (48.2%). Regarding the characteristics of the race, the largest proportion of participants performed street races (67.7%), at distances = 10 km (75.9%), and with practice time = of 4.9 years (74.9%) (Table 1). The occurrence of injuries was 16.9%. The largest proportion of participants reported the occurrence of injuries during training (69.7%), stayed away for a period =15 days (53.1%), used medication (69.7%), and did not need surgical intervention (100.0%) (Table 1).
The most common site of the injury was the leg (49%), while the least common was the thigh (3%) (Figure 1). Tibial periostitis (47%) and muscle strain (3%) were the types of injury most and least reported, respectively (Figure 2). In the bivariate analysis, weekly training frequency = 4 times/week (PR: 2.03; 95% CI: 1.09-3.82; p=0.027) and years of practice = 5 yrs (PR: 2.48; 95% CI: 1.35-4.58; p=0.003) was positively associated with the occurrence of injuries (Table 2). After adjusting for possible confounding factors, there was a reduction in association strength for both (weekly training frequency and years of practice) (Table 3). The weekly frequency of training = 4 times/wk lost significance, but it had a marginal association with the occurrence of injuries (PR: 1.77; 95% CI: 0.94-3.33; p=0.077). However, the years of practice maintained a significant association, indicating that those individuals who performed the primary type of race as trail run mountain, obstacles or triathlon = 5 yrs were 111% more likely to be affected by musculoskeletal injuries (PR: 2.11; 95% CI: 1.07 -4.17; p=0.032) (Table 2).
Discussion
This study's main objective was to estimate injuries in participants in a street running and analyze their association with sociodemographic, training, and competition characteristics in adults from Curitiba, Brazil. In the epidemiological context, running-related injuries were measured using a standardized question and classified according to the consensual definition for this modality, which is one of this study's strengths. The identification of these characteristics enables an adequate preventive approach related to injuries, as well as allowing comparison with similar studies. The results showed a positive association between the years of practice in the primary running competition type and injury occurrence.
In this study, an injury prevalence of 16.9% was identified. Worldwide, a study involving 1,696 runners reported a 34% prevalence of injury (Kluitenberg et al., 2015). A recent meta-analysis published with studies conducted in Brazil (Borel et al., 2019) identified an average prevalence of injuries of 36.5%. Of the 23 studies included, only 11 (48%) reported some conceptual and operational definition of "injury". It is essential to highlight that the consensual definition established in 2015 was not used in the studies included in that meta-analysis, as they were conducted before the year in which the consensus was established (Yamato et al., 2015). This is important implies little comparative data due to the lack of definition or different definitions of injury in the studies, which leads to difficulty in developing prevention strategies.
There seems to be a positive relationship between time of practice and injury. Other studies have reproduced similar results, and for example, a systematic review indicated that a long time of practice was a risk factor for injuries in runners (Van der Worp et al., 2015). Likewise, this same result was found in Brazil's study (Rangel & Farias, 2016). One study identified that an amount of practice experience < 1 year was a factor of protection against injuries (McKean et al., 2016). On the other hand, a longer practice time should reflect a more significant running experience and greater self-knowledge of runners, reducing injuries' prevalence (Damsted et al., 2017). Since the practice of running, however, is based on essential training variables, such as volume, intensity, duration, and frequency, these, if organized incorrectly over time, could generate more significant damage to runners (Benca et al., 2020; Bueno et al., 2018; Nielsen et al., 2012).
Among the injuries identified, tibial periostitis was the most prevalent, with 47%. The tibia is the most common site of stress injuries in runners, representing 33 to 55% of the total reported stress fractures (Zadpoor & Nikooyan, 2011). When the foot is on the ground, the tibia's anterior portion absorbs high compressive loads, while the posterior portion of the leg receives traction loads (Zadpoor & Nikooyan, 2011; Kasimov et al., 2018). This can explain the tibia's bone geometry, wherein the anterior portion there is more bone mass, due to compressive loads, than in the posterior portion that receives traction loads (Meardon et al., 2015). The musculature of the posterior portion of the leg must be strong enough to help distribute the loads, generating a compressive force in the posterior region of the tibia and reducing the loads in the anterior portion. Thus, tibial stress fractures may be more likely to occur in individuals whose muscles suffer fatigue more quickly or those whose muscles fatigue at different rates, resulting in muscle imbalance (Zadpoor & Nikooyan, 2011; Meardon et al., 2015; Lopes et al., 2012).
In this study, the variables sex and age group were not associated with injuries. Some studies have indicated that men, mainly < 40 yrs old, have a higher risk of injury (Van der Worp et al., 2015; Van Gent et al., 2007), mainly due to factors related to overload and overtraining (Benca et al., 2020; Meardon et al., 2015). The relationship between the occurrence of injuries with weight and height is still inconsistent in the literature, and the body mass index does not seem to have any effect on the risk of injury (Van der Worp et al., 2015). Most injuries in runners occur due to overload (Hreljac, 2004), and training characteristics play a fundamental role in this regard (Nielsen et al., 2012). In this study, the variable training frequency was positively associated with injuries only in the bivariate model and was not associated with the other variables. This suggests that the relative risk of injury proportionally increases with weekly training frequency (Nielsen et al., 2012), as well as training volumes >32 km/wk (Van der Worp et al., 2015; Nielsen et al., 2012; Lopes et al., 2012). These characteristics become visible in this study; 70% of the participants reported that the moment of injury occurred during training, yet only 24% had = 11 km as the distance run in their primary type of race; however, 70% had a training volume of >20 km/wk.
Some limitations must be considered for the proper understanding of the results presented here. The sample is not representative of Curitiba's street runners. The type of lesion was self-reported, which does not include diagnostic confirmation (Kasimov et al., 2018). The impossibility of evaluating some essential variables, such as biomechanical data and the type of footwear used, made it impossible to analyze these variables' association with injuries (Benca et al., 2020). Finally, the absence of some information related to training (e. g.: intensity) makes it challenging to comprehend the occurrence of injuries.
Conclusions
The occurrence of running-related injuries in lower limbs among recreational street runners was 16.9%. The most common injury site was the leg, and tibial periostitis is the primary injury reported. The amount of practice time within the primary race type of competition, as a trail run mountain, obstacles, or triathlon, over a period equal to or greater than five years, showed a positive association and increased two times the likely occurrence injuries.
These results can be used as a basis for comparison with future studies that use the same definition of injury. They are also essential to guide interventions that include injury prevention strategies, mainly related to the organization of training variables, so that amount of practice time in running is not a risk factor due to the accumulation of musculoskeletal injuries. Future studies could follow longitudinally different training periodization models for running, including the intensities used and their associations with injury incidence, so the running practice could contain more benefits than risks, thus preserving practitioners' health and longevity. Conflicts of interest: None
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Abstract
Problem statement: The street running practice has grown substantially in the last decades. Some musculoskeletal injuries from this running can cause prolonged periods of absence from this activity. Aim: To estimate the occurrence of running-related injuries and to analyze their association with sociodemographic characteristics, training variables, and characteristics of the primary type of competition in adult street runners from Curitiba, Brazil. Material and methods: A observational and cross-sectional design study was conducted in 2017. The 195 participants (60.5% male) were recreational street runners, intentionally selected among clients of four running consultancy companies or approached after a race competition. Injury occurrence was self-reported and measured with a dichotomous answer to the question: In the last six months, have you suffered any type of injury to your lower limbs as a result of running? The independent variables included sociodemographic characteristics (sex, age group, body mass, height, Body Mass Index), training variables (weekly frequency, volume, place, professional monitoring), and characteristics of the primary type of competition (main running types, distance, and years of practice). Data were analyzed using a multivariate Poisson regression in SPSS 26.0. Results: The prevalence of injury was 16.9% and was positively associated only with five or more years of run practices (PR: 2.11; 95% CI: 1.07-4.17; p = 0.032). The most injured site was the leg (49%), while the least common was the thigh (3%). Tibial periostitis (47%) and muscle strain (3%) were the most and least reported types of injury, respectively. Conclusion: These results may help professionals develop preventive injury strategies with adequate exercise and periodization to preserve long-time street runners' health.
You have requested "on-the-fly" machine translation of selected content from our databases. This functionality is provided solely for your convenience and is in no way intended to replace human translation. Show full disclaimer
Neither ProQuest nor its licensors make any representations or warranties with respect to the translations. The translations are automatically generated "AS IS" and "AS AVAILABLE" and are not retained in our systems. PROQUEST AND ITS LICENSORS SPECIFICALLY DISCLAIM ANY AND ALL EXPRESS OR IMPLIED WARRANTIES, INCLUDING WITHOUT LIMITATION, ANY WARRANTIES FOR AVAILABILITY, ACCURACY, TIMELINESS, COMPLETENESS, NON-INFRINGMENT, MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. Your use of the translations is subject to all use restrictions contained in your Electronic Products License Agreement and by using the translation functionality you agree to forgo any and all claims against ProQuest or its licensors for your use of the translation functionality and any output derived there from. Hide full disclaimer
Details
1 Federal University of Technology - Parana, Post-Graduate Program in Physical Education, Research Group on Environment, Physical Activity and Health, PR, BRAZIL
2 Federal University of Technology - Parana, Academic Department of Physical Education, PR, BRAZIL