The effects of a typical training run on overuse running-related injury risk factors in recreational runners

Riazati, Sherveen (2020) The effects of a typical training run on overuse running-related injury risk factors in recreational runners. Doctoral thesis, Northumbria University.

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Abstract

Running has increased in popularity over recent decades to become one of the five most popular recreational activities worldwide. With this rise in popularity, there has however been a concomitant increase in rate of running related overuse injuries with epidemiology studies reporting 7.7 injuries every 1000 hours of running. Patellofemoral pain and iliotibial band syndrome are the most common RROI accounting up to 17% and 8%, respectively. Runners experiencing either injury share common gait signatures of excessive hip adduction. Running induced fatigue has been shown to reduce strength in numerous muscle groups important for initiating and regulating gait, notably increased hip adduction. These fatigue induced changes to gait have been examined during prolonged or continuous runs, often to exhaustion. Runners however do not typically perform runs to exhaustion during their regular training, rather they perform high intensity interval training or medium intensity continuous running. The level of fatigue induced by these typical training sessions, or its impact on gait is unknown. The aim of this thesis was to examine the effect of fatigue on risk factors associated with development of running related injuries during typical training runs. Acceptable to excellent relative and absolute reliability for risk factors were reported. The absolute reliability enabled an alternative statistical approach to be alongside traditional, group level, P values. This alternative statistical approach used minimum detectable change to detect ‘real changes’ in risk factors post-run. Following two typical running sessions, fatigue induced a changes in running related overuse injury risk factors were found. There was a significant (P < 0.05) reduction in muscle strength (12%) following high intensity interval training session and medium intensity continuous run (10.6%) in both the hip and knee musculature. Force reduction was accompanied by increased maximum hip adduction angle and range of motion (P < 0.05). Fatigue increased coordination variability significantly (P < 0.05) in nearly all variables for hip and knee couplings. Individual assessment showed that the high intensity interval training run induced gait changes in more runners, a finding not observable in group assessment. The fatigue induced changes following training runs could potentially increase the risk of RROI development. This risk however, can only be considered detrimental if still present immediately prior to the next training session. Recovery of strength, kinematic and coordination variability at 24-h following a high intensity interval run was then examined. To fully assess recovery kinetics, evoked electrical stimulation was used to examine the extent of central (voluntary activation) and peripheral (knee extension maximum voluntary contractions and quadriceps twitch potentiation) fatigue immediately post and 24-h after high intensity interval training session. The results not only corroborated those in the previous findings of the thesis, but showed decrements in both central and peripheral drive. Collectively, immediately post, runners exhibited a reduction in hip musculature strength (8.1%),voluntary activation (6.8%), both remaining significantly (P < 0.05) impaired at 24-h. The changes were also accompanied by increased maximum angle and RoM for hip adduction immediately post training run and at 24-hr post. Coordination variability was again increased with fatigue and remained increased at 24-h in those who remained fatigued. The most noteworthy finding was that while collectively there were signs of lack of recovery, on an individual level most runners had recovered within 24-h, while only a few did not and still exhibit impaired gait. Only four runners were identified to be at risk of injury development following fatigue induced changes to risk factors and impaired neuromuscular function following a typical training run. This thesis demonstrated that fatigue induced during a typical training session causes changes to gait. For a minority of runners these changes are still evident 24-h after training placing them at an increased risk of running related overuse injury development.

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