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Janie L. Kelly and Alison R. Valier

Clinical Scenario Overuse injuries are common in physically active populations. A recent report regarding college athletes concluded that overuse injuries occur at a rate of 5.36 per 10,000 athlete-exposures. 1 Reports on military 2 and running 3 populations have suggested that overuse injuries

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Nathaniel S. Nye, Drew S. Kafer, Cara Olsen, David H. Carnahan and Paul F. Crawford

Lower extremity overuse injuries (LEOIs) are common in outpatient clinics 1 , 2 and are observed in both younger and older patients and in both the elite athlete 3 as well as the sedentary 4 individual. These injuries are particularly troublesome for the military, as they impair the ability to

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Daniel Martínez-Silván, Jaime Díaz-Ocejo and Andrew Murray

Purpose:

To analyze the influence of training exposure and the utility of self-report questionnaires on predicting overuse injuries in adolescent endurance athletes.

Methods:

Five adolescent male endurance athletes (15.7 ± 1.4 y) from a full-time sports academy answered 2 questionnaires (Recovery Cue; RC-q and Oslo Sports Trauma Research questionnaire; OSTRC-q) on a weekly basis for 1 season (37 wk) to detect signs of overtraining and underrecovery (RC-q) and early symptoms of lower-limb injuries (OSTRC-q). All overuse injuries were retrospectively analyzed to detect which variations in the questionnaires in the weeks preceding injury were best associated. Overuse incidence rates were calculated based on training exposure.

Results:

Lower-limb overuse injuries accounted for 73% of total injuries. The incidence rate for overuse training-related injuries was 10 injuries/1000 h. Strong correlations were observed between individual running exposure and overuse injury incidence (r 2 = .66), number of overuse injuries (r 2 = .69), and days lost (r 2 = .66). A change of 20% or more in the RC-q score in the preceding week was associated with 67% of the lower-limb overuse injuries. Musculoskeletal symptoms were only detected in advance by the OSTRC-q in 27% of the episodes.

Conclusion:

Training exposure (especially running exposure) was shown to be related to overuse injuries, suggesting that monitoring training load is a key factor for injury prevention. Worsening scores in the RC-q (but not the OSTRC) may be an indicator of overuse injury in adolescent endurance runners when used longitudinally.

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Matthew P. Callahan, Craig R. Denegar and Craig A. Segree

Orthotics are commonly prescribed for the treatment of lower extremity injuries secondary to hyperpronation. However, the efficacy of vacuum-molded orthotics has not been established. We assessed the effects of vacuum-molded orthotics on pain and level of function in athletes suffering from plantar fasciitis, medial tibial stress syndrome, or knee pain secondary to hyperpronation. Fourteen athletes assessed their pain and level of function during athletic activity before being fitted for orthotics (Professional Rx, SuperFeet In-Shoe Systems Inc.) and weekly for 7 weeks following break-in. Five athletes (36%) reported complete pain resolution and eight (57%) reported substantial improvement. Eight athletes (57%) reported full return to athletic participation and five (36%) reported substantial improvement in athletic function. One athlete failed to respond to treatment. Results indicate that vacuum-molded orthotics are an effective treatment for lower extremity overuse injuries secondary to hyperpronation.

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Tiffany Switlick, Thomas W. Kernozek and Stacey Meardon

Context:

A relationship between altered postural control and injury has been reported in sports. Sensorimotor function serves a fundamental role in postural control and is not often studied in runners. Persons who sustain running injury may have altered sensorimotor function contributing to risk of injury or reinjury.

Objectives:

To determine if differences in knee and ankle proprioception or plantar sensation exist between injured and noninjured runners.

Design:

Retrospective case-control study.

Setting:

University campus.

Participants:

Twenty runners with a history of lower-extremity overuse injury and 20 noninjured runners were examined. Injured runners were subcategorized into 2 groups based on site of injury: foot/ankle and knee/hip.

Main Outcome Measures:

Active absolute joint-repositioning error of the ankle at 20° inversion and 10° eversion and the knee at 15° and 40° flexion was assessed using an isokinetic dynamometer. Vibratory threshold at the calcaneus, arch, and great toe was determined for each subject using a handheld electric sensory threshold instrument.

Results:

Runners in the injured-foot/ankle group had increased absolute error during ankle-eversion repositioning (6.55° ± 3.58°) compared with those in the noninjured (4.04° ± 1.78°, P = .01) and the hip/knee (3.63° ± 2.2°, P = .01) groups. Runners in the injured group, as a whole, had greater sensitivity in the arch of the plantar surface (2.94 ± 0.52 V) than noninjured runners (2.38 ± 0.53 V, P = .02).

Conclusions:

Differences in ankle-eversion proprioception between runners with a history of ankle and foot injuries and noninjured runners were observed. Runners with a history of injury also displayed an increased vibratory threshold in the arch region compared with noninjured runners. Poor ankle-joint-position sense and increased plantar sensitivity suggest altered sensorimotor function after injury. These factors may influence underlying postural control and contribute to altered loading responses commonly observed in injured runners.

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John P. Difiori

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Sae Yong Lee and Jay Hertel

Context:

Altered foot dynamics due to malalignment of the foot may change plantar-pressure properties, resulting in various kinds of overuse injuries.

Objective:

To assess the effect of foot characteristics on plantar-pressure-related measures such as maximum pressure, maximum pressure–time, and pressure–time integral underneath the medial aspect of the foot during running.

Design:

Cross-sectional.

Setting:

Laboratory. Participants: 8 men and 17 women.

Main Outcome Measures:

Static non-weight-bearing rear-foot and forefoot alignment and navicular drop were measured. Plantar-pressure data were collected while subjects jogged at 2.6 m/s on a treadmill. Maximum pressure, time to maximum pressure, and pressure–time integral of the medial side of the foot were extracted for data analysis. Multiple-regression analysis was used to examine the effect of arch height and rear-foot and forefoot alignment on maximum pressure and pressure–time integral in the medial side of the foot.

Results:

In the medial rear-foot and midfoot regions, only rear-foot alignment had a significant effect on the variance of maximum pressure and pressure–time integral. There were no significant difference effects in the medial forefoot region.

Conclusion:

Rear-foot alignment was found to be a significant predictor of maximum plantar pressure and pressure–time integral in the medial rear-foot and midfoot regions. This indicates that control of rear-foot alignment may help decrease plantar pressure on the medial region of the foot, which may potentially prevent injuries associated with excessive rear-foot eversion.

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Eric Foch and Clare E. Milner

The accessibility of running makes it a common exercise choice for individuals looking to improve their overall health. However, the likelihood that a runner will develop an overuse injury is high. Prospective studies indicate that 47% to 52% of recreational runners sustained an overuse injury that

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David G. Behm

youngest specialization age were gymnastics [8.9 (1.7)], dance [10.8 (3.0)], and soccer [10.9 (2.4)]. Single-sport specialized athletes in individual sports accounted for a higher proportion of overuse injuries (44.3% vs 32.2%, OR = 1.67, P  = .037) and serious overuse injuries (23.4% vs 11.6%, OR = 2

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Daniel E. Lidstone, Justin A. Stewart, Reed Gurchiek, Alan R. Needle, Herman van Werkhoven and Jeffrey M. McBride

Heavy load carriage has been identified as a main contributing factor to the high incidence of overuse injuries in soldiers 1 , 2 and significant increases in peak or maximal vertical ground reaction force (VGRF MAX ) and maximal vertical loading rate (VLR MAX ). 3 , 4 Furthermore, previous