Defining types and risk factors of overuse injuries of the foot, ankle, leg and knee in distance runners : a scoping review

Abstract

OBJECTIVES: The objectives of this research were to identify literature involving overuse running injuries and consolidate the diverse material available. Currently it is a broad and extensive field of information crossing multiple modalities providing little amalgamation of its knowledge for clinical practitioners that must treat such injuries. In addition, the risk factors (RF) behind those injuries were identified and thematically categorised to help in the development of strategies for the prevention or treatment of future overuse injuries.

METHODS: Arksey and O’Malleys1 scoping review design was used as a conceptual framework alongside the PRISMA-ScR extension, recommended by the EQUATOR network.

RESULTS: Incidence rates varied but the most common overuse running injuries identified through the literature were; patellofemoral pain syndrome, Iliotibial friction syndrome, patellar tendinopathy, chronic compartment syndrome, medial tibial stress syndrome, Achilles tendinopathy/paratenonitis, metatarsalgia, plantar fasciitis and bone stress injuries/stress fractures. The RF associated with these injuries were categorised into one of six overall classifications; Demographic, anatomical, physiological, training errors, training surface and footwear. Within those categories, were further subcategories identified as primary avenues of risk in the development of overuse running injuries.

CONCLUSION: Three themes were developed from the analysis: (1) training errors are frequently cited as being responsible for overuse injuries and could be considered as the root cause behind all overuse injuries. The human body is made to adapt to introduced stressors and can, if given appropriate time and training, build resilience to the repetitive and potentially traumatic forces that running introduces; (2) many of the causes of overuse injuries are interconnected but can also be diametrically opposed, one risk factor that puts a runner at risk of a particular injury may serve as a protective factor for a different injury; (3) there is a potential risk of inappropriate advice from a clinical practitioner that does not understand the interconnected nature of these RF, identified in (2). The anatomical, structural, kinematic, pharmacological, nutritional and training factors that need to be considered when seeking the best outcome for a patient unlikely fall within a single practitioner’s field of expertise and highlights the advantages of greater interprofessional collaboration.