A Gender-Targeted Approach Running Injury Prevention

Transcription

1 Are we comparing apples with apples? A Gender-Targeted Approach Running Injury Prevention Maha Elashi B.Kin Michael Ryan PhD, C Ped (C) Jack Taunton MD Michael Koehl MD, PhD

2 June 23, 1972 Equal Opportunity in Education Act Title IX No person in the United States shall, on the basis of sex, be excluded from par9cipa9on in, be denied the benefits of, or be subjected to discrimina9on under any educa9on program or ac9vity receiving Federal financial assistance Senator Birch Bayh

3 Women in NCAA

4 Women in NCAA

5 Women in Olympics 5.6% athletes in Amsterdam were women (1928) 44% athletes in London were women (2012)

6 Women in Road Running Women are the majority! - 61% participants of Sun Run participants - 75% registrants to Sun Run In Training Clinics

7 Are females at greater risk?

8 Gender Differences In context to running: Neuromotor Physiologic Psycho-social Anatomic Biomechanical

9 Skeletal Differences Women are/have: Shorter Weigh less Shorter limbs Smaller articular surfaces Wider pelvic bones Narrower shoulders Greater femoral head anteversion Greater knee valgus Greater Q-angle

10 Neuromotor Differences Context of ACL literature Altered proprioception, reaction time Postural stability Muscle Activation Patterns

11 Gender Biased Etiology Gluteal Insufficiency Greater hip adduction moment coupled with weak hip abductors associated with ITBFS, gluteal pain, SI injuries in women. Prins et al. 2009, Taunton et al 2002, Ferber et al. 2003

12 Gender Biased Etiology Greater Q-Angle Increased Q-angle associated with PFPS in female runners > 20 at 1.7x greater risk Ruah et al. 2007

13 Compounding effects Greater internal hip abduction moment Greater hip adduction Wider Pelvis Greater external hip adduction moment Greater knee valgus Greater Q-Angle Greater shank internal rotation Greater foot pronation Greater internal ankle inversion moment Greater soft tissue compliance

14 Running Injury Epidemiology Women at risk? High school female track/ cross-country runners have 53% more injuries Rauh et al. 2000

15 Running Injury Epidemiology Women protected? Female recreational runners were ~50% less likely to get injured Buist et al. 2009

16 Running Injury Epidemiology Gender irrelevant? Difference in only 1% across gender in 583 habitual runners Macera et al. 1989

17 Injury Likelihood by Gender Females PFPS ITBFS Males Tendinopathy (Achilles, Patella, Plantar fascia) Gluteal injuries Meniscal injuries SI injuries Gastrocnemius injuries Stress fractures Adductor injuries Knee OA

18 Significant factors associated with overall injury rate (Relative risk (95% CI) Risk Factor Men Women Age: > 50yrs (1.1 to 3.3) BMI (kg/m 2 ) : > (0.2 to 0.8) Running 1day/wk (1.1 to 12.3) Running shoe age: 4-6mo 0.4 (0.2 to 0.8) 1.7 (1.0 to 3.0)

19 Literature Limitations Here s what s lacking in our knowledge: Prospective injury surveillance integrated with independent assessment of outcome measures diagnosis strength measures dynamic balance measures motion analysis measures regional pain perception

20 Research Questions 1. Is gender a true factor in injury risk in runners? 2. What are gender-based factors for injury risk in runners? 3. Would a gender-targeted approach to run injury prevention be effective?

21 Nike Gender Run Injury Project Phase I Investigate whether female runners are at greater risk of injury

22 Phase I - Methods Cohort design 154 runners (68 male, 86 female) Baseline testing included: training history, injury history, anthropometry, LLD & foot posture, leg & hip muscle strength muscle contractures/functional movements Thomas & Kendall Obers Hamstring dynamic balance Standard 12-week running program Outcome measures: Running related injury (RRI) Pain (Overall, region-specific)

23 Phase I - Results Training Sessions Men: 1912 Women: 2526 Injuries: 9 female ; 7 male Injuries/1000 training sessions: 3.56 female ; 3.66 male Relative risk of injury for women 1.02 [95% C.I ]

24 Nike Gender Run Injury Project Phase II Determine if gender-specific risk factors for injury

25 Multivariate Regression Outcomes Model can account for: Can explain ~50% of variation in knee, shin and calf pain in female runners Can explain 25% of variation in overall pain in male runners

26 Multivariate Regression Outcomes Female Risk Factors: 1. Hx severe running/msk injury (prevent running) (8) 2. LLD (5) 3. Dynamic balance recovery (5) 4. Q-angle (4) 5. Hip extension:flexion imbalance (3) Protective factors Run experience Tight hamstrings

27 Multivariate Regression Outcomes Male Risk Factors: 1. Tight IT band 2.?? Protective factors Foot/ankle mobility Run experience MSK Injury history

28 BIG DATA and injury prevention RCT design Sample size ~ 200 runners Intervention approach VS generic stretching & hip strengthening approach Intervention group: All females screened for LLD - physiotherapy, lifts, Prior history of injury - confirm 100% rehabilitated or advised for further treatments, Q-angle - > 20deg indicates use of motion controlling insole/footwear All females receive: Sagittal plane hip muscle activation/strengthen exercises Balance and lower-extremity coordination exercises All males receive: Foot/ankle mobilization exercises - stretching, mobilization, deep tissue work

29 Nike Gender Run Injury Project Thank you