How (not) to interpret a non-causal association in sports injury science

Hjerrild, Mette; Videbaek, Solvej; Theisen, Daniel; Malisoux, Laurent; Nielsen, Rasmus Oestergaard

doi:10.1016/j.ptsp.2018.05.009

Cited by 6 publications

(2 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Finally, running injuries are not only caused by biomechanical factors, but also by an interaction of multiple modifiable and non-modifiable factors [18,[97][98][99][100]. For example, running exposure (workload) is an essential factor involved in injury development [18,101,102], but the interaction with biomechanical risk factors has not yet been investigated in prospective studies. It could be hypothesized that biomechanical risk factors might decrease the ability to tolerate an increase in workload before an injury occurs [21,102,103].…”

Section: Discussionmentioning

confidence: 99%

Biomechanical Risk Factors Associated with Running-Related Injuries: A Systematic Review

et al. 2019

View full text Add to dashboard Cite

Background Running is a popular form of physical activity with many health benefits. However, the incidence and prevalence of running-related injuries (RRIs) is high. Biomechanical factors may be related to the development of RRIs. Objective This systematic review synthesizes biomechanical risk factors related to the development of RRIs in non-injured runners. Methods PubMed, Web of Science, CINAHL, Embase, and SPORTDiscus were searched in July 2018 for original peerreviewed prospective studies evaluating potential biomechanical factors associated with the development of RRIs. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Two reviewers independently assessed articles for inclusion and methodological quality. Due to methodological heterogeneity across studies, a narrative synthesis of findings was conducted, rather than a meta-analysis. Results Sixteen studies, including 13 of high quality and three of moderate quality, were included. A large number of biomechanical variables were evaluated, producing inconsistent evidence overall. Limited evidence indicated greater peak hip adduction in female runners developing patellofemoral pain and iliotibial band syndrome, but not for a mixed-sex population of crosscountry runners sustaining an RRI. The relationship between vertical loading rate and RRIs was inconsistent. Other kinematic, kinetic and spatiotemporal factors were only studied to a limited extent. Conclusions Current prospective evidence relating biomechanical variables to RRI risk is sparse and inconsistent, with findings largely dependent on the population and injuries being studied. Future research is needed to confirm these biomechanical risk factors and determine whether modification of these variables may assist in running injury prevention and management. Key Points Despite the common belief that biomechanical factors greatly influence running-related injury (RRI) risk, only a limited body of high-quality research, with significant heterogeneity in study populations, methodologies and outcome variables, was identified. Current prospective evidence relating biomechanical variables with the risk to sustain an RRI is inconsistent and largely dependent on the population and injuries being studied. A number of single-study findings related to kinematics, kinetics and spatiotemporal variables require confirmation via further high-quality prospective studies before clinical recommendations can be made.

show abstract

Section: Discussionmentioning

confidence: 99%

Biomechanical Risk Factors Associated with Running-Related Injuries: A Systematic Review

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Recent literature has highlighted the importance of correct interpretation of non-causal relationships between biomechanical and musculoskeletal characteristics and RRI [ 65 ]. It has been suggested that atypical biomechanical function alone does not cause RRI but may interact with training characteristics as an effect measure modifier to contribute to the risk of RRI [ 66 ].…”

Section: Directions For Future Researchmentioning

confidence: 99%

Biomechanical and Musculoskeletal Measurements as Risk Factors for Running-Related Injury in Non-elite Runners: A Systematic Review and Meta-analysis of Prospective Studies

et al. 2022

View full text Add to dashboard Cite

Background Running-related injury (RRI) is highly prevalent among recreational runners and is a key barrier to participation. Atypical lower limb alignment and mechanical function have been proposed to play a role in development of lower extremity injury. The purpose of this study was to investigate relationships between incidence of running-related injury (RRI) in non-elite runners with biomechanical and musculoskeletal variables. Methods A systematic review and meta-analysis of prospective studies. Published research indexed in MEDLINE, EMBASE, CINAHL, SPORTDiscus, AMED, and The Cochrane library until 13th January 2021, grey literature, and reference lists of included studies were screened to identify prospective studies of non-elite adult runners that measured a relationship between biomechanical or musculoskeletal measures and incidence of RRI. Results Thirty studies (3404 runners), testing over 100 discrete biomechanical and musculoskeletal risk factors for RRI, were included. Nineteen studies were pooled in twenty-five separate meta-analyses. Meta-analysis of four studies detected significantly less knee extension strength among runners who developed a RRI (SMD − 0.19, 95% CI − 0.36 to − 0.02, p = 0.03), though this may not be clinically important. A meta-analysis of two studies detected significantly lower hip adduction velocity among runners who developed a RRI (MD − 12.80, 95% CI − 25.22 to − 0.38, p = 0.04). Remaining meta-analyses found no significant relationship between biomechanical or musculoskeletal variables and RRI. Conclusion This systematic review and meta-analysis found the currently available literature does not generally support biomechanical or musculoskeletal measures as risk factors for RRI in non-elite runners. While meta-analysis findings for knee extension strength and hip adduction velocity as risk factors for RRI were statistically significant, the associated trivial to small effects sizes suggest these findings should be treated with caution. Until further evidence emerges, recommendations for injury prevention in non-elite runners cannot be made based on biomechanical and musculoskeletal measurements alone.

show abstract

The “impacts cause injury” hypothesis: Running in circles or making new strides?

Gruber

2023

Journal of Biomechanics

View full text Add to dashboard Cite

How (not) to interpret a non-causal association in sports injury science

Cited by 6 publications

References 32 publications

Biomechanical Risk Factors Associated with Running-Related Injuries: A Systematic Review

Biomechanical Risk Factors Associated with Running-Related Injuries: A Systematic Review

Biomechanical and Musculoskeletal Measurements as Risk Factors for Running-Related Injury in Non-elite Runners: A Systematic Review and Meta-analysis of Prospective Studies

The “impacts cause injury” hypothesis: Running in circles or making new strides?

Contact Info

Product

Resources

About