Youth Distance Running and Lower Extremity Injury: A Systematic Review
Abstract
:1. Introduction
2. Methods
2.1. Data Sources and Searches
2.2. Subjects
2.3. Operational Definitions
2.4. Study Selection
2.5. Data Extraction
2.6. Quality Assessment
3. Results
3.1. Study Selection
3.2. Study Characteristics
3.2.1. Cohort Studies
3.2.2. Case Reports and Case Series
3.3. Risk of Bias
4. Discussion
4.1. Type of Injury
4.2. Runner’s Gender and Injury
4.3. Comparison to High School and Adult Runners
4.4. Growth and Development
4.5. Current Recommendations
4.6. Limitations
4.7. Implications
5. Conclusions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
References
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Author, Year, Design | Population (Sample Size, Age) | Running Exposure | Outcome | Downs and Black Risk of Bias |
---|---|---|---|---|
Cohort Studies | ||||
Goldman et al., 2020 Observational Prospective Cohort Study | 720 MS participants (7th and 8th graders) in SRLA marathon training program | 28-week marathon training program 3 weekday training runs 1 long weekend run Began with 2-mile runs and increased to a maximum 20-mile run prior to marathon Week 5: 5K Week 14: half-marathon Week 9 and 17–20: school holiday closures Mean distance per week: 9.87–22.82 m | Injury sites across all runners Knee (33%) Lower leg (19%) Foot (14%) Ankle (13%) Thigh (6%) Hip (6%) 102 reported MS injuries HS runners more likely to report an injury than MS runners (p < 0.001) 20.8% of HS runners reported injuries versus 14.2% of MS runners (p < 0.001) MS runners who sustained an injury ran significantly greater distance on average per week than non-injured MS runners (14.1 mi vs. 11.5 mi, p < 0.001) | 15 |
Reid et al., 2012 Retrospective Epidemiological Study | National Estimates *: Age 10–12: 25,243 injuries (95% CI: 20,125–30,362) Age 13–14: 53,504 injuries (95% CI: 43,286–63,722) | Cross country events | 10–12 year-olds: Estimated 1234 (4.9%) injuries 13–14 year-olds: Estimated 4964 (9.3%) injuries Most frequently injured body part across all runners: Lower extremities (58.2%) Upper extremities (19.0%) Trunk (13.8%) | 17 |
Author, Year | Population | Running Exposure | Symptoms | Outcome |
---|---|---|---|---|
Case Reports | ||||
Clancy et al., 1976 | 1 out of the 13 cases reported was a 14-year-old male cross-country runner | Cross country running | One-month history of gradual onset of pain around right anterior iliac crest Experienced pain when running and coughing or sneezing | Fracture separation of the anterior portion of right anterior iliac apophysis Localized tenderness over right anterior iliac crest. This pain was reproduced with resisted abduction of affected hip. Complete relief of symptoms and full return to running after four weeks of rest |
Daffner et al., 1982 | 1 of the 4 cases reported was an 11-year-old male runner | Running 2–3 m per day | One-month history of pain and localized swelling in the proximal right tibia Pain with direct pressure to proximal tibia, running and walking | Right tibial stress fracture Mild swelling over proximal medial tibia 8 cm distal to joint line and radiograph confirmed circumferential area of periosteal new bone, thickened posteriorly Discharged on minimal activity and improved rapidly |
Dull, 2000 | 14-year-old female competitive cross-country athlete | Running 20 to 30 miles per week including up and down hill running exercises | Bilateral hip pain localized to ASIS, anterior thigh and low back. Pain was greater on the left. Hill running seemed to exacerbate her pain more than any other activity. Initially tried conservative treatment and returned to a moderate running regimen, five days later pain intensified with sharp grabbing sensations in the anterior thigh and pelvis | Bilateral avulsion fractures of the pelvis apophyses Apophyseal separation fracture of the left anterior superior iliac crest Seven months after returning to activity following left apophyseal separation fracture, experienced avulsion fracture to right anterior superior iliac crest Training was ceased for a short period of time, and she returned to a successful running regimen within 12 weeks |
Gamble, 1986 | 13-year-old female competitive athlete | Running, placed first in her age bracket in a 10 km race prior to onset of symptoms | Two-month history of increasing pain and swelling of right knee One-month prior to presentation experienced sensation of the knee giving way while trying to accelerate while running Tender to palpation of patella and discomfort with patellar compression and maximal quadriceps contraction | Symptomatic dorsal defect of the right patella Excisional biopsy was performed. Four months after surgery, she had full range of motion and no symptoms. |
Nishio et al., 2012 | 14-year-old male member of track athletics club | Running more than 10 km daily | One-month history of progressively worsening pain in medial aspect of the left thigh Pain was initially experienced only after running but progressed to also occur with weightbearing activities | Adductor insertion avulsion syndrome CT: presence of periosteal reaction and intracortical linear hypoattenuation and showed no fracture line MRI: periosteal, cortical, and intramedullary signal intensity abnormalities Treated with initial avoidance of weight bearing using crutches for ambulation, followed by progressive weight bearing for two weeks. Symptoms resolved completely seven weeks after initial evaluation and he had normal gait without pain. At three months returned to gradual running program. |
Ross et al., 2008 | 14-year-old male cross-country runner | Cross country training, began training 2 months prior to presentation | Three to four weeks into training developed pain in left distal thigh. Soon after also began to experience right thigh pain. | Bilateral supracondylar stress fracture Decreased activity to pain-free levels with acetaminophen for pain. At one-month follow-up he was pain free and allowed to gradually return to running. |
Sakamoto et al., 2008 | 12-year-old male member of a track athletics club | Running more than 5 km a day | Seven-week history of discomfort in distal left thigh when running Symptoms were gradually worsening, with discomfort increasing to pain four weeks prior to presentation Tenderness over distal thigh and increased pain with weightbearing | Pathological insufficiency fracture associated with nonossifying fibroma in the distal femur CT: showed radiolucent cortical lesion seen on plain radiographs as a well-defined area of decreased density in the cortex, consistent with a diagnosis of NOF, with periosteal new bone Initial avoidance of weightbearing using two crutches for ambulation, followed by progressive weightbearing over five weeks. Three months after onset, he had normal gait without pain and returned to running. |
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Paz, T.; Meyers, R.N.; Faverio, C.N.; Wang, Y.; Vosburg, E.M.; Clewley, D.J. Youth Distance Running and Lower Extremity Injury: A Systematic Review. Int. J. Environ. Res. Public Health 2021, 18, 7542. https://doi.org/10.3390/ijerph18147542
Paz T, Meyers RN, Faverio CN, Wang Y, Vosburg EM, Clewley DJ. Youth Distance Running and Lower Extremity Injury: A Systematic Review. International Journal of Environmental Research and Public Health. 2021; 18(14):7542. https://doi.org/10.3390/ijerph18147542
Chicago/Turabian StylePaz, Tatiana, Rachel N. Meyers, Cayla N. Faverio, Yuxuan Wang, Emily M. Vosburg, and Derek J. Clewley. 2021. "Youth Distance Running and Lower Extremity Injury: A Systematic Review" International Journal of Environmental Research and Public Health 18, no. 14: 7542. https://doi.org/10.3390/ijerph18147542