Paper title: Should We Trust Perceived Effort for Loading Control and Resistance Exercise Prescription After ACL Reconstruction? Publication: Sports Health Publication date: September, 2021 INTRODUCTION Quadriceps weakness is a barrier to anterior cruciate ligament reconstruction (ACLR) rehabilitation. In addition, neural inhibition causes arthrogenic muscle inhibition (AMI). The management of AMI includes strength and proprioception exercises.... MORE
Can a website prevent running-related injuries?
Running remains a popular pastime and sport for amateur competitors and those who simply want to stay fit. Upwards of 85% of the population that participates in running report a running-related injury (RRI)(1). Some of the risk factors associated with RRIs include overweight, training error, and faulty equipment (worn shoes). However, the primary risk factor for an RRI is a previous RRI(1). Therefore, it makes sense to try to prevent as many injuries as possible and thus reduce the incidence of repeated injury.
Some sports programs have success with injury prevention through active warm-ups and strengthening. For those on the links, Pat Gillham highlights what the modern golfer should do to stay fit and injury free. Andrew Hamilton recently explored how best to avoid winter sports injuries. However, running lacks a tried and true approach to keep participants healthy.
Researchers have attempted to establish an injury prevention program for runners with limited success. Historically, these programs only addressed one aspect of running, such as strength or flexibility. Investigators in the Netherlands, however, decided to test whether a multifactorial online injury prevention program would impact the number of RRIs suffered by recreational runners. They randomly assigned volunteers registered for major races in the Netherlands to either a control group or an experimental group.
The intervention group (n=1196) answered a pre-participation questionnaire before gaining access to a multifactorial injury prevention program via a password-restricted website. The website offered information applicable to both new and experienced runners in the areas of personal factors and intrinsic characteristics, training, biomechanics, and equipment. Each runner was free to access the information independently and apply it where they saw fit. The study did not track the login time or pages visited by each participant.
The control group subjects (n=1182) also completed a pre-participation questionnaire. They were informed that they were assigned to the control group and asked to proceed with their event training as usual. Both groups received a follow-up questionnaire two weeks prior to their scheduled event, the day after their event, and one month following the event. The follow-up questionnaires asked the participants about pre-existing RRIs, new RRIs, and their utilization of the injury prevention program.
Participants completed 60% of all follow-up questionnaires. A little over half (62.7%) of the intervention participants reported reading the information on the injury prevention website, while only 38.8% of those read the material presented on all four topics. Not quite half (44.1%) of the subjects said they applied the content read to their training. However, despite access to high-quality prevention information, the self-reported incidence of injury was just as high in the intervention group (36.7%) as in the control group (37.1%). When confounding variables were accounted for, such as gender, event distance, running experience, or previous RRI, the incidence remained nearly identical between the groups.
This study enrolled a large population and effectively randomized the subjects to a control and intervention group. Its limitations included the fact that all RRIs, both previous and those occurring during the intervention period, were self-reported. Furthermore, the time spent with the prevention website was self-reported and not actually tracked. Another limitation is the fact that just over 25% of the total follow-up questionnaires weren’t completed.
What’s to be learned
With the high incidence of RRIs, runners typically gravitate toward any gadget or training fad that will keep them in the race. However, when presented with free quality information, just under half of the large intervention population didn’t even access it. Of those that did, again, just under half applied what they learned to their training.
As the authors acknowledge, running injuries cover a wide gamut of issues. Attempting to cover the breadth of all possible contributing factors would take a very comprehensive program. The authors attempted to do this in their multifactorial website, however, without guidance and accountability, few runners integrated the information. Without better compliance, the authors were unable to determine if the injury prevention program really did prevent injuries.
What does this tell us about the needs of this population? Firstly, runners suffer from RRIs at nearly the same rate as controls if only passively consuming information. Consider this the next time you send an athlete home with an exercise program and no follow-up. Secondly, most runners are solo athletes. Therefore, in order to integrate this information, runners may need a group or coaching program to personalize instruction and provide accountability. Thirdly, considering the number of recreational and competitive runners, and the high rates of RRIs, there is room for clinical research and innovative programs to address injury prevention and provide athletes with longevity in their sport and cost savings to the community.
Clinicians, consider this your starting gun!