Injury prevalence and associated factors in runners from the city of Juiz de Fora (MG)

ABSTRACT

In Brazil, running is the second most practiced sport, and it can cause musculoskeletal injuries. Studies on the subject are important to guide prevention and intervention strategies. Therefore, the objective of the study was to investigate the prevalence of injuries and associated factors in road runners in the city of Juiz de Fora-MG-Brazil. This is an observational cross-sectional study. A convenience sampling was adopted. This study included amateur runners of both sexes, aged between 18 and 60, training in the city of Juiz de Fora-MG. Participants with history of fracture and osteosynthesis in lower limbs or who performed sports practices other than weight training were excluded. Student’s t-tests, Mann-Whitney and X² (α = 0,05) were used to analyze the data. Participants were allocated in Injury Group (IG, n=37) and Without Injury Group (WIG, n=113). Injury prevalence was 24.7%. The IG had been practicing running for a longer time (76.2±9.1 X 36.7±39.0 months, p<.01); had their weekly training frequency increased (49.5% vs. 54.2%, P=.04); stretched less before training (48.6% X 75.2%, P=.02); presented a higher percentage of gait analysis for footwear selection (62.1% X 43.3%, P=.04) and insole use (35.1% X 14.1%, P=<.01). Injury prevalence was low and those who have been running longer than others had a higher risk of injury even without an increase in weekly frequency. Stretching was protective and the prescription of indiscriminate footwear and insole did not guarantee satisfactory results.

Keywords
Running/injuries; Prevalence

RESUMO

No Brasil, a corrida de rua é o segundo esporte mais praticado; entretanto, pode ocasionar lesões musculoesqueléticas. Estudos sobre o tema são importantes para nortear estratégias de prevenção e intervenção. Assim, o objetivo foi investigar a prevalência de lesões e os fatores associados em corredores de rua da cidade de Juiz de Fora(MG). Trata-se de um estudo observacional do tipo transversal. A amostra foi selecionada por conveniência. Foram incluídos corredores amadores, entre 18 e 60 anos e que realizavam treinos em diferentes locais da cidade. Foram excluídos participantes com histórico de fratura e osteossíntese em membros inferiores ou que praticassem outro esporte que não fosse a musculação. Para analisar os dados, foram utilizados os testes t de Student, Mann-Whitney e X² (α=0,05). Os participantes foram alocados em grupo lesão (GL, n=37) e grupo sem lesão (GSL, n=113). A prevalência de lesão foi de 24,7%. O GL praticava a corrida há mais tempo (76,2 ± 9,1 × 36,7 ± 39,0 meses; P<.01), teve menor aumento da frequência semanal do treinamento (49,5% × 54,2%; P=.04), realizou menos alongamento prévio (48,6% × 75,2%; P=.02), apresentou maior percentual de análise da marcha para escolha do calçado (62,1% × 43,3%; P=.04) e uso de palmilha (35,1% X 14,1%; P=<.01). A prevalência de lesões foi baixa. Os que correm há mais tempo têm maior risco de lesão mesmo sem incremento na frequência semanal. O alongamento foi protetor e a prescrição de calçado e palmilha indiscriminados não garantiram resultados satisfatórios.

Descritores
Corrida/lesões; Lesão; Prevalência

RESUMEN

En Brasil, la carrera callejera es el segundo deporte más practicado; mientras tanto, puede ocasionar lesiones musculo esqueléticas. Estudios sobre el tema son importantes para orientar estrategias de prevención e intervención. Así, el objetivo ha sido investigar la prevalencia de lesiones y los factores asociados en corredores callejeros de la ciudad de Juiz de Fora (MG). Se trata de un estudio observacional del tipo transversal. La muestra ha sido seleccionada por conveniencia. Han sido incluidos los corredores amadores, entre 18 y 60 años y que realizaban entrenos en distintos locales de la ciudad. Han sido excluidos los participantes con historial de fractura y osteosíntesis en miembros inferiores o que practicaran otro deporte que no fuera la musculación. Para analizar los datos, han sido utilizadas las pruebas t de Student, Mann-Whitney y X² (α=0,05). Los participantes han sido asignados en grupo lesión (GL, n=37) y grupo sin lesión (GSL, n=113). La prevalencia de lesión ha sido del 24,7%. El GL practicaba la carrera hacía más tiempo (76,2 ± 9,1 × 36,7 ± 39,0 meses; P<.01), ha tenido menor incremento de la frecuencia semanal del entrenamiento (el 49,5% × el 54,2%; P=.04), ha realizado menos tiramiento previo (el 48,6% × el 75,2%; P=.02), ha presentado mayor porcentual de análisis de la marcha para escoja del calzado (el 62,1% × el 43,3%; P=.04) y uso de plantilla (el 35,1% × el 14,1%; P=<.01). La prevalencia de lesiones ha sido baja. Los que corren hace más tiempo tienen mayor riesgo de contusión aunque sin incremento en la frecuencia semanal. El tiramiento ha sido protector y la prescripción de calzado y plantilla indiscriminados no ha garantizado resultados satisfactorios.

Palabras clave
Carrera/lesiones; Prevalencia

INTRODUCTION

Regular running practice improves cardiorespiratory fitness in inactive people, resulting in improved quality of life, reduction in the percentage of fat and in the concentration of blood elements^{1)- (3}. Its ease of execution and low cost⁴ helps making it the second most practiced sport in Brasil⁵. However, when practiced inappropriately or without guidance, it can cause lesions on the musculoskeletal system².

The increase in the number of sports injuries is closely related to intrinsic and extrinsic factors^{6), (7}. The intrinsic factors are age, gender, experience, aptitude and anatomical changes. The extrinsic factors are, directly or indirectly, related to the preparation or practice of running, involving the activity type, footwear, surface on which training occurs, etc⁸.

Musculoskeletal impairment can be a challenge to regular practice and work leave for extended periods, in addition to high costs⁹. A prospective cohort study with 1,696 participants investigated the economic burden of lesions in runners. With converted values, health care costs and absenteeism of work activities reached R$303.00^{10)- (12}. In Brazil, no data on the topic was found; therefore, it is not possible to infer that this value is approximate. Thus, the objective of this study was to investigate the prevalence of injuries and associated factors in road runners in the municipality of Juiz de Fora (MG).

METHODOLOGY

Study design and ethical aspects

This is an observational, cross-sectional study, approved by the Research Ethics Committee (CEP) from the Federal University of Juiz de Fora (UFJF) (registered No. 1.803.411/2016). All participants signed the Informed Consent Form (IFC).

Sample

Convenience sampling was performed. The sample size was calculated by using the formula n = Z*Z[P(1-P)]/(D*D), where:

Z = Value of the standard normal distribution corresponding to the desired level of confidence (Z=1.96 for 95% Confidence Interval), P = Prevalence Expected and D = Maximum Acceptable Error for Estimate¹³. The expected prevalence was of 15% (P=0.15), with 95% CI range of 12% (D=0.06), this way: n=1.96² (0.15 (1-0.15))/(0.06²) = 136 people.

Data collection was conducted at training sites and in competitions of the Ranking de Corridas de Rua (Road Running Ranking) of Juiz de Fora/MG. Amateur runners of both sexes were included, aged between 18 and 60 years and who were training in different places of the city, and were excluded participants with prior history of fracture and internal fracture fixation in lower limbs or who performed non-bodybuilding-based sports. For analysis of associated factors, the participants were allocated into Injury Group (IG) and Without Injury Group (WIG).

Procedures

Analysis of injury prevalence

To categorize the sample, information regarding age, gender, education level, height and body mass was collected. For analysis of injury prevalence, any pain or injury that has limited or prevented the athlete from participating in training and/or competitions in the last six months was considered⁸.

Analysis of associated factors

With respect to the associated factors, data was collected on the variables of training. Investigation was focused on whether there was an increase in weekly frequency, distance traveled and duration of daily practice, in addition to the practice time, distance and average daily duration, use of specific shoes for running, period shoes were used, if the period corresponded to kind of footstep and if there was more than a pair, plus the use of orthopedic insole, during the last six months. Stretching and warm-ups before practice, cooldown after practice, weight training and whether the participant had guidance for training were also aspects analyzed. If true, which professional(s) were involved and whether assessment regarding the identification of risk factors for injury while running was made.

Statistical analysis

The characterization of the sample was conducted by descriptive statistics. To evaluate the differences between groups, Student’s t-test, Mann-Whitney U and Chi-squared were used for independent groups. For inferential analyses, a significance level of 0.05% was considered. The data were analyzed using the software SPSS® version 15.0.

RESULTS

Figure 1 represents sample recruitment.

Figure 1
Flowchart depicting the sample selection

A total of 150 individuals participated in this study, the majority males (52%). Table 1 presents demographic and anthropometric characteristics of the sample. Injury prevalence was of 24.7% (n=37)

Table 1
Mann-Whitney U test used to verify demographic and anthropometric characteristics (n = 150)

	IG (n=37)	WIG (n=113)	P-value
Age (years)	34±11.1	35.8±9.9	0.52
Education level (years)	15.5±4.8	14.7±3.5	0.52
BMI (Kg/m ²)	23.8±3.9	23.7±3.4	0.49

• Caption: IG = Injury Group; WIG= Without Injury Group; BMI = Body Mass Index

Table 2 presents the differences between the characteristics of training of the IG and WIG.

Table 2
Mann-Whitney U test used to verify training characteristics (n = 150)

	IG (n=37)	WIG (n=113)	P-value
Practice time (months)	76.2±99.1	36.7±39.0	0.01*
Weekly frequency (days)	3.5±2.0	3.3±1.3	0.51
Training distance (km)	11.6±14.8	9.0±5.8	0.61
Training time	230.5±98.7	56.6±25.4	0.33

• Caption: IG = Injury Group; WIG = Without Injury Group; KM = Kilometers

Table 3 presents the factors associated with injuries.

Table 3
Chi-squared test to verify factors associated with injuries (n=150)

	IG (n=37)			WIG (n=113)		P-value
	Yes	No		Yes	No
Increase in training time	2054.1%	1745.9%		6961.1%	4438.9%	0.45
Increase in distance run	2156.8%	1643.2%		8171.7%	3228.3%	0.09
Increase in weekly frequency (days)	1549.5%	2250.5%		6754.2%	4645.8%	0.04*
Runs in the same location	1643.2%	2156.8%		3430%	7970%	0.09
Use of specific shoes	3697.3%	12.7%		10290.2%	119.8%	0.17
Footwear prescribed for footstep	2362.1%	1437.9%		4943.3%	6456.7%	0.04*
Uses more than one pair of shoes	2875.6%	924.4%		8272.5%	3127.5%	0.71
Prior stretching	1848.6%	1951.4%		8575.2%	2824.8%	0.02*
Prior warm-ups	2670.3%	1129.7%		9382.3%	2017.7%	0.11
Cooldown	2567.6%	1232.4%		7566.4%	3833.6%	0.89
Bodybuilding	2362.2%	1437.8%		7061.9%	4338.1%	0.98
Insole	1335.1%	2464.9%		1614.1%	9785.9%	<0.01*
Professional guidance	2464.8%	1335.2%		6254.8%	5145.2%	0.24
Physiotherapeutic Assessment	2464.8%	1335.2%		6759.3%	4640.7%	0.48

• Caption: IG = Injury Group; WIG = Without Injury Group; * = Significant Difference

DISCUSSION

The objective of this study was to investigate the prevalence of injuries and associated factors in road runners in the municipality of Juiz de Fora (MG). Injury prevalence was of 24.7% Among the associated factors, the IG had practiced running for a longer time; increased weekly training less (49.5% × 54.2%); had less prior stretching (48.6% X 75.2%); showed higher percentage of gait analysis for shoes choice (62.1% X 43.3%) and use of insoles (35.1% X 14.1%).

The sample was constituted by 150 volunteers, where most were of male sex. This higher percentage was observed in prior studies^{7), (14} and is related to social construction, since women present double work shift¹⁵.

Injury prevalence was 24.7% and the literature presents a variability between 24 and 65%¹⁶, explained by the distinct characteristics of the samples and by the definition of injury. Injury rates can be overestimated or underestimated by using a broad definition. It is therefore necessary that there be a standard term¹⁷.

With respect to the training characteristics, it was observed that the IG has been running for a longer time, which corroborates with the study by Rangel et al. ⁽¹⁸ stating a positive relationship between practice time and injury occurrence. There is evidence that running for a longer period is an important predictive factor of injury, as it is associated with overlapping repeated trauma^{2), (19}.

There is a directly proportional relationship between increase in weekly training and risk of musculoskeletal injury, due to a chronic state of fatigue caused by imbalance between regeneration time and the sports practice^{2), (19}. In this study, WIG participants increased the percentage of weekly training. The descriptive data explain the occurred since, despite having increased the training week in the past six months, the average of WIG was 3.3 days in week (sustainable period for tissue recovery).

In this study, 62.1% of IG wore footwear prescribed for their kind of footstep. Systematic reviews have concluded that no injury can be prevented with the use of specific footwear^{20), (21}. These findings are contradictory, given that other studies have concluded that the use of specific shoes for different types of footsteps prevents injuries due to the cushioning and absorption of impact forces between foot and soil²². A review study with a sample of 423 individuals concluded that the use of specific shoes offers a protective effect only on volunteers with flatfeet, while those with neutral footstep and talipes cavus did not have any benefits. It can be concluded that there are gaps on the subject¹⁸.

In addition, in the IG, the percentage of insole use was higher, thus being shown as a factor associated with injury. Considering that the purpose of the insole is to generate corrective reflexes, it is not always prescribed judiciously and individually²³.

In this research, stretching was a protective factor. This occurs because stretching retracted muscles increases their ability to generate force and torque, which benefits amateur runners²⁵. This discussion still has gaps, since other studies have indicated that stretching done immediately before training leads to injury predisposition, since it decreases muscle performance^{25)- (29}.

Among the limitations of this study there is the use of structured questionnaire, which is susceptible to memory bias and misinterpretation. Future studies are encouraged to evidence the causality relationship between these elements.

CONCLUSION

The prevalence of injuries in amateur runners in Juiz de Fora/MG was low. Having practiced running for longer time increases the risk of injury even when there is no increase in weekly frequency. Stretching was a protective measure against injury prevalence. Among associated factors that influence the appearance of lesions are: practice time of running, increase in weekly training frequency, indiscriminate prescription of footwear and insoles.

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• Laboratório de Análise do Movimento (LAM), Faculdade de Fisioterapia, Universidade Federal de Juiz de Fora (UFJF) - Juiz de Fora (MG), Brasil.
• Financing source: Nothing to declare
• Approved by the Ethics Committee of UFJF under protocol no. 1.803.411.

Publication Dates

• Publication in this collection
  Jul-Sep 2018

History

• Received
  10 Oct 2017
• Accepted
  24 Apr 2018