Běžecké zranění Achillovy šlachy: prospektivní a průřezové biomechanické studie

Mgr. Jiří SKÝPALA

Doctoral thesis

Achilles Tendon Running-Related Injuries: Prospective and Cross-Sectional Biomechanical Studies

Abstract:

The dissertation focused on whether biomechanical running parameters and AT dimensions are associated with the incidence of AT running-related injuries in healthy recreational runners. The first study of the dissertation was to determine the reliability of AT length measurements using a combination of ultrasound imaging and a motion capture system. AT lengths (calcaneus to the soleus, calcaneus to gastrocnemius) were measured on both right and left lower extremities in 19 healthy participants on six days. The reliability results indicated high intraclass correlation coefficients (ICC > 0.8), a low typical error (< 0.6), and a standard error of measurement (SEM < 5.5 mm) for all measured AT lengths within and between sessions. The second study of the dissertation compared the AT and foot dimensions between runners with Achilles tendinopathy and healthy control runners. Based on age, mass, and height, 12 runners diagnosed with Achilles tendinopathy were paired with 12 healthy control runners. The dimensions of AT and foot were measured using a combination of ultrasound imaging and motion capture systems on the affected lower limb. A significant difference was found only for AT thickness. Runners diagnosed with Achilles tendinopathy (6.2 ? 0.5 cm) had thicker AT than healthy control runners (5.5 ? 0.4 cm, p = 0.011). Our findings confirmed the findings of previous studies that recreational runners diagnosed with Achilles tendinopathy have a thicker AT compared to healthy recreational runners. The third study of the dissertation examined the relationship among AT dimensions, ankle joint stiffness, and footfall patterns in recreational rearfoot (47 females / 40 males and non-rearfoot runners (14 females / 6 males). In laboratory-neutral shoes, overground running biomechanics were measured at a self-selected running speed. According to the partial correlation coefficient and Benjamini-Hochberg corrections, a significant relationship was found between ankle joint stiffness and footfall pattern in rearfoot (r = 0.391, p = 0.046) and non-rearfoot runners (r = -0.821, p = 0.012). Another finding shows that non-rearfoot runners' footfall pattern is closer to the toe have a thinner AT (r = -0.522). The footfall pattern from toe to heel increased the value of ankle joint stiffness during the energy absorption phase. The last study of the dissertation investigated whether biomechanical running parameters and AT dimensions are associated with the incidence of AT running-related injuries in healthy recreational runners after a one-year follow-up. At the start of the prospective study, a total of 103 healthy recreational runners (57 females and 46 males) underwent baseline measurements (set of questionnaires, overground running biomechanics, AT, and foot dimensions). After baseline measurements, the incidence of AT running-related injury was followed for one year using a standardized electronic weekly running-related injury questionnaire. AT dimensions and potential biomechanical risk factors for the development of AT running-related injury were determined using multivariable logistic regression. Of the 103 participants, 26 (11 females and 15 males) sustained an AT running-related injury during the one-year follow-up. A more flexed knee at initial foot contact (OR = 1.152, 95% CI = 1.014 - 1.310, p = 0.030) and at the midstance phase (OR = 1.143, 95% CI = 1.008 - 1.297, p = 0.037) were significant predictors for developing AT running-related injury thus causing a limitation of training or a stoppage of running in recreational runners. Each 1° increase in knee flexion was associated with a 15% increase in the risk of AT running-related injury in healthy recreational runners. Greater ankle dorsiflexion during the midstance of running appeared to be another potential risk factor for AT running-related injury. Footfall pattern and AT dimensions were not associated with AT running-related injury.

Abstract:

The dissertation focused on whether biomechanical running parameters and AT dimensions are associated with the incidence of AT running-related injuries in healthy recreational runners. The first study of the dissertation was to determine the reliability of AT length measurements using a combination of ultrasound imaging and a motion capture system. AT lengths (calcaneus to the soleus, calcaneus to gastrocnemius) were measured on both right and left lower extremities in 19 healthy participants on six days. The reliability results indicated high intraclass correlation coefficients (ICC > 0.8), a low typical error (< 0.6), and a standard error of measurement (SEM < 5.5 mm) for all measured AT lengths within and between sessions. The second study of the dissertation compared the AT and foot dimensions between runners with Achilles tendinopathy and healthy control runners. Based on age, mass, and height, 12 runners diagnosed with Achilles tendinopathy were paired with 12 healthy control runners. The dimensions of AT and foot were measured using a combination of ultrasound imaging and motion capture systems on the affected lower limb. A significant difference was found only for AT thickness. Runners diagnosed with Achilles tendinopathy (6.2 ? 0.5 cm) had thicker AT than healthy control runners (5.5 ? 0.4 cm, p = 0.011). Our findings confirmed the findings of previous studies that recreational runners diagnosed with Achilles tendinopathy have a thicker AT compared to healthy recreational runners. The third study of the dissertation examined the relationship among AT dimensions, ankle joint stiffness, and footfall patterns in recreational rearfoot (47 females / 40 males and non-rearfoot runners (14 females / 6 males). In laboratory-neutral shoes, overground running biomechanics were measured at a self-selected running speed. According to the partial correlation coefficient and Benjamini-Hochberg corrections, a significant relationship was found between ankle joint stiffness and footfall pattern in rearfoot (r = 0.391, p = 0.046) and non-rearfoot runners (r = -0.821, p = 0.012). Another finding shows that non-rearfoot runners' footfall pattern is closer to the toe have a thinner AT (r = -0.522). The footfall pattern from toe to heel increased the value of ankle joint stiffness during the energy absorption phase. The last study of the dissertation investigated whether biomechanical running parameters and AT dimensions are associated with the incidence of AT running-related injuries in healthy recreational runners after a one-year follow-up. At the start of the prospective study, a total of 103 healthy recreational runners (57 females and 46 males) underwent baseline measurements (set of questionnaires, overground running biomechanics, AT, and foot dimensions). After baseline measurements, the incidence of AT running-related injury was followed for one year using a standardized electronic weekly running-related injury questionnaire. AT dimensions and potential biomechanical risk factors for the development of AT running-related injury were determined using multivariable logistic regression. Of the 103 participants, 26 (11 females and 15 males) sustained an AT running-related injury during the one-year follow-up. A more flexed knee at initial foot contact (OR = 1.152, 95% CI = 1.014 - 1.310, p = 0.030) and at the midstance phase (OR = 1.143, 95% CI = 1.008 - 1.297, p = 0.037) were significant predictors for developing AT running-related injury thus causing a limitation of training or a stoppage of running in recreational runners. Each 1° increase in knee flexion was associated with a 15% increase in the risk of AT running-related injury in healthy recreational runners. Greater ankle dorsiflexion during the midstance of running appeared to be another potential risk factor for AT running-related injury. Footfall pattern and AT dimensions were not associated with AT running-related injury.

Keywords

running, running-related injury, Achilles tendon, Achilles tendon length, Achilles tendon moment arm, footfall pattern, biomechanical risk factors, knee flexion, ankle dorsiflexion, rearfoot runners, non-rearfoot runners

Language used: English

Date on which the thesis was submitted / produced: 15. 11. 2022

Accessible from:: 31. 12. 2999

Thesis defence

• Supervisor: doc. Mgr. Daniel Jandačka, Ph.D., doc. Mgr. Daniel Jandačka, Ph.D.

University of Ostrava

Pedagogical Faculty

Doctoral programme / field:
Kinanthropology / Kinanthropology