Volume 5 Supplement 1

3rd Congress of the International Foot and Ankle Biomechanics Community

Open Access

Do lower extremity kinematics and training variables affect the development of overuse injuries in runners? - a prospective study

  • Tobias Hein1Email author,
  • Pia Janssen1,
  • Ursula Wagner-Fritz1 and
  • Stefan Grau1
Journal of Foot and Ankle Research20125(Suppl 1):O46

DOI: 10.1186/1757-1146-5-S1-O46

Published: 10 April 2012


The incidence of running injuries appears to be multi-factorial, e.g. with regard to training errors or kinematics of the lower extremity [1, 2]. To date, studies examining differences between healthy and injured runners are mainly retrospective, and therefore not able to determine whether these differences are the cause or effect of injury. The goal of this prospective study is to evaluate whether the development of overuse injuries in initially healthy subjects is caused by alterations in lower extremity kinematics and/or training habits.

Materials and methods

Since April 2009, 218 healthy runners (m=139, w=79) have been included in the study. Besides a standardized clinical examination, 3D-kinematics of both lower extremities were recorded according to ISB-recommendations [3]. Hip, knee and ankle joint motions were quantified by calculating Cardan angles [4]. Mean angular displacements and discrete parameters were calculated from 10 valid trials of barefoot running. All subjects were asked to complete and return weekly training logs with information about their weekly mileage, running time, and type of training sessions, as well as information about the occurrence of pain during training. Study duration lasted a maximum of 12 months or until diagnosis of an overuse injury.


Currently, 35 from 104 subjects who have completed the study have developed overuse injuries. Symptomatic runners ran more training kilometers per week than healthy runners, and showed a shift from slow and medium to fast endurance training sessions. Further, runners who generated overuse injuries exhibited differences in rear foot, ankle and knee kinematics compared to runners who remained uninjured during their participation.


The initial results indicate that lower leg kinematics and training parameters are risk factors and consequently possible causes for developing overuse injuries. Further subjects will be included in the evaluation to enable a division into larger injury-specific groups.

Authors’ Affiliations

Department of Sports Medicine, Medical Clinic, University of Tübingen


  1. van Gent RN, Siem D, van Middelkoop M, et al: Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. Br J Sports Med. 2007, 41: 469-480. 10.1136/bjsm.2006.033548.PubMed CentralView ArticlePubMedGoogle Scholar
  2. Willems TM, De CD, Delbaere K, Vanderstraeten G, et al: A prospective study of gait related risk factors for exercise-related lower leg pain. Gait Posture. 2006, 23: 91-98. 10.1016/j.gaitpost.2004.12.004.View ArticlePubMedGoogle Scholar
  3. Wu G, Siegler S, Allard P, et al: ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion--part I: ankle, hip, and spine. International Society of Biomechanics. J Biomech. 2002, 35: 543-548. 10.1016/S0021-9290(01)00222-6.View ArticlePubMedGoogle Scholar
  4. Grood ES, Suntay WJ: A joint coordinate system for the clinical description of three-dimensional motions: application to the knee. J Biomech Eng. 1983, 105: 136-144. 10.1115/1.3138397.View ArticlePubMedGoogle Scholar


© Hein et al; licensee BioMed Central Ltd. 2012

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.