Advertisement

Incidence of Achilles tendinopathy and associated risk factors in recreational runners: A large prospective cohort study

Published:December 19, 2019DOI:https://doi.org/10.1016/j.jsams.2019.12.013

      Abstract

      Objectives

      To determine the incidence of Achilles tendinopathy in a large group of recreational runners and to determine risk factors for developing AT.

      Design

      Observational cohort study.

      Methods

      Runners registering for running events (5–42 km) in the Netherlands were eligible for inclusion. Main inclusion criteria were: age ≥18 years, and registration ≥2 months before the running event. The digital baseline questionnaire obtained at registration consisted of demographics, training characteristics, previous participation in events, lifestyle and previous running-related injuries. All participants received 3 follow-up questionnaires up to 1 month after the running event with self-reported AT as primary outcome measure. To study the relationship between baseline variables and AT onset, multivariable logistic regression analyses were performed.

      Results

      In total, 2378 runners were included, of which 1929 completed ≥1 follow-up questionnaire, and 100 (5.2%, 95%CI [4.2;6.2]) developed AT. Runners registered for a marathon (7.4%) had the highest incidence of AT. Risk factors for developing AT were use of a training schedule (odds ratio (OR) = 1.8 (95%Confidence Interval(CI)[1.1;3.0])), use of sport compression socks ((OR = 1.7, 95%CI[1.0;2.8]) and AT in the previous 12 months (OR = 6.3, 95%CI[3.9;10.0]). None of the demographic, lifestyle or training-related factors were associated with the onset of AT.

      Conclusion

      One in twenty recreational runners develop AT. AT in the preceding 12 months is the strongest risk factor for having AT symptoms. Using a training schedule or sport compression socks increases the risk of developing AT and this should be discouraged in a comparable running population.

      Trial registration number

      The Netherlands Trial Register (ID number: NL5843).

      Keywords

      To read this article in full you will need to make a payment

      References

        • van Dijk C.N.
        • van Sterkenburg M.N.
        • Wiegerinck J.I.
        • et al.
        Terminology for Achilles tendon related disorders.
        Knee Surg Sports Traumatol Arthrosc. 2011; 19: 835-841
        • Fokkema T.
        • de Vos R.J.
        • van Ochten J.M.
        • et al.
        Preventing running-related injuries using evidence-based online advice: the design of a randomised-controlled trial.
        BMJ Open Sport Exerc Med. 2017; 3e000265
        • Cook J.L.
        • Purdam C.R.
        Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy.
        Br J Sports Med. 2009; 43: 409-416
        • Zwiers R.
        • Wiegerinck J.I.
        • van Dijk C.N.
        Treatment of midportion Achilles tendinopathy: an evidence-based overview.
        Knee Surg Sports Traumatol Arthrosc. 2016; 24: 2103-2111
        • van Mechelen W.
        • Hlobil H.
        • Kemper H.C.
        Incidence, severity, aetiology and prevention of sports injuries. A review of concepts.
        Sports Med. 1992; 14: 82-99
        • Hopkins C.
        • Fu S.C.
        • Chua E.
        • et al.
        Critical review on the socio-economic impact of tendinopathy.
        Asia Pac J Sports Med Arthrosc Rehabil Technol. 2016; 4: 9-20
        • Kujala U.M.
        • Sarna S.
        • Kaprio J.
        Cumulative incidence of achilles tendon rupture and tendinopathy in male former elite athletes.
        Clin J Sport Med. 2005; 15: 133-135
        • Scheerder J.
        • Breedveld K.
        • Borgers J.
        Running across Europe.
        Palgrave Macmillan, UK2015
      1. Stam C. Hardloopblessures (2016). 2016; https://www.kenniscentrumsport.nl/publicatie/?hardloopblessures&kb_id=20927. (Accessed 25 March 2019).

        • McKean K.A.
        • Manson N.A.
        • Stanish W.D.
        Musculoskeletal injury in the masters runners.
        Clin J Sport Med. 2006; 16: 149-154
        • Lysholm J.
        • Wiklander J.
        Injuries in runners.
        Am J Sports Med. 1987; 15: 168-171
        • Van Ginckel A.
        • Thijs Y.
        • Hesar N.G.
        • et al.
        Intrinsic gait-related risk factors for Achilles tendinopathy in novice runners: a prospective study.
        Gait Posture. 2009; 29: 387-391
        • Taunton J.E.
        • Ryan M.B.
        • Clement D.B.
        • et al.
        A retrospective case-control analysis of 2002 running injuries.
        Br J Sports Med. 2002; 36: 95-101
        • van der Vlist A.C.
        • Breda S.J.
        • Oei E.H.G.
        • et al.
        Clinical risk factors for Achilles tendinopathy: a systematic review.
        Br J Sports Med. 2019;
        • Bahr R.
        • Holme I.
        Risk factors for sports injuries — a methodological approach.
        Br J Sports Med. 2003; 37: 384-392
        • Hirschmuller A.
        • Frey V.
        • Konstantinidis L.
        • et al.
        Prognostic value of Achilles tendon Doppler sonography in asymptomatic runners.
        Med Sci Sports Exerc. 2012; 44: 199-205
        • Van Middelkoop M.
        • Kolkman J.
        • Van Ochten J.
        • et al.
        Risk factors for lower extremity injuries among male marathon runners.
        Scand J Med Sci Sports. 2008; 18: 691-697
        • Mahieu N.N.
        • Witvrouw E.
        • Stevens V.
        • et al.
        Intrinsic risk factors for the development of achilles tendon overuse injury: a prospective study.
        Am J Sports Med. 2006; 34: 226-235
        • Marti B.
        • Vader J.P.
        • Minder C.E.
        • et al.
        On the epidemiology of running injuries. The 1984 Bern Grand-Prix study.
        Am J Sports Med. 1988; 16: 285-294
        • Damsted C.
        • Parner E.T.
        • Sorensen H.
        • et al.
        Preparing for half-marathon: the association between changes in weekly running distance and running-related injuries-does it matter how the running is scheduled?.
        J Orthop Sports Phys Ther. 2018; : 1-24
        • Sigel B.
        • Edelstein A.L.
        • Savitch L.
        • et al.
        Type of compression for reducing venous stasis. A study of lower extremities during inactive recumbency.
        Arch Surg. 1975; 110: 171-175
        • Agu O.
        • Baker D.
        • Seifalian A.M.
        Effect of graduated compression stockings on limb oxygenation and venous function during exercise in patients with venous insufficiency.
        Vascular. 2004; 12: 69-76
        • Ali A.
        • Caine M.P.
        • Snow B.G.
        Graduated compression stockings: physiological and perceptual responses during and after exercise.
        J Sports Sci. 2007; 25: 413-419
        • Maffulli N.
        • Reaper J.
        • Ewen S.W.
        • et al.
        Chondral metaplasia in calcific insertional tendinopathy of the Achilles tendon.
        Clin J Sport Med. 2006; 16: 329-334
        • Book J.
        • Prince C.N.
        • Villar R.
        • et al.
        Investigating the impact of passive external lower limb compression on central and peripheral hemodynamics during exercise.
        Eur J Appl Physiol. 2016; 116: 717-727
        • Varela-Sanz A.
        • Espana J.
        • Carr N.
        • et al.
        Effects of gradual-elastic compression stockings on running economy, kinematics, and performance in runners.
        J Strength Cond Res. 2011; 25: 2902-2910
        • Knobloch K.
        The role of tendon microcirculation in Achilles and patellar tendinopathy.
        J Orthop Surg Res. 2008; 3: 18
        • Owens B.D.
        • Wolf J.M.
        • Seelig A.D.
        • et al.
        Risk factors for lower extremity tendinopathies in military personnel.
        Orthop J Sports Med. 2013; 1 (2325967113492707)
        • Langberg H.
        • Skovgaard D.
        • Karamouzis M.
        • et al.
        Metabolism and inflammatory mediators in the peritendinous space measured by microdialysis during intermittent isometric exercise in humans.
        J Physiol. 1999; 515: 919-927
        • Foxen-Craft E.
        • Scott E.L.
        • Kullgren K.A.
        • et al.
        Pain location and widespread pain in youth with orthopaedic conditions: Exploration of the reliability and validity of a body map.
        Eur J Pain. 2019; 23: 57-65
        • Southerst D.
        • Cote P.
        • Stupar M.
        • et al.
        The reliability of body pain diagrams in the quantitative measurement of pain distribution and location in patients with musculoskeletal pain: a systematic review.
        J Manipulative Physiol Ther. 2013; 36: 450-459
        • Goss D.L.
        • Lewek M.
        • Yu B.
        • et al.
        Lower extremity biomechanics and self-reported foot-strike patterns among runners in traditional and minimalist shoes.
        J Athl Train. 2015; 50: 603-611
        • Bade M.B.
        • Aaron K.
        • McPoil T.G.
        Accuracy of self-reported foot strike pattern in intercollegiate and recreational runners during shod running.
        Int J Sports Phys Ther. 2016; 11: 350-355