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Strategies to prevent and manage running-related knee injuries: A systematic review of randomised controlled trials

Journal: Journal of Science and Medicine in Sport Date: Nov 2022 2022-11-02, 25Pages: S42-S43. doi: Subito , type of study: systematic review

Full text    (https://www.jsams.org/article/S1440-2440(22)00277-8/fulltext#relatedArticles)

Keywords:

knee injury [2]
running [12]
knee pain [14]
warm up [1]
foot orthosis [1]
runner [4]
prevention [34]
shoe [3]
accident prevention [2]
osteopathic manipulative treatment [2973]
OMT [2951]
conference abstract [108]
systematic review [297]

Abstract:

Introduction: The incidence of running-related knee injuries is as high as 31% and 26% in novice and recreational runners, respectively. Prognosis for injured runners is often poor, with most facing prolonged recovery periods impacting participation. No recent systematic review has evaluated the effectiveness of prevention strategies for running-related knee injuries. Additionally, reviews evaluating interventions to manage common running-related knee injuries have not specifically focused on running populations. This systematic review aimed to synthesise and critically appraise randomised controlled trial (RCT) evidence on the prevention and management of running-related knee injuries. Methods: This systematic review conforms to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines and was prospectively registered. Two separate systematic literature searches were performed in five databases, including MEDLINE and EMBASE, to identify RCTs published up to March 2021. Eligibility criteria included RCTs with a primary aim of evaluating the effectiveness of intervention(s) to prevent or manage running-related knee injuries. Primary outcomes included the number of participants developing a running-related knee injury (prevention) and self-reported knee pain following intervention (management). Included studies were appraised with the Physiotherapy Evidence Database (PEDro) scale and the Cochrane Risk of Bias tool. Data from trials investigating similar interventions were pooled using random-effects meta-analyses. Data not appropriate for meta-analysis were qualitatively synthesised. The certainty of evidence for pooled trials was assessed and interpreted using Grading of Recommendations, Assessment, Development and Evaluations (GRADE). Results: Twenty-seven RCTs (15 prevention, 12 management) analysed multiple interventions in novice and recreational running populations. Prevention: Low-certainty evidence (1 trial, 320 participants) indicated that running technique retraining (cues to “land softer”) reduced the risk of running-related knee injury compared to controlled treadmill running (risk ratio (RR) 0.32, 95%CI 0.16, 0.63). Very low- to low-certainty evidence from 14 other prevention trials (participant range: n=24-874) indicated that various footwear options, multicomponent exercise-therapy, graduated running programs, and education regarding warm-up practices, did not influence running-related knee injury risk (RR range: 0.55 to 1.06). Management: Very low- to low-certainty evidence indicated that running technique retraining (i.e., 10% increase in running cadence combined with the use of minimalist footwear and transitioning to a non-rearfoot-strike pattern), medial-wedged foot orthoses, multicomponent exercise-therapy and osteopathic manipulation can reduce running-related patellofemoral pain in the short-term (standardised mean difference range: -4.96 to -0.90). Discussion/Conclusion: Running technique retraining to land softer may reduce the risk of running-related knee injuries. There is no evidence to advocate for specific footwear prescription, multicomponent exercise-therapy, graduated running programs, or education to reduce the risk of running-related knee injury. When managing running-related patellofemoral pain, exercise-therapy, running technique retraining, prefabricated medial-wedged foot orthoses, and osteopathic manipulation may be considered to reduce pain in the short-term. Impact/Application to the field: • This systematic review provides the first comprehensive evidence synthesis for the prevention and management of running-related knee injuries in novice and recreational runners. • Our findings identify effective and ineffective intervention strategies, providing guidance for clinicians and direction for future research. Conflict of interest statement: my co-authors and I acknowledge that we have no conflict of interest of relevance of to the submission of this abstract.


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