Eric J. Hegedus

Cross-country runners’ risk for injury is high in-season potentially due to changes in biomechanics during prescribed fast running speeds and competitions. The purpose of this study was to determine if biomechanics associated with overuse knee and lower leg injury during running change similarly across speeds between female and male collegiate cross-country runners. Sixteen collegiate cross-country runners (8 females) participated. A self-selected running speed was entered into regression equations to determine treadmill speeds for the conditions: recovery (∼9% slower), threshold (∼25% faster), interval (∼36% faster), and repetition (∼50% faster). Three-dimensional lower-extremity biomechanics were collected during running. Dependent variables were analyzed via mixed-model analysis of variance and pairwise post hoc tests. Both peak rearfoot angle increased ( P = .005, Cohen’s f = 0.84) and rearfoot excursion increased ( P = .002, Cohen’s f = 0.88) with the conditions’ treadmill speed. Peak knee adduction angle was greater in females compared with males ( P = .032, Cohen’s f = 0.67) during: recovery, easy, threshold, and interval conditions. Increases in running speed affected joint kinematics and kinetics similarly between groups. Generally, similar running biomechanics observed between females and males may indicate that faster training speeds could accentuate the contribution of rearfoot eversion to lower leg overuse injury.

Background: Newly graduated physical therapists have high amounts of educational debt. Educational debt may negatively affect job satisfaction, aspirations for professional development, and choice of workplace setting. Research has not shown this association directly, yet it is conceptually supported by the Labor-Search Model. The purpose of this study was to understand the role that educational debt has on additional factors related to job choice in the Labor-Search Model. Methods: Retrospective data were captured through the Virginia Longitudinal Data System (VLDS) for 12,594 licensed physical therapists within the Commonwealth of Virginia from 2014 to 2020. A fixed effects panel analysis, with inflation-adjusted educational debt as the variable of interest, was conducted to assess whether patterns of professional certifications, volume of work, workplace setting, and job satisfaction were related to educational debt. Results: Educational debt was positively correlated with higher professional degrees (p = 0.009), the number of hours worked per week (p = 0.049), and expected number of years until retirement (p = 0.013). Job satisfaction was statistically significant (p = 0.042) and negatively correlated with educational debt. Conclusions: Those with higher educational debt appear to have the habit of working more hours per week and have a longer time horizon until retirement. Newly licensed physical therapists with higher amounts of educational debt are more likely to experience this trend. Income and job satisfaction demonstrated an interaction effect on educational debt, such that those with lower levels of income had a stronger, negative relationship between their debt and job satisfaction, as compared to those with higher income.

Stress fractures likely have a 1–2% incidence in athletes in general. In runners, a more vulnerable population, incidence rates likely range between 3.2 and 21% with female runners having greater susceptibility. The incidence of femoral shaft stress fractures is less well known. New basic and translational science research may impact the way clinicians diagnose and treat femoral stress fractures. By using a fictitious case study, this paper applies bone science to suggest new approaches to evaluating and treating femoral shaft stress fractures in the running population.

Rehabilitation professionals prescribe exercise regularly with the goals of decreasing pain, increasing function, and returning athletes to competition. To maximize the effect of an exercise intervention, the program must be individualized and in context for the athlete considering biopsychosocial aspects of care. Current models of exercise prescription may not be ideal considering that less than 50% of injured athletes return to their pre-injury level. Advice on exercise prescription has been offered in the past, but the paradigms are either not user friendly or user friendly but linear, based on phases of recovery. As such, there is a need for a more flexible exercise prescription paradigm that should improve the individuality of exercise prescription. In this Current Opinion, we offer a user-friendly construct-oriented paradigm designed to facilitate the creation of individualized exercise programs for athletes.

Running injuries are very common, and there are well-established protocols for clinicians to manage specific musculoskeletal conditions in runners. However, competitive and elite runners may experience different injuries than the average recreational runner, due to differences in training load, biomechanics, and running experience. Additionally, injury-specific rehabilitation protocols do not consider the broader goal of return to competitive running, including the unique psychosocial and cardiorespiratory fitness needs of elite athletes. This review aims to suggest a guideline for running-specific progression as part of a comprehensive rehabilitation program for injured competitive runners. Tools to evaluate an athlete’s psychosocial preparedness to return to competition are presented. Recommendations are also provided for monitoring cardiorespiratory fitness of injured runners, including the nuances of interpreting these data. Finally, a six-phase training paradigm is proposed to guide clinicians as they help competitive runners transition from the early stages of injury through a full return to competition.

Certainly times have changed, and incorporation of evidence-based practice into clinical practice is a welcome change from the past. Unfortunately, the expected improved efficiency and clinical outcomes have yet to be observed, and we believe this to be related to multiple disciplines working independently and a lack of focus on an interprofessional, systems-based approach to health care. Shared decision making amongst all members of the health care team is needed with a patient first mindset.