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

https://doi.org/10.1016/j.ams.2019.12.013Get rights and content

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 yearsand registration ≥2 months before the running event. The digital baseline questionnaire obtained at registration consisted of demographicstraining characteristicsprevious participation in eventslife 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 onsetmultivariable logistic regression analyses were performed.

Results

In total2378 runners were includedof which 1929 completed ≥1 follow-up questionnaireand 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 = 1.795%CI[1.0;2.8]) and AT in the previous 12 months (OR = 6.395%CI[3.9;10.0]). None of the demographiclife 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).

Section snippets

Practical implications

  • •
    Achilles tendinopathy is a serious problemas it occurs in one in twenty runners.
  • •
    Marathon runners have the highest incidence of Achilles tendinopathywith an incidence of 7.4%.
  • •
    Previous Achilles tendinopathy is the strongest risk factor for having (recurrent) symptomsso runners with a history of Achilles tendinopathy should be regarded as high-risk.
  • •
    The use of a training schedule and use of sport compression socks should not be encouraged in a high-risk populationas they may increase the

Methods

This study is part of the INSPIRE trial (INntervention Study on Prevention of Injuries in Runners at Erasmus MC)2 and was approved by the Medical Ethics Committee of the Erasmus MC University Medical Centre RotterdamThe Netherlands (MEC-2016-292). The trial is registered in the Netherlands Trial Register (NTR number: NL5843).
Runners of 18 years or older signing up for one of three large running events (5–42.2 km) in the Netherlands were asked to participate in this study. Recruitment was from

Results

A total of 2378 runners were included in the INSPIRE trial. Of these runners1929 (81.1%) completed one or more follow-up questionnaires with a mean follow-up (standard deviationSD) of 20.5 (7.0) weeksand were therefore included in the current study (Table 1). We found a number of statistical differences between the included runners and the runners who did not complete any follow-up questionnaire (Supplementary file 2).
Of the 1929 included runners100 runners reported the onset of AT

Discussion

This is the first large prospective cohort study in recreational runners reporting the incidence of AT and the risk factors for developing AT. We found an overall AT incidence in runners of 5.2% with the highest incidence in the subgroup of runners registered for a marathon (7.4%). In the two-week period before up to 1 day after the running eventonset of AT peaked to 1.9 developed AT per day. Presence of AT in the previous 12 months was the strongest risk factor for having (recurrent) AT

Conclusion

The incidence of AT in the recreational running population is 5.2% and this incidence rate is especially high in the runners preparing for a marathon (7.4%). AT in the previous 12 months was the strongest risk factor for having (recurrent) AT symptoms. Use of a training schedule and use of sport compression socks are two newly discovered risk factors for developing AT. Contrary to popular beliefoften suggested demographics-relatedlife-related and training-related risk factors did not

Acknowledgements

Our thanks go out to the Vereniging voor Sportgeneeskunde (VSG) and Golazo Sports for the collaboration. We are grateful for the participation of all runners in the INSPIRE trial.

References (33)

  • Stam C. Hardloopblessures (2016). 2016; https://www.kenniscentrumsport.nl/publicatie/?hardloopblessures&kb_id=20927....
  • K.A. McKean et al.

    Musculoskeletal injury in the masters runners

    Clin J Sport Med

    (2006)
  • J. Lysholm et al.

    Injuries in runners

    Am J Sports Med

    (1987)
  • J.E. Taunton et al.

    A retrospective case-control analysis of 2002 running injuries

    Br J Sports Med

    (2002)
  • A.C. van der Vlist et al.

    Clinical risk factors for Achilles tendinopathy: a systematic review

    Br J Sports Med

    (2019)
  • R. Bahr et al.

    Risk factors for sports injuries — a methodological approach

    Br J Sports Med

    (2003)

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