Br J Sports Med doi:10.1136/bjsports-2015-094579
  • Original article

Greater vertical impact loading in female runners with medically diagnosed injuries: a prospective investigation

  1. David R Mullineaux3
  1. 1Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
  2. 2Department of Health and Nutritional Sciences, South Dakota State University, Brookings, South Dakota, USA
  3. 3School of Sport and Exercise Science, University of Lincoln, Lincoln, Lincolnshire, UK
  1. Correspondence to Professor Irene S Davis, Spaulding National Running Center, 1575 Cambridge Street, Cambridge, MA 02115, USA; isdavis{at}
  • Received 5 January 2015
  • Revised 6 August 2015
  • Accepted 31 October 2015
  • Published Online First 7 December 2015


Background Running has been critical to human survival. Therefore, the high rate of injuries experienced by modern day runners is puzzling. Landing on the heel, as most modern day shod runners do, results in a distinct vertical impact force that has been shown to be associated with running-related injuries. However, these injury studies were retrospective in nature and do not establish cause and effect.

Objective To determine whether runners with high impacts are at greater risk for developing medically diagnosed injuries.

Methods 249 female runners underwent a gait analysis to measure vertical instantaneous loading rate, vertical average loading rate (VALR), vertical impact peak (VIP) and peak vertical force. Participants then recorded their mileage and any running-related injuries monthly in a web-based, database programme. Variables were first compared between the entire injured (INJ; n=144) and uninjured (n=105) groups. However, the focus of this study was on those injured runners seeking medical attention (n=103) and those who had never injured (n=21).

Results There were no differences between the entire group of injured and uninjured groups. However, all impact-related variables were higher in those with medically diagnosed injuries compared with those who had never been injured. (effect size (ES) 0.4–0.59). When VALR was >66.0 body weight (BW)/s, the odds of being DX_INJ were 2.72 (95% CI 1.0 to 7.4). Impact loading was associated with bony and soft-tissue injuries.

Conclusions Vertical average loading rate was lower in female runners classified as ‘never injured’ compared with those who had been injured and sought medical attention.

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