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Do runners who suffer injuries have higher vertical ground reaction forces than those who remain injury-free? A systematic review and meta-analysis
  1. Henk van der Worp,
  2. Jelte W Vrielink,
  3. Steef W Bredeweg
  1. University of Groningen, University Medical Center Groningen, Center for Sports Medicine, Groningen, The Netherlands
  1. Correspondence to Dr Henk van der Worp, Center for Sports Medicine, University Medical Center Groningen, P.O. BOX 30.001, 9700 RB Groningen, The Netherlands; h.van.der.worp{at}


Background Vertical ground reaction force (VGRF) parameters have been implicated as a cause of several running-related injuries. However, no systematic review has examined this relationship.

Aim We systematically reviewed evidence for a relation between VGRF parameters and specific running-related injuries.

Methods MEDLINE, Web of Science and EMBASE databases were searched. Two independent assessors screened the articles and rated the methodological quality. The 3 key VGRF parameters we measured were vertical loading rate, impact/passive peak (Fz1) and propulsive/active peak (Fz2). Standardised mean differences of these parameters were calculated using a random-effects model. Meta-regression was performed using injury type, study type and methodological quality as factors.

Results The search yielded 2016 citations and 18 met the inclusion criteria for the systematic review. The loading rate was higher in studies that included patients with a history of stress fractures and patients with all injury types, both compared with controls. Only studies that included patients with a history of symptoms at the time of kinetic data collection showed higher loading rates overall in cases than in controls. There were no differences between injured subjects and controls for the active and passive peaks of the VGRF.

Summary The loading rate is higher in respondents with a history of stress fractures than in respondents without running injuries. Owing to the absence of prospective studies on other injury types, it is not possible to draw definite conclusions regarding their relation with loading rate.

  • Running
  • Biomechanics
  • Meta-analysis

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