Journal of Orthopaedic & Sports Physical Therapy - Mitchell J. Rauh, PT, PhD, MPH

Quadriceps Angle and Risk of Injury Among High School Cross-Country Runners

Mitchell J. Rauh, Thomas D. Koepsell, Frederick P. Rivara, Stephen G. Rice, Anthony J. Margherita
DESIGN: Prospective cohort study. OBJECTIVES: To determine the relationship between quadriceps angle (Q-angle) and risk of lower extremity injury among adolescent cross-country runners. BACKGROUND: No consensus exists on the role of the Q-angle as a risk factor for lower-extremity overuse injury, especially the effect of large Q-angle or right-left Q-angle difference. METHODS AND MEASURES: The Q-angles of 393 high school cross-country runners, 13 to 19 years of age, were goniometrically measured in a static, standing position with quadriceps relaxed. The runners were followed during a cross-country season to assess lower extremity injuries resulting from running in practices or competitions. RESULTS: Runners with a Q-angle >20° were at 1.7 times greater risk of injury (relative risk [RR], 1.7; 95% confidence interval [CI]: 1.2, 2.4) compared with runners whose Q-angle was 10° to <15°. The RR estimates were similar among girls and boys. Runners with >4° absolute right-left Q-angle difference were at 1.8 times greater risk (RR, 1.8; 95% CI: 1.4, 2.5) compared to runners with a smaller difference. Runners with a Q-angle >20° were more likely to injure their knee, while runners with >4° Q-angle difference were more likely to injure their shin. Runners with a Q-angle >20° had greater time lost due to injury. CONCLUSIONS: High school cross-country runners with large or asymmetric Q-angles may be at greater risk for running injury. Our study suggests that Q-angle measurement be included in preseason screening exams.

J Orthop Sports Phys Ther 2007;37(12):725-733, published online 29 August 2007. doi:10.2519/jospt.2007.2453

KEY WORDS: asymmetry, athletic injuries, prospective cohort, Q-angle, running injuries

Star Excursion Balance Test as a Predictor of Lower Extremity Injury in High School Basketball Players

Phillip J. Plisky, Mitchell J. Rauh, Thomas W. Kaminski, Frank B. Underwood
Study Design: Prospective cohort. Objective: To determine if Star Excursion Balance Test (SEBT) reach distance was associated with risk of lower extremity injury among high school basketball players. Background: Although balance has been proposed as a risk factor for sports-related injury, few researchers have used a dynamic balance test to examine this relationship. Methods and Measures: Prior to the 2004 basketball season, the anterior, posteromedial, and posterolateral SEBT reach distances and limb lengths of 235 high school basketball players were measured bilaterally. The Athletic Health Care System Daily Injury Report was used to document time loss injuries. After normalizing for lower limb length, each reach distance, right/left reach distance difference, and composite reach distance were examined using odds ratio and logistic regression analyses. Results: The reliability of the SEBT components ranged from 0.82 to 0.87 (ICC_3,1) and was 0.99 for the measurement of limb length. Logistic regression models indicated that players with an anterior right/left reach distance difference greater than 4 cm were 2.5 times more likely to sustain a lower extremity injury (P<.05). Girls with a composite reach distance less than 94.0% of their limb length were 6.5 times more likely to have a lower extremity injury (P<.05). Conclusions: We found components of the SEBT to be reliable and predictive measures of lower extremity injury in high school basketball players. Our results suggest that the SEBT can be incorporated into preparticipation physical examinations to identify basketball players who are at increased risk for injury.

J Orthop Sports Phys Ther. 2006; 36(12):911-919. doi:10.2519/jospt.2006.2244

Key Words: female athlete, neuromuscular control, postural stability

Medial Tibial Stress Syndrome in High School Cross-Country Runners: Incidence and Risk Factors

Melody S. Plisky, Mitchell J. Rauh, Robert T. Tank, Bryan C. Heiderscheit, Frank B. Underwood

STUDY DESIGN: Prospective cohort. OBJECTIVE: To determine (1) the cumulative seasonal incidence and overall injury rate of medial tibial stress syndrome (MTSS) and (2) risk factors for MTSS with a primary focus on the relationship between navicular drop values and MTSS in high school cross-country runners. BACKGROUND: MTSS is a common injury among runners. However, few studies have reported the injury rate and risk factors for MTSS among adolescent runners. METHODS AND MEASURES: Data collected included measurement of bilateral navicular drop and foot length, and a baseline questionnaire regarding the runner’s height, body mass, previous running injury, running experience, and orthotic or tape use. Runners were followed during the season to determine athletic exposures (AEs) and occurrence of MTSS. RESULTS: The overall injury rate for MTSS was 2.8/1000 AEs. Although not statistically different, girls had a higher rate (4.3/1000 AEs) than boys (1.7/1000 AEs) (P = .11). Logistic regression modeling indicated that only gender and body mass index (BMI) were significantly associated with the occurrence of MTSS. However, when controlled for orthotic use, only BMI was associated with risk of MTSS. No significant associations were found between MTSS and navicular drop or foot length. CONCLUSIONS: Our findings suggest that navicular drop may not be an appropriate measure to identify runners who may develop MTSS during a cross-country season; thus, additional studies are needed to identify appropriate preseason screening tools.

J Orthop Sports Phys Ther. 2007;37(2):40-47. doi:10.2519/jospt.2007.2343

KEY WORDS: injury risk, female athlete, navicular drop, shin splints