Elsevier

Gait & Posture

Volume 99, January 2023, Pages 60-75
Gait & Posture

Effects of level running-induced fatigue on running kinematics: A systematic review and meta-analysis

https://doi.org/10.1016/j.gaitpost.2022.09.089Get rights and content

Abstract

Background

Runners have a high risk of acquiring a running-related injury. Understanding the mechanisms of impact force attenuation into the body when a runner fatigues might give insight into the role of running kinematics on the aetiology of overuse injuries.

Research questions

How do running kinematics change due to running-induced fatigue? And what is the influence of experience level on changes in running kinematics due to fatigue?

Methods

Three electronic databases were searched: PubMed, Web of Science, and Scopus. This resulted in 33 articles and 19 kinematic quantities being included in this review. A quality assessment was performed on all included articles and meta-analyses were performed for 18 kinematic quantities.

Results and significance

Main findings included an increase in peak acceleration at the tibia and a decrease in leg stiffness after a fatiguing protocol. Additionally, level running-induced fatigue increased knee flexion at initial contact and maximum knee flexion during swing. An increase in vertical centre of mass displacement was found in novice but not in experienced runners with fatigue. Overall, runners changed their gait pattern due to fatigue by moving to a smoother gait pattern (i.e. more knee flexion at initial contact and during swing, decreased leg stiffness). However, these changes were not sufficient to prevent an increase in peak accelerations at the tibia after a fatigue protocol. Large inter-individual differences in responses to fatigue were reported. Hence, it is recommended to investigate changes in running kinematics as a result of fatigue on a subject-specific level since group-level analysis might mask individual responses.

Introduction

Running is a popular sport worldwide. With up to 79% of runners acquiring a running-related injury in the lower extremity, runners are likely to get injured [1]. Most injuries are overuse related and assumed to be caused by training load errors (i.e. too fast and too far) and running kinematics [2], [3], [4]. During running the body repetitively endures high impact forces caused by the feet colliding with the ground. High impact forces on the body and changes in attenuation of these forces with fatigue are expected to result in overuse-related injuries such as tibial stress fractures [5].

Understanding the mechanisms of impact force attenuation into the body when a runner fatigues might give insight into the role of running kinematics on the aetiology of overuse injuries. Running kinematics largely influence peak impact forces during running [6], [7], [8], [9], possibly by modulating the stiffness of the lower body. Peak accelerations of body segments during running are mostly caused by impact forces and can be used as measures for loading on the body. Peak accelerations can quantify how well the body can attenuate impact forces [10]. A general idea is that higher peak accelerations due to fatigue indicate a higher load on the body and therefore increase the risk of overuse injuries, although this relationship needs further investigation [11], [12]. Multiple studies showed an increase in peak accelerations and change in joint angles due to running-induced fatigue, although there is not yet a consensus about the exact effect of fatigue on peak accelerations and joint angles in running [13], [14], [15].

The effect of fatigue on running kinematics was previously investigated in three literature reviews. Winter et al. [16] summarized the effects of fatigue on kinematics and kinetics during overground running while Kim et al. [17] summarized the effects of fatigue on foot plantar pressure and associated kinematic quantities. Apte et al. [18] investigated the effect of fatigue, the severity of fatigue and the influence of running surface on a total of 42 quantities. From these literature reviews, it can be concluded that the maximal vertical ground reaction force (Fz,max) generally decreases after a fatigue protocol. Spatiotemporal changes with fatigue were dependent on the running surface, and plantar pressure measurements showed that the loading under the metatarsal area was increased after a fatigue protocol. Winter et al. [16], Kim et al. [17] and Apte et al. [18] concluded that it was difficult to compare kinematic results from studies due to small numbers of studies investigating some quantities, differences in subject characteristics (i.e. experience level, familiarity with fatigue protocols, lack of information) and fatigue protocols (i.e. speed, duration, stopping criteria). All three of these literature reviews do not give us insight into the amount of change in kinematic quantities to expect after a fatiguing protocol. Additionally, Apte et al. [18] mentioned that combining results of runners with different skill levels might lead to confounding effects. Hence, there is a need for a systematic literature review in combination with meta-analyses on the effect of running-induced fatigue on running kinematics, which also takes subject characteristics into account.

The primary aim of this study was therefore to provide an overview of kinematic changes due to running-induced fatigue. The secondary aim was to investigate the influence of experience level on kinematic changes with fatigue.

Many quantities related to running biomechanics have been proposed in the literature. This review focused on a selection of intertwined quantities related to peak accelerations and shock attenuation, because of the assumed link with the development of running-related injuries [11], [12]. Quantities included in this review were:

1.

Peak accelerations

2.

Shock attenuation

3.

Vertical and leg stiffness

4.

Vertical COM displacement (COMz)

5.

Lower body joint angles

It is hypothesized that fatigued runners adopt a stiffer gait pattern to save energy [19], at the cost of higher impact forces on the body. A stiffer gait pattern would result in increased peak accelerations, decreased shock attenuation, decreased COMz and decreased joint flexion angles. Experienced runners are hypothesized to show smaller changes in kinematics due to fatigue since they are more familiar with, and accustomed to, running-induced fatigue.

Section snippets

Search strategy

For this systematic review, three electronic databases were searched: PubMed, Web of Science and Scopus. The search terms used can be found in Table 1, the search strings can be found in Appendix A. The first literature search was performed in May 2019 (without time constraints), the literature search was repeated in April 2020 (period: 2019–01–01 till 2020–12–31) to ensure no relevant new studies were missing.

Selection criteria

Two researchers independently performed screening of titles, abstracts and full-text

Results

An overview of the literature search process is shown in Fig. 1. Details about the subject characteristics, fatigue protocols, measurement systems and data analyses can be found in Table 2. The mean quality assessment score was 10 (SD: 1, range: 6–12) out of 14, indicating an overall good quality. Heterogeneity was high for most kinematic quantities, indicating that the variation in results between studies is larger than expected by chance [31]. All quality assessment scores can be found in

Discussion

The primary aim of this study was to provide an overview of kinematic changes due to running-induced fatigue. The main changes in kinematics due to fatigue included an increase in peak accelerations at the tibia, decreased leg stiffness, an increase in knee flexion at initial contact and maximum knee flexion and an increase in COMz in novice, but not in experienced runners. The hypothesis that the lower body would behave stiffer with fatigue was not supported by the results of this literature

Conclusions and recommendations

This literature review showed that running kinematics change as a result of running-induced fatigue. As a consequence of fatigue, peak accelerations at the tibia increased, leg stiffness decreased, knee flexion at initial contact and maximum knee flexion increased and COMz increased in novice but not in experienced runners. In addition, large inter-individual differences in responses to fatigue were found. Changes in running kinematics due to fatigue might be explained by a decrease in the

Conflict of interest statement

None of the authors has a financial or personal relationship with other people or organisations that could inappropriately influence this work.

Acknowledgement

This study was supported by EFRO OP Oost (Grant number: 0784). The study sponsor had no involvement in the study design, data collection, analysis, interpretation, writing or decision to submit the manuscript for publication. The authors would like to thank Bouke Scheltinga, Anne Haitjema and Xanthe ter Wengel for their help with reviewing articles and Job van der Palen for his statistical advice.

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