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Influence of Step Rate on Shin Injury and Anterior Knee Pain in High School Runners


Medicine & Science in Sports & Exercise: July 2016 - Volume 48 - Issue 7 - p 1244–1250
doi: 10.1249/MSS.0000000000000890
Clinical Sciences

Purpose High school cross-country runners have a high incidence of injury, particularly at the shin and knee. An increased step rate during running has been shown to reduce impact forces and loading of the lower extremity joints. The purpose of this prospective study was to examine step rate as a risk factor for injury occurrence.

Materials and Methods Running step rates of 68 healthy high school cross-country runners (47 females; 21 males; mean age 16.2 ± 1.3 yr) were assessed at a fixed speed (3.3 ± 0.0 m·s−1) and self-selected speed (mean, 3.8 ± 0.5 m·s−1). Runners were prospectively followed during the interscholastic season to determine athletic exposures, occurrences of shin injury and anterior knee pain (AKP), and days lost to injury.

Results During the season, 19.1% of runners experienced a shin injury and 4.4% experienced AKP. Most injuries (63.6%) were classified as minor (1–7 d lost). At the fixed speed, runners in the lowest tertile of step rate (≤164 steps per minute) were more likely (odds ratio, 6.67; 95% confidence interval, 1.2–36.7; P = 0.03) to experience a shin injury compared with runners in the highest tertile (≥174 steps per minute). Similarly, for self-selected speed, runners in the lowest tertile (≤166 steps per minute) (odds ratio, 5.85; 95% confidence interval, 1.1–32.1; P < 0.04) were more likely to experience a shin injury than runners in the highest tertile (≥178 steps per minute). AKP incidence was not significantly influenced by step rate.

Conclusion A lower running step rate was associated with a greater likelihood of shin injury at both self-selected and fixed running speeds. Future studies evaluating whether increasing running step rate reduces shin injury risk and time lost during a high school cross-country season should be considered.

1Rocky Mountain University of Health Professions, Provo, UT; 2Department of Kinesiology, University of Wisconsin–Oshkosh, Oshkosh, WI; 3Department of Orthopedics and Rehabilitation, Department of Biomedical Engineering, University of Wisconsin, Madison, WI; 4VCU Run Lab, Virginia Commonwealth University, Richmond, VA; and 5Doctor of Physical Therapy Program, San Diego State University, San Diego, CA

Address for correspondence: Lace E. Luedke, P.T., D.P.T., University of Wisconsin–Oshkosh, 108B Albee Hall, 800 Algoma Boulevard, Oshkosh, WI 54901-8630; E-mail:

Submitted for publication September 2015.

Accepted for publication January 2016.

© 2016 American College of Sports Medicine