Page 135 - 《运动与健康科学》(英文)2024年第2期

Epidemiology of Achilles tendinopathy 257
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cohort studies is an essential step in injury prevention. Several controlled trial of runners who were included in a comparable
systematic reviews 8,9 have previously identified and summa- study in the same setting.TaggedAPTARAEnd
rized clinical risk factors for AT, including being overweight,
having certain genetic variants, a prior lower-extremity tendino-
pathy, frequent alcohol use, plantar flexor strength, certain TaggedAPTARAH22.3. Procedures and data collectionTaggedAPTARAEnd
gait-related parameters, administration of ofloxacin, renal TaggedAPTARAPParticipants were requested to provide digital informed
dysfunction, heart transplantation, and winter training. The consent and fill in 4 questionnaires, i.e., at baseline (at registra-
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evidence for these risk factors was, however, limited. Further- tion), 1 month, 1 week prior to the registered running event,
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more, as suggested by Bahr and Holme, to detect the associa- and 1 month after the event. Moreover, an ad hoc question-
tion between a risk factor and injury in a cohort, at least 20 naire was attached to a biweekly newsletter of the SPRINT
injury cases are needed to provide sufficient statistical power. study and sent to participants to increase the likelihood of
However, 6 of the 10 included cohort studies being analyzed by registration of new-onset injuries. Participants who completed
the systematic reviews had less than 20 cases of AT. 1113 More- none of the follow-up or the ad hoc questionnaires were
over, these risk factors have been assessed in specific populations, excluded from the current study.TaggedAPTARAEnd
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like military personnel or patients undergoing a heart transplan- TaggedAPTARAPThe baseline questionnaire collected information concerning
15
tation, making them less applicable for generalizing to athletic demographics, training, registered running events, and previous
populations. Research in recreational runners is highly relevant as or current running-related injuries. The follow-up and ad hoc
16
they represent a large population and have a high susceptibility questionnaires collected information on new-onset injuries
4
to AT. Risk factors for AT were recently assessed in a large (including the location of symptoms using a standardized
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population of recreational runners. This study found that AT in Achilles tendon pain map) (Fig. 1). The specific items in the
the preceding 12 months, using a training schedule, and sport questionnaires are presented in Supplementary Table 1.TaggedAPTARAEnd
compression socks increased the risk of developing AT. Though TaggedAPTARAPThe collected baseline data were considered as potential risk
a limitation of this study was the use of self-reported injuries factors for new-onset AT. Based on previous publications 8,9,17
without additional tools. This may have prevented the ability to and clinical experience, 14 potential risk factors were pre-selected
accurately diagnose AT and to distinguish between insertional for the analyses: sex, age (year), body weight (kg), running expe-
and midportion AT. No study to date has compared the incidence rience (year), distance of the registered event (1042.195 km),
and risk factors between insertional AT and midportion AT, even use of a training schedule (yes/no), use of compression socks
3
though the literature considers them to be distinct entities. TaggedAPTARAEnd (yes/no), landing type (hindfoot/midfoot/forefoot), running
TaggedAPTARAPThe current study uses data from a large prospective cohort 80% on paved road (yes/no), have a history of AT (yes/no),
of recreational runners with the primary aim of assessing risk have a history of other running-related injury (yes/no), change of
factors for new-onset AT using a standardized pain map. Our training load (presented as month:year distance ratio and month:
secondary aim was to explore differences in risk factors year speed ratio, and physical activity level (Short Questionnaire
to Assess Health) score). The month:year distance ratio was
between insertional and midportion AT.TaggedAPTARAEnd
calculated by dividing the average running distance per
week of last month by that of last year. The month:year
TaggedAPTARAH12. MethodsTaggedAPTARAEnd
speed ratio was calculated by dividing the mean running
speed of last year by the mean running speed of last
TaggedAPTARAH22.1. Study designTaggedAPTARAEnd
TaggedAPTARAPThe current study was part of the Shaping up Prevention of month). Short Questionnaire to Assess Health scores come
Running Injuries in the Netherlands using Ten steps (SPRINT) from a validated questionnaire with the general purpose of
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study, which was registered in the Netherlands Trial register assessing habitual physical activity. TaggedAPTARAEnd
TaggedAPTARAFigure
(www.trialregister.nl; NL7694). Medical ethics approval was
obtained from the Medical Ethical Committee of the Erasmus
Medical Centre Rotterdam, the Netherlands (MEC-2019-
0136).TaggedAPTARAEnd

TaggedAPTARAH22.2. ParticipantsTaggedAPTARAEnd
TaggedAPTARAPRegistered runners from any 1 of 4 running events
(1042.195 km) in the Netherlands 18 were invited to partici-
pate in this research project. Recruitment was performed by
way of online registration from August 2019 to February
2020. The inclusion criteria included: (a) age 18 years,
(b) registration at least 2 months before the event, (c) a good
understanding of the Dutch language, (d) access to a personal
Fig. 1. The standardized Achilles tendon pain map. The purple area indicates
email box, and (e) no participation in the INtervention Study
the first 2 cm from the attachment of the Achilles tendon to the calcaneus, also
on Prevention of Injuries in Runners at Erasmus University known as the insertional region; the red area indicates >2 cm above the attach-
Medical Center (MC) study, 19 which was a large randomized ment of the Achilles tendon, also known as the midportion region.TaggedAPTARAEnd