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Injuries common among cross-county runners

NEW YORK (Reuters Health) - Theirs may not be a contact sport, but high school cross-country runners are not exempt from injury. In fact, injuries are quite common among these athletes, new study findings show.

"The results from our study suggest that the injury rates of high school cross country runners continue to be consistently high, per athletic exposure (i.e., actual runner participation in a practice or meet), especially for girls, and that the causes of running injuries are likely multi-faceted," study author Dr. Mitchell J. Rauh told Reuters Health.

During the 2003-2004 school year, more than 364,000 students in the United States participated in high school cross-country running, which was ranked as the seventh most popular high school sport nationwide for girls and boys, respectively. Previous reports suggest that the incidence of injury among cross-country runners ranges from less than 2 percent to nearly 50 percent, but little research on the topic has been conducted among high school athletes.

To investigate, Rauh, of the Rocky Mountain University of Health Professions in Provo, Utah, and his team followed 421 male and female runners from 23 cross-country teams at 12 high schools in Seattle, Washington during the 1996 cross-country running season.

Overall, 162 runners experienced a total of 316 injuries during the season, the investigators report in the American Journal of Epidemiology.

The rate of injury was generally higher for girls than for boys, the study findings show, and girls were four times more likely than boys to experience an injury that kept them from running for 15 or more days.

Why the girls had higher injury rates than boys is unclear, Rauh told Reuters Health.

Preliminary findings revealed differences in pre-season summer training among girls versus boys, which, according to Rauh, may explain some of the gender differences in injury rates.

The runners' quadriceps angle, or Q-angle, which is formed from a point on the hip to the middle of the kneecap and from the kneecap to a point on the upper shin, was also associated with their risk of injury.

A Q-angle of 20 degrees or greater, which was more common among girls than boys, was associated with a nearly two-fold increased risk of injury in comparison to a Q-angle of less than 20 degrees, the report indicates. Boys with a Q-angle of 15 degrees or more were also more likely to be injured.

"Our findings suggest that coaches may want to screen runners for large Q-angle and other lower limb malalignment at the beginning of the season," Rauh noted.

Athletes were injured more frequently during practices than during meets, and the body parts most commonly affected included the shin, the knee, and the ankle.

The researchers did not investigate potential methods of injury prevention, but, according to Rauh, the findings suggest that pre-season screening may be needed to identify athletes with prior injuries that have not yet been fully rehabilitated. Coaches should allow these athletes, as well as those who are injured during the running season, to fully recuperate before returning to cross-country running, he recommended.

Further, the findings also suggest that "coaches should progressively increase the intensity and duration rather than compressing the amount and intensity of workouts during the first part of the season, " Rauh added.

Despite the high injury rate reported in the current study, however, "there are many benefits related to participating in high school cross-country running," Rauh told Reuters Health.

SOURCE: American Journal of Epidemiology, January 15, 2006.