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Objective: To evaluate the effectiveness of footwear, foot orthoses and training-related strategies to prevent lower extremity bone stress injury (BSI). Design: Systematic review and meta-analysis. Data sources: Four bibliographic databases (from inception until November 2021): Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and CINAHL. Eligibility criteria: Randomised controlled trials (RCTs) that assessed the risk of developing a BSI when using particular footwear, foot orthoses or training-related strategies such as muscle strengthening, stretching, and mechanical loading exercises. Results: Eleven studies were included in this systematic review. When wearing foot orthoses, the risk ratio of developing a BSI on any lower extremity bone is 0.47 (95% CI 0.26 to 0.87; p = 0.02). When doing pre-exercise dynamic stretching, the risk ratio of suffering a tibial BSI is 1.06 (95% CI 0.67 to 1.68; p = 0.79). No meta-analyses could be performed for footwear or training-related strategies. The quality of evidence for all these results is low considering the high risk of bias in each study, the low number of studies and the low number of cases in each study. Conclusion: This systematic review reveals the lack of high-quality studies in BSI prevention. Based on studies at high risk of bias, foot orthoses could potentially help prevent BSIs in the military setting. It is still unknown whether footwear and training-related strategies have any benefits. It is crucial to further investigate potential BSI prevention strategies in women and athletes. Research is also needed to assess the influence of running shoes and loading management on BSI incidence. [ABSTRACT FROM AUTHOR]

• Nike Vaporfly 4% (VP4) and Saucony Endorphin lightweight racing flats improved running economy in male recreational runners vs. their habitual running footwear. • The 3-km time-trial times were faster in VP4 than Saucony Endorphin lightweight racing flats and habitual running footwear. • The VP4 meaningfully improved economy and time-trial times in recreational runners. • However, individual responses were evident and did not appear driven by perceptions. • This study adds to VP4 research, which had involved high-caliber runners only to date. We compared running economy (RE) and 3-km time-trial (TT) variables of runners wearing Nike Vaporfly 4% (VP4), Saucony Endorphin lightweight racing flats (FLAT), and their habitual running (OWN) footwear. Eighteen male recreational runners (age = 33.5 ± 11.9 year (mean ± SD), peak oxygen uptake (VO 2peak) = 55.8 ± 4.4 mL/kg·min) attended 4 sessions approximately 7 days apart. The first session consisted of a VO 2peak test to inform subsequent RE speeds set at 60%, 70%, and 80% of the speed eliciting VO 2peak. In subsequent sessions, treadmill RE and 3-km TTs were assessed in the 3 footwear conditions in a randomized, counterbalanced crossover design. Oxygen consumption (mL/kg·min) was less in VP4 (from 4.3% to 4.4%, p ≤ 0.002) and FLAT (from 2.7% to 3.4%, p ≤ 0.092) vs. OWN across intensities, with a non-significant difference between VP4 and FLAT (1.0%–1.7%, p ≥ 0.292). Findings related to energy cost (W/kg) and energetics cost of transport (J/kg·m) were comparable. VP4 3-km TT performance (11:07.6 ± 0:56.6 mm:ss) was enhanced vs. OWN by 16.6 s (2.4%, p = 0.005) and vs. FLAT by 13.0 s (1.8%, p = 0.032). The 3-km times between OWN and FLAT (0.5%, p = 0.747) were similar. Most runners (n = 11, 61%) ran their fastest TT in VP4. Overall, VP4 improved laboratory-based RE measures in male recreational runners at relative speeds compared to OWN, but the RE improvements in VP4 were not significant vs. FLAT. More runners exhibited better treadmill TT performances in VP4 (61%) vs. FLAT (22%) and OWN (17%). The variability in RE (–10.3% to 13.3%) and TT (–4.7% to 9.3%) improvements suggests that responses to different types of shoes are individualized and warrant further investigation. [Display omitted] [ABSTRACT FROM AUTHOR]

Objectives To compare hip kinematics during two functional tasks in females with and without patellofemoral pain (PFP), and to determine if hip kinematics and, symptoms and functional limitations were improved after a rehabilitation program. Design Cross sectional and longitudinal. Participants Sixteen females with and 15 without PFP. Setting Laboratory and physical therapy clinic. Main outcome measures Hip adduction (HADD) and medial rotation (HMR) peak angles, time integrals and inter-movement variability during step-down and vertical drop jump, symptoms and functional limitations evaluated using the Activities of Daily Living Scale of the Knee Outcome Survey (KOS-ADLS). Results At baseline, no significant differences were found in step-down and vertical drop jump between PFP and controls. Following rehabilitation, significant improvements were reported in KOS-ADLS (p < 0.001). There was a significant decrease in HADD and HMR variability (p < 0.05), a trend for decreased peak HMR (p = 0.06) during step-down, and a significant decrease in HADD variability (p < 0.05) during vertical drop jump. These kinematic changes did not correlate with changes in KOS-ADLS (all p > 0.05). Conclusion Females with and without PFP demonstrated no hip kinematic differences during functional tasks. A rehabilitation program improved symptoms and functional status, and modified hip kinematics in females with PFP; however these changes were not correlated. [ABSTRACT FROM AUTHOR]