Association between temporal spatial parameters and overuse injury history in runners: a systematic review and meta-analysis

The verdict

Do running gait metrics like cadence, stride length, and contact time differ between runners who have had overuse injuries and those who have not?

Based on pooled data from multiple studies, average stride time, contact time, cadence, and stride length during running are not meaningfully different between runners with and without a history of overuse injury. Current wearable-device metrics alone are unlikely to reliably identify injury risk based on group averages.

ChallengesRead paper

Meta-analysis13 Trials517 ParticipantsModerate evidence

Key points

Meta-analysis of 11 retrospective cohorts found no significant difference in stride time, contact time, cadence, or stride length between injured and uninjured runners
Mean cadence difference was only 0.3 steps per minute (95% CI -1.8 to 2.5 spm), which is clinically negligible
Mean stride length difference was 0.00 m (95% CI -0.04 to 0.05 m) and mean contact time difference was 0.00 s
Limited prospective evidence hints that shorter contact time may matter in male runners, but data are too sparse for a meta-analysis
Practitioners should exercise caution when using temporal spatial parameters from wearables to assess injury risk

How it was conducted

Design: Systematic review and meta-analysis (PRISMA guidelines); PROSPERO registration CRD42018112290
Databases searched: CINAHL, Medline, PubMed, SCOPUS, SPORTDiscus; search from January 1980 to November 2018
Studies included: 13 articles reporting on 11 distinct cohorts (2 prospective, 10 retrospective, 1 both)
Meta-analysis scope: Inverse variance fixed-effect model on 4 parameters (stride time, contact time, cadence, stride length) using retrospective studies only
Quality assessment: NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies; 2 studies low risk, 9 moderate risk, 1 high risk of bias
Primary outcome: Mean difference in temporal spatial parameters between runners with and without overuse injury history

What they found

Stride time: mean difference 0.00 s (95% CI -0.01 to 0.01 s), p > 0.05
Contact time: mean difference 0.00 s (95% CI 0.00 to 0.01 s), p > 0.05; based on 12 group comparisons from 517 individuals
Cadence: mean difference 0.3 spm (95% CI -1.8 to 2.4 spm), p > 0.05
Stride length: mean difference 0.00 m (95% CI -0.04 to 0.05 m), p > 0.05; based on 10 group comparisons from 229 individuals
One prospective sub-group finding: injured male runners had a shorter contact time than uninjured males by 24 ms, but this was in a small group (n = 11 injured males)
High school cross-country runners with cadence below 167 spm had greater odds of shin injury than those above 173 spm, but only 11 runners sustained a shin injury in that study

Limitations

Meta-analyses were limited to retrospective studies, so causation cannot be established
High methodological variability across studies in measurement tools, running speeds, and footwear conditions
Injury definitions were inconsistent, ranging from professionally diagnosed conditions to self-reported lifetime injury history
Most studies did not control for potential confounders such as body mass, height, leg length, or running experience; sex-stratified analyses were also lacking

Why it matters

For patients: Runners should not assume that a normal cadence or stride length reading on a fitness tracker means they are injury-free, as these averages do not distinguish injured from uninjured runners.
For clinicians: Temporal spatial averages from wearables provide limited utility for screening overuse injury risk; prospective studies and threshold-based or variability-based analyses are needed before clinical adoption.
For readers: This meta-analysis challenges the assumption that simple gait metrics can flag injury risk, underscoring the multifactorial nature of running overuse injuries and the need for better prospective data.

Source

doi:10.1007/s40279-019-01207-5

Read the original paper