The Runners and Injury Longitudinal Study: Update

TRAILS: Meet Dr. Stephen Messier

We posted recently about our visit to Wake Forest University for participation in the TRAILS study.

Running Shorts interviewed Messier (above), professor and director of Wake's J.B Snow Biomechanics Laboratory, this week by phone. More from that in just a minute.

First, the background on TRAILS:

Researchers at Wake Forest, led by Dr. Stephen Messier, are using a $600,000 grant from the U.S. Army to try to determine the difference between runners who become injured and those who stay injury-free. The Runners and Injury Longitudinal Study, or TRAILS, is considering biomechanical, behavioral and physiological risk factors for injury.

According to the university, running injuries are important to the U.S. Army because medical disability discharge rates have increased more than 600 percent in 25 years. Many of those discharges are caused by knee pain and other running-related injuries, such as medial tibial stress syndrome (shin splints), plantar fasciitis, Achilles tendinitis and iliotibial band friction syndrome.

Selections from our interview with Messier:

RS: Can you give an update on where the study stands right now?

SM: Fifty-one runners have been accepted in the study, and about 200 remain on the waiting list. We take them in as fast as we can test them. The limiting factor is the testing that we have to do. We can only do so many a week. The goal is to get around 200 in the end. We'd like to follow them for at least a year. The expectation is that a good percentage of them will become injured during that time. Our study is a prospective study testing people who are not injured, therefore not compensating for their injury, so that we get a pure analysis without any compensation involved. ...

The whole idea there is to narrow down the number of potential risk factors to a meaningful number in which we can then perform a clinical trial, where we would intervene on someone before an injury because they have this risk factor. ... It's like someone who excessively pronates, we would take half of them and intervene so that they are no longer excessively pronating, either by changing the shoe or something we put in the shoe, like an orthotic, compared to the people in the control group, where we'd just let them wear the shoes they normally wear...."

RS: Based on your running knowledge and experience, what expectations do you have about what you’ll discover in this research?

SM: Based on our studies that we've done before, which are retrospective, we've tested people who have already been injured vs. non-injured runners. That’s not as clean of a test. Based on those, we definitely have a number of things we think. No. 1 is strength. Injured runners are weaker than non-injured runners. Strength could be a big factor. It would be a very nice one to do a clinical trial; there’s an obvious intervention there.

RS: You’re testing running gait, flexibility and knee and ankle strength. Can you talk about why those are important to what you’re studying?

SM: Some of them we test because we've seen differences between injured and non-injured runners in previous studies, so we think they may be risk factors. Flexibility, simply because it's such a popular thing and we need to know more about it. But to this date, flexibility has not been shown to be a risk factor, which drives our physical therapist crazy. It could be that we are not testing it properly. It could be that to ask questions about stretching habits on a questionnaire would be so detailed ... that it would be virtually impossible to get what you want. The quality of stretching, exactly what you do, those things are so important to stretching that it would take an incredible amount of time on a questionnaire. Either it's not important for an injury or if it is, we haven’t done a really good job of trying to document that.

RS: How will you expect your findings to be used by the U.S. Army?

SM: We've got two years of funding now, and we're hoping for a third year from the Army. We've had such success in recruiting, we'd hate not to get all those people in the study. Then once they get in, we want them to stay in for a year.

We asked when developing the study, 'Do you want us to have a group of Army recruits in it?' They said no, just do it with normal civilian people. Then with that we can apply it to the Army. The number of people who have dropped out of the Army due to injuries like this over the last 25 years has increased by 600 percent. The No. 1 reason is knee pain.

Getting the people from the Army into this while they're going into training would scientifically be a challenge because they're doing so many other physical activities that involve running. ... We'll do it like this, take this information and translate it into the Army. It’s a cleaner study.

RS: The Wake Forest Runners’ Clinic has existed since 1988. Can you talk about some of the findings of other significant Wake Forest research regarding runners?

SM: One of the frustrating things is most people think knee pain and running are due to excessive amounts of pronation. All kinds of mechanics are susceptible, it makes all the sense in the world. It's frustrating but we have not linked excessive pronation to knee pain. It has been linked to shin splints, to Achilles tendonitis. ... One of the most common injuries was plantar fasciitis, which was second only to knee pain. That was surprising to us. We think our data would suggest underpronation may be a problem with plantar fasciitis. Pronation is a good and necessary thing because it absorbs the shock and impact at heel strike. There's a very narrow window in which you can have normal amounts of pronation. If you go outside of that window either way, too much or too little, you may encounter injury. The plantar fasciitis idea is if I tell you to get on top of a desk, and jump off the desk but don’t bend your knees, you'd tell me to go take a hike. All that force goes straight up into the lower extremities. (Running is) a series of collisions with the ground, and when you hit the ground, you give with the ground. With plantar fasciitis, when people tend to underpronate, not giving enough, the first thing there is the plantar fascia, the first soft tissue that the force is going to encounter.

RS: For me, the participant, what sort of evaluation will you be able to offer?

SM: The thing people want to know is one, what am I doing wrong, and two, can you make me run faster. There are two lines of research in running: Injury prevention, and the other is performance. As far as perfomance, I don’t care how slow you run. All I care is that you can run for the rest of your life. ...

After the study is done we hope to invite people back and say, 'These are the results, thanks for being part of the study,' and hopefully be able to give each participant some information about themselves. But you can imagine with 200 people, to give all the information that we tested you on would be a big job by itself. We'll try to give some key pieces of information to each of the runners.

RS: Can you talk about your own running game these days?

SM: 52 miles a week.

RS: What types of competitive races do you enter most often? How many times have you run the Boston Marathon?

SM: I've run the Boston Marathon twice, done 10 marathons. My last one was a year ago November in Richmond. I was turning 60, and I wanted to see where I was. The good news was I ran really well. The bad news was about two months later I had a hamstring problem.I had thought I was at the top of the world (after the race). After the marathon, I went back to my buddy's house in Midlothian and went for a 5-mile walk on the golf course.

RS: Where is your favorite place to run in Winston-Salem and why?

SM: Right here. I feel so fortunate being at Wake Forest University. It's a great institution, and it's a wonderful place to run. ... I've been known for doing the same route every day.

RS: Do you belong to a regular running group?

SM: The last 20 years, we've had a group every Sunday morning, a group of four of us that run at 6 o’clock in the morning and run the same 10-mile run. If we're going to do 20, we'll do the same 10-mile route twice. I've got an eight-mile route during the week. And a 10- to 12-mile route during the weekends.