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UNASSIGNED: Extracorporeal shockwave therapy (ESWT) is a noninvasive treatment modality that is used in the treatment of chronic Achilles tendinopathy (AT).
UNASSIGNED: To (1) retrospectively assess outcomes after ESWT for both noninsertional AT (NAT) and insertional AT (IAT) at >1-year follow-up and (2) identify potential predictors of outcomes.
UNASSIGNED: Cohort study; Level of evidence, 3.
UNASSIGNED: Chart review was conducted to identify patients who underwent ESWT for AT with a minimum of 1-year follow-up. Data collected and assessed included patient demographic characteristics, pathological characteristics including the location of AT (NAT or IAT), presence of a Haglund deformity, and severity of tendon degeneration on magnetic resonance imaging (MRI), in addition to treatment characteristics including number of sessions and intensity of ESWT. The Victorian Institute of Sports Assessment-Achilles (VISA-A) and visual analog scale (VAS) pain scores were obtained before ESWT, 6 months after ESWT, and at final follow-up. Failures were also recorded, which were defined as no improvement in VISA-A or VAS scores or need for surgical intervention. Linear regression was performed to identify potential predictors of inferior subjective clinical outcomes and failures. Survival analysis was conducted using Kaplan-Meier curves.
UNASSIGNED: The study included 52 patients with IAT and 34 patients with NAT. The mean follow-up in the NAT cohort was 22.3 ± 10.2 months and the mean follow-up in the IAT cohort was 26.8 ± 15.8 months. Improvements in VISA-A and VAS scores were observed in the NAT cohort at 6-month follow-up and at final follow-up (P < .05). Improvements in VISA-A and VAS scores were recorded in the IAT cohort at 6-month follow-up, which subsequently deteriorated at final follow-up. In the NAT cohort, the failure rate at 6-month follow-up was 11.8%, which increased to 29.4% at final follow-up. In the IAT cohort, the failure rate at 6-month follow-up was 32.7%, which increased to 59.6% at final follow-up. Predictors of inferior subjective clinical outcomes and failures in the NAT cohort included pre-ESWT subjective clinical score, male sex, presence of a cardiovascular risk factor, and more severe MRI grading of tendinopathy. Predictors of inferior subjective clinical outcomes and failures in the IAT cohort included pre-ESWT subjective clinical score and more severe MRI grading of tendinopathy.
UNASSIGNED: Superior subjective clinical outcomes together with a lower failure rate were maintained for >1 year in the NAT cohort compared with the IAT cohort, calling into question the long-term benefit of ESWT for patients with IAT.

This study investigated the coactivation of plantar flexor and dorsiflexor muscles and oxygen uptake during running with forefoot and rearfoot strikes at 15 and 19 km/h. We included 16 male runners in this study. The participants ran each foot strike pattern for 5 min at 15 and 19 km/h on a treadmill. During the running, respiratory gas exchange data and surface electromyographic (EMG) activity of the medial gastrocnemius (MG), lateral gastrocnemius (LG), soleus, and tibialis anterior muscles of the right lower limb were continuously recorded. The indices of oxygen uptake, energy expenditure (EE), and muscle activation were calculated during the last 2 min in each condition. During the stance phase of running at 15 and 19 km/h, activation of the tibialis anterior and MG muscles was lower and higher, respectively, with forefoot strike than with rearfoot strike. The foot strike pattern did not influence the oxygen uptake. These results suggest that the foot strike pattern has no clear effect on the oxygen uptake when running at 15 and 19 km/h. However, forefoot strike leads to plantar flexion dominance during co-contraction of the tibialis anterior and MG muscles, which are an antagonist and agonist for plantar flexion, respectively, during the stance phase.

The majority of participants in Ironman triathlon races are age group athletes. We have extensive knowledge about recreational athletes\' training and competition participation. Nonetheless, Ironman age group triathletes must achieve fast race times to qualify for the Ironman World Championship in Hawaii. They can, therefore, benefit from knowing where the fastest Ironman racecourses in the world are. The aim of the present study was to investigate where the fastest Ironman racecourses for age group triathletes are located in the world. Data from 677,702 Ironman age group finishers\' records (544,963 from men and 132,739 from women) originating from 228 countries and participating in 444 events across 66 different Ironman race locations between 2002 and 2022 were analyzed. Data was analyzed through traditional descriptive statistics and with machine learning regression models. Four algorithms were tested (Random Forest Regressor, XG Boost Regressor, Cat Boot Regressor, and Decision Tree Regressor). The models used gender, age group, country of origin, environmental factors (average air and water temperatures), and the event location as independent variables to predict the final overall race time. Despite the majority of successful Ironman age group triathletes originating from the USA (274,553), followed by athletes from the United Kingdom (55,410) and Canada (38,264), these countries exhibited average overall race times that were significantly slower compared to the fastest countries. Most of the triathletes competed in Ironman Wisconsin (38,545), followed by Ironman Florida (38,157) and Ironman Lake Placid (34,341). The fastest overall race times were achieved in Ironman Copenhagen (11.68 ± 1.38 h), followed by Ironman Hawaii (11.72 ± 1.86 h), Ironman Barcelona (11.78 ± 1.43 h), Ironman Florianópolis (11.80 ± 1.52 h), Ironman Frankfurt (12.03 ± 1.38 h) and Ironman Kalmar (12.08 ± 1.47 h). The fastest athletes originated from Belgium (11.48 ± 1.47 h), followed by athletes from Denmark (11.59 ± 1.40 h), Switzerland (11.62 ± 1.49 h), Austria (11.68 ± 1.50), Finland (11.68 ± 1.40 h) and Germany (11.74 ± 15.1 h). Flat running and cycling courses were associated with faster overall race times. Three of the predictive models identified the \'country\' and \'age group\' variables as the most important predictors. Environmental characteristics showed the lowest influence regarding the other variables. The origin of the athlete was the most predictive variable whereas environmental characteristics showed the lowest influence. Flat cycling and flat running courses were associated with faster overall race times. The fastest overall race times were achieved mainly in European races such as Ironman Copenhagen, Ironman Hawaii, Ironman Barcelona, Ironman Florianópolis, Ironman Frankfurt and Ironman Kalmar. The fastest triathletes originated from European countries such as Belgium, Denmark, Switzerland, Austria, Finland, and Germany.

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OBJECTIVE: To study whether, during typical-level running, non-rear-foot strikers (non-RFS) or rear-foot strikers (RFS) presented a similar or different extent of neuromuscular fatigue after a prolonged graded run.
METHODS: Sixteen experienced male trail runners (8 non-RFS and 8 RFS) performed a 2.5-hour treadmill graded running exercise. Before and after exercise, neuromuscular tests were performed to assess neuromuscular fatigue of the plantar flexors. Biomechanical gait parameters were acquired with an instrumented treadmill, and electromyographic activity of the lower-limb muscles was collected as an index of muscle activation.
RESULTS: There were no significant time × foot strike interactions for neuromuscular (all P ≥ .742), muscle activation (all P ≥ .157), or biomechanical (all P ≥ .096) variables.
CONCLUSIONS: A dominant level running foot-strike pattern did not directly affect the extent of neuromuscular fatigue during a prolonged graded run. This suggests that no ideal running foot-strike pattern exists to minimize neuromuscular fatigue during prolonged-duration races wherein cumulative uphill and downhill segments are high, such as in trail running.

OBJECTIVE: This study aimed to evaluate the relationship between peak tibial acceleration and peak ankle joint contact forces in response to stride length manipulation during level-ground running.
METHODS: Twenty-seven physically active participants ran 10 trials at preferred speed in each of 5 stride length conditions: preferred, ±5%, and ±10% of preferred stride length. Motion capture, force platform, and tibial acceleration data were directly measured, and ankle joint contact forces were estimated using an inverse-dynamics-based static optimization routine.
RESULTS: In general, peak axial tibial accelerations (p < 0.001) as well as axial (p < 0.001) and resultant (p < 0.001) ankle joint contact forces increased with stride length. When averaged within the 10 strides of each stride condition, moderate positive correlations were observed between peak axial acceleration and joint contact force (r = 0.49) as well as peak resultant acceleration and joint contact force (r = 0.51). However, 37% of participants illustrated either no relationship or negative correlations. Only weak correlations across participants existed between peak axial acceleration and joint contact force (r = 0.12) as well as peak resultant acceleration and ankle joint contact force (r = 0.18) when examined on a step-by-step basis.
CONCLUSIONS: These results suggest that tibial acceleration should not be used as a surrogate for ankle joint contact force on a step-by-step basis in response to stride length manipulations during level-ground running. A 10-step averaged tibial acceleration metric may be useful for some runners, but an initial laboratory assessment would be required to identify these individuals.

UNASSIGNED: The aim of this study was to determine the incidence and nature (severity and type by organ system and specific diagnosis) of all medical encounters (MEs), including serious/life-threatening MEs (SLMEs) during a South African road marathon.
UNASSIGNED: This descriptive study was a retrospective analysis of data collected over 6 years at the Cape Town Marathon from 2014 to 2019, which included 40 446 starters. All MEs were collected and described as per the consensus statement for mass community-based sporting events. Incidences (I; per 1000 starters; 95% CI) are described for all MEs, SLMEs, and by organ system and specific diagnosis.
UNASSIGNED: The incidence of all MEs was 8.7 (95% CI: 7.8-9.6) per 1000 starters. The largest contributor to all MEs, by organ system affected, was cardiovascular-related, with an incidence of 1.8 (95% CI: 1.4-2.2), where exercise-associated postural hypotension was the most common specific diagnosis (I = 1.3; 95% CI: 1.0-1.7). The incidence of all SLMEs was 1.0 (95% CI: 0.7-1.4) making up 11.7% (41/350) of all MEs. The incidence of SLMEs by organ system was highest in the cardiovascular system (I = 0.4; 95% CI: 0.3-0.7), with acute coronary syndrome (ACS) (I = 0.2; 95% CI: 0.1-0.4) the most common specific diagnosis. There were no sudden cardiac deaths (SCD) nor sudden cardiac arrests (SCA).
UNASSIGNED: There was a high proportion of cardiovascular-related medical encounters, as well as SLMEs. We recommend that event organizers and race medical directors investigate prevention strategies to mitigate against risk of SLMEs, specifically acute cardiovascular SLMEs.