High school cross country runners have a high incidence of overuse injury, particularly at the shin and knee. An increased step rate during running has been shown to reduce impact forces and loading of the lower extremity joints. While step rate manipulation is presently used in the treatment of running injury, there has been no prospective evidence reported on the risk relationship between step rate and injury. The primary purpose of this prospective study was to examine step rate as a risk factor for shin injury and anterior knee pain (AKP) occurrence in high school cross country runners. Secondary aims were to determine 1) if a relationship existed between isometric hip abductor, knee extensor and flexor strength and the incidence of shin injury and AKP; and 2) if running experience, selected anthropometric factors, muscle strength, and prior injury were related with preferred step rate. We hypothesized that 1) runners with lower step rates would have a higher incidence of shin injury and AKP, and 3) runners with more running experience, shorter leg length or greater hamstring strength would demonstrate higher step rates.
