title: Effects of fatigue on kinematics and kinetics during overground running: a systematic review.
abstract: BACKGROUND
  Understanding kinematic and kinetic changes with fatigue during running is important to assess changes that may influence performance and injury. The aim of this systematic review was to identify, critique and summarize literature about the effects of fatigue on kinematics and kinetics during a fatiguing overground run and present the reported influence on performance and injury.
  
  
  METHODS
  An electronic search was conducted of MEDLINE, SPORTDiscus, CINAHL and PubMed databases. Two reviewers assessed articles for inclusion, and evaluated the quality of articles included using a modified version of the Downs and Black Quality Index.
  
  
  RESULTS
  A total of twelve articles were identified for review. The mean quality assessment score was seven out of a possible 12. Kinematic and kinetic changes reported to affect performance included decreased speed, step or stride frequency and length, increased trunk flexion, lower leg position at heel strike, mediolateral acceleration, changes in hip and knee ranges, and decreased stride regularity, heel lift, maximum knee rotation and backward ankle velocity. Alterations reported to increase risk of injury included decreased step frequency, increased upper body rotation and lower leg position at heel strike, and decreased knee flexion during stance. Reduced risk of injury has been linked to decreased step length and hip ranges, and increased trunk flexion.
  
  
  CONCLUSIONS
  This review found limited evidence regarding changes in kinematic and kinetic during a fatiguing run in relation to performance and injury. Higher quality studies are warranted, with a larger sample of homogenous runners, and type of run carefully selected to provide quality information for runners, coaches and clinicians.
authors.affiliation: Department of Physiotherapy, James Cook University, Townsville, Queensland, Australia - sara.winter@jcu.edu.au.
authors.forename: Sara
authors.initials: S
authors.lastname: Winter
authors.affiliation: School of Health Sciences, Flinders University, Bedford Park, Australia.
authors.forename: Susan
authors.initials: S
authors.lastname: Gordon
authors.affiliation: Department of Public Health, James Cook University, Townsville, Australia.
authors.forename: Kerrianne
authors.initials: K
authors.lastname: Watt
mesh_terms: D000054:Acceleration; D000843:Ankle Joint / Q000502:physiology*; D001696:Biomechanical Phenomena / Q000502:physiology; D005221:Fatigue / Q000503:physiopathology*; D005684:Gait / Q000502:physiology; D006801:Humans; D007700:Kinetics; D007719:Knee Joint / Q000502:physiology*; D012420:Running / Q000502:physiology*; D060726:Torso / Q000502:physiology