Introduction

The half marathon has gained popularity worldwide due to its accessibility, community involvement, and associated health benefits1. However, half marathon runners face a range of possible injuries stemming from the sport’s repetitive, high-impact nature2. Among them, the incidence of lower limb injuries was the highest, ranging from 18.2 to 92.4%3,4. Videbæk et.al found that hip injuries were among the most frequently reported by half marathon runners, with an incidence of 8.4 injuries per 1000 h of running5. Recently, Mohseni et.al found that hip injuries accounted for 17% in half-marathon runners6. Soft tissue injuries, such as strains and tears of the hip muscles and tendons, are the most common type of hip injury in runners7. At present, hip injury prevention research mainly focuses on ballet, outdoor sports, and football8,9,10. Few studies have proposed effective measures to reduce hip injuries in marathon runners. Given this, exploring the mechanism and the related preventive intervention for the hip injuries in marathon runners is crucial for maintaining their physical health.

Proprioception refers to the ability to perceive the position and movement of the body in space, while dynamic balance refers to the ability to maintain stability while in motion11. Hip proprioception and dynamic balance are essential components of efficient and injury-free half marathon running. The hip joint requires adequate proprioception and dynamic balance to maintain stability during the high loads and repetitive motions of running. Impaired hip proprioception and dynamic balance have been linked to an increased risk of hip injuries12,13. Specifically, runners need a strong and steady boost of propulsion to move into the next stride during a run. At this point, continuous and repetitive hip extension informed by good proprioception plays an important role in keeping dynamic balance during marathon. Decreased proprioception at the hip joint can lead to compromised neuromuscular control of the lower extremity. Willson et al. demonstrated that runners with > 4° hip joint position sense error had 2.3-fold higher patellofemoral pain risk14. Recently, Wang et al. quantified acute post-marathon hip proprioceptive deficits lasting 48 h and found that each 1° increment in position sense error was associated with an increased patellofemoral contact pressure of 18%15. Therefore, the first aim in this study was to explore whether reduced hip proprioception is observed after a half-marathon.

Further, it is important to investigate interventions that may improve hip extension proprioception and dynamic balance and subsequently reduce the incidence of hip injuries in half marathon runners. At present, joint stabilizers are commonly used in clinical management and sports as rehabilitation, prevention and performance enhancement, involving interventions such as taping, compression garments, and braces. These are used mainly because of their proprioceptive enhancement effects, which are due to the increase of sensory input from skin mechanoreceptors16,17,18,19. Compression garments (CG) have seen widespread adoption across different sports in recent years. Recent research by Chang et al. demonstrated that CG effectively preserved knee and ankle proprioception in the later stages of the half-marathon20,21. Moreover, the additional sensory input from cutaneous receptors provided by CG may also improve motor control, such as with balance19,22. Nevertheless, limited research has explored the impact of CG on hip proprioception and dynamic balance in half marathon runners. This area of study could offer valuable insights into the potential role of CG in preventing hip injuries during endurance running.

Hence, this study aims to determine whether wearing compression pants would influent hip proprioception and dynamic balance during the different stages of a 21-km distance run on a treadmill. We hypothesized that (1) hip proprioception decreases with increasing running distance; (2) compression pants could maintain hip proprioception and dynamic balance scores during 21-km treadmill running.

Methods

Participants

Using G*Power’s(version3.1.9.3) F-tests (ANOVA: repeated measures, within factors) with α = 0.05, power = 0.8, and effect size f = 0.3(Based on similar previous studies, the desired study power was set to 0.8 and the effect size to 0.320,21,23), 18 participants were required. Eighteen amateur runners (9 male/9 female: mean ± SD: age(y)36.8 ± 10.4, height(cm)169.3 ± 10.3, weight(kg)60 ± 9.8, week volume(km)44.17 ± 16.27) volunteered for this study, as detailed in Table 1. Each participant provided informed consent. The study’s testing procedure received approval from the Shanghai University of Sport’s committee (102772020RT069). All methods were performed in accordance with the relevant guidelines and regulations. All participants had experience running on a treadmill and were able to run continuously for 21 km. None of whom had ever worn compression pants, confirmed that they had maintained regular training routines over the past 6 months and had not suffered any lower limb injuries during that time. Individuals with neuromuscular disorders, a history of cardiovascular diseases, any recent lower limb trauma, or who had taken various medications in the past were excluded from the study.

Table 1 Characteristics of the participants (N = 18): Mean values with standard deviation.
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Experimental design

The research involved two indoor running tests carried out on a treadmill at 16 °C to ensure temperature consistency as in the previous studies20. During the two tests, all the participants ran at 8 o’clock in the morning and were required to run 21 km in self-determined speeds while wearing either compression pants or normal shorts, with a break of one week between the two trials. Participants used their personal running shoes, with the same pair worn for both trials to control for footwear effects. This 21 km distance was broken down into three segments of 7 km (Fig. 1). Measurements were taken immediately after each 7 km segment, with a standardized 5-min break for assessment procedures before continuing24. The order of the tests was determined randomly using Python 3.11.9 (https://www.python.org/, USA). The durations of the two runs were comparable (Table 2). Before beginning and after every 7 km interval, measures of heart rate (HR), Rating of Perceived Exertion (RPE), blood lactate, hip extension proprioception, and dynamic balance of the participants were taken. In this study, a single-blind design was implemented to minimize biases and enhance result reliability.

Fig. 1
Fig. 1The alternative text for this image may have been generated using AI.
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Workflow diagram.

Table 2 Average completion times for Each 7 km Segment in compression pants and normal shorts-Mean (standard deviation).
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Garment

Participants wore compression pants which are standard compression running pants covering from the ankle up to the waist, made of 88% polyester and 12% spandex. As a control, participants were also provided with Normal Running Shorts that exerted no pressure. Clothing sizes were determined based on the manufacturer’s guidelines.

Measurements

Participants made their RPE using the Borg 6–20 scale25. HR was tracked in real-time with the Polar H10 device, while blood lactate levels were determined using the Lactate Scout4 instrument. Hip extension proprioception was evaluated through the active movement extent discrimination apparatus (AMEDA)26,27. The Star Excursion Balance Test (SEBT) was employed to assess dynamic balance. The dominant hip’s proprioception and dynamic balance were examined, with dominance determination based on the Waterloo Footedness Questionnaire28.

Hip proprioception

The Hip AMEDA comprises three components: a standing platform, a horizontal bar positioned 20 cm positioned above to the platform, and a movable disc with a 10 cm radius (Fig. 2). The standing platform features a 5 cm deep rectangular groove at its center. During testing, participants placed their testing leg into this groove, with the foot oriented towards the movable wooden disc. The disc’s height was adjusted to align with the participant’s Achilles tendon, with the distance from the Achilles tendon varied by setting the disc to one of four positions: 11 cm (Position 1), 12 cm (Position 2), 13 cm (Position 3), and 14 cm (Position 4). During the test, participants were instructed to face forward and extend their hip from initial position (where the upper forefoot of the non-testing foot is in contact with the horizontal bar, as indicated by a in Fig. 2), until their Achilles tendon contacts the disc (b in Fig. 2), then revert to the initial position.

Fig. 2
Fig. 2The alternative text for this image may have been generated using AI.
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Hip proprioception evaluated using the hip AMEDA. a. Initial position. b. Final position on the adjustable contact plate.

Before commencing the actual test, participants were first familiarized with the four positions by experiencing each (1, 2, 3, and 4) in sequence, repeated over three rounds. During the actual test, the four positions were presented randomly, 10 times each, and the participants were asked to make an absolute judgment about which position they perceived each time.

Dynamic balance

The SEBT has been proved to be an effective and reliable measurement method29,30. Before the test, the participants were asked to put their hands on their waist, and they were asked to practice 3 times in the 8 directions. After a 5 min rest, the test was performed. Participants were instructed to stand at the center of the SEBT diagram, using their dominant foot as the support during the test. The non-supporting foot was extended in eight directions as far as possible, and each time before moving to the next direction, they were required to move their foot back to the center and stand on one foot. If the non-supporting foot touches the ground during the test, it will be considered a failure and the test needs to be repeated. Procedure is to record the value achieved in each direction, repeat the test 3 times, and calculate the average value. To account for the effect of lower limb length, the composite value was finally recorded. The following equation shows the calculation method for obtaining the composite value (Fig. 3).

Fig. 3
Fig. 3The alternative text for this image may have been generated using AI.
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SEBT test.

$$Composite value=\frac{L1+L2+L3+L4+L5+L6+L7+L8}{lower limb length}*100$$

L was defined as the maximum distance achieved by the non-supported foot in each direction.

Data analysis

The data collected were processed using IBM SPSS V.25.0(IBM corp., https://www.ibm.com/products/spss-statistics, USA), with a significance threshold of 0.05. The acuity of hip extension proprioception was indicated by the average Area Under the Receiver Operating Characteristic Curve (AUC) score across consecutive positions, where AUC refers to the Area Under the Receiver Operating Characteristic Curve (ROC). This illustrates an individual’s sensitivity to proprioceptive discrimination across the four distinct hip extension extents31. The AUC metric varies from 0.5 to 1.0, where the lower value signifies random responding and the upper value indicates flawless discrimination.

To assess the influence of compression pants at varying running phases on hip extension proprioception and dynamic balance, along with measures in blood lactate levels, HR and RPE, a two-way repeated measures ANOVA was employed. The repeated factors included Garment Type, featuring compression pants and normal shorts, and running distance, with levels 0 km, 7 km, 14 km, and 21 km. For the running distance factor, a polynomial trend examination was conducted, providing tests for linear, quadratic, and cubic components regarding the measures across running distance32. The ANOVA produced F-tests for Garment Type. To examine differences between the testing conditions, paired sample t-tests were conducted.

Results

During the two running trials with different garments, participants ran at their own pace. The results showed comparable running times for compression pants and normal shorts, averaging 117.8 ± 12.3 min and 116.9 ± 12.1 min, respectively (p = 0.26, 95%CI = − 0.774, 2.663) (Table 2). All ANOVA assumptions were verified: Shapiro–Wilk tests confirmed normality (all p > 0.05), Mauchly’s tests indicated sphericity was met (p > 0.05), and Levene’s tests showed homogeneity of variance. Statistical tests indicated no significant differences between compression pants and normal shorts in terms of RPE (F1,17 = 1.240, p = 0.28), heart rate (F1,17 = 0.046, p = 0.83), or blood lactate levels (F1,17 = 0.008, p = 0.93). Trend analysis highlighted a significant linear increase in heart rate (F1,17 = 1494.991, p < 0.01) and RPE (F1,17 = 132.936, p < 0.01) as running distance increased, indicating a comparable trend in fatigue levels and exercise intensity for both garments (Fig. 4 a & b). These findings indicated that there was the same increasing fatigue in the running trials with the two garment conditions.

Fig. 4
Fig. 4The alternative text for this image may have been generated using AI.
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RPE, heart rate, hip extension proprioception and SEBT scores at different running distances (compression pants vs normal shorts). AUC, Area Under the ROC.

No significant interactions were observed between garment condition and running distance regarding hip proprioception AUC scores and dynamic balance SEBT scores (F = 1.692, p = 0.19; F = 1.293, p = 0.29). Using repeated measures ANOVA, with garment condition as the main effect, there was no significant difference observed in hip proprioception and SEBT scores between running with compression pants or normal shorts (F = 1.677, p = 0.21 and F = 0.094, p = 0.76). In contrast, hip extension proprioception AUC scores showed a significant linear decline (F1,17 = 8.862, p = 0.01), but there was no linear effect in SEBT scores (F1,17 = 4.048, p = 0.06) (Fig. 4c, d).

Paired samples t-tests with Bonferroni correction were performed to identify the impact of compression pants on hip proprioception across the different running stages. The results showed a significant decrease in hip proprioception AUC values in the normal shorts condition after running 14 km compared to pre-run values (p = 0.03, Cohen’s d = 0.65), while hip proprioception was held equivalent to baseline in the compression pants condition (p = 0.93, Cohen’s = − 0.04) (Table 3). This suggests that within 14 km, compression pants can effectively maintain hip extension proprioception.

Table 3 Differences in hip proprioception AUC values between different distances in two conditions.
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Discussion

This study was the first to investigate the effects of compression pants on hip proprioception and dynamic balance in different running stages of the half marathon. The major results revealed hip proprioception decreased with increased running distance, and that compression pants can maintain hip proprioception level without decline due of fatigue within 14 km, but that wearing compression pants could not affect dynamic balance during half marathon.

The results of this study indicate a significant decline in hip extension proprioception as the running distance increases. The marathon is an endurance sport which could lead to central and peripheral fatigue33. The observed decline in proprioception during prolonged endurance activity can be attributed to several underlying mechanisms. One plausible explanation is the progressive muscular fatigue experienced during long-distance running. Fatigue affects the muscle spindles and Golgi tendon organs, which are crucial for proprioceptive feedback34. As muscles fatigue, their ability to generate accurate proprioceptive signals diminishes, leading to decreased proprioceptive acuity35. Another contributing factor is central nervous system (CNS) fatigue. Endurance exercise places substantial demands on the CNS, which can impair the integration and processing of sensory information, including proprioceptive input36. CNS fatigue not only affects the motor pathways but also the sensory pathways, thereby compromising overall proprioceptive function37.

This study showed that within 14 km, compression pants can effectively maintain hip extension proprioception without decline. This result is consistent with previous studies and supports the effectiveness of compression clothing in providing additional mechanical support and sensory feedback38. Compression pants may help runners maintain hip proprioception by reducing muscle vibration, increasing blood flow, and providing better sensory feedback39. However, when running more than 14 km, the compression effect of the pants may be offset by the gradually accumulation of muscle fatigue. The importance of this study is that it reveals the protective effect of compression pants within a specific running distance. For long-distance runner, this means that running in competition or training within the first 14 km in compression pants may help maintain hip joint proprioception, thus improving running efficiency and reducing the risk of injury. However, for longer runs, additional strategies may be needed to cope with fatigue-induced declines in sensory feedback.

In addition, the study found that compression pants had no positive effect on dynamic balance in runners running half marathon distances on a treadmill. Jaakkola et.al explored the effects of socks with different compression degrees on the static and dynamic balance ability of healthy people, and found that compression socks did not improve the static and dynamic balance ability of participants40. On the other hand, Sun et.al demonstrated that the sensory enhancement from compression garments improved balance38. After analysis, sensorimotor control and muscle strength may affect SEBT performance and affect the effectiveness of compression garments41. Meanwhile, Baige et.al found that compression garments had no significant effect on balance control, but subgroup analysis showed that participants with poor balance could benefit from wearing compression garments42. So wearing compression garments during sports can be considered a potential preventive measure for individuals at risk of injury due to poor balance43.

Implications

  1. (1)

    Based on the results of the present study, the effects of hip proprioception reduction on different sports injuries and injury rates should be further explored. The recovery of proprioception after a marathon is also worth exploring, to provide guidance for the interval between marathons.

  2. (2)

    This study showed that Compression pants had effects on hip proprioception within 14 km of running, which suggests that future studies can explore the different effects of different types (specific pressure applied by garments, compression pants material, etc.) of compression pants on hip proprioception.

Clinical implication

  1. (1)

    The observed decline in hip proprioception underscores the need for targeted interventions to mitigate this effect. Strengthening and proprioceptive training could be incorporated into runners’ routines, to enhance hip joint stability and proprioception, potentially reducing injury risk.

  2. (2)

    Given that compression pants can effectively maintain hip extension proprioception without decline within 14 km of running, the use compression pants to maintain hip proprioception is recommended if the running distance is not more than 14 km.

Study limitations

First, to minimize the impact of environmental temperature, participants were required to run a half marathon on an indoor treadmill, and it is not known what would occur if researchers were to fully replicate sports performance during a half marathon competition. Second, the compression pants in this study went below the knee, which could cause the hip joint to be unable to compress independently and be affected by knee joint compression. While participants completed all trials in a temperature-controlled lab, nutritional status were not controlled. Future studies should standardize this factor to better isolate garment effects. There are also limitations due to the lack of comparison between brands, and the existence of time intervals between each test, which may affect the generalizability of the results.

Conclusion

Compression pants did not influence dynamic balance during an intermittent 21 km run. However, within 14 km of running distance, hip proprioception wearing normal shorts dropped significantly, while in compression pants, hip proprioception was more stable. Therefore, compression pants may be used when running distance less than 14 km to maintain hip proprioception. In the future, it would be worthwhile to further explore whether different compression degrees or different types of compression pants have different effects on hip proprioception in runners. Compression pants preserve hip proprioception during segmented running with cumulative fatigue loading.