Bone Stress in Runners with Tibial Stress Fracture

NewsBot · Aug 9, 2015

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Bone Stress in Runners with Tibial Stress Fracture
Stacey A. Meardonl, John D. Willson, Samantha R. Gries, Thomas W. Kernozek, Timothy R. Derrick
Clinical Biomechanics; Article in Press

Highlights
?Bone geometry and internal loads contributes to bone stress
?We examined tibia bone stress in runners with tibia stress fracture
?Runners with stress fracture demonstrated greater stress at common injury sites
?Tibia size & sagittal plane moment predicted bone stress at common injury sites
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Background
Combinations of smaller bone geometry and greater applied loads may contribute to tibial stress fracture. We examined tibial bone stress, accounting for geometry and applied loads, in runners with stress fracture.

Methods
23 runners with a history of tibial stress fracture & 23 matched controls ran over a force platform while 3-D kinematic and kinetic data were collected. An elliptical model of the distal 1/3 tibia cross section was used to estimate stress at 4 locations (anterior, posterior, medial and lateral). Inner and outer radii for the model were obtained from 2 planar x-ray images. Bone stress differences were assessed using two-factor ANOVA (α = 0.05). Key contributors to observed stress differences between groups were examined using stepwise regression.

Findings
Runners with tibial stress fracture experienced greater anterior tension and posterior compression at the distal tibia. Location, but not group, differences in shear stress were observed. Stepwise regression revealed that anterior-posterior outer diameter of the tibia and the sagittal plane bending moment explained >80% of the variance in anterior and posterior bone stress.

Interpretation
Runners with tibial stress fracture displayed greater stress anteriorly and posteriorly at the distal tibia. Elevated tibial stress was associated with smaller bone geometry and greater bending moments about the medial-lateral axis of the tibia. Future research needs to identify key running mechanics associated with the sagittal plane bending moment at the distal tibia as well as to identify ways to improve bone geometry in runners in order to better guide preventative and rehabilitative efforts.
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Kevin Kirby · Aug 10, 2015

I first lectured on this very same idea that medial tibial stress syndrome and medial tibial stress fracture are more likely due to bending of the tibia rather than traction of soft tissue structures on the tibia ten years ago at the 2005 Australian Conference of Science and Medicine in Sport in Melbourne, Australia in October 2005. Here is the lecture slide from my lecture on the etiology and biomechanics of medial tibial stress syndrome and medial tibial stress fracture.

NewsBot · Jun 16, 2021

Peak and Per-Step Tibial Bone Stress During Walking and Running in Female and Male Recreational Runners
Stacey A. Meardon, PT, PhD, Timothy R. Derrick, PhD, John D. Willson, PT, PhD, ...
The American Journal of Sports Medicine June 2, 2021

Background:
Athletes, especially female athletes, experience high rates of tibial bone stress injuries (BSIs). Knowledge of tibial loads during walking and running is needed to understand injury mechanisms and design safe running progression programs.

Purpose:
To examine tibial loads as a function of gait speed in male and female runners.

Study Design:
Controlled laboratory study.

Methods:
Kinematic and kinetic data were collected on 40 recreational runners (20 female, 20 male) during 4 instrumented gait speed conditions on a treadmill (walk, preferred run, slow run, fast run). Musculoskeletal modeling, using participant-specific magnetic resonance imaging and motion data, was used to estimate tibial stress. Peak tibial stress and stress-time impulse were analyzed using 2-factor multivariate analyses of variance (speed*sex) and post hoc comparisons (α = .05). Bone geometry and tibial forces and moments were examined.

Results:
Peak compression was influenced by speed (P < .001); increasing speed generally increased tibial compression in both sexes. Women displayed greater increases in peak tension (P = .001) and shear (P < .001) than men when transitioning from walking to running. Further, women displayed greater peak tibial stress overall (P < .001). Compressive and tensile stress-time impulse varied by speed (P < .001) and sex (P = .006); impulse was lower during running than walking and greater in women. A shear stress-time impulse interaction (P < .001) indicated that women displayed greater impulse relative to men when changing from a walk to a run. Compared with men, women displayed smaller tibiae (P < .001) and disproportionately lower tibial forces (P≤ .001-.035).

Conclusion:
Peak tibial stress increased with gait speed, with a 2-fold increase in running relative to walking. Women displayed greater tibial stress than men and greater increases in stress when shifting from walking to running. Sex differences appear to be the result of smaller bone geometry in women and tibial forces that were not proportionately lower, given the womens’ smaller stature and lower mass relative to men.

Clinical Relevance:
These results may inform interventions to regulate running-related training loads and highlight a need to increase bone strength in women. Lower relative bone strength in women may contribute to a sex bias in tibial BSIs, and female runners may benefit from a slower progression when initiating a running program.
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