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Risk factors for stress fractures

Discussion in 'Biomechanics, Sports and Foot orthoses' started by NewsBot, Apr 12, 2013.

  1. NewsBot

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    Identifying Sex-Specific Risk Factors for Stress Fractures in Adolescent Runners
    Tenforde, Adam S.; Sayres, Lauren C.; Liz McCurdy, Mary; Sainani, Kristin L.; Fredericson, Michael
    Medicine & Science in Sports & Exercise: 11 April 2013
     
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    Landing Error Scoring System (LESS) Items are Associated with the Incidence Rate of Lower Extremity Stress Fracture
    Kenneth L. Cameron et al
    Orthopaedic Journal of Sports Medicine July 2014 2:
     
  4. NewsBot

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    RANK/RANKL/OPG pathway: Genetic associations with stress fracture period prevalence in elite athletes
    Ian Varley et al
    Bone Volume 71, February 2015, Pages 131–136
    .
     
  5. NewsBot

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    Epidemiology of Stress Fracture Injuries Among US High School Athletes, 2005-2006 Through 2012-2013
    Bradley G. Changstrom, MD, Lina Brou, MPH, Morteza Khodaee, MD, MPH, Cortney Braund, MD and R. Dawn Comstock, PhD
    Am J Sports Med December 5, 2014
     
  6. NewsBot

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    Lower extremity overuse bone injury risk factors in collegiate athletes: a pilot study.
    Reinking MF, Austin TM, Bennett J, Hayes AM, Mitchell WA
    Int J Sports Phys Ther. 2015 Apr;10(2):155-67.
     
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    Stress fracture injury in female endurance athletes in the United Kingdom: A 12-month prospective study
    R. L Duckham et al
    Scandinavian Journal of Medicine & Science in Sports; Early View
     
  8. NewsBot

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    Risk factors associated with lower extremity stress fractures in runners: a systematic review with meta-analysis
    Alexis A Wright, Jeffrey B Taylor, Kevin R Ford, Lindsey Siska, James M Smoliga
    Br J Sports Med doi:10.1136/bjsports-2015-094828
     
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    Mechanical Risk Factors for Stress Fracture in Elite Runners
    Kenneth Hunt et al
    Orthopaedic Journal of Sports Medicine July 2016 vol. 4 no. 7 suppl4
     
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    Bone strength estimates relative to vertical ground reaction force discriminates women runners with stress fracture history
    Kristin L. Popp, William McDermott, Julie M. Hughes, Stephanie A. Baxter, Steven D. Stovitz, Moira A. Petit
    Bone; January 2017Volume 94, Pages 22–28
     
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    PUBLIC RELEASE: 12-JUN-2017
    Study: Underweight female runners more likely to get stress fractures
    Doctors find women with lower BMIs are at a higher risk of injury, take longer to heal

    Carrying less weight may make female runners faster, but a new study from The Ohio State University Wexner Medical Center shows it may also put them at a higher risk for injuries.

    Published in Current Orthopaedic Practice, the study found that female runners who have a body mass index (BMI) of less than 19 are at a higher risk of developing stress fractures than women with a BMI of 19 or higher. It also found that lighter women who suffered stress fractures took longer to recover from them than other runners.

    "We found that over time, we were able to identify the factors that put female runners at an increased risk of developing a stress fracture," said Dr. Timothy Miller, assistant professor of clinical orthopaedic surgery and sports medicine. "One of the most important factors we identified was low body weight, or low body mass index."

    Miller said runners endure repetitive pounding on hard surfaces and, without enough lean muscle mass for dissipation of impact forces, the bones of the legs are vulnerable.

    "When body mass index is very low and muscle mass is depleted, there is nowhere for the shock of running to be absorbed other than directly into the bones. Until some muscle mass is developed and BMI is optimized, runners remain at increased risk of developing a stress fracture," Miller said.

    For three years, Miller and his team looked at injuries in dozens of Division I college athletes using the Kaeding-Miller classification system, which he developed with another sports medicine expert at Ohio State. This system is unique in that it characterizes injuries on a scale of 1 to 5, taking into consideration not only the patient's symptoms, but also x-ray results, bone scan and computed tomography (CT) images, and magnetic resonance imaging (MRI) findings.

    Among those with grade 5 stress fractures - the most severe - the research team found that women whose BMI was 19 or higher took about 13 weeks to recover. Those with a low BMI (below 19), took more than 17 weeks to recover and return to running - a full month longer.

    Studies show that between 25 and 50 percent of track athletes have at least one stress fracture in their career, with an increased incidence in female track athletes.

    "It's imperative that women know their BMI and work to maintain a healthy level. They should also include resistance training in their training regimen to strengthen the lower leg to prevent injury, even if that means adding weight from additional muscle mass," Miller said.

    According to the Centers for Disease Control and Prevention, the body mass index for an average woman is 26. Miller suggests female athletes maintain a body mass index of 20-24.
     
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    Development of a Prediction Model for Stress Fracture During an Intensive Physical Training Program: The Royal Marines Commandos.
    Sanchez-Santos M et al
    Orthop J Sports Med. 2017 Jul 25;5(7):23259671177163.
     
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    The Epidemiology of Stress Fractures in Collegiate Student-Athletes, 2004–2005 Through 2013–2014 Academic Years.
    Katherine H. Rizzone, Kathryn E. Ackerman, Karen G. Roos, Thomas P. Dompier, and Zachary Y. Kerr
    Journal of Athletic Training: October 2017, Vol. 52, No. 10, pp. 966-975.
     
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    Biomechanical Model for Stress Fracture–related Factors in Athletes and Soldiers
    Hadid, Amir et al
    Medicine & Science in Sports & Exercise: April 2, 2018 - Volume Publish Ahead of Print - Issue - p
     
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    The Role of Athletic Identity in the Etiology of Stress Fractures in Collegiate Runners
    Leah Mae Reeder, Cedarville UniversityFollow
    Kurt D. Beachy, Cedarville UniversityFollow
    Source
     
  16. NewsBot

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    Association between stress fracture incidence and predicted body fat in United States Army Basic Combat Training recruits
    Joseph J. Knapik, Marilyn A. Sharp and Scott J. Montain
    BMC Musculoskeletal Disorders: 22 May 2018
     
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    Prospective study of biomechanical risk factors for second and third metatarsal stress fractures in military recruits.
    Dixon S et al
    J Sci Med Sport. 2018 Jul 26.
     
  18. NewsBot

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    Risk factors of stress fractures due to the female athlete triad: Differences in teens and twenties
    Sayaka Nose‐Ogura Osamu Yoshino Michiko Dohi Mika Kigawa Miyuki Harada Osamu Hiraike Takashi Onda Yutaka Osuga Tomoyuki Fujii Shigeru Saito
    SJSM: 17 May 2019
     
  19. NewsBot

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    Articles:
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    Risk factors of stress fractures due to the female athlete triad: Differences in teens and twenties
    Sayaka Nose‐Ogura Osamu Yoshino Michiko Dohi Mika Kigawa Miyuki Harada Osamu Hiraike Takashi Onda Yutaka Osuga Tomoyuki Fujii Shigeru Saito
    17 May 2019
     
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    Perceptions of risk for stress fractures: A qualitative study of female runners with and without stress fracture histories
    Therese E.Johnston et al
    Physical Therapy in Sport; 4 March 2020
     
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    Bilateral calcaneal insufficiency fractures due to chronic carbamazepine use for trigeminal neuralgia: A case report.
    Kaya O et al
    Niger J Clin Pract. 2020 Apr;23(4):574-576
     
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    Press Release:
    Causes of Higher Risk of Stress Fractures in Female Runners
    A pair of new studies identify overlooked physiological factors and lack of knowledge around wellness as contributors to risk of stress fracture in women who run.


    PHILADELPHIA – Running is one of the most popular forms of exercise, enjoyed by a broad range of age groups and skill levels. More women are running recreationally compared to men; specifically 54% of runners are female as indicated by a 2018 National Runner Survey. Women, however, are at least twice as likely as men to develop stress fractures, an injury that impacts around 20% of runners. However, information is still lacking on how to best prevent and treat stress fractures in women. New pilot research from Jefferson suggests physiological factors that could be included in routine screening for stress fracture risk, as well as changes in training approach to aid in prevention.

    The researchers examined physiological differences that might contribute to increased risk of stress fractures in a study published in Sports Health and also surveyed women’s perception of risk and behaviors that contribute to stress fractures in a separate study published in Physical Therapy in Sport.

    “Most of the literature focuses on elite runners or athletes,” says Therese Johnston, PT, PhD, MBA, Professor in the Department of Physical Therapy and first author of both studies. “It was important for us to capture the regular or average female runner in these studies, and the main goal was to see how we can prevent a first or subsequent fracture.”

    Both studies surveyed the same group of 40 female recreational runners, age 18-65 years. 20 women had a history of running-related stress fractures, and they were matched according to age and running abilities with 20 women with no history of stress fractures. The two studies aimed to assess what contributed to risk of stress fractures, from the physiological, such as - bone structure and density, muscle mass, hormonal status, to ones influenced by training routine, such as training intensity, nutrition, insufficient strengthening, and ignoring pain.

    “This mixed methods approach provides a richer context and a more detailed picture of the practices and risks that contribute to stress fractures in every-day women runners,” says Jeremy Close, MD, associate professor in family and sports medicine and one of the lead authors on the research. “It also tells us how perceived risk informs physiological risk.”

    For the study focused on physiological factors, the subjects underwent a comprehensive blood panel that examined levels of hormones like estradiol and testosterone, vitamins and minerals important for bone health such as vitamin D and calcium, and bone markers. They also underwent dual energy x-ray absorptiometry (DXA) to test for bone mineral density. The researchers found that while there was no difference in estradiol hormone levels between the two groups, women who had a stress fracture history reported menstrual changes or irregular periods as a result of their training, or during peak training times. The blood panel also examined markers for bone formation and resorption, and pointed to increased bone turnover in the group of women with stress fractures. They also found through the DXA testing that women with a history of stress fractures had lower hip bone mineral density compared to women with no history of stress fractures, indicating decreased bone strength that could increase risk of injury.

    “DXA for bone density and blood testing for bone markers are not routinely performed in this population – they are usually reserved for post-menopausal women – so we may be missing important clinical indicators for stress fractures in these women,” says Dr. Johnston. “While the link between menstrual changes and bone strength is unclear, our findings also indicate that asking female runners about any menstrual irregularities during heavier training times is important during routine screening.”

    For the study investigating women’s self-perception of risk, interviews were conducted with the goals of finding out which factors women thought were associated with stress fractures or maintaining bone health while running. Several themes emerged from these interviews. Specifically, compared to women without stress fractures, women with histories of stress fractures had increased their training load more quickly. Also, while they knew of the importance of nutrition and strengthening exercises, women with a history of stress fracture more often reported not having or making the time for a balanced diet and proper cross-training to complement their running regimen.

    Finally, women in this group reported pushing through the pain and running despite an injury more often than those without stress fracture. “In the interviews, it sounded like these women had trouble knowing which pain was normal, and which pain was abnormal. They also reported not always receiving appropriate guidance from healthcare providers on how to progress running safely,” says Dr. Johnston.

    “It is clear that there needs to be more guidance from healthcare providers for woman runners on how to prevent stress fractures” says Dr. Close. “It can be very frustrating for these women who are on a path to wellness, but are impeded by an injury that can take several months to heal. If they don’t have the proper guidance on how to return to running safely, they risk a second injury.”

    “We hope that our findings will encourage more thorough and routine screening in women runners for bone density and strength,” says Dr. Johnston, “as well as a comprehensive education plan on how to balance running with cross-training, and how to interpret pain cues from the body, to help women differentiate between normal aches and pains and indicators of a serious injury.”

    Dr. Johnston plans to continue this research by studying women with acute stress fractures as they start running again, in order to identify factors related to successful or unsuccessful return to running following a stress fracture. The study will include Dr. Close as well as Marc Harwood, MD, service chief in the department of non-operative sports medicine at Rothman Orthopaedic Institute.

    The work was funded by the Thomas Jefferson University Office of the Provost. The authors report no conflict of interest
     
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