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Martin JA, Stiffler-Joachim MR, Wille CM, Heiderscheit BC. A hierarchical clustering approach for examining potential risk factors for bone stress injury in runners. J Biomech 2022; 141:111136. [PMID: 35816783 PMCID: PMC9773850 DOI: 10.1016/j.jbiomech.2022.111136] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 04/04/2022] [Accepted: 05/09/2022] [Indexed: 12/24/2022]
Abstract
Bone stress injuries (BSI) are overuse injuries that commonly occur in runners. BSI risk is multifactorial and not well understood. Unsupervised machine learning approaches can potentially elucidate risk factors for BSI by looking for groups of similar runners within a population that differ in BSI incidence. Here, a hierarchical clustering approach is used to identify groups of collegiate cross country runners (32 females, 21 males) based on healthy pre-season running (4.47 m·s-1) gait data which were aggregated and dimensionally reduced by principal component analysis. Five distinct groups were identified using the cluster tree. Visual inspection revealed clear differences between groups in kinematics and kinetics, and linear mixed effects models showed between-group differences in metrics potentially related to BSI risk. The groups also differed in BSI incidence during the subsequent academic year (Rand index = 0.49; adjusted Rand index = -0.02). Groups ranged from those including runners spending less time contacting the ground and generating higher peak ground reaction forces and joint moments to those including runners spending more time on the ground with lower loads. The former groups showed higher BSI incidence, indicating that short stance phases and high peak loads may be risk factors for BSI. Since ground contact duration may itself account for differences in peak loading metrics, we hypothesize that the percentage of time a runner is in contact with the ground may be a useful metric to include in machine learning models for predicting BSI risk.
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Affiliation(s)
- Jack A. Martin
- Department of Mechanical Engineering, Department of Orthopedics and Rehabilitation, Badger Athletic Performance Program, University of Wisconsin-Madison, 3046 Mechanical Engineering Building; 1513 University Ave; Madison, WI 53703
| | - Mikel R. Stiffler-Joachim
- Department of Orthopedics and Rehabilitation, Badger Athletic Performance Program, University of Wisconsin-Madison
| | - Christa M. Wille
- Department of Orthopedics and Rehabilitation, Badger Athletic Performance Program, Department of Biomedical Engineering, University of Wisconsin-Madison
| | - Bryan C. Heiderscheit
- Department of Orthopedics and Rehabilitation, Badger Athletic Performance Program, Department of Biomedical Engineering, University of Wisconsin-Madison
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52
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Bruce OL, Baggaley M, Khassetarash A, Haider IT, Edwards WB. Tibial-fibular geometry and density variations associated with elevated bone strain and sex disparities in young active adults. Bone 2022; 161:116443. [PMID: 35589067 DOI: 10.1016/j.bone.2022.116443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/25/2022] [Accepted: 05/11/2022] [Indexed: 11/02/2022]
Abstract
Tibial stress fracture is a common injury in runners and military personnel. Elevated bone strain is believed to be associated with the development of stress fractures and is influenced by bone geometry and density. The purpose of this study was to characterize tibial-fibular geometry and density variations in young active adults, and to quantify the influence of these variations on finite element-predicted bone strain. A statistical appearance model characterising tibial-fibular geometry and density was developed from computed tomography scans of 48 young physically active adults. The model was perturbed ±1 and 2 standard deviations along each of the first five principal components to create finite element models. Average male and female finite element models, controlled for scale, were also generated. Muscle and joint forces in running, calculated using inverse dynamics-based static optimization, were applied to the finite element models. The resulting 95th percentile pressure-modified von Mises strain (peak strain) and strained volume (volume of elements above 4000 με) were quantified. Geometry and density variations described by principal components resulted in up to 12.0% differences in peak strain and 95.4% differences in strained volume when compared to the average tibia-fibula model. The average female illustrated 5.5% and 41.3% larger peak strain and strained volume, respectively, when compared to the average male, suggesting that sexual dimorphism in bone geometry may indeed contribute to greater stress fracture risk in females. Our findings identified important features in subject-specific geometry and density associated with elevated bone strain that may have implications for stress fracture risk.
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Affiliation(s)
- Olivia L Bruce
- Biomedical Engineering Graduate Program, 2500 University Drive NW, University of Calgary, Calgary, AB T2N 1N4, Canada; Human Performance Laboratory, Faculty of Kinesiology, 2500 University Drive NW, University of Calgary, Calgary, AB T2N 1N4, Canada; McCaig Institute for Bone and Joint Health, 3280 Hospital Dr NW, University of Calgary, Calgary, AB T2N 4Z6, Canada.
| | - Michael Baggaley
- Human Performance Laboratory, Faculty of Kinesiology, 2500 University Drive NW, University of Calgary, Calgary, AB T2N 1N4, Canada; McCaig Institute for Bone and Joint Health, 3280 Hospital Dr NW, University of Calgary, Calgary, AB T2N 4Z6, Canada.
| | - Arash Khassetarash
- Human Performance Laboratory, Faculty of Kinesiology, 2500 University Drive NW, University of Calgary, Calgary, AB T2N 1N4, Canada; McCaig Institute for Bone and Joint Health, 3280 Hospital Dr NW, University of Calgary, Calgary, AB T2N 4Z6, Canada.
| | - Ifaz T Haider
- Human Performance Laboratory, Faculty of Kinesiology, 2500 University Drive NW, University of Calgary, Calgary, AB T2N 1N4, Canada; McCaig Institute for Bone and Joint Health, 3280 Hospital Dr NW, University of Calgary, Calgary, AB T2N 4Z6, Canada.
| | - W Brent Edwards
- Biomedical Engineering Graduate Program, 2500 University Drive NW, University of Calgary, Calgary, AB T2N 1N4, Canada; Human Performance Laboratory, Faculty of Kinesiology, 2500 University Drive NW, University of Calgary, Calgary, AB T2N 1N4, Canada; McCaig Institute for Bone and Joint Health, 3280 Hospital Dr NW, University of Calgary, Calgary, AB T2N 4Z6, Canada.
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53
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Høeg TB, Olson EM, Skaggs K, Sainani K, Fredericson M, Roche M, Kraus E. Prevalence of Female and Male Athlete Triad Risk Factors in Ultramarathon Runners. Clin J Sport Med 2022; 32:375-381. [PMID: 34232162 DOI: 10.1097/jsm.0000000000000956] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/29/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify the prevalence of male and female athlete triad risk factors in ultramarathon runners and explore associations between sex hormones and bone mineral density (BMD). DESIGN Multiyear cross-sectional study. SETTING One hundred-mile ultramarathon. PARTICIPANTS Competing runners were recruited in 2018 and 2019. ASSESSMENT OF RISK FACTORS Participants completed a survey assessing eating behaviors, menstrual history, and injury history; dual-energy x-ray absorptiometry for BMD; and laboratory evaluation of sex hormones, vitamin D, and ferritin (2019 cohort only). MAIN OUTCOME MEASURE A Triad Cumulative Risk Assessment Score was calculated for each participant. RESULTS One hundred twenty-three runners participated (83 males and 40 females, mean age 46.2 and 41.8 years, respectively). 44.5% of men and 62.5% of women had elevated risk for disordered eating. 37.5% of women reported a history of bone stress injury (BSI) and 16.7% had BMD Z scores <-1.0. 20.5% of men had a history of BSI and 30.1% had Z-scores <-1.0. Low body mass index (BMI) (<18.5 kg/m 2 ) was seen in 15% of women and no men. The Triad Cumulative Risk Assessment classified 61.1% of women and 29.2% of men as moderate risk and 5.6% of both men and women as high risk. CONCLUSIONS Our study is the first to measure BMD in both male and female ultramarathon runners. Our male population had a higher prevalence of low BMD than the general population; females were more likely to report history of BSI. Risk of disordered eating was elevated among our participants but was not associated with either low BMD or low BMI.
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Affiliation(s)
- Tracy Beth Høeg
- Department of Physical Medicine & Rehabilitation School of Medicine, University of California-Davis, Sacramento, California.,Northern California Orthopaedic Associates, Grass Valley, California
| | - Emily Miller Olson
- Stanford Department of Orthopaedic Surgery, Stanford University, Palo Alto, California; and
| | - Kira Skaggs
- Stanford Department of Orthopaedic Surgery, Stanford University, Palo Alto, California; and
| | - Kristin Sainani
- Department of Epidemiology and Population Health, Stanford University, Stanford, California
| | - Michael Fredericson
- Stanford Department of Orthopaedic Surgery, Stanford University, Palo Alto, California; and
| | - Megan Roche
- Department of Epidemiology and Population Health, Stanford University, Stanford, California
| | - Emily Kraus
- Stanford Department of Orthopaedic Surgery, Stanford University, Palo Alto, California; and
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54
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Keast M, Bonacci J, Fox A. Acute Effects of Gait Interventions on Tibial Loads During Running: A Systematic Review and Meta-analysis. Sports Med 2022; 52:2483-2509. [PMID: 35708887 PMCID: PMC9474464 DOI: 10.1007/s40279-022-01703-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2022] [Indexed: 11/24/2022]
Abstract
Introduction Changing running technique or equipment can alter tibial loads. The efficacy of interventions to modify tibial loads during running is yet to be synthesised and evaluated. This article reviewed the effect of running technique and footwear interventions on tibial loading during running. Methods Electronic databases were searched using terms relevant to tibial load and running. Interventions were categorised according to their approach (i.e., footwear; barefoot running; speed; surface; overground versus treadmill; orthotics, insoles and taping; and technique); if necessary, further subgrouping was applied to these categories. Standardised mean differences (SMDs) with 95% confidence intervals (CIs) for changes in tibial loading were calculated and meta-analyses performed where possible. Results Database searches yielded 1617 articles, with 36 meeting the inclusion criteria. Tibial loading increased with (1) barefoot running (SMD 1.16; 95% CI 0.50, 1.82); (2) minimalist shoe use by non-habitual users (SMD 0.89; 95% CI 0.40, 1.39); (3) motion control shoe use (SMD 0.46; 95% CI 0.07, 0.84); (4) increased stride length (SMD 0.86; 95% CI 0.18, 1.55); and (5) increased running speed (SMD 1.03; 95% CI 0.74, 1.32). Tibial loading decreased when (1) individuals ran on a treadmill versus overground (SMD − 0.83; 95% CI − 1.53, − 0.12); and (2) targeted biofeedback was used (SMD − 0.93; 95% CI − 1.46, − 0.41). Conclusions Running barefoot, in motion control shoes or in unfamiliar minimalist shoes, and with an increased stride length increases tibial loads and may increase the risk of a tibial stress injury during periods of high training load. Adopting interventions such as running on a treadmill versus overground, and using targeted biofeedback during periods of high loads could reduce tibial stress injury.
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Affiliation(s)
- Meghan Keast
- Centre for Sport Research, School of Exercise and Nutrition Sciences, Deakin University, 75 Pigdons Road, Waurn Ponds, VIC, 3216, Australia.
| | - Jason Bonacci
- Centre for Sport Research, School of Exercise and Nutrition Sciences, Deakin University, 75 Pigdons Road, Waurn Ponds, VIC, 3216, Australia
| | - Aaron Fox
- Centre for Sport Research, School of Exercise and Nutrition Sciences, Deakin University, 75 Pigdons Road, Waurn Ponds, VIC, 3216, Australia
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55
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Pruthi P, Singh AP. Bilateral radial stress fractures in rheumatoid arthritis. J R Coll Physicians Edinb 2022; 52:57-58. [DOI: 10.1177/14782715221088979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Punit Pruthi
- Department of Internal Medicine and Rheumatology, Asian Institute of Medical Sciences, Faridabad, India
| | - Ajit Pratap Singh
- Department of Radiodiagnosis, Asian Institute of Medical Sciences, Faridabad, India
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56
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Wilzman AR, Tenforde AS, Troy KL, Hunt K, Fogel N, Roche MD, Kraus E, Trikha R, Delp S, Fredericson M. Medical and Biomechanical Risk Factors for Incident Bone Stress Injury in Collegiate Runners: Can Plantar Pressure Predict Injury? Orthop J Sports Med 2022; 10:23259671221104793. [PMID: 35734769 PMCID: PMC9208063 DOI: 10.1177/23259671221104793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/23/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Bone stress injury (BSI) is a common reason for missed practices and competitions in elite track and field runners. Hypothesis: It was hypothesized that, after accounting for medical risk factors, higher plantar loading during running, walking, and athletic movements would predict the risk of future BSI in elite collegiate runners. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 39 elite collegiate runners (24 male, 15 female) were evaluated during the 2014-2015 academic year to determine the degree to which plantar pressure data and medical history (including Female and Male Athlete Triad risk factors) could predict subsequent BSI. Runners completed athletic movements while plantar pressures and contact areas in 7 key areas of the foot were recorded, and the measurements were reported overall and by specific foot area. Regression models were constructed to determine factors related to incident BSI. Results: Twenty-one runners (12 male, 9 female) sustained ≥1 incident BSI during the study period. Four regression models incorporating both plantar pressure measurements and medical risk factors were able to predict the subsequent occurrence of (A) BSIs in female runners, (B) BSIs in male runners, (C) multiple BSIs in either male or female runners, and (D) foot BSIs in female runners. Model A used maximum mean pressure (MMP) under the first metatarsal during a jump takeoff and only misclassified 1 female with no BSI. Model B used increased impulses under the hindfoot and second through fifth distal metatarsals while walking, and under the lesser toes during a cutting task, correctly categorizing 83.3% of male runners. Model C used higher medial midfoot peak pressure during a shuttle run and triad cumulative risk scores and correctly categorized 93.3% of runners who did not incur multiple BSIs and 66.7% of those who did. Model D included lower hindfoot impulses in the shuttle run and higher first metatarsal MMP during treadmill walking to correctly predict the subsequent occurrence of a foot BSI for 75% of women and 100% without. Conclusion: The models collectively suggested that higher plantar pressure may contribute to risk for BSI.
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Affiliation(s)
| | - Adam S Tenforde
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Karen L Troy
- Worcester Polytechnic Institute, Worcester, Massachusetts, USA
| | - Kenneth Hunt
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Nathaniel Fogel
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | | | - Emily Kraus
- Stanford Medical Center, Redwood City, California, USA
| | - Rishi Trikha
- Department of Orthopaedic Surgery, University of California, Los Angeles, Santa Monica, California, USA
| | - Scott Delp
- Human Performance Laboratory, Stanford University, Stanford, California, USA
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57
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Restrictive Eating and Prior Low-Energy Fractures Are Associated With History of Multiple Bone Stress Injuries. Int J Sport Nutr Exerc Metab 2022; 32:325-333. [PMID: 35523419 DOI: 10.1123/ijsnem.2021-0323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 04/01/2022] [Accepted: 04/05/2022] [Indexed: 11/18/2022]
Abstract
Bone stress injuries (BSIs) are common among athletes and have high rates of recurrence. However, risk factors for multiple or recurrent BSIs remain understudied. Thus, we aimed to explore whether energy availability, menstrual function, measures of bone health, and a modified Female Athlete Triad Cumulative Risk Assessment (CRA) tool are associated with a history of multiple BSIs. We enrolled 51 female runners (ages 18-36 years) with history of ≤1 BSI (controls; n = 31) or ≥3 BSIs (multiBSI; n = 20) in this cross-sectional study. We measured lumbar spine, total hip, and femoral neck areal bone mineral density by dual-energy X-ray absorptiometry, bone material strength index using impact microindentation, and volumetric bone mineral density, microarchitecture, and estimated strength by high-resolution peripheral quantitative computed tomography. Participants completed questionnaires regarding medical history, low-energy fracture history, and disordered eating attitudes. Compared with controls, multiBSI had greater incidence of prior low-energy fractures (55% vs. 16%, p = .005) and higher modified Triad CRA scores (2.90 ± 2.05 vs. 1.84 ± 1.59, p = .04). Those with multiBSI had higher Eating Disorder Examination Questionnaire (0.92 ± 1.03 vs. 0.46 ± 0.49, p = .04) scores and a greater percentage difference between lowest and highest body mass at their current height (15.5% ± 6.5% vs. 11.5% ± 4.9% p = .02). These preliminary findings indicate that women with a history of multiple BSIs suffered more prior low-energy fractures and have greater historical and current estimates of energy deficit compared with controls. Our results provide strong rationale for future studies to examine whether subclinical indicators of energy deficit contribute to risk for multiple BSIs in female runners.
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58
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Popp KL, Cooke LM, Bouxsein ML, Hughes JM. Impact of Low Energy Availability on Skeletal Health in Physically Active Adults. Calcif Tissue Int 2022; 110:605-614. [PMID: 35171303 DOI: 10.1007/s00223-022-00957-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 02/04/2022] [Indexed: 12/13/2022]
Abstract
For decades researchers reported that pre-menopausal women who engage in extensive endurance exercise and have menstrual dysfunction can develop low bone mineral density (BMD) or osteoporosis. More recently, low energy availability has been recognized as the initiating factor for low BMD in these women. Furthermore, the relationship between low energy availability and poor skeletal health is not exclusive to women engaging in endurance exercise. Rather, both males and females commonly experience endocrine dysfunction resulting from low energy availability and high exercise levels that degrades skeletal health. Consequences to skeletal health can range from short-term changes in bone metabolism and increased risk of bone stress injuries to long-term consequences of low BMD, such as osteoporosis and related fragility fractures. The degree to which low energy availability degrades skeletal health may be dependent on the length and extent of the energy deficit. However, the complex relationships between under-fueling, short- and long-term skeletal consequences and the factors that mediate these relationships are not well described. In this review, we discuss the consequences of low energy availability on sex hormones and skeletal health in two highly-active populations-athletes and military trainees-and provide a summary of existing knowledge gaps for future study.
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Affiliation(s)
- Kristin L Popp
- United States Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA, 01760, USA.
- Massachusetts General Hospital, Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, 02215, USA.
| | - Laura M Cooke
- Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Mary L Bouxsein
- United States Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA, 01760, USA
- Massachusetts General Hospital, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02215, USA
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Julie M Hughes
- United States Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA, 01760, USA
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59
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Hoenig T, Ackerman KE, Beck BR, Bouxsein ML, Burr DB, Hollander K, Popp KL, Rolvien T, Tenforde AS, Warden SJ. Bone stress injuries. Nat Rev Dis Primers 2022; 8:26. [PMID: 35484131 DOI: 10.1038/s41572-022-00352-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2022] [Indexed: 01/11/2023]
Abstract
Bone stress injuries, including stress fractures, are overuse injuries that lead to substantial morbidity in active individuals. These injuries occur when excessive repetitive loads are introduced to a generally normal skeleton. Although the precise mechanisms for bone stress injuries are not completely understood, the prevailing theory is that an imbalance in bone metabolism favours microdamage accumulation over its removal and replacement with new bone via targeted remodelling. Diagnosis is achieved by a combination of patient history and physical examination, with imaging used for confirmation. Management of bone stress injuries is guided by their location and consequent risk of healing complications. Bone stress injuries at low-risk sites typically heal with activity modification followed by progressive loading and return to activity. Additional treatment approaches include non-weight-bearing immobilization, medications or surgery, but these approaches are usually limited to managing bone stress injuries that occur at high-risk sites. A comprehensive strategy that integrates anatomical, biomechanical and biological risk factors has the potential to improve the understanding of these injuries and aid in their prevention and management.
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Affiliation(s)
- Tim Hoenig
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Kathryn E Ackerman
- Wu Tsai Female Athlete Program, Boston Children's Hospital, Boston, MA, USA.,Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Belinda R Beck
- School of Health Sciences & Social Work, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Gold Coast, Queensland, Australia.,The Bone Clinic, Brisbane, Queensland, Australia
| | - Mary L Bouxsein
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Orthopedic Surgery, Harvard Medical School and Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - David B Burr
- Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indiana University, Indianapolis, IN, USA.,Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Karsten Hollander
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Kristin L Popp
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,U.S. Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Tim Rolvien
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Adam S Tenforde
- Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, MA, USA.
| | - Stuart J Warden
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indiana University, Indianapolis, IN, USA. .,Department of Physical Therapy, School of Health & Human Sciences, Indiana University, Indianapolis, IN, USA. .,La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia.
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60
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Lodge MT, Ackerman KE, Garay J. Knowledge of the Female Athlete Triad and Relative Energy Deficiency in Sport Among Female Cross-Country Athletes and Support Staff. J Athl Train 2022; 57:385-392. [PMID: 35439313 PMCID: PMC9020605 DOI: 10.4085/1062-6050-0175.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Female endurance athletes exhibit an increased risk of the female athlete triad (Triad) and relative energy deficiency in sport (RED-S). The triad and RED-S are conditions that involve the health and performance consequences of low energy availability. Few authors of studies to date have assessed the knowledge that athletes, coaches, and athletic trainers (ATs) have regarding the Triad or RED-S. Proper education has been shown to be effective in increasing knowledge of sports medicine concerns for athletes, yet no known continuing education programs for the Triad or RED-S exist at collegiate institutions. OBJECTIVE To assess the knowledge, confidence, and educational impact of identifying, screening, treating, and preventing the Triad or RED-S. DESIGN Cross-sectional study. SETTING An evidence-based online survey was developed and administered via Qualtrics. PATIENTS OR OTHER PARTICIPANTS Female collegiate cross-country athletes (n = 275, age = 20 ± 1 years), collegiate cross-country coaches (n = 55, age = 34 ± 9 years), and ATs working with cross-country teams (n = 30, age = 36 ± 11 years). MAIN OUTCOME MEASURE(S) Knowledge, confidence, and educational impact scores were assessed among groups using analysis of variance. Independent t tests were calculated to determine differences in impact scores between people who had or had not received education on the topic. RESULTS Female cross-country athletes' total knowledge, confidence, and educational impact scores (mean scores = 25.00 ± 5.27, 95.42 ± 28.83, and 18.81 ± 7.05, respectively) were different from those of coaches (mean scores = 26.92 ± 5.02, 111.35 ± 24.14, and 22.41 ± 6.33, respectively) and ATs (mean scores = 28.66 ± 4.02, 117.67 ± 22.53, and 23.93 ± 5.69, respectively; P < .05). CONCLUSIONS Knowledge, confidence, and educational impact scores regarding Triad or RED-S were lowest in female cross-country athletes and highest in ATs. These findings support the call for education, which should be regarded as the primary tool for increasing knowledge, to improve the prevention and treatment of the Triad or RED-S.
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61
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Shaw KA, Moreland CM, Hunt TJ, Barkley C, O'Brien F, Jackson KL. Femoral Neck Stress Fractures in Athletes and the Military. J Bone Joint Surg Am 2022; 104:473-482. [PMID: 35234724 DOI: 10.2106/jbjs.21.00896] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Femoral neck stress fractures (FNSFs) are an infrequent condition in athletic and military populations. ➤ A high index of suspicion with liberal use of magnetic resonance imaging (MRI) is vital for early recognition and treatment initiation. ➤ An associated hip effusion on MRI is a risk factor for an evolving stress injury and requires close assessment and consideration for repeat MRI. ➤ Stress reactions and stable, incomplete FNSFs (<50% of femoral neck width) can be treated nonsurgically. ➤ Surgical intervention is accepted for high-risk, incomplete (≥50% of femoral neck width), and complete FNSFs. ➤ Overall, there is a paucity of high-quality literature on the rates of return to activity following FNSF.
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Affiliation(s)
- K Aaron Shaw
- Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Colleen M Moreland
- Department of Orthopaedic Surgery, Womack Army Medical Center, Fort Bragg, North Carolina
| | - Tyler J Hunt
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania
| | - Colleen Barkley
- Department of Physical Therapy, Moncrief Army Health Clinic, Fort Jackson, South Carolina
| | - Frederick O'Brien
- Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia
| | - Keith L Jackson
- Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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62
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Holmes RD, Yan YY, Mallinson PI, Andrews GT, Munk PL, Ouellette HA. Imaging Review of Hockey-related Lower Extremity Injuries. Semin Musculoskelet Radiol 2022; 26:13-27. [PMID: 35139556 DOI: 10.1055/s-0041-1731795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hockey is a fast-paced contact sport with a high incidence of injuries. Although injuries are more frequent among elite players, recreational hockey injuries are a common issue faced by primary care and emergency physicians. Lower extremity injuries in hockey are particularly important because they account for approximately a third of all injuries and > 60% of all overuse injuries. This pictorial review provides the general and specialty trained radiologist with a knowledge of the patterns of lower extremity injury that occur in ice hockey.
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Affiliation(s)
- R Davis Holmes
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Yet Yen Yan
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada.,Department of Radiology, Changi General Hospital, Singapore
| | - Paul I Mallinson
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Gordon T Andrews
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Peter L Munk
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Hugue A Ouellette
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
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Tenforde AS, Outerleys J, Bouxsein ML, Buckless CG, Besier T, Davis IS, Bredella MA. Metatarsal Bone Marrow Edema on Magnetic Resonance Imaging and Its Correlation to Bone Stress Injuries in Male Collegiate Basketball Players. Orthop J Sports Med 2022; 10:23259671211063505. [PMID: 35071655 PMCID: PMC8777350 DOI: 10.1177/23259671211063505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/10/2021] [Indexed: 11/15/2022] Open
Abstract
Background: The presence of bone marrow edema (BME) on magnetic resonance imaging (MRI) has been used to evaluate for bone stress injuries in athletes. Purpose: To examine the prevalence of MRI findings, including BME, in a single male collegiate basketball team before and after a single season and to assess its association with clinically symptomatic metatarsal bone stress injuries. Study Design: Cohort Study; Level of evidence, 3. Methods: A total of 16 men on a single collegiate basketball team (mean age, 20.0 ± 1.8 years) underwent 1.5-T MRI focused on both midfeet during the preseason, and 13 underwent repeat MRI during the postseason. MRI findings included the presence of BME and the radiographic classification of the bone stress injury (grades 1-4). Injury surveillance performed by athletic trainers was used to identify metatarsal bone stress injuries over the course of the season. Results: Preseason MRI demonstrated metatarsal BME in 5 of the 16 participants, and postseason MRI demonstrated metatarsal BME in 4 of the 13 participants. All 4 of the participants with postseason BME had MRI findings of BME in the same metatarsals. Compared to those without BME, participants with metatarsal BME had a shorter history of basketball exposure (preseason: 10.4 ± 4.1 vs 14.2 ± 1.9 years, respectively [ P = .023]; postseason: 9.6 ± 4.1 vs 14.0 ± 2.1 years, respectively [ P = .024]), and those with postseason BME had started playing at an older age (9.8 ± 4.3 vs 6.2 ± 1.6 years, respectively; P = .050). The preseason MRI classification for metatarsals included grade 1 (n = 3), followed by grades 2 and 3 (n = 2 each). In the 4 participants with postseason MRI findings, the grade increased from 1 to 4 in 1 participant and was stable in the other 3. No participants were diagnosed clinically with a metatarsal bone stress injury during the season. BME of the sesamoids was identified in 6 participants, who trended toward being older (21.0 ± 2.2 vs 19.4 ± 1.3 years, respectively; P < .10), with the abnormalities persisting on postseason MRI in all players. Conclusion: Collegiate male basketball players may have a high prevalence of BME, often without associated symptoms. The absence of foot pain or a corresponding diagnosis of a metatarsal bone stress injury in this study suggests that MRI findings of BME in asymptomatic athletes should be interpreted with caution.
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Affiliation(s)
- Adam S. Tenforde
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Jereme Outerleys
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Mary L. Bouxsein
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Thor Besier
- University of Auckland, Auckland, New Zealand
| | - Irene S. Davis
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
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Nadwodny JP, Pujalte G, Bertasi TGDO, Huff T. Intertrochanteric hip stress fracture in a male ultramarathon runner. BMJ Case Rep 2022; 15:e239594. [PMID: 35027376 PMCID: PMC8762139 DOI: 10.1136/bcr-2020-239594] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2021] [Indexed: 11/04/2022] Open
Abstract
Stress fractures are injuries frequently seen in high-performance athletes, especially runners. In the femur, the most commonly affected locations are the femoral neck, condylar area and proximal shaft. Intertrochanteric fractures are much more common in the elderly population, especially among those with osteoporosis, but they can also be a result of high-energy repetitive mechanisms. We present a case of an intertrochanteric stress fracture in a young male runner. The diagnosis was suspected after persistent pain following his first marathon, and it was confirmed with an MRI. Operative fixation of the fracture was performed 22 days after the pain started, which allowed the patient to return to his activities, including 50 km marathon 4 months following the surgery.
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Affiliation(s)
| | - George Pujalte
- Family Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Tamara Huff
- Orthopaedic Surgery, Mayo Clinic, Jacksonville, Florida, USA
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The Relationship Between Stress Fractures and Bone Turnover Markers Is Unclear in Athletic and Military Populations: A Critically Appraised Topic. INTERNATIONAL JOURNAL OF ATHLETIC THERAPY AND TRAINING 2022. [DOI: 10.1123/ijatt.2021-0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Clinical Scenario: Having an indication of how bone is remodeling in response to training load could help identify athletes and military personnel at increased stress fracture (SFx) risk. Direct assessment of bone remodeling is impractical. Biochemical markers of bone turnover are used as an indirect measure of bone remodeling and have potential to inform prevention and treatment efforts. To date, the relationship between bone turnover markers and SFxs in athletes or military personnel remains unclear. Clinical Question: Are SFxs related to bone turnover markers in athletes and military personnel? Summary of Key Findings: Seven met eligibility criteria. In five studies, an association between SFxs and bone turnover markers existed. Clinical Bottom Line: The evidence supporting a relationship between SFxs and bone turnover markers in athletes and military personnel is mixed. While five of the seven studies reported some type of relationship, no studies prospectively measured bone turnover markers in a group of athletes or military personnel without an SFx or without SFx history and followed them over time to reassess bone turnover markers upon SFx occurrence. Strength of Clinical Recommendation: In accordance with the Strength of Recommendation Taxonomy, Grade C is the most appropriate strength of recommendation rating.
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Carroll LA, Paulseth S, Martin RL. Forefoot Injuries in Athletes: Integration of the Movement System. Int J Sports Phys Ther 2022; 17:81-89. [PMID: 35024208 PMCID: PMC8720253 DOI: 10.26603/001c.30021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/04/2021] [Indexed: 12/13/2022] Open
Abstract
Despite the prevalence of forefoot related problems in athletes, there are few comprehensive summaries on examination and intervention strategies for those with forefoot related symptoms. While many factors may contribute to pathology and injury, the presence of abnormal foot alignment can negatively affect lower extremity biomechanics and be associated with injuries. Physical therapists may use the characteristics associated abnormal pronation or abnormal supination to describe the movement system disorder and serve as a guide for evaluating and managing athletes with forefoot pathologies. Athletes with an abnormal pronation movement system diagnosis typically demonstrate foot hypermobility, have decreased strength of the tibialis posterior muscle, and present with a medially rotated lower extremity position. Athletes with abnormal supination movement system diagnosis typically demonstrate foot hypomobility, decreased strength of the fibularis muscles, and a laterally rotated lower extremity position. Interventions of manual therapy, taping, strengthening exercises, and neuromuscular reeducation can be directed at the identified impairments and abnormal movements. The purpose of this clinical commentary is to integrate a movement system approach in pathoanatomical, evaluation, and intervention considerations for athletes with common forefoot pathologies, including stress fractures, metatarsalgia, neuroma, turf toe, and sesamoiditis. By applying a prioritized, objective problem list and movement system diagnosis, emphasis is shifted from a pathoanatomical diagnosis-based treatment plan to a more impairment and movement focused treatment. LEVEL OF EVIDENCE 5.
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67
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Tao H, Thompson C, Weber S. Can a Modified Y-Balance Test Predict Running Overuse Injuries over the Course of a Division I Collegiate Cross-Country Season? Int J Sports Phys Ther 2021; 16:1434-1441. [PMID: 34909250 PMCID: PMC8637294 DOI: 10.26603/001c.29871] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/28/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Collegiate distance runners often suffer from running overuse injuries (ROI). The Y-Balance Test (YBT) has the potential to predict ROI risk in collegiate runners. PURPOSE To investigate whether a preseason clinical assessment of dynamic balance, through a modified version of the YBT (mYBT), can predict risk of ROIs during one NCAA Division I cross-country (XC) season. STUDY DESIGN Prospective case-control study. METHODS Participants from a Division I XC team were screened for mYBT performance in four directions: anterior (AN), posteromedial (PM), posterolateral (PL), and posterior (PO). ROIs were tracked over the course of the XC season. Receiver operating characteristic (ROC) curve analysis (α = 0.05) was utilized to investigate the effectiveness of the mYBT in predicting injury risk. RESULTS Nine (5 female, 4 male) of 29 runners developed an ROI during the XC season. Five components of the mYBT were found to predict injuries, including normalized nondominant PO score (AUC = 0.756, p = 0.03; RR = 1.90), AN raw difference and limb asymmetry (AUC = 0.808, p = 0.01), and PM raw difference and limb asymmetry in males (AUC = 0.958, p = 0.02). CONCLUSION Specific components of the mYBT can help predict the risk of developing a running overuse injury over one Division I XC season. LEVEL OF EVIDENCE Screening, Level 3.
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Affiliation(s)
- Hanz Tao
- Physical Therapy, University of South Dakota
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68
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Richman EH, Qureshi MB, Brinkman JC, Tummala SV, Makovicka JL, Kuttner NP, Pollock JR, Chhabra A. Lower Back Injuries in NCAA Female Volleyball Athletes: A 5-Year Epidemiologic Characterization. Orthop J Sports Med 2021; 9:23259671211050893. [PMID: 34778479 PMCID: PMC8573494 DOI: 10.1177/23259671211050893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/26/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Although lower back injuries (LBIs) are common among National Collegiate Athletic Association (NCAA) female volleyball athletes, their incidence and etiology has not been well-defined. PURPOSE To describe the epidemiology of LBIs in collegiate female volleyball athletes over a 5-year period from the academic years 2009 to 2010 and 2013 to 2014. STUDY DESIGN Descriptive epidemiology study. METHODS The incidence and characteristics of spine injuries were identified utilizing the NCAA Injury Surveillance Program database. Rates of injury were calculated as the number of injuries by the total number of athlete-exposures (AEs). AEs were defined as any student participation in any single NCAA-sanctioned practice or competition. The injury rate was computed as the number of injuries per the total number of AEs and reported as a ration of injuries per 10,000 exposures. The ratio was then reported as overall number as well as stratified for event, time of season, and athletic NCAA division. Incidence rate ratios were then calculated to compare rates between event type. Results with 95% CIs that did not include 1.0 were considered statistically significant. RESULTS An estimated 3384 LBIs occurred in NCAA female volleyball players during this 5-year time frame. These LBIs occurred at a rate of 4.89 injuries per 10,000 AEs. LBIs were 2.76 times more likely in preseason when compared with regular season. More injuries occurred in practice (85%) when compared with competition (15%). The outside hitter and middle blocker were the most commonly position to sustain an LBI. Almost 70% of injuries were new injuries, and another 29% were recurrent injuries. The most common mechanism of injury was equally split between contact (50.4%) and overuse (45.5%) injuries, whereas the remaining mechanisms of injury were secondary for unknown reasons (4.14%). Most players returned to play within 24 hours (72.3%) followed by 1 to 6 days (16.4%), and finally 7 to 12 days (11.3%). No patient required surgical intervention. CONCLUSION The rate of LBIs was high (4.89/10,000 AEs) and injuries commonly recurred (29.2%). Most injuries were new, with most athletes returning to play with 24 hours.
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Affiliation(s)
- Evan H. Richman
- Creighton University School of Medicine--Phoenix Regional Campus, Phoenix, Arizona, USA
| | | | - Joseph C. Brinkman
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Sailesh V. Tummala
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Justin L. Makovicka
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Nicolas P. Kuttner
- Creighton University School of Medicine--Phoenix Regional Campus, Phoenix, Arizona, USA
| | | | - Anikar Chhabra
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
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Rockwell MS, Kostelnik SB, McMillan RP, Lancaster M, Larson-Meyer DE, Hulver MW. An Association between Bioavailable 25-Hydroxyvitamin D and Bone Mineral Density in a Diverse Cohort of Collegiate Athletes. Med Sci Sports Exerc 2021; 54:371-376. [PMID: 34652336 DOI: 10.1249/mss.0000000000002807] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Although vitamin D is intimately involved in bone metabolism, the relationship between vitamin D status, as measured by serum total 25-hydroxyvitamin D [25(OH)D] concentration, and bone mineral density (BMD) is weak, particularly in non-White populations. Measurement of bioavailable 25(OH)D has been suggested as a better indicator of vitamin D status than total 25(OH)D concentration. To date, the bioavailable 25(OH)D biomarker has been explored minimally in athletic populations. The purpose of this study was to investigate the relationship between total and bioavailable 25(OH)D concentrations and BMD in collegiate athletes. METHODS NCAA Division 1 basketball and swimming athletes served as study participants (n = 53; 28 females, 25 males; 28 basketball players, 25 swimmers). All participants completed dual energy x-ray absorptiometry (DXA) scans for analysis of BMD, blood draws for vitamin D measures, and diet/lifestyle questionnaires. RESULTS Overall, total 25(OH)D was 80.0 + 13.9 nmol/L and bioavailable 25(OH)D was 6.0 ± 1.9 nmol/L. There was strong disagreement between total 25(OH)D and bioavailable 25(OH)D concentrations (κ = -0.299; r = -0.129) (p = 0.100); 53% of total participants and 77% of Black participants were classified differently (low vs. normal vitamin D status) based on total and bioavailable 25(OH)D criteria. Black participants had significantly lower total 25(OH)D and higher bioavailable 25(OH)D concentrations than White participants (59.5 vs. 102.5 nmol/L and 7.9 vs. 5.4 nmol/L, respectively) (p < 0.001). Total 25(OH)D and total BMD were not correlated, but bioavailable 25(OH)D and total BMD demonstrated a positive correlation (r = 0.618, p < 0.01). CONCLUSIONS These results suggest that bioavailable 25(OH)D concentration may be a better clinical measure of vitamin D status than total 25(OH)D in collegiate athletes as related to BMD, particularly in Black athletes. Further research on the utility of the bioavailable 25(OH)D biomarker in athletes is needed.
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Affiliation(s)
- Michelle S Rockwell
- Fralin Life Sciences Institute, Virginia Tech, Blacksburg, VA Department of Family and Community Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA Department of Human Nutrition, Foods, and Exercise, Blacksburg, VA The Metabolism Core at Virginia Tech, Blacksburg, VA
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Ingel N, Vice V, Dommer C, Csonka J, Moore T, Zaleski A, Killelea C, Faherty M, Feld J, Sell T. Examining Sex Differences in Visual Reliance During Postural Control in Intercollegiate Athletes. Int J Sports Phys Ther 2021; 16:1273-1277. [PMID: 34631247 PMCID: PMC8486396 DOI: 10.26603/001c.28099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/23/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Risk factors for different sports injuries vary between sexes. Deficits in postural stability have been associated with several lower extremity injuries. The purpose of this study was to examine the differences in static postural stability between male and female intercollegiate athletes with and without visual information. # HypothesisThere will be no difference in visual reliance between sexes during static postural stability. STUDY DESIGN Cross-sectional Study. METHODS Static postural stability was assessed during a single session for football, soccer, basketball, and volleyball intercollegiate athletes (males, n=135, females, n=51) under eyes open (EO) and eyes closed (EC) conditions via performance of single limb stance on a force plate. Ground reaction force component data in all directions were quantified as a unitless composite score (COMP) where lower values indicated better postural stability. The absolute change and percentage change between EO and EC conditions were calculated for each sex. Two-sample Kolmogorov-Smirnov tests were used to compare differences between sexes. RESULTS Males had greater EO COMP (males=7.77±3.40; females=6.48±4.61; p=0.038; Cohen's d=0.343) and EC COMP (males=19.43±8.91; females 14.66±6.65; p=0.001; Cohen's d=0.571) than females. A significant difference in absolute change from EO to EC was observed between sexes (males=-11.65±7.05; females=-8.18±5.61; p=0.01, Cohen's d=-0.520) indicating that males had a greater change between conditions for the worse. There was no significant difference in percent change from EO to EC between sexes (males=159.2±90.7; females=156.7±109.2; p=0.39; Cohen's d=0.026). CONCLUSIONS The observed differences between males and females in EO COMP, EC COMP, and absolute difference in COMP indicate that there is some factor that causes a difference in static postural stability between sexes. No difference in percent change between groups indicates that the difference in static postural stability between sexes may not be due to visual reliance. Female athletes may inherently have better postural stability than males, but both sexes were able to compensate for the loss of visual input. LEVEL OF EVIDENCE 3.
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Abstract
BACKGROUND This review paper aims to report on the last 5 years of relevant research on pediatric bone health in regard to nutrition and obesity, ethnic disparities, common orthopaedic conditions, trauma, spine, and sports medicine. METHODS A search of the PubMed database was completed using the following terms: bone health, Vitamin D, pediatric, adolescent, sports medicine, fractures, spine, scoliosis, race, ethnicity, obesity, Slipped Capital Femoral Epiphysis, Osteogenesis Imperfecta, Duchenne's Muscular Dystrophy, neuromuscular, and cancer. Resultant papers were reviewed by study authors and determined to be of quality and relevance for description in this review. Papers from January 1, 2015 to August 31, 2020 were included. RESULTS A total of 85 papers were selected for review. General results include 7 key findings. (1) Obesity inhibits pediatric bone health with leptin playing a major role in the process. (2) Socioeconomic and demographic disparities have shown to have a direct influence on bone health. (3) Vitamin D deficiency has been linked to an increased fracture risk and severity in children. (4) Formal vitamin D monitoring can aid with patient compliance with treatment. (5) Patients with chronic medical conditions are impacted by low vitamin D and need ongoing monitoring of their bone health to decrease their fracture risk. (6) Vitamin D deficiency in pediatrics has been correlated to low back pain, spondylolysis, and adolescent idiopathic scoliosis. Osteopenic patients with AIS have an increased risk of curve progression requiring surgery. Before spine fusion, preoperative screening for vitamin D deficiency may reduce complications of fractures, insufficient tissue repair, loosening hardware, and postoperative back pain. (7) Increasing youth sports participation has resulted in increased bone health related injuries. However, improved understanding of Relative Energy Deficiency in Sport effects on bone health has recently occurred. CONCLUSIONS Increasing awareness of bone health issues in children will improve their recognition and treatment. Further research is needed on diagnosis, treatment, outcomes, and most importantly prevention of pediatric bone health diseases.
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Affiliation(s)
| | - Susan T Mahan
- Boston Children's Hospital/Harvard Medical School, Boston, MA
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72
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Stress Fractures of the Foot and Ankle. OPER TECHN SPORT MED 2021. [DOI: 10.1016/j.otsm.2021.150852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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73
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The Mediterranean dietary pattern for optimising health and performance in competitive athletes: a narrative review. Br J Nutr 2021; 128:1285-1298. [PMID: 34420536 DOI: 10.1017/s0007114521003202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Nutrition plays a key role in training for, and competing in, competitive sport, and is essential for reducing risk of injury and illness, recovering and adapting between bouts of activity, and enhancing performance. Consumption of a Mediterranean diet (MedDiet) has been demonstrated to reduce risk of various non-communicable diseases and increase longevity. Following the key principles of a MedDiet could also represent a useful framework for good nutrition in competitive athletes under most circumstances, with potential benefits for health and performance parameters. In this review, we discuss the potential effects of a MedDiet, or individual foods and compounds readily available in this dietary pattern, on oxidative stress and inflammation, injury and illness risk, vascular and cognitive function, and exercise performance in competitive athletes. We also highlight potential modifications which could be made to the MedDiet (whilst otherwise adhering to the key principles of this dietary pattern) in accordance with contemporary sports nutrition practices, to maximise health and performance effects. In addition, we discuss potential directions for future research.
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Chandran A, Roby PR, Boltz AJ, Robison HJ, Morris SN, Collins CL. Epidemiology of Injuries in National Collegiate Athletic Association Women's Gymnastics: 2014-2015 Through 2018-2019. J Athl Train 2021; 56:688-694. [PMID: 34280287 DOI: 10.4085/1062-6050-635-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Women's gymnastics athletes in the National Collegiate Athletic Association (NCAA) constitute a unique population of NCAA athletes given the nature and dynamics of the sport. BACKGROUND Routine examination of women's gymnastics injuries is important for identifying the evolving burden of injuries in this sport. METHODS Exposure and injury data collected in the NCAA Injury Surveillance Program during 2014-2015 through 2018-2019 were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics; injury rate ratios were used to examine differential injury rates. RESULTS The overall injury rate was 8.00 per 1000 athlete-exposures; injury incidence was greater in competitions than in practices (injury rate ratio = 1.84; 95% CI = 1.48, 2.29), though practice injury rates increased during 2015-2016 through 2018-2019. Most injuries were classified as strains (16.5%), sprains (16.4%), and inflammatory conditions (12.3%), with overuse injuries prevalent among practice injuries (22.5%). Concussions (8.4%) were the most commonly reported specific injury. SUMMARY The increasing trend in practice injury incidence is noteworthy although competition injury rates were higher overall. Findings also suggest that the etiologies of overuse injuries and inflammatory conditions as well as the biomechanical aspects of concussions warrant further attention.
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Affiliation(s)
- Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| | - Patricia R Roby
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, PA
| | - Adrian J Boltz
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| | - Hannah J Robison
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| | - Sarah N Morris
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| | - Christy L Collins
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
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Bratsman A, Wassef A, Wassef CR, Jayaram P, Mosely JB, Shybut TB. Epidemiology of NCAA Bone Stress Injuries: A Comparison of Athletes in Divisions I, II, and III. Orthop J Sports Med 2021; 9:23259671211014496. [PMID: 34291114 PMCID: PMC8274115 DOI: 10.1177/23259671211014496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/03/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Bone stress injuries (BSIs) are a major source of functional impairment in athletes of all sports, with many risk factors, including athlete characteristics and type of sport. In National Collegiate Athletic Association (NCAA) athletics, the stratification of programs into divisions with different characteristics and makeup has been identified as increasing the risk for certain kinds of injuries, but there have been no studies on the difference of BSI rates and characteristics between athletes in Division I (DI) and those in Divisions II and III (DII and DIII). Purpose/Hypothesis: To characterize the BSI rates in each division and compare the incidence and characteristics of BSIs within divisions. Our hypothesis was that BSI rates would be higher in DII and DIII athletes as compared with DI athletes. Study Design: Descriptive epidemiology study. Methods: Five years of recorded BSI data in collegiate athletes via the NCAA Injury Surveillance Program were examined for the academic years 2009-2010 to 2013-2014. BSI rates per 100,000 athlete-exposures (AEs) were compared for DI versus DII and DIII athletes using risk ratios and 95% CIs. Time lost to injury, time of season of injury, and class composition of injured athletes were also compared between divisions. Results: Over the 5 years studied, DII and DIII programs reported 252 BSIs more than 1,793,777 AEs (14.05 per 100,000 AEs), and DI programs reported 235 BSIs over 2,022,592 AEs (11.62 per 100,000 AEs). The risk ratio was significant for D1 versus DII and DIII (1.21; 95% CI, 1.01-1.44). There was a significant difference in time lost to injury in DI versus DII and DIII, χ2(5, n = 449) = 16.54; P = .006. When data were stratified by individual sport, there were no significant divisional differences in high-risk sports. Conclusion: In the current study, NCAA DII and DIII athletes had higher rates of BSI than their DI counterparts. As compared with DII and DIII athletes, the DI athletes had a significantly greater proportion of BSIs that did not result in absence from participation in sport.
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Affiliation(s)
- Andrew Bratsman
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Audrey Wassef
- Department of Orthopedic Surgery, University of New Mexico, Albuquerque, New Mexico, USA
| | - Christina R Wassef
- Department of Orthopedic Surgery, John Peter Smith Health Network, Fort Worth, Texas, USA
| | - Prathap Jayaram
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas, USA.,Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - J Bruce Mosely
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Theodore B Shybut
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas, USA
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Ishizu T, Torii S, Taguchi M. Habitual Dietary Status and Stress Fracture Risk Among Japanese Female Collegiate Athletes. J Am Coll Nutr 2021; 41:481-488. [PMID: 34125657 DOI: 10.1080/07315724.2021.1920068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The aim of the present study was to identify the habitual dietary intake and stress fractures history among sport types and to determine the factors related to the risk of stress fractures among Japanese female collegiate athletes. METHODS This study involved 589 Japanese female collegiate athletes. We investigated habitual dietary intake (food frequency questionnaire), eating attitude (EAT-26), demographics, training status, participation in sports events, history of injury in their career, and menstrual status using a self-reported questionnaire. A multivariate logistic regression analysis was conducted to determine the risk factors associated with stress fractures. RESULTS Thirty percent of the total participants had a history of stress fractures, although most participants had no risk of eating disorders. Most Japanese female collegiate athletes consumed less than the dietary reference intake levels for the general Japanese female population aged 18-29 years and the athletes' dietary guideline for key bone-health nutrients such as calcium and vitamin D. The multivariate logistic regression analysis revealed body mass index (BMI; OR, 0.91; 95% CI, 0.82-0.99) and energy intake (EI; OR, 0.99; 95% CI, 0.99-0.99) as significant and independent factors in the history of stress fractures among Japanese female collegiate athletes (p = 0.047 and p = 0.039, respectively). CONCLUSIONS Japanese female collegiate athletes failed to meet energy and nutrient recommendations; BMI and EI were significantly associated with stress fractures, a diet that includes an appropriate amount of energy is essential.
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Affiliation(s)
- Tatsuya Ishizu
- Graduate School of Sport Sciences, Waseda University, Saitama, Japan
| | - Suguru Torii
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | - Motoko Taguchi
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
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Warden SJ, Edwards WB, Willy RW. Preventing Bone Stress Injuries in Runners with Optimal Workload. Curr Osteoporos Rep 2021; 19:298-307. [PMID: 33635519 PMCID: PMC8316280 DOI: 10.1007/s11914-021-00666-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 02/07/2023]
Abstract
Bone stress injuries (BSIs) occur at inopportune times to invariably interrupt training. All BSIs in runners occur due to an "error" in workload wherein the interaction between the number and magnitude of bone tissue loading cycles exceeds the ability of the tissue to resist the repetitive loads. There is not a single optimal bone workload, rather a range which is influenced by the prevailing scenario. In prepubertal athletes, optimal bone workload consists of low-repetitions of fast, high-magnitude, multidirectional loads introduced a few times per day to induce bone adaptation. Premature sports specialization should be avoided so as to develop a robust skeleton that is structurally optimized to withstand multidirectional loading. In the mature skeleton, optimal workload enables gains in running performance but minimizes bone damage accumulation by sensibly progressing training, particularly training intensity. When indicated (e.g., following repeated BSIs), attempts to reduce bone loading magnitude should be considered, such as increasing running cadence. Determining the optimal bone workload for an individual athlete to prevent and manage BSIs requires consistent monitoring. In the future, it may be possible to clinically determine bone loads at the tissue level to facilitate workload progressions and prescriptions.
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Affiliation(s)
- Stuart J Warden
- Department of Physical Therapy, School of Health & Human Sciences, Indiana University, 1140 W. Michigan St., CF-124, Indianapolis, IN, 46202, USA.
- Indiana Center for Musculoskeletal Health, Indiana University, Indianapolis, IN, USA.
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia.
| | - W Brent Edwards
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
| | - Richard W Willy
- School of Physical Therapy & Health Sciences, University of Montana, Missoula, MT, USA
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78
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Hamstra-Wright KL, Huxel Bliven KC, Napier C. Training Load Capacity, Cumulative Risk, and Bone Stress Injuries: A Narrative Review of a Holistic Approach. Front Sports Act Living 2021; 3:665683. [PMID: 34124660 PMCID: PMC8192811 DOI: 10.3389/fspor.2021.665683] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/14/2021] [Indexed: 01/09/2023] Open
Abstract
Bone stress injuries (BSIs) are a common orthopedic injury with short-term, and potentially long-term, effects. Training load capacity, influenced by risk factors, plays a critical role in the occurrence of BSIs. Many factors determine how one's body responds to repetitive loads that have the potential to increase the risk of a BSI. As a scientific community, we have identified numerous isolated BSI risk factors. However, we have not adequately analyzed the integrative, holistic, and cumulative nature of the risk factors, which is essential to determine an individual's specific capacity. In this narrative review, we advocate for a personalized approach to monitor training load so that individuals can optimize their health and performance. We define “cumulative risk profile” as a subjective clinical determination of the number of risk factors with thoughtful consideration of their interaction and propose that athletes have their own cumulative risk profile that influences their capacity to withstand specific training loads. In our narrative review, we outline BSI risk factors, discuss the relationship between BSIs and training load, highlight the importance of individualizing training load, and emphasize the use of a holistic assessment as a training load guide.
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Affiliation(s)
- Karrie L Hamstra-Wright
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, United States
| | - Kellie C Huxel Bliven
- Department of Interdisciplinary Health Sciences, Arizona School of Health Sciences, A.T. Still University, Mesa, AZ, United States
| | - Christopher Napier
- Menrva Research Group, Faculty of Applied Science, Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, Vancouver, BC, Canada.,Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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79
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Kliethermes SA, Stiffler-Joachim MR, Wille CM, Sanfilippo JL, Zavala P, Heiderscheit BC. Lower step rate is associated with a higher risk of bone stress injury: a prospective study of collegiate cross country runners. Br J Sports Med 2021; 55:851-856. [PMID: 33990294 DOI: 10.1136/bjsports-2020-103833] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To determine if running biomechanics and bone mineral density (BMD) were independently associated with bone stress injury (BSI) in a cohort of National Collegiate Athletic Association Division I cross country runners. METHODS This was a prospective, observational study of 54 healthy collegiate cross country runners over three consecutive seasons. Whole body kinematics, ground reaction forces (GRFs) and BMD measures were collected during the preseason over 3 years via motion capture on an instrumented treadmill and total body densitometer scans. All medically diagnosed BSIs up to 12 months following preseason data collection were recorded. Generalised estimating equations were used to identify independent risk factors of BSI. RESULTS Univariably, step rate, centre of mass vertical excursion, peak vertical GRF and vertical GRF impulse were associated with BSI incidence. After adjusting for history of BSI and sex in a multivariable model, a higher step rate was independently associated with a decreased risk of BSI. BSI risk decreased by 5% (relative risk (RR): 0.95; 95% CI 0.91 to 0.98) with each one step/min increase in step rate. BMD z-score was not a statistically significant risk predictor in the final multivariable model (RR: 0.93, 95% CI 0.85 to 1.03). No other biomechanical variables were found to be associated with BSI risk. CONCLUSION Low step rate is an important risk factor for BSI among collegiate cross country runners and should be considered when developing comprehensive programmes to mitigate BSI risk in distance runners.
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Affiliation(s)
- Stephanie A Kliethermes
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA .,Badger Athletic Performance, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Mikel R Stiffler-Joachim
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Badger Athletic Performance, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Christa M Wille
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Badger Athletic Performance, University of Wisconsin Madison, Madison, Wisconsin, USA.,Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jennifer L Sanfilippo
- Badger Athletic Performance, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Pedro Zavala
- Badger Athletic Performance, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Bryan C Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Badger Athletic Performance, University of Wisconsin Madison, Madison, Wisconsin, USA.,Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
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80
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Kardouni JR, McKinnon CJ, Taylor KM, Hughes JM. Timing of stress fracture in soldiers during the first 6 career months: a retrospective cohort study. J Athl Train 2021; 56:465003. [PMID: 33975344 PMCID: PMC8675322 DOI: 10.4085/1062-6050-0380.19] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Stress fractures (SF) are injuries that can result from beginning new or higher volume physical training regimens. The pattern of clinical presentation of SF over time after individuals start a new or more demanding physical training regimen is not well defined in medical literature. OBJECTIVE Report trends in the clinical presentation of stress fractures over the first six month of soldiers' time in the service. DESIGN Retrospective Cohort study Setting: This study was conducted using medical encounter and personnel data from U.S. Army soldiers during the first 6 months of their career. PARTICIPANTS U.S. Army soldiers beginning their careers from 2005-2014 (N=701,027). DATA COLLECTION AND ANALYSIS Weekly SF numbers and incidence were calculated overall, as well as by sex, over the first 6 months of military service. RESULTS SF diagnoses (N=14,155) increased steeply in weeks 3 and 4, with a peak in the overall incidence of SF diagnoses occurring during weeks 5-8. Although clinical incidence of stress fracture generally decreased beyond 8 weeks, incident lower extremity stress fractures continued to present for over 20 weeks. The hazard ratio (HR) for SF among women compared to men was 4.14 (95% CI = [4.01, 4.27]). CONCLUSIONS Across the 6-month study period, women showed over 4 times greater hazard for stress fracture. The results also suggest that health care providers should be particularly vigilant for stress fractures within 3 weeks after the beginning of a new or higher intensity exercise regimen. The incidence of SF may continue to climb for several weeks. Even as stress fracture incidence declines, it should be noted that these injuries may also continue to appear clinically even several months after a change in activity or training.
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Affiliation(s)
- Joseph R Kardouni
- 1U.S. Army Forces Command, Fort Bragg, NC, 28310
- 2U.S. Army Research Institute of Environmental Medicine, Military Performance Division, Natick, MA 01760
- E-mail correspondence may be directed to the authors at the following addresses: Joseph R. Kardouni - , Julie M. Hughes - , Craig J. McKinnon - , Kathryn M. Taylor -
| | - Craig J McKinnon
- 2U.S. Army Research Institute of Environmental Medicine, Military Performance Division, Natick, MA 01760
- E-mail correspondence may be directed to the authors at the following addresses: Joseph R. Kardouni - , Julie M. Hughes - , Craig J. McKinnon - , Kathryn M. Taylor -
| | - Kathryn M Taylor
- 2U.S. Army Research Institute of Environmental Medicine, Military Performance Division, Natick, MA 01760
- E-mail correspondence may be directed to the authors at the following addresses: Joseph R. Kardouni - , Julie M. Hughes - , Craig J. McKinnon - , Kathryn M. Taylor -
| | - Julie M Hughes
- 2U.S. Army Research Institute of Environmental Medicine, Military Performance Division, Natick, MA 01760
- E-mail correspondence may be directed to the authors at the following addresses: Joseph R. Kardouni - , Julie M. Hughes - , Craig J. McKinnon - , Kathryn M. Taylor -
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81
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Schiefer M, Nanci F, Abílio LE, Ching San Junior YA, Motta Filho G. Fratura por estresse diafisária do úmero em atleta de tênis adolescente: Relato de caso. Rev Bras Ortop 2021; 57:175-179. [PMID: 35198126 PMCID: PMC8856851 DOI: 10.1055/s-0040-1721837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/17/2020] [Indexed: 10/28/2022] Open
Abstract
ResumoUm tenista adolescente tinha dor crônica no braço dominante durante os treinos de tênis. A ressonância magnética (RM) sugeriu lesão por estresse na diáfise do úmero. Depois de 4 semanas, ele se tornou assintomático e voltou a jogar. No entanto, houve recidiva da dor após 3 dias. A nova RM revelou fratura diafisária não desviada do úmero e edema significativo da medula óssea. O paciente ficou em repouso por 4 semanas. Depois disso, exercícios de fortalecimento foram introduzidos e o retorno aos treinamentos foi permitido após 12 semanas. Mesmo que assintomáticos, sugerimos que esses pacientes não voltem a jogar antes das 12 semanas, dependendo dos exames físicos e dos achados por imagem.
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Affiliation(s)
- Márcio Schiefer
- Departamento de Ortopedia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
- Centro de Cirurgia do Ombro e Cotovelo, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
| | - Francisco Nanci
- Hospital Central da Polícia Militar, Rio de Janeiro, RJ, Brasil
| | - Luiz Eduardo Abílio
- Estagiário de Ombro e Cotovelo, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
| | | | - Geraldo Motta Filho
- Centro de Cirurgia do Ombro e Cotovelo, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
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82
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Iizawa N, Sonoki K, Obara Y, Kataoka T, Majima T. An Isolated Iliac Wing Stress Fracture in a Male Marathon Runner: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00035. [PMID: 33979810 DOI: 10.2106/jbjs.cc.20.00541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 49-year-old man, who had started jogging 3 months before his first participation in a marathon race, presented with acute pain and difficulty walking that began during the marathon race. Tumors and bone metabolism factors were ruled out by blood examination and various imaging findings. Isolated iliac wing fatigue fracture was diagnosed and treated with conservative therapy. CONCLUSION This is the first English-literature report we know of an isolated iliac wing stress fracture in a male marathon runner without underlying disease. Our study highlights the importance of considering this rare fracture when diagnosing patients presenting with iliac pain.
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Affiliation(s)
- Norishige Iizawa
- Department of Orthopaedic Surgery, Nippon Medical School, Tokyo, Japan
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83
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Lytle JB, Parikh KB, Tarakemeh A, Vopat BG, Mulcahey MK. Epidemiology of Foot and Ankle Injuries in NCAA Jumping Athletes in the United States During 2009-2014. Orthop J Sports Med 2021; 9:2325967121998052. [PMID: 33948444 PMCID: PMC8053761 DOI: 10.1177/2325967121998052] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/02/2020] [Indexed: 11/15/2022] Open
Abstract
Background Foot and ankle injuries comprise a significant proportion of all injuries sustained by National Collegiate Athletic Association (NCAA) athletes. In particular, sports that combine jumping and rapid changes in direction are associated with increased lower extremity injuries. Purpose To describe the epidemiology of foot and ankle injuries in men's and women's jumping sports, including NCAA men's and women's basketball, women's volleyball, and women's gymnastics, during the 2009-2010 through 2013-2014 seasons. Study Design Descriptive epidemiology study. Methods Injury-surveillance data were obtained from the NCAA Injury Surveillance Program for the 2009-2010 through 2013-2014 seasons. Injuries were examined by mechanism, activity during injury, and participation restriction time. Injury rates per 1000 athlete-exposures (AEs), injury rate ratios, and risk ratios with 95% CIs were calculated. Reported sex differences were calculated for men's and women's basketball. All 95% CIs not containing 1.0 were considered statistically significant. Results A total of 1136 players sustained foot and ankle injuries (483 male and 653 female) over 612,680 AEs. These injuries resulted in a combined rate of 1.85 per 1000 AEs (95% CI, 1.75-1.97). Ankle sprains were the most common injury (63.7%), with lateral ligamentous complex injuries making up 77.1% of all ankle sprains. The most common foot injury varied based on sport and sex. Ankle injury rates were higher in male versus female basketball players (injury rate ratio, 1.33 [95% CI, 1.13-1.57]), but foot injury rates did not differ. Among basketball and volleyball players, player contact during jumping was the most common injury mechanism. Female gymnasts had higher overuse injury rates than other athletes (0.49/1000 AEs [95% CI, 0.30-0.74]; P < .002). Overall, female basketball players were 1.81 times more likely to sustain an overuse injury than male basketball players (95% CI, 1.02-3.20; P = .02). Conclusion The most common foot and ankle injury sustained in collegiate jumping sports was a lateral ligamentous complex ankle sprain. Injury-prevention programs focusing on ankle flexibility, strength, and proprioception may help to alleviate the injury burden and lessen severity. Improving the anticipation of contact during jumping and landing may reduce injury rates and increase player safety. The increased prevalence of overuse injuries in female collegiate athletes competing in jumping sports necessitates further investigation to reduce injury rates through prevention and training programs.
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Affiliation(s)
- Joseph B Lytle
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kisan B Parikh
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Armin Tarakemeh
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Bryan G Vopat
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Mary K Mulcahey
- Department of Orthopaedics, Tulane University School of Medicine, New Orleans, Louisiana, USA
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84
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Risk Factors, Diagnosis and Management of Bone Stress Injuries in Adolescent Athletes: A Narrative Review. Sports (Basel) 2021; 9:sports9040052. [PMID: 33923520 PMCID: PMC8073721 DOI: 10.3390/sports9040052] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/03/2021] [Accepted: 04/13/2021] [Indexed: 12/14/2022] Open
Abstract
Physical activity is known to be beneficial for bone; however, some athletes who train intensely are at risk of bone stress injury (BSI). Incidence in adolescent athlete populations is between 3.9 and 19% with recurrence rates as high as 21%. Participation in physical training can be highly skeletally demanding, particularly during periods of rapid growth in adolescence, and when competition and training demands are heaviest. Sports involving running and jumping are associated with a higher incidence of BSI and some athletes appear to be more susceptible than others. Maintaining a very lean physique in aesthetic sports (gymnastics, figure skating and ballet) or a prolonged negative energy balance in extreme endurance events (long distance running and triathlon) may compound the risk of BSI with repetitive mechanical loading of bone, due to the additional negative effects of hormonal disturbances. The following review presents a summary of the epidemiology of BSI in the adolescent athlete, risk factors for BSI (physical and behavioural characteristics, energy balance and hormone disruption, growth velocity, sport-specific risk, training load, etc.), prevention and management strategies.
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85
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Alcantara RS, Day EM, Hahn ME, Grabowski AM. Sacral acceleration can predict whole-body kinetics and stride kinematics across running speeds. PeerJ 2021; 9:e11199. [PMID: 33954039 PMCID: PMC8048400 DOI: 10.7717/peerj.11199] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 03/10/2021] [Indexed: 12/31/2022] Open
Abstract
Background Stress fractures are injuries caused by repetitive loading during activities such as running. The application of advanced analytical methods such as machine learning to data from multiple wearable sensors has allowed for predictions of biomechanical variables associated with running-related injuries like stress fractures. However, it is unclear if data from a single wearable sensor can accurately estimate variables that characterize external loading during running such as peak vertical ground reaction force (vGRF), vertical impulse, and ground contact time. Predicting these biomechanical variables with a single wearable sensor could allow researchers, clinicians, and coaches to longitudinally monitor biomechanical running-related injury risk factors without expensive force-measuring equipment. Purpose We quantified the accuracy of applying quantile regression forest (QRF) and linear regression (LR) models to sacral-mounted accelerometer data to predict peak vGRF, vertical impulse, and ground contact time across a range of running speeds. Methods Thirty-seven collegiate cross country runners (24 females, 13 males) ran on a force-measuring treadmill at 3.8-5.4 m/s while wearing an accelerometer clipped posteriorly to the waistband of their running shorts. We cross-validated QRF and LR models by training them on acceleration data, running speed, step frequency, and body mass as predictor variables. Trained models were then used to predict peak vGRF, vertical impulse, and contact time. We compared predicted values to those calculated from a force-measuring treadmill on a subset of data (n = 9) withheld during model training. We quantified prediction accuracy by calculating the root mean square error (RMSE) and mean absolute percentage error (MAPE). Results The QRF model predicted peak vGRF with a RMSE of 0.150 body weights (BW) and MAPE of 4.27 ± 2.85%, predicted vertical impulse with a RMSE of 0.004 BW*s and MAPE of 0.80 ± 0.91%, and predicted contact time with a RMSE of 0.011 s and MAPE of 4.68 ± 3.00%. The LR model predicted peak vGRF with a RMSE of 0.139 BW and MAPE of 4.04 ± 2.57%, predicted vertical impulse with a RMSE of 0.002 BW*s and MAPE of 0.50 ± 0.42%, and predicted contact time with a RMSE of 0.008 s and MAPE of 3.50 ± 2.27%. There were no statistically significant differences between QRF and LR model prediction MAPE for peak vGRF (p = 0.549) or vertical impulse (p = 0.073), but the LR model's MAPE for contact time was significantly lower than the QRF model's MAPE (p = 0.0497). Conclusions Our findings indicate that the QRF and LR models can accurately predict peak vGRF, vertical impulse, and contact time (MAPE < 5%) from a single sacral-mounted accelerometer across a range of running speeds. These findings may be beneficial for researchers, clinicians, or coaches seeking to monitor running-related injury risk factors without force-measuring equipment.
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Affiliation(s)
- Ryan S Alcantara
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States of America
| | - Evan M Day
- Department of Human Physiology, University of Oregon, Eugene, OR, United States of America
| | - Michael E Hahn
- Department of Human Physiology, University of Oregon, Eugene, OR, United States of America
| | - Alena M Grabowski
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States of America
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86
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Rudolph SE, Caksa S, Gehman S, Garrahan M, Hughes JM, Tenforde AS, Ackerman KE, Bouxsein ML, Popp KL. Physical Activity, Menstrual History, and Bone Microarchitecture in Female Athletes with Multiple Bone Stress Injuries. Med Sci Sports Exerc 2021; 53:2182-2189. [PMID: 33831898 PMCID: PMC8440446 DOI: 10.1249/mss.0000000000002676] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Bone stress injuries (BSIs) occur in up to 20% of runners and military recruits and those with a history of BSI have a 5-fold higher risk for a subsequent BSI. Yet, little is known about prior training, menstrual status and bone structure in runners who experience multiple BSIs. PURPOSE To determine differences in health and physical activity history, bone density, microarchitecture, and strength among female athletes with a history of multiple BSI, athletes with ≤1 BSI, and non-athletes. METHODS We enrolled 101 women (ages 18-32 years) for this cross-sectional study: non-athlete controls (n=17) and athletes with a history of ≥ 3 BSIs (n=21) or ≤1 BSI (n=63). We collected subjects' health and training history and measured bone microarchitecture of the distal tibia via high-resolution peripheral quantitative computed tomography (HR-pQCT) and areal bone mineral density (aBMD) of the hip and spine by dual-energy X-ray absorptiometry (DXA). RESULTS Groups did not differ according to age, BMI, age at menarche, aBMD, or tibial bone microarchitecture. Women with multiple BSIs had a higher prevalence of primary and secondary amenorrhea (p<0.01) compared to other groups. Total hours of physical activity in middle school were similar across groups; however, women with multiple BSIs performed more total hours of physical activity in high school (p=0.05), more hours of uniaxial loading in both middle school and high school (p=0.004, p=0.02) and a smaller proportion of multiaxial loading activity compared to other groups. CONCLUSION These observations suggest that participation in sports with multiaxial loading and maintaining normal menstrual status during adolescence and young adulthood may reduce the risk of multiple bone stress injuries.
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Affiliation(s)
- Sara E Rudolph
- Massachusetts General Hospital, Boston, MA United States Army Research Institute of Environmental Medicine, Natick MA Harvard Medical School, Boston MA Spaulding Rehabilitation Hospital, Cambridge MA Boston Children's Hospital, Boston MA Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA
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87
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Pereira Filho MV, Stéfani KC, Ferreira GF, Nogueira MP. Risk Factors Associated With Foot and Ankle Insufficiency Fractures in Postmenopausal Sedentary Women. Foot Ankle Int 2021; 42:482-487. [PMID: 33203230 DOI: 10.1177/1071100720969654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Insufficiency fractures occur in bones with low elastic resistance. In contrast to stress fractures, which affect normal bones and have been extensively studied, insufficiency fractures of the foot and ankle have been the subject of little research. The objective of this study was to identify risk factors associated with the development of foot and ankle insufficiency fractures. METHODS The study included 55 postmenopausal sedentary women with foot and ankle insufficiency fractures and 51 women in the control group. The data collected were the fracture site, body mass index, use of corticosteroids, T scores of the femur and lumbar spine measured by bone densitometry, and serum 25-OH vitamin D level. The calcaneal pitch (CP), talar-first metatarsal, and metatarsus adductus (MA) angles were measured on radiographs. RESULTS In 49 patients (89%), fractures occurred in the metatarsals. All metatarsals were affected, and the most common fracture site was the base of the fifth metatarsal, with 21 cases (33%). Twenty patients (36%) in the study group reported chronic use of corticosteroids and had lower bone mineral density levels than controls (P < .05). The factors associated with fracture development (P < .05) were the CP and MA angles and low lumbar bone mineral density. CONCLUSION Insufficiency fractures in this population were associated with low bone mineral density and unfavorable biomechanical characteristics such as pes cavus and metatarsus adductus. LEVEL OF EVIDENCE Level IIIB, case-control study.
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Affiliation(s)
- Miguel Viana Pereira Filho
- Post-Graduation in Health Sciences Program of Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo (IAMSPE), São Paulo, Brazil.,Foot and Ankle Surgery Group, Orthopaedics and Traumatology Unit, Prevent Senior, São Paulo, Brazil
| | - Kelly Cristina Stéfani
- Department of Orthopedics, Hospital do Servidor Público Estadual de São Paulo (HSPE), São Paulo, Brazil
| | - Gabriel Ferraz Ferreira
- Foot and Ankle Surgery Group, Orthopaedics and Traumatology Unit, Prevent Senior, São Paulo, Brazil
| | - Monica Paschoal Nogueira
- Post-Graduation in Health Sciences Program of Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo (IAMSPE), São Paulo, Brazil.,Department of Orthopedics, Hospital do Servidor Público Estadual de São Paulo (HSPE), São Paulo, Brazil
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88
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Knechtle B, Jastrzębski Z, Hill L, Nikolaidis PT. Vitamin D and Stress Fractures in Sport: Preventive and Therapeutic Measures-A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:223. [PMID: 33804459 PMCID: PMC7999420 DOI: 10.3390/medicina57030223] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 01/13/2023]
Abstract
There are numerous risk factors for stress fractures that have been identified in literature. Among different risk factors, a prolonged lack of vitamin D (25(OH)D) can lead to stress fractures in athletes since 25(OH)D insufficiency is associated with an increased incidence of a fracture. A 25(OH)D value of <75.8 nmol/L is a risk factor for a stress fracture. 25(OH)D deficiency is, however, only one of several potential risk factors. Well-documented risk factors for a stress fracture include female sex, white ethnicity, older age, taller stature, lower aerobic fitness, prior physical inactivity, greater amounts of current physical training, thinner bones, 25(OH)D deficiency, iron deficiency, menstrual disturbances, and inadequate intake of 25(OH)D and/or calcium. Stress fractures are not uncommon in athletes and affect around 20% of all competitors. Most athletes with a stress fracture are under 25 years of age. Stress fractures can affect every sporty person, from weekend athletes to top athletes. Stress fractures are common in certain sports disciplines such as basketball, baseball, athletics, rowing, soccer, aerobics, and classical ballet. The lower extremity is increasingly affected for stress fractures with the locations of the tibia, metatarsalia and pelvis. Regarding prevention and therapy, 25(OH)D seems to play an important role. Athletes should have an evaluation of 25(OH)D -dependent calcium homeostasis based on laboratory tests of 25-OH-D3, calcium, creatinine, and parathyroid hormone. In case of a deficiency of 25(OH)D, normal blood levels of ≥30 ng/mL may be restored by optimizing the athlete's lifestyle and, if appropriate, an oral substitution of 25(OH)D. Very recent studies suggested that the prevalence of stress fractures decreased when athletes are supplemented daily with 800 IU 25(OH)D and 2000 mg calcium. Recommendations of daily 25(OH)D intake may go up to 2000 IU of 25(OH)D per day.
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Affiliation(s)
- Beat Knechtle
- Medbase St. Gallen Am Vadianplatz, 9000 St. Gallen, Switzerland
- Institute of Primary Care, University Hospital Zurich, University of Zurich, Pestalozzistrasse 24, 8091 Zürich, Switzerland
| | - Zbigniew Jastrzębski
- Department of Health and Life Sciences, Gdansk University of Physical Education and Sport, 80-336 Gdańsk, Poland;
| | - Lee Hill
- Division of Gastroenterology & Nutrition, Department of Pediatrics, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada;
| | - Pantelis T. Nikolaidis
- Exercise Physiology Laboratory, 18450 Nikaia, Greece;
- School of Health and Caring Sciences, University of West Attica, 12243 Athens, Greece
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89
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Haase DR, Brown K, Templeton KJ. Adolescent Athlete Stress Fractures Associated with Vitamin D Insufficiency: Three Cases with Review of the Literature. JBJS Case Connect 2021; 11:01709767-202103000-00027. [PMID: 33617155 DOI: 10.2106/jbjs.cc.20.00367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE The authors present 3 adolescent athletes who presented with stress fractures in their lower extremities, initially diagnosed as tumors. All 3 patients received an inconclusive magnetic resonance imaging before referral; fractures were confirmed on radiographs and computed tomography. All were found to have vitamin D insufficiency. CONCLUSIONS Vitamin D insufficiency is a global epidemic mainly focused on adults and young-adult athletes. These case reports raise concerns about a growing prevalence of vitamin D insufficiency in adolescents, the potential risk of stress fracture, and the need for screening and possible supplementation in adolescent athletes to improve their bone health.
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Affiliation(s)
- Douglas R Haase
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Kevin Brown
- Department of Radiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Kimberly J Templeton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
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90
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Lambert BS, Cain MT, Heimdal T, Harris JD, Jotwani V, Petak S, McCulloch PC. Physiological Parameters of Bone Health in Elite Ballet Dancers. Med Sci Sports Exerc 2021; 52:1668-1678. [PMID: 32079918 DOI: 10.1249/mss.0000000000002296] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Stress fractures are common among elite ballet dancers whereby musculoskeletal health may be affected by energy balance and overtraining. PURPOSE This study aimed to characterize bone health in relation to stress fracture history, body composition, eating disorder risk, and blood biomarkers in professional male and female ballet dancers. METHODS A single cohort of 112 dancers (male: 55, 25 ± 6 yr; female: 57, 24 ± 6 yr) was recruited. All participants underwent bone and body composition measures using dual-energy x-ray absorptiometry. In a subset of our cohort (male: 30, 24 ± 6 yr; female, 29, 23 ± 5 yr), a blood panel, disordered eating screen, menstrual history, and stress fracture history were also collected. Age-matched Z scores and young-adult T scores were calculated for bone mineral density (BMD) and body composition. Independent-samples t-tests and Fisher's exact tests were used to compare BMD, Z-scores, T scores, and those with and without history of stress fractures. A 1 × 3 ANOVA was used to compare BMD for those scoring 0-1, 2-6, and 7+ using the EAT26 questionnaire for eating disorder risk. Regression was used to predict BMD from demographic and body composition measures. RESULTS Female dancers demonstrated reduced spinal (42nd percentile, 10%T < -1) and pelvic (16th percentile, 76%T < -1) BMD. Several anthropometric measures were predictive of BMD (P < 0.05, r = 0.65-0.81, standard error of estimate = 0.08-0.10 g·cm, percent error = 6.3-8.5). Those scoring >1 on EAT26 had lower BMD than did those with a score of 0-1 (P < 0.05). CONCLUSIONS Professional female ballet dancers exhibit reduced BMD, fat mass, and lean mass compared with the general population whereby low BMD and stress fractures tend to be more prevalent in those with a higher risk of disordered eating. Anthropometric and demographic measures are predictive of BMD in this population.
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Affiliation(s)
- Bradley S Lambert
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX
| | - Michael T Cain
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX
| | - Tyler Heimdal
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX
| | - Joshua D Harris
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX
| | - Vijay Jotwani
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX
| | - Steven Petak
- Department of Endocrinology, Houston Methodist Hospital, Houston, TX
| | - Patrick C McCulloch
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX
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91
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Hollander K, Rahlf AL, Wilke J, Edler C, Steib S, Junge A, Zech A. Sex-Specific Differences in Running Injuries: A Systematic Review with Meta-Analysis and Meta-Regression. Sports Med 2021; 51:1011-1039. [PMID: 33433864 PMCID: PMC8053184 DOI: 10.1007/s40279-020-01412-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Running is a popular sport with high injury rates. Although risk factors have intensively been investigated, synthesized knowledge about the differences in injury rates of female and male runners is scarce. OBJECTIVE To systematically investigate the differences in injury rates and characteristics between female and male runners. METHODS Database searches (PubMed, Web of Science, PEDro, SPORTDiscus) were conducted according to PRISMA guidelines using the keywords "running AND injur*". Prospective studies reporting running related injury rates for both sexes were included. A random-effects meta-analysis was used to pool the risk ratios (RR) for the occurrence of injuries in female vs. male runners. Potential moderators (effect modifiers) were analysed using meta-regression. RESULTS After removal of duplicates, 12,215 articles were screened. Thirty-eight studies were included and the OR of 31 could be pooled in the quantitative analysis. The overall injury rate was 20.8 (95% CI 19.9-21.7) injuries per 100 female runners and 20.4 (95% CI 19.7-21.1) injuries per 100 male runners. Meta-analysis revealed no differences between sexes for overall injuries reported per 100 runners (RR 0.99, 95% CI 0.90-1.10, n = 24) and per hours or athlete exposure (RR 0.94, 95% CI 0.69-1.27, n = 6). Female sex was associated with a more frequent occurrence of bone stress injury (RR (for males) 0.52, 95% CI 0.36-0.76, n = 5) while male runners had higher risk for Achilles tendinopathies (RR 1. 86, 95% CI 1.25-2.79, n = 2). Meta-regression showed an association between a higher injury risk and competition distances of 10 km and shorter in female runners (RR 1.08, 95% CI 1.00-1.69). CONCLUSION Differences between female and male runners in specific injury diagnoses should be considered in the development of individualised and sex-specific prevention and rehabilitation strategies to manage running-related injuries.
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Affiliation(s)
- Karsten Hollander
- Medical School Hamburg, Hamburg, Germany.
- Department of Physical Medicine and Rehabilitation, Spaulding National Running Center, Harvard Medical School, Cambridge, MA, USA.
| | - Anna Lina Rahlf
- Department of Human Movement Science and Exercise Physiology, Institute of Sport Science, Friedrich Schiller University Jena, Jena, Germany
| | - Jan Wilke
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Frankfurt, Germany
| | - Christopher Edler
- Prevention, Rehabilitation and Interdisciplinary Sports Medicine, BG Trauma Hospital of Hamburg, Hamburg, Germany
| | - Simon Steib
- Department of Human Movement, Training and Active Aging, Institute of Sports and Sports Science, Heidelberg University, Heidelberg, Germany
| | - Astrid Junge
- Medical School Hamburg, Hamburg, Germany
- Swiss Concussion Center, Schulthess Klinik, Zürich, Switzerland
| | - Astrid Zech
- Department of Human Movement Science and Exercise Physiology, Institute of Sport Science, Friedrich Schiller University Jena, Jena, Germany
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92
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Popp KL, Ackerman KE, Rudolph SE, Johannesdottir F, Hughes JM, Tenforde AS, Bredella MA, Xu C, Unnikrishnan G, Reifman J, Bouxsein ML. Changes in Volumetric Bone Mineral Density Over 12 Months After a Tibial Bone Stress Injury Diagnosis: Implications for Return to Sports and Military Duty. Am J Sports Med 2021; 49:226-235. [PMID: 33259223 DOI: 10.1177/0363546520971782] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bone stress injuries (BSIs) occur in up to 20% of runners and military personnel. Typically, after a period of unloading and gradual return to weightbearing activities, athletes return to unrestricted sports participation or military duty approximately 4 to 14 weeks after a BSI diagnosis, depending on the injury location and severity. However, the time course of the recovery of the bone's mechanical competence is not well-characterized, and reinjury rates are high. PURPOSE To assess the bone microarchitecture and volumetric bone mineral density (vBMD) over 12 months after a tibial BSI diagnosis. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS We enrolled 30 female athletes from the local community (aged 18-35 years) with a tibial BSI (grade ≥2 of 4 on magnetic resonance imaging) for this prospective observational study. Participants completed a baseline visit within 3 weeks of the diagnosis. At baseline and 6, 12, 24, and 52 weeks after the BSI diagnosis, we collected high-resolution peripheral quantitative computed tomography scans of the ultradistal tibia (4% of tibial length) of the injured and uninjured legs as well as pain and physical activity assessment findings. RESULTS From baseline to 12 weeks after the diagnosis, total, trabecular, and cortical vBMD declined by 0.58% to 0.94% (P < .05 for all) in the injured leg. Total and trabecular vBMD also declined by 0.61% and 0.67%, respectively, in the uninjured leg (P < .05 for both). At 24 weeks, mean values for all bone parameters were nearly equivalent to baseline values, and by 52 weeks, several mean values had surpassed baseline values. Of the 30 participants, 10 incurred a subsequent BSI during the course of the study, and 1 of these 10 incurred 2 subsequent BSIs. Participants who suffered an additional BSI were younger and had a later age of menarche, a greater incidence of previous fractures, and lower serum parathyroid hormone levels (P < .05 for all). CONCLUSION Bone density declined in both the injured and the uninjured legs and, on average, did not return to baseline for 3 to 6 months after a tibial BSI diagnosis. The observed time to the recovery of baseline vBMD, coupled with the high rate of recurrent BSIs, suggests that improved return-to-sports and military duty guidelines may be in order.
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Affiliation(s)
- Kristin L Popp
- Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Kathryn E Ackerman
- Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Boston Children's Hospital, Boston, Massachusetts, USA
| | - Sara E Rudolph
- Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Fjola Johannesdottir
- Harvard Medical School, Boston, Massachusetts, USA.,Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Julie M Hughes
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Adam S Tenforde
- Harvard Medical School, Boston, Massachusetts, USA.,Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Miriam A Bredella
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Chun Xu
- Biotechnology High Performance Computing Software Applications Institute, Department of Defense, Frederick, Maryland, USA
| | - Ginu Unnikrishnan
- Biotechnology High Performance Computing Software Applications Institute, Department of Defense, Frederick, Maryland, USA
| | - Jaques Reifman
- Biotechnology High Performance Computing Software Applications Institute, Department of Defense, Frederick, Maryland, USA
| | - Mary L Bouxsein
- Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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93
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Millward D, Root AD, Dubois J, Cohen RP, Valdivia L, Helming B, Kokoskie J, Waterbrook AL, Paul S. Association of Serum Vitamin D Levels and Stress Fractures in Collegiate Athletes. Orthop J Sports Med 2020; 8:2325967120966967. [PMID: 33816638 PMCID: PMC8008136 DOI: 10.1177/2325967120966967] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/20/2020] [Indexed: 12/16/2022] Open
Abstract
Background Low vitamin D levels along with high-intensity athletic training may put an athlete at increased risk for a stress fracture. Purpose To assess whether supplementation with vitamin D is associated with a reduced risk of stress fractures in college athletes. We also assessed differences in vitamin D levels among athletes participating in outdoor versus indoor sports. Study Design Cohort study; Level of evidence, 2. Methods The study participants included 802 National Collegiate Athletic Association Division I intercollegiate athletes (497 men and 305 women) on a sports team for at least 1 semester from 2012 to 2018. All athletes who had a baseline vitamin D level in their medical record were included. Athletes with vitamin D levels <40 ng/mL were given vitamin D supplements. We assessed differences in the rate of stress fracture among those who maintained or improved vitamin D levels to ≥40 ng/mL and those who did not, as well as differences in average baseline vitamin D levels by sport type (indoor vs outdoor). Results The rate of stress fracture was 12% higher (95% CI, 6-19; P < .001) for those who remained low in vitamin D compared with those who were low at baseline but improved their vitamin D status to ≥40 ng/mL. The rate of stress fracture was also 12% higher (95% CI, 5-18; P < .001) for those who had low vitamin D levels compared with those who maintained normal levels. The mean baseline vitamin D values were significantly higher for men participating in outdoor sports versus indoor sports. For men, the mean vitamin D level was 5.7 ng/mL higher (95% CI, 0.9-10.5; P = .01) in outdoor athletes. For women, the mean vitamin D level was 3.7 ng/mL higher (95% CI, -0.58 to 8.03; P < .04) for outdoor versus indoor sports. Conclusion Study results indicated that correcting low serum vitamin D levels reduces the risk of stress fracture. This study also presented evidence that athletes who participate in indoor sports may be at greater risk for vitamin D deficiency than those who compete in outdoor sports.
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94
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High Number of Daily Steps Recorded by Runners Recovering from Bone Stress Injuries. HSS J 2020; 16:408-411. [PMID: 33380974 PMCID: PMC7749902 DOI: 10.1007/s11420-020-09787-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 07/23/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Bone stress injuries (BSIs) are common among runners for which activity modification is the primary treatment. The clinical utility of measuring activity during recovery has not been evaluated. QUESTIONS/PURPOSES We sought to measure the physical activity of runners recovering from BSIs and determine if activity can be correlated with symptoms. METHODS A prospective observational pilot study was performed of runners with a new lower extremity BSI treated non-surgically. For 30 days, activity of runners was measured with a physical activity tracker and daily pain scores were collected. RESULTS We enrolled 18 runners (average age, 33 years; 72% female). Twelve had stress fractures and six had stress reactions. The average daily steps of all runners during the observation period was 10,018 ± 3232, and the runner with the highest daily steps averaged 15,976. There were similar average daily steps in those with stress fractures versus reactions, 10,329 versus 9965, respectively. There was no correlation between daily steps or relative change in daily steps with pain or relative change in pain scores. CONCLUSION Runners with BSIs averaged over 10,000 steps per day during early recovery. Clinicians may not be aware of the amount of activity runners maintain after being diagnosed with a BSI. Although daily steps and symptoms could not be correlated in this study, objectively measuring activity may assist clinicians in guiding runners recovering from BSIs.
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95
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Troy KL, Davis IS, Tenforde AS. A Narrative Review of Metatarsal Bone Stress Injury in Athletic Populations: Etiology, Biomechanics, and Management. PM R 2020; 13:1281-1290. [PMID: 33155355 DOI: 10.1002/pmrj.12518] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/21/2020] [Accepted: 10/27/2020] [Indexed: 01/13/2023]
Abstract
Metatarsal bone stress injuries (BSIs) are common in athletic populations. BSIs are overuse injuries that result from an accumulation of microdamage that exceeds bone remodeling. Risk for metatarsal BSI is multifactorial and includes factors related to anatomy, biology, and biomechanics. In this article, anatomic factors including foot type, metatarsal length, bone density, bone geometry, and intrinsic muscle strength, which each influence how the foot responds to load, are discussed. Biologic factors such as low energy availability and impaired bone metabolism influence the quality of the bone. Finally, the influence of biomechanical loads to bone such as peak forces, load rates, and loading cycles are reviewed. General management of metatarsal BSI is discussed, including acute care, rehabilitation, treatment of refractory metatarsal BSI, and evaluation of healing/return to sport. Finally, we identify future research priorities and emerging treatments for metatarsal BSI.
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Affiliation(s)
- Karen L Troy
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Irene S Davis
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, MA, USA.,Spaulding National Running Center, Spaulding Hospital, Cambridge, MA, USA
| | - Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, MA, USA.,Spaulding National Running Center, Spaulding Hospital, Cambridge, MA, USA
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96
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Burland JP, Outerleys JB, Lattermann C, Davis IS. Reliability of wearable sensors to assess impact metrics during sport-specific tasks. J Sports Sci 2020; 39:406-411. [PMID: 32951565 DOI: 10.1080/02640414.2020.1823131] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
There is little information on the reliability of inertial measurement units for capturing impact load metrics during sport-specific movements. The purpose of this study is to determine the reliability of the Blue Trident IMU sensors in measuring impact load, step count and cumulative bone stimulus during a series of soccer-related tasks. Ten healthy recreational soccer players (age: 27.9 ± 2.18; height: 1.77 ± 0.10 m; mass: 79.02 ± 13.07 kg) volunteered for a 3-visit study and performed 4 tasks. Bilateral impact load, total number of steps and cumulative bone stimulus during the tasks were collected. Data were sampled using a dual-g sensor. Intraclass correlation coefficients (ICC3,1) with 95% confidence intervals assessed between-day reliability. Impact load (0.58-0.89) and cumulative bone stimulus (0.90-0.97) had good to excellent reliability across tasks. ICC values for right/left step count were good to excellent during acceleration-deceleration (0.728-0.837), change direction (0.734-0.955) and plant/cut manoeuvres (0.701-0.866) and fair to good during the ball kick (0.588-0.683). This suggests that wearable sensors can reliably measure the cumulative impact load during outdoor functional movements; however, kicking manoeuvres are less reliable. Measuring impact load in the field expands the ability to capture more ecologically valid data.
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Affiliation(s)
- Julie P Burland
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts, USA.,Department of Physical Medicine and Rehabilitation, Harvard Medical School , Boston, Massachusetts, USA.,Harvard Medical School , Boston, MA, USA
| | - Jereme B Outerleys
- Department of Physical Medicine and Rehabilitation, Harvard Medical School , Boston, Massachusetts, USA.,Harvard Medical School , Boston, MA, USA
| | - Christian Lattermann
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts, USA.,Harvard Medical School , Boston, MA, USA
| | - Irene S Davis
- Department of Physical Medicine and Rehabilitation, Harvard Medical School , Boston, Massachusetts, USA.,Harvard Medical School , Boston, MA, USA
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97
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Rubenstein WJ, Allahabadi S, Curriero F, Feeley BT, Lansdown DA. Fracture Epidemiology in Professional Baseball From 2011 to 2017. Orthop J Sports Med 2020; 8:2325967120943161. [PMID: 32923499 PMCID: PMC7446273 DOI: 10.1177/2325967120943161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 03/19/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Fractures are a significant cause of missed time in Major League Baseball (MLB) and Minor League Baseball (MiLB). MLB and the MLB Players Association recently instituted rule changes to limit collisions at home plate and second base. Purpose: To evaluate the epidemiologic characteristics of fractures in professional baseball and to assess the change in acute fracture incidence secondary to traumatic collisions at home plate and second base after the recently instituted rule changes. Study Design: Descriptive epidemiology study. Methods: The MLB Health and Injury Tracking System (HITS) database was used to access injury information on MLB and MiLB players to analyze fracture data from 2011 to 2017. Injuries were included if the primary diagnosis was classified as a fracture in the HITS system in its International Classification of Diseases, Ninth Revision, codes; injuries were excluded if they were not work related, if they occurred in the offseason, or if they were sustained by a nonplayer. The proportion of fractures occurring due to contact with the ground or another person in the relevant area of the field—home plate or second base—in the years before rule implementation was compared with the years after. Results: A total of 1798 fractures were identified: 342 among MLB players and 1456 among MiLB players. Mean time missed per fracture was 56.6 ± 48.4 days, with significantly less time missed in MLB (46.8 ± 47.7 days) compared with MiLB (59.0 ± 48.3 days) (P < .0001). A 1-way analysis of variance with post hoc Bonferroni correction demonstrated that starting pitchers missed significantly more time due to fractures per injury than all other position groups (P < .0001). Acute fractures due to contact with the ground or with another athlete were significantly decreased after rule implementation at home plate in 2014 (22 [3.0%] vs 14 [1.3%]; P = .015) and at second base in 2016 (90 [7.0%] vs 23 [4.5%]; P = .045). Conclusion: The recently instituted rule changes to reduce collisions between players at home plate and at second base are associated with reductions in the proportion of acute fractures in those areas on the field.
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Affiliation(s)
- William J Rubenstein
- Department of Orthopedics, University of California San Francisco, San Francisco, California, USA
| | - Sachin Allahabadi
- Department of Orthopedics, University of California San Francisco, San Francisco, California, USA
| | - Frank Curriero
- Department of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Brian T Feeley
- Department of Orthopedics, University of California San Francisco, San Francisco, California, USA
| | - Drew A Lansdown
- Department of Orthopedics, University of California San Francisco, San Francisco, California, USA
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98
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Shapiro M, Zubkov K, Landau R. Diagnosis of Stress fractures in military trainees: a large-scale cohort. BMJ Mil Health 2020; 168:382-385. [PMID: 32817239 DOI: 10.1136/bmjmilitary-2020-001406] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 06/17/2020] [Accepted: 06/26/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The Israel Defense Forces (IDF) has strict protocols for the diagnosis and treatment of stress fractures wherein diagnosis is clinical with imaging used for persistent symptoms only. The purpose of this study was to examine the incidence of clinical and radiological stress fractures during IDF combat training. METHODS Medical records of all soldiers enlisted to combat training between 2014 and 2017 were scanned for the diagnosis of stress fractures. We examined the imaging tests ordered (plain radiographs and bone scans) and their results and the time between the clinical diagnosis to imaging tests. RESULTS During 4 years, 62 371 soldiers (10.1% women) had started combat training, and 3672 of them (5.9%) were diagnosed with clinical stress fractures. Radiographs were ordered for 53.5% of those diagnosed, of whom 29.7% also had a bone scan. Some 42% of radiographs were taken within 21 days. Radiographs were positive for stress fractures in 11.1% of tests. Bone scans showed evidence of stress fractures in 49.7%, of which 49.2% diagnosed stress fractures in multiple bones. CONCLUSION The high percentage of negative radiographs may indicate towards alternative causes for symptoms. Performing the radiograph before or after 21 days did not affect workup results diverting from current belief that later radiographs will be more sensitive. Multiple stress fractures are a common finding, indicating that the increased training load puts the whole musculoskeletal system at increased risk for injury. Research results may necessitate a revision of clinical guidelines for the diagnosis of stress fractures in military trainees.
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Affiliation(s)
- Michael Shapiro
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Israel Defense Forces Medical Corps, Ramat Gan, Israel.,Department of Internal Medicine T, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - K Zubkov
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - R Landau
- Israel Defense Forces Medical Corps, Ramat Gan, Israel .,Internal Medicine D, Chaim Sheba medical center, Tel Hashomer, Israel
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99
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Henriques-Neto D, Magalhães JP, Hetherington-Rauth M, Santos DA, Baptista F, Sardinha LB. Physical Fitness and Bone Health in Young Athletes and Nonathletes. Sports Health 2020; 12:441-448. [PMID: 32660392 PMCID: PMC7485020 DOI: 10.1177/1941738120931755] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Physical activity (PA) and physical fitness (PF) are crucial for bone health. However, children participating in competitive sports with high PA are at a greater risk of fracture from trauma or overuse. Given the importance of bone development during adolescence, associations between commonly used physical fitness tests with distal third radius (R-SoS) and midshaft tibia (T-SoS) speed of sound by quantitative ultrasound were assessed in adolescent athletes and nonathletes. HYPOTHESIS The relationship between physical fitness tests and R-SoS and T-SoS will differ depending on sex and athletic status. STUDY DESIGN Cross-sectional study. LEVEL OF EVIDENCE Level 3. METHODS Physical fitness of 285 boys (156 athletes) and 311 girls (74 athletes) aged 10 to 18 years was assessed through strength, speed, agility, and cardiorespiratory tests. Linear regression was used to assess the associations of physical fitness tests with R-SoS and T-SoS. RESULTS For boys, favorable associations were observed between physical fitness tests with R-SoS in athletes and T-SoS in both athletes and nonathletes (P < 0.05). For nonathlete girls, favorable associations were found for handgrip (R-SoS and T-SoS, both P < 0.05), whereas the progressive aerobic cardiovascular endurance run, vertical jump, speed at 20 m and 40 m were only favorably associated with T-SoS. For athlete girls, the association between handgrip (P = 0.03), vertical jump, and 4 × 10 m shuttle run (P < 0.05) with T-SoS was significantly related to a bone outcome. CONCLUSION The handgrip test and vertical jump were associated with T-SoS in boys and girls independent of sport status. These results suggest that physical fitness is associated with bone health in adolescents, particularly boys, and that the relationship between physical fitness and bone may differ depending on sex and athletic status. CLINICAL RELEVANCE Physical fitness tests are simple, easy-to-use tools for monitoring bone health and should be used by sport and health professsionals to promote healthy sport participation and prevent bone injuries.
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Affiliation(s)
- Duarte Henriques-Neto
- CIPER, Faculdade de Motricidade Humana,
Universidade de Lisboa, Lisbon, Cruz-Quebrada, Portugal
- COP, Comité Olímpico de Portugal,
Lisbon, Portugal
| | - João P. Magalhães
- CIPER, Faculdade de Motricidade Humana,
Universidade de Lisboa, Lisbon, Cruz-Quebrada, Portugal
| | | | - Diana A. Santos
- CIPER, Faculdade de Motricidade Humana,
Universidade de Lisboa, Lisbon, Cruz-Quebrada, Portugal
| | - Fátima Baptista
- CIPER, Faculdade de Motricidade Humana,
Universidade de Lisboa, Lisbon, Cruz-Quebrada, Portugal
| | - Luís B. Sardinha
- CIPER, Faculdade de Motricidade Humana,
Universidade de Lisboa, Lisbon, Cruz-Quebrada, Portugal
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Williams K, Askew C, Mazoue C, Guy J, Torres-McGehee TM, Jackson III JB. Vitamin D3 Supplementation and Stress Fractures in High-Risk Collegiate Athletes - A Pilot Study. Orthop Res Rev 2020; 12:9-17. [PMID: 32161507 PMCID: PMC7051810 DOI: 10.2147/orr.s233387] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 02/07/2020] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Vitamin D is paramount to bone health and little is known about vitamin D's role in the prevention of stress fractures in high-risk athletes. This study consists of a prospective, cross-sectional analysis accompanied by a retrospective review for control comparison of vitamin D3 supplementation in high-risk athletes. Our hypothesis is that supplemental vitamin D3 treatment will decrease the occurrence of stress fractures in high-risk collegiate athletes. MATERIALS AND METHODS A total of 118 NCAA Division I athletes were recruited from 6 high-risk collegiate teams. Blood draws in August and February established baseline 25(OH)D levels. Subjects with serum 25(OH)D <30 ng/mL were supplemented with 50,000 IU of vitamin D3/week for 8 weeks. Treated subjects were re-tested to ensure serum 25(OH)D levels rose to sufficient status. All enrolled subjects were monitored for the development of stress fractures. A 5-year retrospective chart review of athletes from the same sports teams was conducted to determine the incidence of any reported stress fractures in the past. RESULTS Prospective: 112 of the 118 enrolled subjects were tested in August. Sixty-one demonstrated vitamin D sufficiency (40.2 ng/mL ±8.28) and 51 were either insufficient or deficient (22.7 ng/mL ±4.89). Of the 118 enrolled subjects, 104 were tested in February. Fifty-six demonstrated vitamin D sufficiency (40.7 ng/mL ±9.47) and 48 were insufficient or deficient (21.6 ng/mL ±5.87). Two stress fractures were diagnosed amongst our cohort of 118 student athletes (1.69%). Retrospective: 34 stress fractures were diagnosed in 453 subjects from 01/2010-05/2015 (7.51%). Amongst our athletic teams, the cross-country team specifically demonstrated a statistically significant decrease in stress fracture incidence (p<0.05). We also found a statistically significant reduction in stress fracture incidence amongst the current overall cohort compared to our retrospective cohort (p<0.05). CONCLUSION In our population, almost half of the tested athletes proved to be vitamin D deficient. Hypovitaminosis D was prevalent throughout the winter months compared with the summer. With vitamin D3 supplementation, the stress fracture rate in our overall cohort demonstrated a statistically significant decrease from 7.51% to 1.65% (p=0.009).
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Affiliation(s)
- Kevin Williams
- University of South Carolina School of Medicine, Department of Orthopaedic Surgery, Columbia, SC, USA
| | - Christian Askew
- University of South Carolina School of Medicine, Department of Orthopaedic Surgery, Columbia, SC, USA
| | - Christopher Mazoue
- University of South Carolina School of Medicine, Department of Orthopaedic Surgery, Columbia, SC, USA
| | - Jeffrey Guy
- University of South Carolina School of Medicine, Department of Orthopaedic Surgery, Columbia, SC, USA
| | | | - J Benjamin Jackson III
- University of South Carolina School of Medicine, Department of Orthopaedic Surgery, Columbia, SC, USA
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