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Wayner RA, Brown Crowell CN, Bovbjerg V, Federicson M, Soucy M, Choe S, Simon JE. Epidemiology of Bone-Stress Injuries and Health Care Use in Pac-12 Cross-Country Athletes. J Athl Train 2024; 59:641-648. [PMID: 37459389 PMCID: PMC11220775 DOI: 10.4085/1062-6050-0089.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
CONTEXT Bone-stress injury (BSI) is common in collegiate athletes. Injury rates and health care use in running athletes are not well documented. OBJECTIVE To describe the rate and classification of injury and associated health care use in collegiate cross-country runners with BSI. DESIGN Descriptive epidemiology study. SETTING Sports medicine facilities participating in the Pac-12 Health Analytics Program. PATIENTS OR OTHER PARTICIPANTS Pac-12 Conference collegiate cross-country athletes. MAIN OUTCOME MEASURE(S) Counts of injury and health care resources used for each injury. Injury rates were calculated based on athlete-seasons. RESULTS A total of 168 BSIs were reported over 4 seasons from 80 team-seasons (34 men's and 46 women's team-seasons) and 1220 athlete-seasons, resulting in 1764 athletic training services and 117 physician encounters. Bone-stress injuries represented 20% of all injuries reported by cross-country athletes. The average BSI rate was 0.14 per athlete-season. Injury rates were higher in female (0.16) than male (0.10) athletes and higher in the 2019-2020 season (0.20) than the 2020-2021 (0.14), 2018-2019 (0.12), and 2021-2022 (0.10) seasons. Most BSIs occurred in the lower leg (23.8%) and the foot (23.8%). The majority of injuries were classified as overuse and time loss (72.6%) and accounted for most of the athletic training services (75.3%) and physician encounters (72.6%). We found a mean of 10.89 athletic training services per overuse and time-loss injury and 12.20 athletic training services per overuse and non-time-loss injury. Mean occurrence was lower for physician encounters (0.70), prescription medications (0.04), tests (0.75), procedures (0.01), and surgery (0.02) than for athletic training services (10.50). CONCLUSIONS Bone-stress injuries are common in collegiate cross-country runners and require considerable athletic training resources. Athletic trainers should be appropriately staffed for this population, and suspected BSIs should be confirmed with a medical diagnosis. Future investigators should track treatment codes associated with BSI to determine best-practice patterns.
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Affiliation(s)
- Robert Aaron Wayner
- Division of Physical Therapy, School of Rehabilitation and Communication Sciences and
| | | | - Viktor Bovbjerg
- College of Public Health and Human Sciences, Oregon State University, Corvallis
| | - Michael Federicson
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Michael Soucy
- College of Public Health and Human Sciences, Oregon State University, Corvallis
| | - SeokJae Choe
- College of Public Health and Human Sciences, Oregon State University, Corvallis
| | - Janet E. Simon
- Division of Athletic Training, School of Applied Health Sciences & Wellness, Ohio University, Athens
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Tenforde AS, Ackerman KE, Bouxsein ML, Gaudette L, McCall L, Rudolph SE, Gehman S, Garrahan M, Hughes JM, Outerleys J, Davis IS, Popp KL. Factors Associated With High-Risk and Low-Risk Bone Stress Injury in Female Runners: Implications for Risk Factor Stratification and Management. Orthop J Sports Med 2024; 12:23259671241246227. [PMID: 38779133 PMCID: PMC11110515 DOI: 10.1177/23259671241246227] [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: 09/11/2023] [Accepted: 10/24/2023] [Indexed: 05/25/2024] Open
Abstract
Background Bone stress injury (BSI) is a common overuse injury in active women. BSIs can be classified as high-risk (pelvis, sacrum, and femoral neck) or low-risk (tibia, fibula, and metatarsals). Risk factors for BSI include low energy availability, menstrual dysfunction, and poor bone health. Higher vertical load rates during running have been observed in women with a history of BSI. Purpose/Hypothesis The purpose of this study was to characterize factors associated with BSI in a population of premenopausal women, comparing those with a history of high-risk or low-risk BSI with those with no history of BSI. It was hypothesized that women with a history of high-risk BSI would be more likely to exhibit lower bone mineral density (BMD) and related factors and less favorable bone microarchitecture compared with women with a history of low-risk BSI. In contrast, women with a history of low-risk BSI would have higher load rates. Study Design Cross-sectional study; Level of evidence, 3. Methods Enrolled were 15 women with a history of high-risk BSI, 15 with a history of low-risk BSI, and 15 with no history of BSI. BMD for the whole body, hip, and spine was standardized using z scores on dual-energy x-ray absorptiometry. High-resolution peripheral quantitative computed tomography was used to quantify bone microarchitecture at the radius and distal tibia. Participants completed surveys characterizing factors that influence bone health-including sleep, menstrual history, and eating behaviors-utilizing the Eating Disorder Examination Questionnaire (EDE-Q). Each participant completed a biomechanical assessment using an instrumented treadmill to measure load rates before and after a run to exertion. Results Women with a history of high-risk BSI had lower spine z scores than those with low-risk BSI (-1.04 ± 0.76 vs -0.01 ± 1.15; P < .05). Women with a history of high-risk BSI, compared with low-risk BSI and no BSI, had the highest EDE-Q subscores for Shape Concern (1.46 ± 1.28 vs 0.76 ± 0.78 and 0.43 ± 0.43) and Eating Concern (0.55 ± 0.75 vs 0.16 ± 0.38 and 0.11 ± 0.21), as well as the greatest difference between minimum and maximum weight at current height (11.3 ± 5.4 vs 7.7 ± 2.9 and 7.6 ± 3.3 kg) (P < .05 for all). Women with a history of high-risk BSI were more likely than those with no history of BSI to sleep <7 hours on average per night during the week (80% vs 33.3%; P < .05). The mean and instantaneous vertical load rates were not different between groups. Conclusion Women with a history of high-risk BSI were more likely to exhibit risk factors for poor bone health, including lower BMD, while load rates did not distinguish women with a history of BSI.
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Affiliation(s)
- Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Spaulding National Running Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Kathryn E Ackerman
- Wu Tsai Female Athlete Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mary L Bouxsein
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Logan Gaudette
- Department of Physical Medicine and Rehabilitation, Spaulding National Running Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Lauren McCall
- Wu Tsai Female Athlete Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sara E Rudolph
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah Gehman
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Margaret Garrahan
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Julie M Hughes
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Jereme Outerleys
- Department of Physical Medicine and Rehabilitation, Spaulding National Running Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Irene S Davis
- School of Physical Therapy Tampa, University of South Florida, Florida, USA
| | - Kristin L Popp
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
- Oak Ridge Associated Universities, Oak Ridge, Tennessee, USA. A.S.T., K.E.A., and M.L.B. contributed equally to this study. I.S.D. and K.L.P. contributed equally to this study
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3
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Sax AJ. Osseous Stress Injuries: Treatment Algorithms and Return to Play. Semin Musculoskelet Radiol 2024; 28:130-138. [PMID: 38484765 DOI: 10.1055/s-0043-1778030] [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: 03/19/2024]
Abstract
Osseous stress injuries are common in athletes. Specifically, lower extremity injuries are prevalent in running athletes and upper extremity injuries are prevalent in throwing athletes. Such injuries are suspected when there is focal bone tenderness and increased pain with the inciting activity. In elite athletes, osseous stress injuries are a relatively common culprit in lost play time. Thus rapid diagnosis and treatment is imperative to expedite return to play (RTP). The radiologist's role in these cases is not only for diagnosis, but also to grade the injury, which has implications in determining a treatment regimen. The high sensitivity and specificity of magnetic resonance imaging is thus the preferred imaging modality. This article discusses common osseous stress injuries, the imaging findings, and how different treatment regimens affect RTP.
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Affiliation(s)
- Alessandra J Sax
- The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, Rhode Island
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Raiser SN, Schroeder AN, Lawley RJ, Tenforde AS. Bone health and the masters runner. PM R 2024; 16:363-373. [PMID: 38532664 DOI: 10.1002/pmrj.13175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 02/13/2024] [Accepted: 02/25/2024] [Indexed: 03/28/2024]
Abstract
Masters runners are often defined as those ages 35 years and older who train and compete in running events. These runners represent a growing population of the overall running community and experience running-related injuries including bone stress injuries (BSIs). Similar to younger runners, health considerations in masters runners include the goal to optimize bone health with focus on mitigating age-associated loss of bone strength and preventing BSIs through a combination of ensuring appropriate physical activity, optimizing nutrition, and correcting faulty biomechanics. Importantly, BSIs in masters runners may include characteristics of both overuse injury from insufficient recovery and failure of bone weakened by age-related loss of bone (insufficiency fractures). This narrative review covers the limited available research on strategies to optimize bone health in masters runners. Applying knowledge on masters athletes and extrapolating from other populations, we propose strategies on treatment and prevention of BSIs. Finally, the review highlights gaps in knowledge that require further age-specific discoveries to advance treatment and prevention.
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Affiliation(s)
- Sara N Raiser
- Department of Physical Medicine & Rehabilitation, University of Virginia, Charlottesville, Virginia, USA
| | - Allison N Schroeder
- Department of Orthopedics, University Hospitals and Case Western Reserve University, Cleveland, Ohio, USA
| | - Richard J Lawley
- Department of Physical Medicine & Rehabilitation, Loyola University Medical Center, Maywood, Illinois, USA
| | - Adam S Tenforde
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
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Kelly S, Waring A, Stone B, Pollock N. Epidemiology of bone injuries in elite athletics: A prospective 9-year cohort study. Phys Ther Sport 2024; 66:67-75. [PMID: 38340615 DOI: 10.1016/j.ptsp.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVES To describe bone injury patterns in elite track and field athletes. To investigate relationships between bone injury and athlete characteristics to inform future injury prevention strategies. DESIGN Descriptive epidemiology study. SETTING Elite athletics training centres across the United Kingdom and internationally, observed between 2012 and 2020. PARTICIPANTS 207 Olympic programme senior track and field athletes. MAIN OUTCOME MEASURES Injury number, Incidence, Severity, Burden, Time Loss. RESULTS There were 78 fractures during the study period. Gradual repetitive bone injuries were the most common type of injury mode. The foot, pelvis and the lumbar spine were the regions with the highest number of bone stress injuries. Stress fractures had a higher burden overall compared to stress reactions. Average return to full training was 67.4 days (±73.1) for stress reactions and 199 (±205.2) days for stress fractures. There was no relationship between bone injury type and age, sex, ethnicity, side dominance or event group. CONCLUSION Bone stress injuries in athletics have a high severity and burden warranting continued efforts to prevent their occurrence and optimize management. Age, sex, ethnicity, side dominance and event region do not have any relationship with bone injury occurrence and are therefore unlikely to increase risk in this cohort.
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Affiliation(s)
- Shane Kelly
- Ballet Healthcare, The Royal Opera House, London, WC2E9DD, United Kingdom.
| | - Anthony Waring
- Fortius Clinic, 17 Fitzhardinge Street, London, W1H 6EQ, United Kingdom. https://twitter.com/Sport_Ex_Dr
| | - Ben Stone
- British Athletics, National Performance Institute (NPI), Loughborough, LE11 3TU, United Kingdom. https://twitter.com/B_W_Stone
| | - Noel Pollock
- Institute of Sport, Exercise and Health (ISEH), University College of London, London, W1T 7HA, United Kingdom. https://twitter.com/DrNoelPollock
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Burke LM, Ackerman KE, Heikura IA, Hackney AC, Stellingwerff T. Mapping the complexities of Relative Energy Deficiency in Sport (REDs): development of a physiological model by a subgroup of the International Olympic Committee (IOC) Consensus on REDs. Br J Sports Med 2023; 57:1098-1108. [PMID: 37752007 DOI: 10.1136/bjsports-2023-107335] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2023] [Indexed: 09/28/2023]
Abstract
The 2023 International Olympic Committee (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs) notes that exposure to low energy availability (LEA) exists on a continuum between adaptable and problematic LEA, with a range of potential effects on both health and performance. However, there is variability in the outcomes of LEA exposure between and among individuals as well as the specific manifestations of REDs. We outline a framework for a 'systems biology' examination of the effect of LEA on individual body systems, with the eventual goal of creating an integrated map of body system interactions. We provide a template that systematically identifies characteristics of LEA exposure (eg, magnitude, duration, origin) and a variety of moderating factors (eg, medical history, diet and training characteristics) that could exacerbate or attenuate the type and severity of impairments to health and performance faced by an individual athlete. The REDs Physiological Model may assist the diagnosis of underlying causes of problems associated with LEA, with a personalised and nuanced treatment plan promoting compliance and treatment efficacy. It could also be used in the strategic prevention of REDs by drawing attention to scenarios of LEA in which impairments of health and performance are most likely, based on knowledge of the characteristics of the LEA exposure or moderating factors that may increase the risk of harmful outcomes. We challenge researchers and practitioners to create a unifying and dynamic physiological model for each body system that can be continuously updated and mapped as knowledge is gained.
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Affiliation(s)
- Louise M Burke
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Kathryn E Ackerman
- Wu Tsai Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Ida A Heikura
- Canadian Sport Institute Pacific, Victoria, British Columbia, Canada
- Exercise Science, Physical & Health Education, University of Victoria, Victoria, British Columbia, Canada
| | - Anthony C Hackney
- Department of Exercise & Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Trent Stellingwerff
- Canadian Sport Institute Pacific, Victoria, British Columbia, Canada
- Exercise Science, Physical & Health Education, University of Victoria, Victoria, British Columbia, Canada
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White L, Losciale JM, Squier K, Guy S, Scott A, Prior JC, Whittaker JL. Combined hormonal contraceptive use is not protective against musculoskeletal conditions or injuries: a systematic review with data from 5 million females. Br J Sports Med 2023; 57:1195-1202. [PMID: 37225254 DOI: 10.1136/bjsports-2022-106519] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Assess the association between combined hormonal contraceptives (CHC) use and musculoskeletal tissue pathophysiology, injuries or conditions. DESIGN Systematic review with semiquantitative analyses and certainty of evidence assessment, guided by the Grading of Recommendations Assessment, Development and Evaluation approach. DATA SOURCES MEDLINE, EMBASE, CENTRAL, SPORTDiscus, CINAHL searched from inception to April 2022. ELIGIBILITY Intervention and cohort studies that assessed the association between new or ongoing use of CHC and an outcome of musculoskeletal tissue pathophysiology, injury or condition in postpubertal premenopausal females. RESULTS Across 50 included studies, we assessed the effect of CHC use on 30 unique musculoskeletal outcomes (75% bone related). Serious risk of bias was judged present in 82% of studies, with 52% adequately adjusting for confounding. Meta-analyses were not possible due to poor outcome reporting, and heterogeneity in estimate statistics and comparison conditions. Based on semiquantitative synthesis, there is low certainty evidence that CHC use was associated with elevated future fracture risk (risk ratio 1.02-1.20) and total knee arthroplasty (risk ratio 1.00-1.36). There is very low certainty evidence of unclear relationships between CHC use and a wide range of bone turnover and bone health outcomes. Evidence about the effect of CHC use on musculoskeletal tissues beyond bone, and the influence of CHC use in adolescence versus adulthood, is limited. CONCLUSION Given a paucity of high certainty evidence that CHC use is protective against musculoskeletal pathophysiology, injury or conditions, it is premature and inappropriate to advocate, or prescribe CHC for these purposes. PROSPERO REGISTRATION NUMBER This review was registered on PROSPERO CRD42021224582 on 8 January 2021.
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Affiliation(s)
- Lynita White
- Tall Tree Physiotherapy and Health Centre, Vancouver, British Columbia, Canada
| | - Justin M Losciale
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kipling Squier
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah Guy
- City Sport + Physiotherapy Clinic, Vancouver, British Columbia, Canada
| | - Alex Scott
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jerilynn C Prior
- Centre for Menstrual Cycle and Ovulation Research, The University of British Columbia, Vancouver, British Columbia, Canada
- Women's Health Research Institute, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jackie L Whittaker
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
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8
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Beling A, Saxena A, Hollander K, Tenforde AS. Outcomes Using Focused Shockwave for Treatment of Bone Stress Injury in Runners. Bioengineering (Basel) 2023; 10:885. [PMID: 37627770 PMCID: PMC10451564 DOI: 10.3390/bioengineering10080885] [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: 06/16/2023] [Revised: 07/13/2023] [Accepted: 07/17/2023] [Indexed: 08/27/2023] Open
Abstract
Bone stress injury (BSI) is a common overuse injury that can result in prolonged time away from sport. Limited studies have characterized the use of extracorporeal shockwave therapy (ESWT) for the treatment of BSI. The purpose of this study was to describe the use of ESWT for the management of BSI in runners. A retrospective chart review was performed to identify eligible patients in a single physician's clinic from 1 August 2018 to 30 September 2022. BSI was identified in 40 runners with 41 injuries (28 females; average age and standard deviation: 30 ± 13 years; average pre-injury training 72 ± 40 km per week). Overall, 63% (n = 26) met the criteria for moderate- or high-risk Female or Male Athlete Triad categories. Runners started ESWT at a median of 36 days (IQR 11 to 95 days; range 3 days to 8 years) from BSI diagnosis. On average, each received 5 ± 2 total focused ESWT treatments. Those with acute BSI (ESWT started <3 months from BSI diagnosis) had an average return to run at 12.0 ± 7.5 weeks, while patients with delayed union (>3 months, n = 3) or non-union (>6 months, n = 9) had longer time for return to running (19.8 ± 14.8 weeks, p = 0.032). All runners returned to pain-free running after ESWT except one runner with non-union of grade 4 navicular BSI who opted for surgery. No complications were observed with ESWT. These findings suggest that focused ESWT may be a safe treatment for the management of BSI in runners.
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Affiliation(s)
- Alexandra Beling
- Spaulding Rehabilitation Hospital, 300 First Avenue, Charlestown, MA 02129, USA
| | - Amol Saxena
- Palo Alto Medical Foundation, Palo Alto, CA 94301, USA
| | - Karsten Hollander
- Institute of Interdisciplinary Exercise Science and Sports Medicine, Medical School Hamburg, 20457 Hamburg, Germany
| | - Adam S. Tenforde
- Spaulding Rehabilitation Hospital, 300 First Avenue, Charlestown, MA 02129, USA
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Sundaramurthy A, Tong J, Subramani AV, Kote V, Baggaley M, Edwards WB, Reifman J. Effect of stride length on the running biomechanics of healthy women of different statures. BMC Musculoskelet Disord 2023; 24:604. [PMID: 37488528 PMCID: PMC10364351 DOI: 10.1186/s12891-023-06733-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/17/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Tibial stress fracture is a debilitating musculoskeletal injury that diminishes the physical performance of individuals who engage in high-volume running, including Service members during basic combat training (BCT) and recreational athletes. While several studies have shown that reducing stride length decreases musculoskeletal loads and the potential risk of tibial injury, we do not know whether stride-length reduction affects individuals of varying stature differently. METHODS We investigated the effects of reducing the running stride length on the biomechanics of the lower extremity of young, healthy women of different statures. Using individualized musculoskeletal and finite-element models of women of short (N = 6), medium (N = 7), and tall (N = 7) statures, we computed the joint kinematics and kinetics at the lower extremity and tibial strain for each participant as they ran on a treadmill at 3.0 m/s with their preferred stride length and with a stride length reduced by 10%. Using a probabilistic model, we estimated the stress-fracture risk for running regimens representative of U.S. Army Soldiers during BCT and recreational athletes training for a marathon. RESULTS When study participants reduced their stride length by 10%, the joint kinetics, kinematics, tibial strain, and stress-fracture risk were not significantly different among the three stature groups. Compared to the preferred stride length, a 10% reduction in stride length significantly decreased peak hip (p = 0.002) and knee (p < 0.001) flexion angles during the stance phase. In addition, it significantly decreased the peak hip adduction (p = 0.013), hip internal rotation (p = 0.004), knee extension (p = 0.012), and ankle plantar flexion (p = 0.026) moments, as well as the hip, knee, and ankle joint reaction forces (p < 0.001) and tibial strain (p < 0.001). Finally, for the simulated regimens, reducing the stride length decreased the relative risk of stress fracture by as much as 96%. CONCLUSIONS Our results show that reducing stride length by 10% decreases musculoskeletal loads, tibial strain, and stress-fracture risk, regardless of stature. We also observed large between-subject variability, which supports the development of individualized training strategies to decrease the incidence of stress fracture.
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Affiliation(s)
- Aravind Sundaramurthy
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, FCMR-TT, 504 Scott Street, Fort Detrick, MD, 21702-5012, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, 20817, USA
| | - Junfei Tong
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, FCMR-TT, 504 Scott Street, Fort Detrick, MD, 21702-5012, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, 20817, USA
| | - Adhitya V Subramani
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, FCMR-TT, 504 Scott Street, Fort Detrick, MD, 21702-5012, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, 20817, USA
| | - Vivek Kote
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, FCMR-TT, 504 Scott Street, Fort Detrick, MD, 21702-5012, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, 20817, USA
| | - Michael Baggaley
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, T2N 1N4, Canada
- The McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - W Brent Edwards
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, T2N 1N4, Canada
- The McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Jaques Reifman
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, FCMR-TT, 504 Scott Street, Fort Detrick, MD, 21702-5012, USA.
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10
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Fredericson M, Roche M, Barrack MT, Tenforde A, Sainani K, Kraus E, Kussman A, Miller Olson E, Kim BY, Fahy K, Miller E, Diamond E, Meraz S, Singh S, Nattiv A. Healthy Runner Project: a 7-year, multisite nutrition education intervention to reduce bone stress injury incidence in collegiate distance runners. BMJ Open Sport Exerc Med 2023; 9:e001545. [PMID: 37180969 PMCID: PMC10174024 DOI: 10.1136/bmjsem-2023-001545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
Objectives We evaluated the effect of a nutrition education intervention on bone stress injury (BSI) incidence among female distance runners at two NCAA Division I institutions. Methods Historical BSI rates were measured retrospectively (2010-2013); runners were then followed prospectively in pilot (2013-2016) and intervention (2016-2020) phases. The primary aim was to compare BSI rates in the historical and intervention phases. Pilot phase data are included only for descriptive purposes. The intervention comprised team nutrition presentations focused on optimising energy availability plus individualised nutrition sessions for runners with elevated Female Athlete Triad risk. Annual BSI rates were calculated using a generalised estimating equation Poisson regression model adjusted for age and institution. Post hoc analyses were stratified by institution and BSI type (trabecular-rich or cortical-rich). Results The historical phase included 56 runners and 90.2 person-years; the intervention phase included 78 runners and 137.3 person-years. Overall BSI rates were not reduced from the historical (0.52 events per person-year) to the intervention (0.43 events per person-year) phase. Post hoc analyses demonstrated trabecular-rich BSI rates dropped significantly from 0.18 to 0.10 events per person-year from the historical to intervention phase (p=0.047). There was a significant interaction between phase and institution (p=0.009). At Institution 1, the overall BSI rate dropped from 0.63 to 0.27 events per person-year from the historical to intervention phase (p=0.041), whereas no decline was observed at Institution 2. Conclusion Our findings suggest that a nutrition intervention emphasising energy availability may preferentially impact trabecular-rich BSI and depend on team environment, culture and resources.
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Affiliation(s)
- Michael Fredericson
- Department of Orthopaedic Surgery, Division of Physical Medicine & Rehabilitation, Stanford University, Stanford, California, USA
| | - Megan Roche
- Department of Epidemiology, Stanford Hospital and Clinics, Stanford, California, USA
| | - Michelle T Barrack
- Department of Family and Consumer Sciences, California State University Long Beach, Long Beach, California, USA
| | - Adam Tenforde
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Kristin Sainani
- Department of Epidemiology and Population Health, Stanford University, Stanford, California, USA
| | - Emily Kraus
- Department of Orthopaedic Surgery, Stanford Hospital and Clinics, Stanford, California, USA
| | - Andrea Kussman
- Department of Orthopaedic Surgery, Stanford Hospital and Clinics, Stanford, California, USA
| | | | - Brian Young Kim
- Family Medicine, University of California, Los Angeles, Santa Monica, California, USA
| | - Katherine Fahy
- Department of Family Medicine, University of Washington Medical Center, Seattle, Washington, USA
| | - Emily Miller
- Family Medicine, University of California, Los Angeles, Santa Monica, California, USA
| | - Ellie Diamond
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - Sonya Meraz
- School of Nursing, University of Massachusetts System, Boston, Massachusetts, USA
| | - Sonal Singh
- School of Medicine, St George’s University, St George’s, Grenada
| | - Aurelia Nattiv
- Division of Sports Medicine, Departments of Family Medicine and Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
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11
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Popp KL, Outerleys J, Gehman S, Garrahan M, Rudolph S, Loranger E, Ackerman KE, Tenforde AS, Bouxsein ML, Davis IS. Impact loading in female runners with single and multiple bone stress injuries during fresh and exerted conditions. JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:406-413. [PMID: 35218949 DOI: 10.1016/j.jshs.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/25/2021] [Accepted: 01/13/2022] [Indexed: 05/17/2023]
Abstract
BACKGROUND Bone stress injuries (BSIs) are common in female runners, and recurrent BSI rates are high. Previous work suggests an association between higher impact loading during running and tibial BSI. However, it is unknown whether impact loading and fatigue-related loading changes discriminate women with a history of multiple BSIs. This study compared impact variables at the beginning of a treadmill run to exertion and the changes in those variables with exertion among female runners with no history of BSI as well as among those with a history of single or multiple BSIs. METHODS We enrolled 45 female runners (aged 18-40 years) for this cross-sectional study: having no history of diagnosed lower extremity BSI (N-BSI, n = 14); a history of 1 lower extremity BSI (1-BSI, n = 16); and diagnosed by imaging, or a history of multiple (≥3) lower extremity BSIs (M-BSI, n = 15). Participants completed a 5-km race speed run on an instrumented treadmill while wearing an Inertial Measurement Unit. The vertical average loading rate (VALR), vertical instantaneous loading rate (VILR), vertical stiffness during impact via instrumented treadmill, and tibial shock determined as the peak positive tibial acceleration via Inertial Measurement Unit were measured at the beginning and the end of the run. RESULTS There were no differences between groups in VALR, VILR, vertical stiffness, or tibial shock in a fresh or exerted condition. However, compared to N-BSI, women with M-BSI had greater increase with exertion in VALR (-1.8% vs. 6.1%, p = 0.01) and VILR (1.5% vs. 4.8%, p = 0.03). Similarly, compared to N-BSI, vertical stiffness increased more with exertion among women with M-BSI (-0.9% vs. 7.3%, p = 0.006) and 1-BSI (-0.9% vs. 1.8%, p = 0.05). Finally, compared to N-BSI, the increase in tibial shock from fresh to exerted condition was greater among women with M-BSI (0.9% vs. 5.5%, p = 0.03) and 1-BSI (0.9% vs. 11.2%, p = 0.02). CONCLUSION Women with 1-BSI or M-BSIs experience greater exertion-related increases in impact loading than women with N-BSI. These observations imply that exertion-related changes in gait biomechanics may contribute to risk of BSI.
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Affiliation(s)
- Kristin L Popp
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, MA 01760, USA; Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 , USA.
| | - Jereme Outerleys
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, MA 02138, USA
| | - Sarah Gehman
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 , USA
| | - Margaret Garrahan
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 , USA
| | - Sara Rudolph
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 , USA
| | - Elizabeth Loranger
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 , USA
| | - Kathryn E Ackerman
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 , USA; Department of Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, MA 02138, USA
| | - Mary L Bouxsein
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 , USA; Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Irene S Davis
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, MA 02138, USA
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12
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Gaudette LW, Bradach MM, de Souza Junior JR, Heiderscheit B, Johnson CD, Posilkin J, Rauh MJ, Sara LK, Wasserman L, Hollander K, Tenforde AS. Clinical Application of Gait Retraining in the Injured Runner. J Clin Med 2022; 11:6497. [PMID: 36362725 PMCID: PMC9655004 DOI: 10.3390/jcm11216497] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 10/28/2022] [Accepted: 10/31/2022] [Indexed: 06/22/2024] Open
Abstract
Despite its positive influence on physical and mental wellbeing, running is associated with a high incidence of musculoskeletal injury. Potential modifiable risk factors for running-related injury have been identified, including running biomechanics. Gait retraining is used to address these biomechanical risk factors in injured runners. While recent systematic reviews of biomechanical risk factors for running-related injury and gait retraining have been conducted, there is a lack of information surrounding the translation of gait retraining for injured runners into clinical settings. Gait retraining studies in patients with patellofemoral pain syndrome have shown a decrease in pain and increase in functionality through increasing cadence, decreasing hip adduction, transitioning to a non-rearfoot strike pattern, increasing forward trunk lean, or a combination of some of these techniques. This literature suggests that gait retraining could be applied to the treatment of other injuries in runners, although there is limited evidence to support this specific to other running-related injuries. Components of successful gait retraining to treat injured runners with running-related injuries are presented.
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Affiliation(s)
- Logan W. Gaudette
- Spaulding Rehabilitation Hospital, Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02138, USA
| | - Molly M. Bradach
- Spaulding Rehabilitation Hospital, Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02138, USA
| | - José Roberto de Souza Junior
- Spaulding Rehabilitation Hospital, Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02138, USA
- Graduate Program of Sciences and Technologies in Health, University of Brasilia, Brasilia 72220-275, DF, Brazil
| | - Bryan Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI 53706, USA
| | - Caleb D. Johnson
- Spaulding Rehabilitation Hospital, Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02138, USA
- United States Army Research Institute for Environmental Medicine, Military Performance Division, Natick, MA 01760, USA
| | - Joshua Posilkin
- Spaulding Rehabilitation Hospital, Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02138, USA
| | - Mitchell J. Rauh
- Doctor of Physical Therapy Program, San Diego State University, San Diego, CA 92182, USA
| | - Lauren K. Sara
- Spaulding Rehabilitation Hospital, Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02138, USA
| | - Lindsay Wasserman
- Spaulding Rehabilitation Hospital, Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02138, USA
| | - Karsten Hollander
- Institute of Interdisciplinary Exercise Science and Sports Medicine, Faculty of Medicine, MSH, Medical School Hamburg, 20457 Hamburg, Germany
| | - Adam S. Tenforde
- Spaulding Rehabilitation Hospital, Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02138, USA
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13
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Stürznickel J, Hinz N, Delsmann MM, Hoenig T, Rolvien T. Impaired Bone Microarchitecture at Distal Radial and Tibial Reference Locations Is Not Related to Injury Site in Athletes With Bone Stress Injury. Am J Sports Med 2022; 50:3381-3389. [PMID: 36053067 PMCID: PMC9527365 DOI: 10.1177/03635465221120385] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bone stress injuries (BSIs) are common sports injuries that occur because of an imbalance between microdamage accumulation and removal through bone remodeling. The underlying bone phenotype has been assumed to be a contributing factor. However, the bone microarchitecture of athletes with BSI is not well characterized, and no study has investigated whether impaired bone microarchitecture is associated with bone composition or anatomic site of injury. PURPOSE/HYPOTHESIS This cross-sectional study characterizes the bone microarchitecture at distal radial and tibial reference locations in athletes with BSI. Based on previous dual-energy X-ray absorptiometry (DXA) findings, the aim was to compare anatomic injury sites, hypothesizing that athletes with BSIs in bones with greater trabecular composition show impaired bone microarchitecture parameters compared with those with BSIs in bones with greater cortical composition. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Athletes who had presented to our outpatient clinic because of a high-grade BSI (ie, stress fracture) were retrospectively included. Blood and urine samples were collected. Areal bone mineral density (aBMD) was assessed by DXA at the lumbar spine and both hips. Bone microarchitecture was analyzed by high-resolution peripheral quantitative computed tomography (HR-pQCT) at the distal radius and tibia. HR-pQCT parameters were expressed in relation to available sex-, age-, and device-adjusted reference values and compared with a cohort of 53 age- and sex-matched controls. RESULTS In total, 53 athletes had a BSI of the foot (n = 20), tibia/fibula (n = 18), pelvis (n = 9), femur (n = 5), or sternum (n = 1). Based on DXA measurements, a Z-score of -1.0 or lower was found in 32 of 53 (60.4%) of the athletes, of whom 16 of 53 (30.2%) had a Z score -2.0 or lower. While an impairment of cortical area (P = .034 and P = .001) and thickness (P = .029 and P < .001) was detected at the distal radius and tibia in the BSI cohort compared with controls, no differences in BMD or bone microarchitecture were observed between anatomic injury sites. Furthermore, no difference was revealed when BSIs were grouped into cortical- and trabecular-rich sites. CONCLUSION Reduced aBMD and impaired cortical bone microarchitecture were present in a considerable number of athletes with BSI. Neither aBMD nor bone microarchitecture was related to the injury site, highlighting the multifactorial etiology of BSI.
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Affiliation(s)
- Julian Stürznickel
- Department of Osteology and
Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,Department of Trauma and Orthopaedic
Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,Julian Stürznickel, MD,
Department of Osteology and Biomechanics, University Medical Center
Hamburg-Eppendorf, Lottestraße 59, 22529 Hamburg, Germany (
); or Tim Rolvien, MD, PhD, MBA,
Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery,
University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg,
Germany ()
| | - Nico Hinz
- Department of Trauma and Orthopaedic
Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,Department of Trauma Surgery,
Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - Maximilian M. Delsmann
- Department of Osteology and
Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,Department of Trauma and Orthopaedic
Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim Hoenig
- Department of Trauma and Orthopaedic
Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim Rolvien
- Department of Trauma and Orthopaedic
Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,Julian Stürznickel, MD,
Department of Osteology and Biomechanics, University Medical Center
Hamburg-Eppendorf, Lottestraße 59, 22529 Hamburg, Germany (
); or Tim Rolvien, MD, PhD, MBA,
Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery,
University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg,
Germany ()
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14
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Alway P, Peirce N, Johnson W, King M, Kerslake R, Brooke-Wavell K. Activity specific areal bone mineral density is reduced in athletes with stress fracture and requires profound recovery time: A study of lumbar stress fracture in elite cricket fast bowlers. J Sci Med Sport 2022; 25:828-833. [PMID: 36064501 DOI: 10.1016/j.jsams.2022.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of this study were to determine whether lumbar areal bone mineral density differed between cricket fast bowlers with and without lumbar stress fracture, and whether bone mineral density trajectories differed between groups during rehabilitation. DESIGN Cross-sectional and cohort. METHODS 29 elite male fast bowlers received a post-season anteroposterior lumbar dual-energy X-ray absorptiometry scan and a lumbar magnetic resonance imaging scan to determine stress fracture status. Participants were invited for three additional scans across the 59 weeks post baseline or diagnosis of injury. Bone mineral density was measured at L1 - L4 and ipsilateral and contralateral L3 and L4 sites. Independent-sample t-tests determined baseline differences in bone mineral density and multilevel models were used to examine differences in bone mineral density trajectories over time between injured and uninjured participants. RESULTS 17 participants with lumbar stress fracture had lower baseline bone mineral density at L1 - L4 (7.6 %, p = 0.034) and contralateral sites (8.8-10.4 %, p = 0.038-0.058) than uninjured participants. Bone mineral density at all sites decreased 1.9-3.0 % by 20-24 weeks before increasing to above baseline levels by 52 weeks post injury. CONCLUSIONS Injured fast bowlers had lower lumbar bone mineral density at diagnosis that decreased following injury and did not return to baseline until up to a year post-diagnosis. Localised maladaptation of bone mineral density may contribute to lumbar stress fracture. Bone mineral density loss following injury may increase risk of recurrence, therefore fast bowlers require careful management when returning to play.
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Affiliation(s)
- Peter Alway
- School of Sport, Exercise and Health Sciences, Loughborough University, United Kingdom; Department of Science and Medicine, England and Wales Cricket Board, United Kingdom.
| | - Nicholas Peirce
- Department of Science and Medicine, England and Wales Cricket Board, United Kingdom
| | - William Johnson
- School of Sport, Exercise and Health Sciences, Loughborough University, United Kingdom
| | - Mark King
- School of Sport, Exercise and Health Sciences, Loughborough University, United Kingdom
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15
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Tenforde AS, Katz NB, Sainani KL, Carlson JL, Golden NH, Fredericson M. Female Athlete Triad Risk Factors Are More Strongly Associated With Trabecular-Rich Versus Cortical-Rich Bone Stress Injuries in Collegiate Athletes. Orthop J Sports Med 2022; 10:23259671221123588. [PMID: 36157087 PMCID: PMC9502250 DOI: 10.1177/23259671221123588] [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: 05/13/2022] [Accepted: 07/05/2022] [Indexed: 11/26/2022] Open
Abstract
Background: Bone stress injuries (BSIs) are common in athletes. Risk factors for BSI may differ by skeletal anatomy and relative contribution of trabecular-rich and cortical-rich bone. Hypothesis: We hypothesized that Female Athlete Triad (Triad) risk factors would be more strongly associated with BSIs sustained at trabecular-rich versus cortical-rich skeletal sites. Study Design: Cohort study; Level of evidence, 2. Methods: The study population comprised 321 female National Collegiate Athletic Association Division I athletes participating in 16 sports from 2008 to 2014. Triad risk factors and a Triad cumulative risk score were assessed using responses to preparticipation examination and dual energy x-ray absorptiometry to measure lumbar spine and whole-body bone mineral density (BMD). Sports-related BSIs were diagnosed by a physician and confirmed radiologically. Athletes were grouped into those sustaining a subsequent trabecular-rich BSI, a subsequent cortical-rich BSI, and those without a BSI. Data were analyzed with multinomial logistic regression adjusted for participation in cross-country running versus other sports. Results: A total of 19 participants sustained a cortical-rich BSI (6%) and 10 sustained a trabecular-rich BSI (3%) over the course of collegiate sports participation. The Triad cumulative risk score was significantly related to both trabecular-rich and cortical-rich BSI. However, lower BMD and weight were associated with significantly greater risk for trabecular-rich than cortical-rich BSIs. For every value lower than 1 SD, the odds ratios (95% CIs) for trabecular-rich versus cortical-rich BSI were 3.08 (1.25-7.56) for spine BMD; 2.38 (1.22-4.64) for whole-body BMD; and 5.26 (1.48-18.70) for weight. Taller height was a significantly better predictor of cortical-rich than trabecular-rich BSI. Conclusion: The Triad cumulative risk score was significantly associated with both trabecular-rich and cortical-rich BSI, but Triad-related risk factors appeared more strongly related to trabecular-rich BSI. In particular, low BMD and low weight were associated with significantly higher increases in the risk of trabecular-rich BSI than cortical-rich BSI. These findings suggest Triad risk factors are more common in athletes sustaining BSI in trabecular-rich than cortical-rich locations.
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Affiliation(s)
- Adam S Tenforde
- Spaulding Rehabilitation Hospital, Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Nicole B Katz
- Spaulding Rehabilitation Hospital, Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Kristin L Sainani
- Department of Epidemiology and Population Health, Stanford University, Stanford, California, USA
| | - Jennifer L Carlson
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Neville H Golden
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Michael Fredericson
- Boswell Human Performance Laboratory, Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
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16
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Tenforde AS, DeLuca S, Wu AC, Ackerman KE, Lewis M, Rauh MJ, Heiderscheit B, Krabak BJ, Kraus E, Roberts W, Troy KL, Barrack MT. Prevalence and factors associated with bone stress injury in middle school runners. PM R 2022; 14:1056-1067. [PMID: 34251763 DOI: 10.1002/pmrj.12673] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 06/22/2021] [Accepted: 07/02/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Bone stress injury (BSI) in youth runners is clinically important during times of skeletal growth and is not well studied. OBJECTIVE To evaluate the prevalence, anatomical distribution, and factors associated with running-related BSI in boy and girl middle school runners. DESIGN Retrospective cross-sectional study. SETTING Online survey distributed to middle school runners. METHODS Survey evaluated BSI history, age, grade, height, weight, eating behaviors, menstrual function, exercise training, and other health characteristics. MAIN OUTCOME MEASUREMENTS Prevalence and characteristics associated with history of BSI, stratified by cortical-rich (eg, tibia) and trabecular-rich (pelvis and femoral neck) locations. PARTICIPANTS 2107 runners (n = 1250 boys, n = 857 girls), age 13.2 ± 0.9 years. RESULTS One hundred five (4.7%) runners reported a history of 132 BSIs, with higher prevalence in girls than boys (6.7% vs 3.8%, p = .004). The most common location was the tibia (n = 51). Most trabecular-rich BSIs (n = 16, 94% total) were sustained by girls (pelvis: n = 6; femoral neck: n = 6; sacrum: n = 4). In girls, consuming <3 daily meals (odds ratio [OR] = 18.5, 95% confidence interval [CI] = 7.3, 47.4), eating disorder (9.8, 95% CI = 2.0, 47.0), family history of osteoporosis (OR = 6.9, 95% CI = 2.6, 18.0), and age (OR = 1.6, 95% CI = 1.0, 2.6) were associated with BSI. In boys, family history of osteoporosis (OR = 3.2, 95% CI = 1.2, 8.4), prior non-BSI fracture (OR = 3.2, 95% CI = 1.6, 6.7), and running mileage (OR = 1.1, 95% CI = 1.0, 1.1) were associated with BSI. Participating in soccer or basketball ≥2 years was associated with lower odds of BSI for both sexes. CONCLUSION Whereas family history of osteoporosis and prior fracture (non-BSI) were most strongly related to BSI in the youth runners, behaviors contributing to an energy deficit, such as eating disorder and consuming <3 meals daily, also emerged as independent factors associated with BSI. Although cross-sectional design limits determining causality, our findings suggest promoting optimal skeletal health through nutrition and participation in other sports including soccer and basketball may address factors associated with BSI in this population.
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Affiliation(s)
- Adam S Tenforde
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Stephanie DeLuca
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander C Wu
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Kathryn E Ackerman
- Harvard Medical School, Boston, Massachusetts, USA
- Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Margo Lewis
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Mitchell J Rauh
- Doctor of Physical Therapy Program, San Diego State University, San Diego, California, USA
| | - Bryan Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, Wisconsin, USA
| | - Brian J Krabak
- Rehabilitation, Orthopedics and Sports Medicine, University of Washington, Seattle, Washington, USA
| | - Emily Kraus
- Stanford Children's Orthopedic and Sports Medicine Center, Stanford University, Stanford, California, USA
| | - William Roberts
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Karen L Troy
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, Massachusetts, USA
| | - Michelle T Barrack
- Department of Family and Consumer Sciences, California State University, Long Beach, California, USA
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17
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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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18
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Sugimoto D, Gearhart MG, Kobelski GP, Quinn BJ, Geminiani ET, Stracciolini A. Hallux Sesamoid Injury Characteristics in Young Athletes Presented to the Sports Medicine Clinic. Clin J Sport Med 2022; 32:e276-e280. [PMID: 33852435 DOI: 10.1097/jsm.0000000000000902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/31/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate clinical diagnoses, sports participation, and return to sport timeline associated with hallux sesamoid injuries with sex comparisons. DESIGN Descriptive epidemiology study. SETTING Sports medicine clinics at a tertiary-level pediatric medical center. PATIENTS Six hundred eighty-three young athletes (546 women and 137 men). INDEPENDENT VARIABLES Sex (women vs men). MAIN OUTCOME MEASURES Clinical diagnoses, participating sports, and injury timeline. RESULTS The most common diagnosis was sesamoiditis (62.6%). The top 3 primary sports were dance (34.6%), running (13.7%), and soccer (11.7%). When stratified by sex, dance (40.1%), running (13.6%), and soccer (10.7%) were the top primary sports for women while running (19.4%), soccer (18.5%), and basketball (11.3%) were the leading diagnoses for male athletes. The mean time between injury occurrence and first clinic visit was 135.5 ± 229.3 days. The mean time between the first clinic visit and return to sport was 104.3 ± 128.2 days. Comparison by sex showed that women had a longer mean time than men (women: 111.5 ± 132.5 days, men: 67.2 ± 96.3 days, P = 0.001). The mean time from injury occurrence to return to sport was 235.2 ± 281.0 days. Women showed a longer mean timeline for return to sport compared with men (women: 245.2 ± 288.2 days, men: 179.3 ± 231.9 days, P = 0.014). CONCLUSION Sesamoiditis was the most common diagnosis, and dance, running, and soccer were top 3 sports. The most salient finding was that women taking almost twice as long to return the sport or activity compared with men, which likely stems from delay of reporting symptom onset to clinics.
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Affiliation(s)
- Dai Sugimoto
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts
- Faculty of Sport Sciences,Waseda University, Tokyo, Japan
| | - Marina G Gearhart
- ARFID Program, Department of GI/Nutrition, Boston Children's Hospital, Boston, Massachusetts
| | - Greggory P Kobelski
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts
- Division of Sports Medicine, Department of Orthopaedics and Sports Medicine, Boston Children's Hospital, Boston, Massachusetts; and
| | - Bridget J Quinn
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts
- Division of Sports Medicine, Department of Orthopaedics and Sports Medicine, Boston Children's Hospital, Boston, Massachusetts; and
- Harvard Medical School, Boston, Massachusetts
| | - Ellen T Geminiani
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts
- Division of Sports Medicine, Department of Orthopaedics and Sports Medicine, Boston Children's Hospital, Boston, Massachusetts; and
- Harvard Medical School, Boston, Massachusetts
| | - Andrea Stracciolini
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts
- Division of Sports Medicine, Department of Orthopaedics and Sports Medicine, Boston Children's Hospital, Boston, Massachusetts; and
- Harvard Medical School, Boston, Massachusetts
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19
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Kale NN, Wang CX, Wu VJ, Miskimin C, Mulcahey MK. Age and Female Sex Are Important Risk Factors for Stress Fractures: A Nationwide Database Analysis. Sports Health 2022; 14:805-811. [PMID: 35243941 PMCID: PMC9631038 DOI: 10.1177/19417381221080440] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Stress fractures are caused by micro-trauma due to repetitive stress on bone, common in active individuals and athletes. Previous studies demonstrate that the weightbearing bones of the lower extremities incur stress fractures most often, especially in women and older adults. HYPOTHESIS Prior literature does not quantify the difference in frequency of stress fractures among different genders, age groups, or body mass indices (BMIs). We hypothesized that older female patients would have higher rates of lower extremity stress fractures than male patients. STUDY DESIGN Epidemiological research. LEVEL OF EVIDENCE Level 3. METHODS Records of female and male patients with lower extremity stress fractures from 2010 to 2018 were identified from the PearlDiver administrative claims database using the International Classification of Diseases (ICD)-9/ICD-10 codes. Stress fractures were classified by ICD-10 diagnosis codes to the tibial bone, proximal femur, phalanges, and other foot bones. Comorbidities were incorporated into a regression analysis. RESULTS Of 41,257 stress fractures identified, 30,555 (70.1%) were in women and 10,702 (25.9%) were in men. Our sample was older (>60 years old) (37.3%) and not obese (BMI <30 kg/m2, 37.1%). A greater proportion of female patients with stress fracture were older (P < 0.001) and had foot stress fractures (P < 0.001), while a greater proportion of male patients with stress fracture were younger than 19 years (P < 0.001) and had metatarsal (P < 0.001), hip (P = 0.002), and tibia stress fractures (P < 0.001). CONCLUSION Stress fractures commonly occur in women and older adults with low BMIs. Metatarsal and tibia stress fractures were the most common, and a greater proportion of women had foot stress fractures. CLINICAL RELEVANCE Our study examined the large-scale prevalence of different lower extremity stress fractures among a wide patient population sample of varying ages and BMIs. These findings can help clinicians identify active populations at greater risk for stress fracture injuries.
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Affiliation(s)
- Nisha N. Kale
- Tulane University School of Medicine,
New Orleans, Louisiana
| | - Cindy X. Wang
- Tulane University School of Medicine,
New Orleans, Louisiana
| | - Victor. J. Wu
- Department of Orthopedic Surgery,
McGovern Medical School, Houston, Texas
| | - Cadence Miskimin
- Department of Orthopaedic Surgery,
Tulane University School of Medicine, New Orleans, Louisiana
| | - Mary K. Mulcahey
- Department of Orthopaedic Surgery,
Tulane University School of Medicine, New Orleans, Louisiana,Mary K. Mulcahey, MD,
Department of Orthopaedic Surgery, Tulane University School of Medicine, 1430
Tulane Avenue, 8632, New Orleans, LA 70112 (
) (Twitter: @marykmulcaheymd)
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20
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Koltun KJ, Sekel NM, Bird MB, Lovalekar M, Mi Q, Martin BJ, Nindl BC. Tibial Bone Geometry Is Associated With Bone Stress Injury During Military Training in Men and Women. Front Physiol 2022; 13:803219. [PMID: 35222074 PMCID: PMC8874318 DOI: 10.3389/fphys.2022.803219] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/17/2022] [Indexed: 12/03/2022] Open
Abstract
Bone stress injuries (BSI) are a common musculoskeletal condition among exercising and military populations and present a major burden to military readiness. The purpose of this investigation was to determine whether baseline measures of bone density, geometry, and strength, as assessed via peripheral quantitative computed tomography (pQCT), are predictive of tibial BSI during Marine Officer Candidates School training. Tibial pQCT scans were conducted prior to the start of physical training (n = 504; Male n = 382; Female n = 122) to measure volumetric bone mineral density (vBMD), geometry, robustness, and estimates of bone strength. Bone parameters were assessed at three tibial sites including the distal metaphysis (4% of tibial length measured from the distal endplate), mid-diaphysis (38% of tibial length measured from the distal endplate), and proximal diaphysis (66% of tibial length measured from the distal endplate). Injury surveillance data was collected throughout training. Four percent (n = 21) of the sample were diagnosed with a BSI at any anatomical site during training, 10 injuries were of the tibia. Baseline bone parameters were then tested for associations with the development of a tibial BSI during training and it was determined that cortical bone measures at diaphyseal (38 and 66%) sites were significant predictors of a prospective tibial BSI. At the mid-diaphysis (38% site), in a simple model and after adjusting for sex, age, and body size, total area [Odds Ratio (OR): 0.987, 0.983], endosteal circumference (OR: 0.853, 0.857), periosteal circumference (OR: 0.863, 0.824), and estimated bending strength (SSI; OR: 0.998, 0.997) were significant predictors of a BSI during training, respectively, such that lower values were associated with an increased likelihood of injury. Similarly, at the proximal diaphysis (66% site), total area (OR: 0.989, 0.985), endosteal circumference (OR: 0.855, 0.854), periosteal circumference (OR: 0.867, 0.823), robustness (OR: 0.007, 0.003), and SSI (OR: 0.998, 0.998) were also significant predictors of BSI in the simple and adjusted models, respectively, such that lower values were associated with an increased likelihood of injury. Results from this investigation support that narrower bones, with reduced circumference, lower total area, and lower estimated strength are associated with increased risk for tibial BSI during military training.
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21
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Carbuhn AF, Yu D, Magee LM, McCulloch PC, Lambert BS. Anthropometric Factors Associated With Bone Stress Injuries in Collegiate Distance Runners: New Risk Metrics and Screening Tools? Orthop J Sports Med 2022; 10:23259671211070308. [PMID: 35178462 PMCID: PMC8844446 DOI: 10.1177/23259671211070308] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Lower limb bone stress injury (BSI) of the pelvis, femur, and tibia is prevalent in collegiate track and field distance runners. Bone mineral density (BMD), body composition (BComp), and anthropometric parameters before initial collegiate injury have not been compared between runners with BSI and their noninjured counterparts. PURPOSE To characterize bone health in relation to BComp and anthropometric measurements from total-body dual x-ray absorptiometry (DXA) scans in collegiate male and female distance runners before BSI and develop BMD prediction models. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Distance runners (N = 79) from a single university track and field team were retrospectively enrolled into this study. The runners completed a DXA scan during the fall season (August-November) and participated in sport activities before the scan. Three months after scanning, electronic medical records were reviewed for the occurrence of BSI. An independent-sample t test was used to compare BMD (total and regional [spine, pelvis, and legs]), BComp (% body fat, fat mass, and lean mass), and anthropometric measurements (shoulder width and leg, arm, and trunk length) between runners with versus without BSI (included subgroup analysis by sex). Multiple linear regression with stepwise removal was used to determine variables most predictive of BMD. RESULTS Of the 79 enrolled participants (42 male, 37 female), 18 runners (22.8%; 11 female, 7 male) sustained a lower limb BSI. Compared with the noninjured group, injured runners had lower total and regional BMD (P < .001 for all) and shorter leg and arm lengths (P < .05 for both), whereas injured male runners had lower fat mass and injured female runners had lower lean mass in the legs (P < .05 for both). Injured runners' age-matched total BMD Z score (-0.1 ± 0.6) was considered clinically normal. BComp and anthropometric measures were predictive of total and regional BMD (P < .05; R 2 = 0.64-0.80; percentage error = 3.8%-4.8%). CONCLUSION The DXA scans of injured runners prior to incidence indicated lower BMD compared with noninjured runners. Shorter limb lengths, lower fat mass (male), and lower leg lean mass (female) may also be indicative of risk. Certain BComp and anthropometric measures were predictive of BMD.
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Affiliation(s)
- Aaron F. Carbuhn
- Department of Dietetics and Nutrition, University of Kansas Medical
Center, Kansas City, Kansas, USA
| | - Daniel Yu
- Department of Dietetics and Nutrition, University of Kansas Medical
Center, Kansas City, Kansas, USA
- Kansas Team Health, Kansas Athletics Inc, Lawrence, Kansas,
USA
| | | | - Patrick C. McCulloch
- Department of Orthopedics and Sports Medicine, Houston Methodist
Hospital, Houston, Texas, USA
| | - Bradley S. Lambert
- Department of Orthopedics and Sports Medicine, Houston Methodist
Hospital, Houston, Texas, USA
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22
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Sanfilippo D, Beaudart C, Gaillard A, Bornheim S, Bruyere O, Kaux JF. What Are the Main Risk Factors for Lower Extremity Running-Related Injuries? A Retrospective Survey Based on 3669 Respondents. Orthop J Sports Med 2021; 9:23259671211043444. [PMID: 34820458 PMCID: PMC8606943 DOI: 10.1177/23259671211043444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/25/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Despite the many studies on running-related injuries (RRIs), risk factors for injury remain unclear in the literature. Purpose: To investigate the risk factors of RRIs. Study Design: Case-control study; Level of evidence, 3. Methods: An online survey was conducted among 3669 injured and noninjured runners. Injury was defined as pain of various kinds, without attention to its consequences on running practice. The survey included 41 questions on 5 main categories—personal characteristics, daily lifestyle, training and running characteristics, practice of other sporting activities, and prevention habits—as well as information about the occurrence of RRI over the previous 12 months. Continuous and qualitative variables were analyzed by Student t test and chi-square test, respectively. Sixteen variables were selected for multivariate binary logistic analysis. Results: Among the 3669 runners, 1852 (50.5%) reported at least 1 injury over the previous 12 months. Overuse injuries were largely represented (60.6%). The variables associated with RRIs that remained significant in the fully adjusted model were previous injury (odds ratio [OR], 1.62; 95% CI, 1.42-1.86), higher weight (OR, 1.006; 95% CI, 1.00-1.012), competitive running (OR, 1.53; 95% CI, 1.19-1.98), running >2 h/wk (OR, 1.28; 95% CI, 1.01-1.62), running >20 km/wk (OR, 1.25; 95% CI, 1.001-1.55), and stretching before running (OR, 1.46; 95% CI, 1.25-1.71). Conclusion: Previous injury remains the most relevant risk factor for RRIs according to the current study and previous data. Many training characteristics seem to be involved but still have to be confirmed in view of conflicting data in the literature. Further research would help clinicians better understand RRIs and how to prevent them.
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Affiliation(s)
- Damien Sanfilippo
- Department of Rehabilitation and Sports Sciences, University of Liège, Liège, Belgium.,Department of Physical Medicine and Sports Traumatology, Sports, FIFA Medical Centre of Excellence, IOC Research Centre for Prevention of Injury and Protection of Athlete Health, FIMS Collaborative Center of Sports Medicine, University and University Hospital of Liège, Liège, Belgium
| | - Charlotte Beaudart
- Department of Rehabilitation and Sports Sciences, University of Liège, Liège, Belgium.,World Health Organization Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Allan Gaillard
- Department of Rehabilitation and Sports Sciences, University of Liège, Liège, Belgium
| | - Stephen Bornheim
- Department of Rehabilitation and Sports Sciences, University of Liège, Liège, Belgium
| | - Olivier Bruyere
- World Health Organization Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Jean-François Kaux
- Department of Rehabilitation and Sports Sciences, University of Liège, Liège, Belgium.,Department of Physical Medicine and Sports Traumatology, Sports, FIFA Medical Centre of Excellence, IOC Research Centre for Prevention of Injury and Protection of Athlete Health, FIMS Collaborative Center of Sports Medicine, University and University Hospital of Liège, Liège, Belgium
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23
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Dobrosielski DA, Leppert KM, Knuth ND, Wilder JN, Kovacs L, Lisman PJ. Body Composition Values of NCAA Division 1 Female Athletes Derived From Dual-Energy X-Ray Absorptiometry. J Strength Cond Res 2021; 35:2886-2893. [PMID: 31343559 DOI: 10.1519/jsc.0000000000003213] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Dobrosielski, DA, Leppert, KM, Knuth, ND, Wilder, JN, Kovacs, L, and Lisman, PJ. Body composition values of NCAA Division 1 female athletes derived from dual-energy x-ray absorptiometry. J Strength Cond Res 35(10): 2886-2893, 2021-This study generated descriptive data for regional and total body composition and bone mineral density (BMD) measures using dual-energy x-ray absorptiometry (DXA) across 12 NCAA Division 1 female competitive sports. Two hundred seventy-eight female collegiate athletes underwent DXA: basketball (BB; n = 28), cross country (CC = 11), field hockey (FH; n = 35), gymnastics (GYM; n = 23), lacrosse (LAX; n = 48), soccer (SOC; CC = 27), softball (SB; n = 24), swimming and diving (SW; n = 35), tennis (TN; n = 11), track and field ([TR-throw; n = 10]; [TR-run; n = 10]), and volleyball (VB; n = 16). Descriptive statistics for all body composition and BMD measures were calculated. Group mean differences in all regional and total body composition (all, p < 0.001; η2 range = 0.177-0.365) and BMD (all, p < 0.001; η2 range = 0.317-0.383) measures were observed between teams. The total BF% for gymnasts (23.5%) was lower than TN, FH, LAX, SB, and TR-throw (mean difference range: -4.6 to -12.9%, all p < 0.01); TR-throw had the highest total BF% (36.4%). Cross country had lower total BMD (1.17 g·cm-2) than FH, TR-throw, LAX, GYM, SOC, SB, VB, and BB (mean difference range: -0.12 to -0.26 g·cm-2, all p < 0.01); BB and TR-throw had the highest total BMD (1.40 and 1.43 g·cm-2, respectively). Our data confirm that regional and total body composition and BMD measures varied across female collegiate sports. These findings may assist sports medicine and strength and conditioning practitioners with identifying sport-specific goal values for BF% and BMD to optimize program design.
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Affiliation(s)
- Devon A Dobrosielski
- Department of Kinesiology, Towson University, Towson, MD.,Towson Research Academy of Collaborative Sport Science (TRACS), Towson University, Towson, MD
| | - Kyle M Leppert
- Department of Kinesiology, Towson University, Towson, MD.,Towson Research Academy of Collaborative Sport Science (TRACS), Towson University, Towson, MD
| | - Nick D Knuth
- Department of Kinesiology, Towson University, Towson, MD.,Towson Research Academy of Collaborative Sport Science (TRACS), Towson University, Towson, MD
| | - Joshua N Wilder
- Towson Research Academy of Collaborative Sport Science (TRACS), Towson University, Towson, MD.,Department of Athletics, Towson University, Towson, MD; and
| | - Louis Kovacs
- Towson Research Academy of Collaborative Sport Science (TRACS), Towson University, Towson, MD.,MedStar Sports Medicine, Medstar Health, Baltimore, MD
| | - Peter J Lisman
- Department of Kinesiology, Towson University, Towson, MD.,Towson Research Academy of Collaborative Sport Science (TRACS), Towson University, Towson, MD
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24
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McSweeney SC, Grävare Silbernagel K, Gruber AH, Heiderscheit BC, Krabak BJ, Rauh MJ, Tenforde AS, Wearing SC, Zech A, Hollander K. Adolescent Running Biomechanics - Implications for Injury Prevention and Rehabilitation. Front Sports Act Living 2021; 3:689846. [PMID: 34514384 PMCID: PMC8432296 DOI: 10.3389/fspor.2021.689846] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/23/2021] [Indexed: 12/28/2022] Open
Abstract
Global participation in running continues to increase, especially amongst adolescents. Consequently, the number of running-related injuries (RRI) in adolescents is rising. Emerging evidence now suggests that overuse type injuries involving growing bone (e.g., bone stress injuries) and soft tissues (e.g., tendinopathies) predominate in adolescents that participate in running-related sports. Associations between running biomechanics and overuse injuries have been widely studied in adults, however, relatively little research has comparatively targeted running biomechanics in adolescents. Moreover, available literature on injury prevention and rehabilitation for adolescent runners is limited, and there is a tendency to generalize adult literature to adolescent populations despite pertinent considerations regarding growth-related changes unique to these athletes. This perspective article provides commentary and expert opinion surrounding the state of knowledge and future directions for research in adolescent running biomechanics, injury prevention and supplemental training.
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Affiliation(s)
- Simon C McSweeney
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | | | - Allison H Gruber
- Department of Kinesiology, School of Public Health - Bloomington, Indiana University, Bloomington, IN, United States
| | - Bryan C Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI, United States
| | - Brian J Krabak
- Department of Rehabilitation, Orthopedics and Sports Medicine, University of Washington and Seattle Childrens Hospital, Seattle, WA, United States
| | - Mitchell J Rauh
- Doctor of Physical Therapy Program, San Diego State University, San Diego, CA, United States
| | - Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Scott C Wearing
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Astrid Zech
- Department of Human Movement Science and Exercise Physiology, Institute of Sport Science, Friedrich Schiller University Jena, Jena, Germany
| | - Karsten Hollander
- Institute of Interdisciplinary Exercise Science and Sports Medicine, Faculty of Medicine, MSH Medical School Hamburg, Hamburg, Germany
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25
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Baggaley M, Derrick TR, Vernillo G, Millet GY, Edwards WB. Internal Tibial Forces and Moments During Graded Running. J Biomech Eng 2021; 144:1115052. [PMID: 34318310 DOI: 10.1115/1.4051924] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Indexed: 11/08/2022]
Abstract
The stress experienced by the tibia has contributions from the forces and moments acting on the tibia. We sought to quantify the influence of running grade on internal tibial forces and moments. Seventeen participants ran at 3.33 m/s on an instrumented treadmill at 0 deg, ±5 deg, and ±10 deg while motion data were captured. Ankle joint contact force was estimated from an anthropometrically-scaled musculoskeletal model using inverse dynamics-based static optimization. Internal tibial forces and moments were quantified at the distal 1/3rd of the tibia, by ensuring static equilibrium with all applied forces and moments. Downhill running conditions resulted in lower peak internal axial force (range of mean differences: -9% to -16%, p < 0.001), lower peak internal anteroposterior force (-14% to -21%, p < 0.001), and lower peak internal mediolateral force (-14% to -15%, p < 0.001), compared to 0 deg and +5 deg. Furthermore, downhill conditions resulted in lower peak internal mediolateral moment (-11%to -21%, p < 0.001), lower peak internal anteroposterior moment (-13% to -14%, p < 0.001), and lower peak internal torsional moment (-9% to -21%, p < 0.001), compared to 0 deg, +5 deg, and +10 deg. The +10 deg condition resulted in lower peak internal axial force (-7% to -9%, p < 0.001) and lower peak internal mediolateral force (-9%, p = 0.004), compared to 0 deg and +5 deg. These findings suggest that downhill running may be associated with lower tibial stresses than either level or uphill running.
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Affiliation(s)
- Michael Baggaley
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary AB T2N 1N4, Canada
| | - Timothy R Derrick
- Department of Kinesiology, Iowa State University, 0111 L Forker, 534 Wallace Rd, Ames, IA 50011-4008
| | - Gianluca Vernillo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Colombo, 71, Milano 20133, Italy
| | - Guillaume Y Millet
- Univ Lyon, UJM Saint-Etienne, Inter-University Laboratory of Human Movement Biology, 10 rue de la Marandière, Saint Priest en Jarez 42270, France
| | - W Brent Edwards
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary AB T2N 1N4, Canada
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26
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Hutson MJ, O'Donnell E, Petherick E, Brooke-Wavell K, Blagrove RC. Incidence of bone stress injury is greater in competitive female distance runners with menstrual disturbances independent of participation in plyometric training. J Sports Sci 2021; 39:2558-2566. [PMID: 34269142 DOI: 10.1080/02640414.2021.1945184] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Bone stress injury (BSI) is prevalent in female distance runners. Menstrual disturbances are associated with impaired bone health in endurance athletes. This study aimed to investigate the association between menstrual function and BSI and explore whether plyometric training may protect against BSI in individuals with menstrual disturbances. Competitive female distance runners (n = 183) aged 18-40 years were surveyed for training habits, menstrual function, and BSI, during the previous 12 months. Oligo/amenorrhoea during the previous 12 months (<9 menses) was deemed to indicate menstrual disturbance; hormonal contraceptive users and those previously diagnosed with a pathology that impacted menstrual function were excluded. BSI incidence rate was 2.25 (p = 0.02, 95% CI: 1.14-4.41) times greater in oligo/amenorrhoeic than eumenorrhoeic runners. BSI incidence rate was similar in oligo/amenorrhoeic and eumenorrhoeic runners that did plyometric training, but 3.78 (p = 0.001, 95% CI: 1.68-8.5) times greater in oligo/amenorrhoeic versus eumenorrhoeic runners that did not. However, the effect of plyometrics was non-significant (menstrual function × plyometric training interaction, p = 0.06; main effect, p = 0.89). Conventional plyometric training may not reduce BSI incidence in female distance runners, but menstrual disturbances and prolonged periods of low energy availability should be avoided.
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Affiliation(s)
- Mark J Hutson
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Emma O'Donnell
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Emily Petherick
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | | | - Richard C Blagrove
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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27
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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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28
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Holmes HH, Monaghan PG, Strunk KK, Paquette MR, Roper JA. Changes in Training, Lifestyle, Psychological and Demographic Factors, and Associations With Running-Related Injuries During COVID-19. Front Sports Act Living 2021; 3:637516. [PMID: 34164619 PMCID: PMC8215167 DOI: 10.3389/fspor.2021.637516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/08/2021] [Indexed: 11/13/2022] Open
Abstract
The primary purpose of this study was to examine how the type and magnitude of changes in running behavior, as a consequence of COVID-19 pandemic restrictions, influence running-related injuries. Secondarily, we aimed to examine how lifestyle and psychosocial well-being measures may influence running behavior change. An online survey was advertised to individuals over the age of 18 that currently run or have previously participated in running for exercise. The survey questions examined injury history and new injuries sustained during COVID-19 restrictions, as well as changes related to training behavior changes, training environment changes, social behaviors, and psychosocial well-being. Changes reflected differences in running behaviors prior to COVID-19 restrictions (1 month prior to COVID-19 restrictions being imposed) and during COVID-19 restrictions (May 5 to June 10, 2020). A total of 1,035 runners were included in the analysis. Current injuries sustained during COVID-19 occurred in 9.5% of the runners. Injured runners made a greater number of total changes (p = 0.031) as well as training-related (p = 0.042) and environment-related (p = 0.017) changes compared with uninjured runners. A significant relationship was found between injury and those that reported less time to exercise to changes in work environment (p = 0017). This study highlights the multi-dimensional nature of running-related injuries and the need to consider the interaction of multiple changes in running behavior, rather than isolating single factors. Greater understanding of the underlying causes of running-related injuries can help reduce the risk of future injury.
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Affiliation(s)
- Hillary H Holmes
- School of Kinesiology, Auburn University, Auburn, AL, United States
| | | | - Kamden K Strunk
- Department of Educational Foundations, Leadership and Technology, Auburn University, Auburn, AL, United States
| | - Max R Paquette
- College of Health Sciences, University of Memphis, Memphis, TN, United States
| | - Jaimie A Roper
- School of Kinesiology, Auburn University, Auburn, AL, United States
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29
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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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Effects of Low Energy Availability on Bone Health in Endurance Athletes and High-Impact Exercise as A Potential Countermeasure: A Narrative Review. Sports Med 2021; 51:391-403. [PMID: 33346900 PMCID: PMC7900047 DOI: 10.1007/s40279-020-01396-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Endurance athletes expend large amounts of energy in prolonged high-intensity exercise and, due to the weight-sensitive nature of most endurance sports, often practice periods of dietary restriction. The Female Athlete Triad and Relative Energy Deficiency in Sport models consider endurance athletes at high-risk for suffering from low energy availability and associated health complications, including an increased chance of bone stress injury. Several studies have examined the effects of low energy availability on various parameters of bone structure and markers of bone (re)modelling; however, there are differences in findings and research methods and critical summaries are lacking. It is difficult for athletes to reduce energy expenditure or increase energy intake (to restore energy availability) in an environment where performance is a priority. Development of an alternative tool to help protect bone health would be beneficial. High-impact exercise can be highly osteogenic and energy efficient; however, at present, it is rarely utilized to promote bone health in endurance athletes. Therefore, with a view to reducing the prevalence of bone stress injury, the objectives of this review are to evaluate the effects of low energy availability on bone health in endurance athletes and explore whether a high-impact exercise intervention may help to prevent those effects from occurring.
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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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32
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Rauh MJ, Tenforde AS, Barrack MT, Rosenthal MD, Nichols JF. Sport Specialization and Low Bone Mineral Density in Female High School Distance Runners. J Athl Train 2021; 55:1239-1246. [PMID: 33176358 DOI: 10.4085/1062-6050-0547.19] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Sport specialization may contribute to sport injury and menstrual dysfunction in female high school distance runners. Despite the recent growth in sport specialization, including among high school-aged runners, the association of sport specialization with bone mineral density (BMD) remains poorly described. OBJECTIVE To evaluate whether sport specialization was associated with BMD in female high school distance runners. DESIGN Cross-sectional study. SETTING Six high schools. PATIENTS OR OTHER PARTICIPANTS Sixty-four female runners (age = 15.6 ± 1.4 years) who competed in cross-country or track distance events and were not currently on birth control medication. MAIN OUTCOME MEASURE(S) Each runner completed a survey on menstrual history and sport participation. Height and weight were measured, and dual-energy x-ray absorptiometry was used to measure whole-body, spine, and hip BMD. Each runner was assigned a sport specialization status: low (participation in ≥1 nonrunning sport and distance-running sport(s) for ≤8 mo/y); moderate (participation in both distance-running sport(s) ≥9 mo/y and ≥1 nonrunning sport(s) or limited to distance-running sport(s) for ≤8 mo/y); or high (participation only in distance-running sport(s) for ≥9 mo/y). Multivariable logistic regression was performed to determine the adjusted odds ratio and 95% confidence interval for sport specialization to BMD values, adjusting for body mass index and gynecological age. RESULTS Overall, 21.9%, 37.5%, and 40.6% of participants were high, moderate, or low sport specializers, respectively. Low BMD (spine or whole-body BMD z score < -1.0 [standardized by age and sex normative values]) was present in 23 (35.9%) runners. Compared with low sport specializers, high sport specializers were 5 times more likely (adjusted odds ratio = 5.42, 95% confidence interval = 1.3, 23.3; P = .02) to have low BMD. CONCLUSIONS A high level of sport specialization in high school female distance runners may be associated with a heightened risk for low BMD. Further investigation of this association is warranted due to the health concerns about low BMD in adolescent female runners.
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Affiliation(s)
- Mitchell J Rauh
- Doctor of Physical Therapy Program, San Diego State University, CA
| | - Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA
| | - Michelle T Barrack
- Department of Family and Consumer Sciences, California State University, Long Beach
| | | | - Jeanne F Nichols
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla
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Ricker EA, Goforth CW, Barrett AS, Deuster PA, de la Motte SJ. Female Military Officers Report a Desire for Menstrual Suppression During Military Training. Mil Med 2021; 186:775-783. [PMID: 33499478 DOI: 10.1093/milmed/usaa339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/18/2020] [Accepted: 09/03/2020] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Service women face female-specific challenges that present physiological and logistical burdens and may impact readiness. The stress of training can change menstrual patterns and symptoms, and limited access to hygienic, private facilities can hinder menstrual management. Therefore, suppressing menses with continuous hormonal contraception may be of interest. MATERIALS AND METHODS The 9-item "Military Women's Attitudes Toward Menstrual Suppression." questionnaire was administered to female officers upon entry (baseline) and graduation (post) from a 6-month secondary training course. Respondents rated their attitudes about menstruation and the stress of training, the desire for menstrual suppression, and the logistical burden of menstruation on a 1 (strongly agree) through 5 (strongly disagree) scale. Wilcoxon Signed Rank Tests determined changes in the distribution of responses from baseline to post. RESULTS Female officers (n = 108) completed baseline and post questionnaires (age 25.2 ± 0.3 years). At baseline, the majority disagreed/strongly disagreed that the stress of training "makes periods worse than usual" (n = 77, 71%), "increases menstrual symptoms and bleeding" (n = 77, 71%), or "magnifies premenstrual syndrome" (PMS; n = 69, 64%). Although 50% (n = 54) agreed/strongly agreed that "stopping periods while women are training is a good idea," 37% (n = 40) disagreed/strongly disagreed. The majority agreed/strongly agreed that menstrual suppression would prevent "the worry about menstrual supplies" (n = 75, 70%) and "the inconvenience of having a period during training" (n = 69, 64%). Many agreed/strongly agreed that it is difficult to deal with periods during training because "there is no privacy" (n = 52, 48%), "the inability to find adequate facilities" (n = 70, 65%), and "the lack of opportunity to use adequate facilities" (n = 52, 48%). Opinions remained largely consistent from baseline to post. CONCLUSIONS The desire for menstrual suppression among service women during training is high. Military health care providers should be prepared to counsel service women about strategies to manage menstruation, including the efficacy of continuous hormonal contraception for menstrual suppression. Future studies investigating benefits or risks of continuous hormonal contraception for menstrual suppression in service women should inform the clinical recommendations.
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Affiliation(s)
- Emily A Ricker
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 67020A Rockledge Dr, Suite 100, Bethesda, MD 20817
| | - Carl W Goforth
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814.,Neurotrauma Department, Naval Medical Research Center, 503 Robert Grant Ave., Silver Spring, MD
| | - Amelia S Barrett
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 67020A Rockledge Dr, Suite 100, Bethesda, MD 20817
| | - Patricia A Deuster
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814
| | - Sarah J de la Motte
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814
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Griffin KL, Knight KB, Bass MA, Valliant MW. Predisposing Risk Factors for Stress Fractures in Collegiate Cross-Country Runners. J Strength Cond Res 2021; 35:227-232. [PMID: 29239997 DOI: 10.1519/jsc.0000000000002408] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Giffin, KL, Knight, KB, Bass, MA, and Valliant, MW. Predisposing risk factors and stress fractures in collegiate cross-country runners. J Strength Cond Res 35(1): 227-232, 2021-The purpose of this study was to explore factors associated with increased stress fractures in collegiate cross-country runners. Subjects in this study were 42 male and female cross-country runners at a Division I university. Each athlete completed a questionnaire regarding smoking status, vitamin/mineral intake, previous stress fracture history, birth control usage, menstrual status, and demographic information. Nutritional assessment using a 3-day food record and measurements of whole body, lumbar spine, and hip bone mineral densities (BMDs) were also conducted on each athlete. Results indicated that 40% of the female and 35% of the male runners reported a history of stress fracture, and that all of them did not meet the recommended daily energy intake or adequate intakes for calcium or vitamin D required for their amount of training. Two-tailed t-test found statistically higher incidences of lumbar spine BMD in male and female runners whose daily calcium and vitamin D intakes were below minimum requirements as well as for women whose caloric intake was below the required level. When data on the lumbar spine was evaluated, 31% of subjects (31.8% of the male and 30% of the female runners) were identified as having osteopenia and 4.8% with osteoporosis. Results warrant a need for future longitudinal studies.
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Affiliation(s)
- Kaci L Griffin
- Department of Nutrition and Hospitality Management, University of Mississippi, University, Mississippi; and
| | - Kathy B Knight
- Department of Nutrition and Hospitality Management, University of Mississippi, University, Mississippi; and
| | - Martha A Bass
- Department of Health, Exercise Science, and Recreation Management, University of Mississippi, University, Mississippi
| | - Melinda W Valliant
- Department of Nutrition and Hospitality Management, University of Mississippi, University, Mississippi; and
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van Poppel D, van der Worp M, Slabbekoorn A, van den Heuvel SSP, van Middelkoop M, Koes BW, Verhagen AP, Scholten-Peeters GGM. Risk factors for overuse injuries in short- and long-distance running: A systematic review. JOURNAL OF SPORT AND HEALTH SCIENCE 2021; 10:14-28. [PMID: 32535271 PMCID: PMC7856562 DOI: 10.1016/j.jshs.2020.06.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/25/2020] [Accepted: 05/04/2020] [Indexed: 05/13/2023]
Abstract
PURPOSE The aim of this study was to review information about risk factors for lower extremity running injuries in both short-distance (mean running distance ≤20 km/week and ≤10 km/session) and long-distance runners (mean running distance >20 km/week and >10 km/session). METHODS Electronic databases were searched for articles published up to February 2019. Prospective cohort studies using multivariable analysis for the assessment of individual risk factors or risk models for the occurrence of lower extremity running injuries were included. Two reviewers independently selected studies for eligibility and assessed risk of bias with the Quality in Prognostic Studies Tool. The GRADE approach was used to assess the quality of the evidence. RESULTS A total of 29 studies were included: 17 studies focused on short-distance runners, 11 studies focused on long-distance runners, and 1 study focused on both types of runners. A previous running-related injury was the strongest risk factor for an injury for long-distance runners, with moderate-quality evidence. Previous injuries not attributed to running was the strongest risk factor for an injury for short-distance runners, with high-quality evidence. Higher body mass index, higher age, sex (male), having no previous running experience, and lower running volume were strong risk factors, with moderate quality evidence, for short-distance runners. Low-quality evidence was found for all risk models as predictors of running-related injuries among short- and long-distance runners. CONCLUSION Several risk factors for lower extremity injuries have been identified among short- and long-distance runners, but the quality of evidence for these risk factors for running-related injuries is limited. Running injuries seem to have a multifactorial origin both in short- and long-distance runners.
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Affiliation(s)
- Dennis van Poppel
- Research Group Diagnostics, Avans University of Applied Sciences, Breda, 4818 CR, the Netherlands.
| | - Maarten van der Worp
- Stichting Academie Instituut Fysiotherapie PLUS, Utrecht, 3581 MD, the Netherlands
| | - Anouk Slabbekoorn
- Research Group Diagnostics, Avans University of Applied Sciences, Breda, 4818 CR, the Netherlands
| | | | - Marienke van Middelkoop
- Department of General Practice, Erasmus MC Medical University Center, Rotterdam, 3015 CE, the Netherlands
| | - Bart W Koes
- Department of General Practice, Erasmus MC Medical University Center, Rotterdam, 3015 CE, the Netherlands; Center for Muscle and Joint Health, University of Southern Denmark, Odense, 5230, Denmark
| | - Arianne P Verhagen
- Research Group Diagnostics, Avans University of Applied Sciences, Breda, 4818 CR, the Netherlands; Department of General Practice, Erasmus MC Medical University Center, Rotterdam, 3015 CE, the Netherlands; Discipline of Physiotherapy, Graduate School of Health, University of Technology, Sydney, Chippendale NSW 2008, Australia
| | - Gwendolyne G M Scholten-Peeters
- Research Group Diagnostics, Avans University of Applied Sciences, Breda, 4818 CR, the Netherlands; Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, 1081 HV, the Netherlands
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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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Cheng J, Santiago KA, Abutalib Z, Temme KE, Hulme A, Goolsby MA, Esopenko CL, Casey EK. Menstrual Irregularity, Hormonal Contraceptive Use, and Bone Stress Injuries in Collegiate Female Athletes in the United States. PM R 2020; 13:1207-1215. [PMID: 33340255 DOI: 10.1002/pmrj.12539] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 12/02/2020] [Accepted: 12/14/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Menstrual irregularity (MI) is common in female athletes and is a component of the Female Athlete Triad (Triad). Many athletes with the Triad are started on hormonal contraceptives (HC) for MI, but this interferes with the ability to monitor menstrual cycle regularity and can mask other causes of MI. There are limited studies investigating the relationship between MI, HC use, and injury in female collegiate athletes. OBJECTIVE To examine the prevalence of and relationship between HC use, MI, and bone stress injuries in female collegiate athletes in the United States. DESIGN Cross-sectional study. SETTING Online survey. PARTICIPANTS 1020 U.S. female collegiate athletes (age ≥ 18 years). METHODS OR INTERVENTIONS Assessment of risk factors for menstrual irregularity and bone stress injuries was conducted via a one-time survey. MAIN OUTCOME MEASURES HC use, MI, history of stress fractures. RESULTS Current HC use prevalence was 65% (95% confidence interval [CI], 61.9%, 67.8%). Of all athletes, 47% reported past MI. Of the athletes who were not currently using HCs, 32% had current MI. Compared with athletes without past MI, more athletes with past MI reported current HC use (73% vs. 57%) and indicated menstrual cycle consistency as the primary reason for use (24% vs. 4%) (P < .001). Additionally, 25% of athletes reported a history of stress fractures, which was associated with lean/aesthetic sports participation (odds ratio [95% CI]: 1.9 [1.4, 2.5]; P < .001) and less oral contraceptive pill (OCP) use (0.7 [0.5, 1.0]; P = .043). Compared with OCPs, injectable HCs were associated with greater odds of a history of stress fractures (4.5[1.6, 12.3]; P = .004). CONCLUSIONS HC use was prevalent among this cohort of female collegiate athletes, and almost half of the athletes reported past MI. A goal of menstrual cycle regularity was cited by 24% of athletes as a primary reason to use HCs, which shows that more athlete education is needed to avoid masking MI and the Triad with HCs. Further studies elucidating the relationship between HC use, MI, and sports-related injury are warranted.
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Affiliation(s)
- Jennifer Cheng
- Department of Physiatry, Hospital for Special Surgery, New York, NY, USA
| | - Kristen A Santiago
- Department of Physiatry, Hospital for Special Surgery, New York, NY, USA
| | - Zafir Abutalib
- Biostatistics Core, Hospital for Special Surgery, New York, NY, USA
| | - Kate E Temme
- Department of Physical Medicine and Rehabilitation, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ann Hulme
- Department of Physical Medicine and Rehabilitation, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Marci A Goolsby
- Department of Primary Care Sports Medicine, Hospital for Special Surgery, New York, NY, USA
| | - Carrie L Esopenko
- Department of Rehabilitation and Movement Sciences, Rutgers Biomedical Health Sciences, Newark, NJ, USA
| | - Ellen K Casey
- Department of Physiatry, Hospital for Special Surgery, New York, NY, USA
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Lawley R, Syrop IP, Fredericson M. Vitamin D for Improved Bone Health and Prevention of Stress Fractures: A Review of the Literature. Curr Sports Med Rep 2020; 19:202-208. [PMID: 32516190 DOI: 10.1249/jsr.0000000000000718] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Vitamin D is a vital nutrient and hormone needed for many essential functions in overall health. There is growing literature examining the role of vitamin D not only in the general population but also in athletes. The most predominantly studied area of vitamin D pertains to bone health. Recently, there has been increased investigation into the relationship of vitamin D and stress fractures, including genetic polymorphisms, levels of 25-hydroxyvitamin D, and bioavailable vitamin D. This review will address the most recent developments of vitamin D research and its important role in bone health in athletes.
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Affiliation(s)
| | - Isaac P Syrop
- Columbia University College of Physicians and Surgeons, New York, NY
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Tenforde AS, Carlson JL, Sainani KL, Chang AO, Kim JH, Diaz R, Golden NH, Fredericson M. Lower Trabecular Bone Score and Spine Bone Mineral Density Are Associated With Bone Stress Injuries and Triad Risk Factors in Collegiate Athletes. PM R 2020; 13:945-953. [PMID: 33037847 DOI: 10.1002/pmrj.12510] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/21/2020] [Accepted: 09/28/2020] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Determinants of bone health and injury are important to identify in athletes. Bone mineral density (BMD) is commonly measured in athletes with Female Athlete Triad (Triad) risk factors; the trabecular bone score (TBS) has been proposed to predict fracture risk independent of BMD. Evaluation of TBS and spine BMD in relation bone stress injury (BSI) risk has not been studied in female collegiate athletes. OBJECTIVE We hypothesized that spine BMD and TBS would each independently predict BSI and that the combined measures would improve injury prediction in female collegiate athletes. We also hypothesized that each measure would be correlated with Triad risk factors. DESIGN Retrospective cohort. SETTING Academic Institution. METHODS Dual energy x-ray absorptiometry (DXA) of the lumbar spine was used to calculate BMD and TBS values. Chart review was used to identify BSI that occurred after the DXA measurement and to obtain Triad risk factors. We used logistic regression to examine the ability of TBS and BMD alone or in combination to predict prospective BSI. RESULTS Within 321 athletes, 29 (9.0%) sustained a BSI after DXA. BMD and TBS were highly correlated (Pearson correlation r = 0.62, P < .0001). Spine BMD and TBS had similar ability to predict BSI; the C-statistic and 95% confidence intervals were 0.69 (0.58 to 0.81) for spine BMD versus 0.68 (0.57 to 0.79) for TBS. No improvement in discrimination was observed with combined BMD + TBS (C-statistic 0.70, 0.59 to 0.81). Both TBS and BMD predicted trabecular-rich BSI (defined as pelvis, femoral neck, and calcaneus) better than cortical-rich BSI. Both measures had similar correlations with Triad risk factors. CONCLUSION Lower BMD and TBS values are associated with elevated risk for BSI and similar correlation to Triad risk factors. TBS does not improve prediction of BSI. Collectively, our findings suggest that BMD may be a sufficient measure of skeletal integrity from DXA in female collegiate athletes.
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Affiliation(s)
- Adam S Tenforde
- Spaulding Rehabilitation Hospital, Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, MA, 02129
| | - Jennifer L Carlson
- Stanford University, Department of Pediatrics, Division of Adolescent Medicine, Stanford, CA
| | - Kristin L Sainani
- Stanford University, Department of Epidemiology and Population Health, Stanford, CA
| | | | - Jae Hyung Kim
- Boswell Human Performance Laboratory, Department of Orthopaedic Surgery, Stanford, CA
| | - Robert Diaz
- Kaiser Permanente, Department of Orthopedics and Sports Medicine, Santa Clara, CA
| | - Neville H Golden
- Stanford University, Department of Pediatrics, Division of Adolescent Medicine, Stanford, CA
| | - Michael Fredericson
- Boswell Human Performance Laboratory, Department of Orthopaedic Surgery, Stanford, CA.,Stanford University, Department of Orthopaedic Surgery, Division of Physical Medicine and Rehabilitation, Stanford, CA
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Becerra Sandoval JC, Ventura Huamán L, De La Cruz-Vargas JA. [Factors associated with stress fracture: A case-control study in a Peruvian navy medical center]. Medwave 2020; 20:e7936. [PMID: 32885796 DOI: 10.5867/medwave.2020.05.7936] [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: 11/24/2019] [Accepted: 06/06/2020] [Indexed: 11/27/2022] Open
Abstract
Introduction Stress fractures are injuries produced by the overuse of certain extremities, generating repetitive fatigue in the bone with insufficient rest periods and hormonal disorders, among others. High osteoclastic activity and lower activity of the osteoblasts at the cortical level occurs. Objective To determine the factors associated with a stress fracture in a single medical center of the Peruvian navy. Methods We conducted an observational, analytical case-control study. The dependent variable was stress fracture confirmed by magnetic resonance imaging of the patients; the independent variables were age, sex, calcemia, socioeconomic status, and time of daily physical activity. All data were extracted from the medical records. Crude and adjusted odds ratios were calculated with 95% confidence intervals. Results The sample was comprised of 238 patients (119 cases and 119 controls), of which 79.8% were male, and 20.2% were female; the average age was 20.25. In the bivariate analysis, stress fractures were associated with male sex (odds ratio 3.00; 95% confidence interval 1.51 to 5.95), hypocalcemia (2.83; 2.32 to 3.44), more than two hours of daily physical activity (24.7; 12.51 to 48.95) and socioeconomic level C (6.66; 2.82 to 15.74). Time dedicated to physical activity (adjusted odds ratio 44.46; 95% confidence interval 17.93 to 110.22) and socioeconomic level C (adjusted odds ratio 22.57; 95% confidence interval 7.03 to 72.74) were associated in the multivariate analysis. Conclusion We found that stress fractures were associated with physical activity time and a lower socioeconomic level. Further studies are needed to evaluate the relationship with other factors in the military population of Peru.
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Affiliation(s)
- John C Becerra Sandoval
- Centro Médico Naval Cirujano Mayor Santiago Távara, Lima, Perú. Adress: Mz. C Lt 5 Urb. 7 de Agosto 2do programa, Callao, Lima, Perú. . ORCID: 0000-0002-0743-5555
| | | | - Jhony A De La Cruz-Vargas
- Instituto de Investigación en Ciencias Biomédicas, Universidad Ricardo Palma, Lima, Perú. ORCID: 0000-0002-5592-0504
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Zabriskie HA, Dobrosielski DA, Leppert KM, Droege AJ, Knuth ND, Lisman PJ. Positional Analysis of Body Composition Using Dual-Energy X-Ray Absorptiometry in National Collegiate Athletic Association Division I Football and Men's Lacrosse. J Strength Cond Res 2020; 36:1699-1707. [PMID: 32501891 DOI: 10.1519/jsc.0000000000003669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Zabriskie, HA, Dobrosielski, DA, Leppert, KM, Droege, AJ, Knuth, ND, and Lisman, PJ. Positional analysis of body composition using dual-energy X-ray absorptiometry in National Collegiate Athletic Association Division I football and men's lacrosse. J Strength Cond Res XX(X): 000-000, 2020-Despite the widespread use of dual-energy X-ray absorptiometry (DXA), few studies have examined differences in body composition between positions within sports and none have reported DXA-derived body composition reference values for men's lacrosse. The purpose of this study was to examine differences in measures of total and regional body composition and bone mineral density (BMD) using DXA across sport positions in a large cohort of National Collegiate Athletic Association Division I male lacrosse and football players. A total of 294 male athletes (football, n = 196; lacrosse, n = 98) underwent DXA. One-way analysis of variance or Kruskal-Wallis tests were used to examine whether body composition variables differed by sports position. In football, position was a significant determinant for every compositional variable in football athletes (all, p < 0.05; effect size range = 0.24-0.79). Offensive linemen had the highest total body fat percentage (30.1 ± 2.9%), followed by fullbacks (26.7 ± 3.3%) and defensive linemen (24.6 ± 5.7%); wide receivers had the lowest (14.5 ± 2.1%). For total body BMD, defensive linemen had the highest (1.70 ± 0.09 g·cm), followed by linebackers (1.67 ± 0.09 g·cm) and offensive linemen (1.65 ± 0.09 g·cm); kickers had the lowest (1.45 ± 0.11 g·cm) BMD. In lacrosse, no differences were found between positions for any total or regional body composition and BMD measure (all, p > 0.05). Our data confirm that total and regional measures of body composition and BMD vary across positions in football but not in men's lacrosse. Unlike football, similarities in body composition among lacrosse players may indicate that the uniformity of training demands or preferred player attributes in team selection outweigh the unique positional demands in gameplay.
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Affiliation(s)
- Hannah A Zabriskie
- Department of Kinesiology, Towson University, Towson, Maryland.,Towson Research Academy for Collaborative Sport Science (TRACS), Towson University, Towson, Maryland
| | - Devon A Dobrosielski
- Department of Kinesiology, Towson University, Towson, Maryland.,Towson Research Academy for Collaborative Sport Science (TRACS), Towson University, Towson, Maryland
| | - Kyle M Leppert
- Department of Kinesiology, Towson University, Towson, Maryland.,Towson Research Academy for Collaborative Sport Science (TRACS), Towson University, Towson, Maryland
| | - Aaron J Droege
- Sport Performance, Department of Athletics, Towson University, Towson, Maryland
| | - Nicolas D Knuth
- Department of Kinesiology, Towson University, Towson, Maryland.,Towson Research Academy for Collaborative Sport Science (TRACS), Towson University, Towson, Maryland
| | - Peter J Lisman
- Department of Kinesiology, Towson University, Towson, Maryland.,Towson Research Academy for Collaborative Sport Science (TRACS), Towson University, Towson, Maryland
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Geometric and "True" Densitometric Characteristics of Bones in Athletes with Stress Fracture and Menstrual Disturbances: A Systematic Review. Sports Med 2020; 49:1059-1078. [PMID: 31041601 DOI: 10.1007/s40279-019-01109-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Stress fractures can lead to short- and long-term consequences, impacting participation in sport and general health. Recognizing which skeletal characteristics render bones susceptible to stress fracture may aid stress-fracture prevention. Menstrual disturbances among exercising women are a known risk factor for stress fracture; therefore, assessing skeletal commonalities between women with stress fractures and women with menstrual disturbances may increase our understanding of why menstrual disturbances put athletes at greater risk for stress fracture. Three-dimensional (3D) bone imaging tools provide detailed information about volumetric bone mineral density (vBMD) and bone structure that cannot be obtained using traditional two-dimensional (2D) techniques. OBJECTIVES This systematic review serves to: (1) evaluate the current literature available on vBMD, bone geometry, and bone structure in exercising women with menstrual disturbances and exercising women with stress fractures, and (2) assess the common skeletal characteristics between both conditions. Our aim is to reveal bone properties beyond 2D areal BMD that may indicate increased susceptibility to stress fracture among exercising women with menstrual disturbances. SEARCH METHODS A search of the PubMed/Medline database was completed in May 2018. ELIGIBILITY CRITERIA Eligible articles included those that reported vBMD, bone geometry, or bone structure obtained from 3D imaging techniques or estimated from 2D imaging techniques. Only studies conducted in premenopausal exercising women and girls who had a stress fracture, a menstrual disturbance, or both were included. RESULTS Twenty-four articles met the inclusion criteria. Bone area and cortical thickness at the tibia were identified as altered both in women with menstrual disturbances and in women with stress fractures; however, there was inconsistency in the results observed for all bone parameters. The majority of skeletal parameters of the lower extremities were not significantly different between exercising women with and without stress fractures and between those with and without menstrual disturbances. DISCUSSION Most studies were moderate or low quality based on study design, and only one article combined both conditions to explore vBMD and bone geometry in athletes with menstrual disturbances and a history of stress fracture. These findings highlight the need for more skeletal research on the intersection of these health conditions in exercising women. The lack of observed differences in skeletal parameters suggests that risk factors other than bone geometry and structure may be the primary causes of stress fracture in these women.
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Song SH, Koo JH. Bone Stress Injuries in Runners: a Review for Raising Interest in Stress Fractures in Korea. J Korean Med Sci 2020; 35:e38. [PMID: 32103643 PMCID: PMC7049623 DOI: 10.3346/jkms.2020.35.e38] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 12/26/2019] [Indexed: 01/31/2023] Open
Abstract
A bone stress injury (BSI) means that the bones cannot tolerate repeated mechanical loads, resulting in structural fatigue and local bone pain. A delay in BSI diagnosis can lead to more serious injuries, such as stress fractures that require longer treatment periods. Therefore, early detection of BSI is an essential part of management. Risk factors for BSI development include biological and biomechanical factors. Medical history and physical examination are the basics for a BSI diagnosis, and magnetic resonance imaging is helpful for confirming and grading. In this paper, the authors review the overall content of BSI and stress fractures which are common in runners. Through this review, we hope that interest in stress fractures will be raised in Korea and that active researches will be conducted.
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Affiliation(s)
- Sun Hong Song
- Department of Rehabilitation Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Jung Hoi Koo
- Department of Rehabilitation Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
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Abbott A, Bird ML, Wild E, Brown SM, Stewart G, Mulcahey MK. Part I: epidemiology and risk factors for stress fractures in female athletes. PHYSICIAN SPORTSMED 2020; 48:17-24. [PMID: 31213104 DOI: 10.1080/00913847.2019.1632158] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objectives: Stress fractures (SFx) are a common athletic injury, occurring in up to 40% of athletes at some point in their career. These injuries can cause pain, permanent disability, financial burden, and loss of playing time. This review presents updated epidemiology and comprehensive analysis of risk factors for stress fractures, especially as it pertains to female athletes.Results: Stress fractures (SFx) account for up to 10% of all orthopedic injuries and up to 20% of injuries seen in sports medicine clinics, with an incidence among female athletes as high as 13%. Lower extremity SFx represent 80-95% of SFx, and the increased popularity of endurance running has contributed to the tibia (49% prevalence) replacing the metatarsals (9%) as the most common location for lower extremity SFx. Studies have demonstrated that 50% of peak bone mass is acquired during adolescence, a 'peak time' for eating disorder and female athlete triad development; furthermore, catch-up growth cannot be expected in athletes with diminished bone growth in this critical period. The female athlete triad (low energy availability with or without disordered eating, menstrual dysfunction, and low bone mineral density) are well-known risk factors for SFx; the risk of SFx for female athletes presenting with a single aspect of the triad is 15-20%, and this risk increases to 30-50% for female athletes presenting with multiple aspects of the triad.Conclusion: This review provides a basis for how to identify populations at greatest risk for SFx. Prompt recognition of the intrinsic and extrinsic risk factors for SFx in female athletes is imperative to early diagnosis and to develop targeted strategies to prevent SFx occurrence or recurrence.
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Affiliation(s)
- Alexandra Abbott
- Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, PA, USA
| | | | - Emily Wild
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Symone M Brown
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Greg Stewart
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
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Schanda JE, Kocijan R, Resch H, Baierl A, Feichtinger X, Mittermayr R, Plachel F, Wakolbinger R, Wolff K, Fialka C, Gruther W, Muschitz C. Bone Stress Injuries Are Associated With Differences in Bone Microarchitecture in Male Professional Soldiers. J Orthop Res 2019; 37:2516-2523. [PMID: 31410876 DOI: 10.1002/jor.24442] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 08/07/2019] [Indexed: 02/04/2023]
Abstract
Bone stress injuries are commonly due to repetitive loading, as often described in competitive athletes or military recruits. The underlying pathophysiology of bone stress injuries is multifactorial. The present cross-sectional study investigated (i) cortical and trabecular bone microstructure as well as volumetric bone mineral density in subjects with bone stress injuries at the tibial diaphysis, measured at the distal tibia and the distal radius by means of high-resolution peripheral quantitative computed tomography (CT), (ii) areal bone mineral density using dual-energy X-ray absorptiometry as well as calcaneal dual X-ray absorptiometry and laser, and (iii) the influence on bone turnover markers of formation and resorption at the early phase after injury. A total of 26 Caucasian male professional soldiers with post-training bone stress injury at the tibial diaphysis were included (case group). A total of 50 male, Caucasian professional soldiers from the same military institution served as controls (control group). High-resolution peripheral quantitative CT revealed a higher total area at the radius within the case group. Cortical bone mineral density was reduced at the radius and tibia within the case group. The trabecular number and trabecular thickness were reduced at the tibia in the case group. The trabecular network was more inhomogeneous at the radius and tibia within the case group. Calcaneal dual X-ray absorptiometry and laser was significantly reduced in the case group. This study quantified differences in bone microstructure among otherwise healthy individuals. Differences in bone microarchitecture may impair the biomechanical properties by increasing the susceptibility to sustain bone stress injuries. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2516-2523, 2019.
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Affiliation(s)
- Jakob E Schanda
- Department of Trauma Surgery, AUVA Trauma Center Meidling, Kundratstrasse 37, Vienna, A-1120, Austria
| | - Roland Kocijan
- Medical Department II-VINFORCE Study Group, St. Vincent Hospital, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, Vienna, A-1060, Austria
| | - Heinrich Resch
- Medical Department II-VINFORCE Study Group, St. Vincent Hospital, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, Vienna, A-1060, Austria.,Karl Landsteiner Institute for Gastroenterology, Rheumatology, and Osteology, Stumpergasse 13, Vienna, A-1060, Austria.,Medical Faculty, Bone Diseases Unit, Sigmund Freud University, Freudplatz 1, Vienna, A-1020, Austria
| | - Andreas Baierl
- Department of Statistics and Operations Research, University of Vienna, Oskar-Morgenstern-Platz 1, Vienna, A-1090, Austria
| | - Xaver Feichtinger
- Department of Trauma Surgery, AUVA Trauma Center Meidling, Kundratstrasse 37, Vienna, A-1120, Austria
| | - Rainer Mittermayr
- Department of Trauma Surgery, AUVA Trauma Center Meidling, Kundratstrasse 37, Vienna, A-1120, Austria
| | - Fabian Plachel
- Charité-Universitätsmedizin Berlin, Campus Virchow, Center for Musculoskeletal Surgery, Augustenburger Platz 1, Berlin, D-13353, Germany
| | - Robert Wakolbinger
- Department of Physical Medicine and Rehabilitation, Danube Hospital-Social Medical Center East, Langobardenstrasse 122, Vienna, A-1220, Austria
| | - Klaus Wolff
- Department of Surgery, Austrian Armed Forces, Military Medical Cluster East, Bruenner Strasse 238, Vienna, A-1210, Austria
| | - Christian Fialka
- Department of Trauma Surgery, AUVA Trauma Center Meidling, Kundratstrasse 37, Vienna, A-1120, Austria.,Medical Faculty, Traumatology Unit, Sigmund Freund University, Freudplatz 1, Vienna, A-1020, Austria
| | - Wolfgang Gruther
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, A-1090, Austria
| | - Christian Muschitz
- Medical Department II-VINFORCE Study Group, St. Vincent Hospital, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, Vienna, A-1060, Austria
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Nussbaum ED, Gatt CJ, Epstein R, Bechler JR, Swan KG, Tyler D, Bjornaraa J. Validation of the Shin Pain Scoring System: A Novel Approach for Determining Tibial Bone Stress Injuries. Orthop J Sports Med 2019; 7:2325967119877803. [PMID: 31696132 PMCID: PMC6822191 DOI: 10.1177/2325967119877803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background The incidence of adolescent overuse injuries, including bone stress injuries (BSIs), is on the rise. The identification of a BSI in the early stages is key to successful treatment. The Shin Pain Scoring System (SPSS) was developed to aid clinicians in identifying patients with a BSI. Hypothesis The SPSS will correlate with magnetic resonance imaging (MRI) grading of a BSI in an adolescent population. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods Enrolled in this study were 80 adolescent high school athletes between the ages of 13 and 18 years participating in a variety of sports with more than 1 week of atraumatic shin pain. The SPSS questionnaire was completed for each participant, and physical examination findings were recorded. Each question and physical examination item was allotted a point value, which totaled 29 points. Radiographs and MRI scans of both lower legs were obtained for each participant. The SPSS score was statistically analyzed using logistic regression, a classification matrix, and a 2 × 2 contingency table to evaluate validity and predictability. Results Logistic regression analysis of our data determined that 3 categories of SPSS scores provided the highest diagnostic value when compared with MRI grading based on the Fredericson classification (0-4). The SPSS correctly identified 43.5% of injuries for category 1 (MRI grades 0-1), 62.5% for category 2 (MRI grade 2), and 50.0% for category 3 (MRI grades 3-4). Overall, the SPSS correctly identified the degree of BSI in 54.4% of all tibias studied. Binary analysis for validity demonstrated a sensitivity of 96%, specificity of 26%, positive predictive value of 76%, and negative predictive value of 71% for the SPSS relative to the "gold standard" MRI results. Conclusion The SPSS is a potentially valid method to identify tibial BSIs, given the sensitivity and negative and positive predictive values. It also provides helpful categorization to alert clinicians to the presence of a BSI and direct further diagnostics and/or interventions. The SPSS should be considered as an additional tool to use when evaluating adolescents with atraumatic tibial BSIs.
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Affiliation(s)
- Eric D Nussbaum
- Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA.,University Orthopaedic Associates, Somerset, New Jersey, USA
| | - Charles J Gatt
- Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA
| | - Robert Epstein
- Department of Radiology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA.,University Radiology, New Brunswick, New Jersey, USA
| | - Jeffrey R Bechler
- Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA.,University Orthopaedic Associates, Somerset, New Jersey, USA
| | - Kenneth G Swan
- Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA.,University Orthopaedic Associates, Somerset, New Jersey, USA
| | - David Tyler
- Department of Statistics and Biostatistics, Rutgers University, New Brunswick, New Jersey, USA
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Popp KL, Frye AC, Stovitz SD, Hughes JM. Bone geometry and lower extremity bone stress injuries in male runners. J Sci Med Sport 2019; 23:145-150. [PMID: 31594711 DOI: 10.1016/j.jsams.2019.09.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/13/2019] [Accepted: 09/17/2019] [Indexed: 10/25/2022]
Abstract
Bone stress injuries (BSI) are common among distance runners and research investigations examining risk factors for BSI among men are limited. Therefore, investigations are needed to determine if men with a history of BSI have skeletal properties that may heighten BSI incidence. OBJECTIVES To analyze differences in bone density, bone geometry, and estimates of bone strength in male runners with and without a BSI history. DESIGN Cross-sectional. METHODS We recruited 36 male distance runners ages 18-41 for this study. We used peripheral quantitative computed tomography (pQCT) to assess volumetric bone mineral density (vBMD, mg/mm3), bone geometry (total and cortical bone area, mm2), tibia robustness (total area/tibia length, mm) and estimates of bone strength (section modulus and polar strength-strain index, mm3) at 5 tibial sites. RESULTS After adjusting for age, the BSI group had more slender tibias (9%), lower stress strain indices (-16%), lower section moduli (-17%) and smaller total cross-sectional (-11%) and cortical areas (-12%) at the 66% site of the tibia compared with controls (P < 0.05 for all). Similar differences were found at all other measurement sites. After adjusting for body size, differences in bone outcomes remained significant at the 66% site. CONCLUSIONS These results indicate that men with a history of BSI have lower estimated bending strength compared to controls because of narrower tibias. However, differences are largely attenuated in the distal ½ of the tibia after adjusting for body size. Thus, smaller tibia size, particularly at the mid-diaphysis, may be an important indicator for BSI incidence.
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Affiliation(s)
- Kristin L Popp
- Military Performance Division, United States Army Research Institute of Environmental, USA; Endocrine Unit, Massachusetts General Hospital, USA; Department of Medicine, Harvard Medical School, USA.
| | - Adam C Frye
- Laboratory of Musculoskeletal Health, School of Kinesiology, University of Minnesota, USA
| | | | - Julie M Hughes
- Military Performance Division, United States Army Research Institute of Environmental, USA
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Duckham RL, Bialo SR, Machan J, Kriz P, Gordon CM. A case-control pilot study of stress fracture in adolescent girls: the discriminative ability of two imaging technologies to classify at-risk athletes. Osteoporos Int 2019; 30:1573-1580. [PMID: 31143993 DOI: 10.1007/s00198-019-05001-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/22/2019] [Indexed: 12/14/2022]
Abstract
UNLABELLED Since stress fractures are common among adolescent athletes, it is important to identify bone assessment tools that accurately identify risk. We investigated the discriminative ability of two imaging technologies to classify at-risk athletes. Findings suggested that peripheral quantitative computed tomography (pQCT) has the ability to distinguish differences in bone structure in injured vs. uninjured limbs. INTRODUCTION Given the high stress fracture (SFX) prevalence among adolescent girls, an understanding of the most informative assessment tools to identify SFX risks are required. We investigated the discriminative ability of pQCT vs. dual-energy X-ray absorptiometry (DXA) to classify athletes with or without SFX. METHODS Twelve adolescent athletes diagnosed with a lower-extremity SFX were compared with 12 matched controls. DXA measured areal bone mineral density (aBMD) and content of the total body, and lumbar spine. Bilateral tibiae were assessed with pQCT. At the metaphysis (3%), total density (ToD), trabecular density (TrD), trabecular area (TrA), and estimated bone strength in compression (BSIc), and at the diaphysis (38% and 66%), total bone area (ToA), cortical density (CoD), cortical area (CoA), estimated bone strength in torsion (SSIp), and peri- and endocortical and muscle area (MuA) were obtained. Cortical bone mass/density around the center of mass and marrow density (estimate of adiposity) were calculated using ImageJ software. General estimated equations adjusting for multiple comparisons (Holm-Bonferroni method) were used to compare means between (1) injured limb of the case athletes vs. uninjured limb of the control athletes and (2) uninjured limb of the case athletes vs. uninjured limbs of the controls and injured vs. uninjured limb of case athletes with a SFX. RESULTS aBMD and content showed no significant differences between cases and controls. When comparing the injured vs. uninjured leg in the case athletes by pQCT at the 3% tibia, unadjusted TrD, total density, and BSIc were significantly lower (p < 0.05) in the injured vs. uninjured leg. Marrow density at the 66% site was 1% (p < 0.05) lower in the injured vs. uninjured leg. CONCLUSIONS These preliminary data in athletes with SFX suggest that pQCT has the ability to distinguish differences in bone structure in injured vs. uninjured limbs. No discriminative bone parameter classifications were identified between adolescent athletes with or without SFX.
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Affiliation(s)
- R L Duckham
- Institute for Physical Activity and Nutrition (IPAN) School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Melbourne, Australia
| | - S R Bialo
- Division of Pediatric Endocrinology, Rhode Island Hospital/Hasbro Children's Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - J Machan
- Division of Biostatistics, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - P Kriz
- Division of Sports Medicine, Departments of Orthopedics and Pediatrics, Warren Alpert Medical School Rhode Island Hospital/Hasbro Children's Hospital, Brown University, Providence, RI, USA
| | - C M Gordon
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA.
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Stickler LG, Hoogenboom BJ, Brown J. The Impact of Nutritional Intervention on Menstrual Dysfunction in Female Athletes: a Systematic Review. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s42399-019-00107-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Does a Novice Technician Produce Results Similar to That of an Experienced DXA Technician When Assessing Body Composition and Bone Mineral Density? Int J Sport Nutr Exerc Metab 2019; 29:435–440. [PMID: 30632440 DOI: 10.1123/ijsnem.2018-0299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Dual-energy X-ray absorptiometry is a commonly used clinical assessment tool for body composition and bone mineral density, which is gaining popularity in athletic cohorts. Results from body composition scans are useful for athletic populations to track training and nutritional interventions, while bone mineral density scans are valuable for athletes at risk of developing stress fractures due to low bone mineral density. However, no research has ascertained if a novice technician (accredited but not experienced) could produce similar results to an experienced technician. Two groups of recreational athletes were scanned, one by an experienced technician, one by a novice technician. All participants were scanned twice with repositioning between scans. The experienced technician's reliability (intraclass correlation coefficient = .989-.998; percentage change in mean = -0.01 to 0.10), precision (typical error as coefficient of variation percentage = 0.01-0.47; SEM% = 0.61-1.39), and sensitivity to change (smallest real difference percentage = 1.70-3.85) were similar; however, superior to those of the novice technician. The novice technician results were reliability (intraclass correlation coefficient = .985-.997; percentage change in mean = -0.03 to 0.23), precision (typical error as coefficient of variation percentage = 0.03-0.75; SEM% = 1.06-2.12), and sensitivity to change (smallest real difference percentage = 2.73-5.86). Extensive experience, while valuable, is not a necessary requirement to produce quality results when undertaking whole-body dual-energy X-ray absorptiometry scanning.
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