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de Souza Júnior JR, Gaudette LW, Johnson CD, Matheus JPC, Lemos TV, Davis IS, Tenforde AS. Interaction of Biomechanical, Anthropometric, and Demographic Factors Associated with Patellofemoral Pain in Rearfoot Strike Runners: A Classification and Regression Tree Approach. Sports Med Open 2024; 10:5. [PMID: 38190013 PMCID: PMC10774254 DOI: 10.1186/s40798-023-00671-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 12/21/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Patellofemoral pain (PFP) is among the most common injuries in runners. While multiple risk factors for patellofemoral pain have been investigated, the interactions of variables contributing to this condition have not been explored. This study aimed to classify runners with patellofemoral pain using a combination of factors including biomechanical, anthropometric, and demographic factors through a Classification and Regression Tree analysis. RESULTS Thirty-eight runners with PFP and 38 healthy controls (CON) were selected with mean (standard deviation) age 33 (16) years old and body mass index 22.3 (2.6) kg/m2. Each ran at self-selected speed, but no between-group difference was identified (PFP = 2.54 (0.2) m/s x CON = 2.55 (0.1) m/s, P = .660). Runners with patellofemoral pain had different patterns of interactions involving braking ground reaction force impulse, contact time, vertical average loading rate, and age. The classification and regression tree model classified 84.2% of runners with patellofemoral pain, and 78.9% of healthy controls. The prevalence ratios ranged from 0.06 (95% confidence interval: 0.02-0.23) to 9.86 (95% confidence interval: 1.16-83.34). The strongest model identified runners with patellofemoral pain as having higher braking ground reaction force impulse, lower contact times, higher vertical average loading rate, and older age. The receiver operating characteristic curve demonstrated high accuracy at 0.83 (95% confidence interval: 0.74-0.93; standard error: 0.04; P < .001). CONCLUSIONS The classification and regression tree model identified an influence of multiple factors associated with patellofemoral pain in runners. Future studies may clarify whether addressing modifiable biomechanical factors may address this form of injury.
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Affiliation(s)
- José Roberto de Souza Júnior
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Boston, MA, USA.
- Graduate Program of Sciences and Technologies in Health, University of Brasília, Brasília, DF, Brazil.
- Spaulding National Running Center, 1575 Cambridge St, Cambridge, MA, 02138, USA.
| | - Logan Walter Gaudette
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Boston, MA, USA
| | - Caleb D Johnson
- United States Army Research Institute for Environmental Medicine, Natick, MA, USA
| | | | - Thiago Vilela Lemos
- Department of Physical Therapy, State University of Goiás, Goiânia, GO, Brazil
| | - Irene S Davis
- School of Physical Therapy and Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Boston, MA, USA
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Weart AN, Miller EM, Brindle RA, Ford KR, Goss DL. Wearable technology assessing running biomechanics and prospective running-related injuries in Active Duty Soldiers. Sports Biomech 2023:1-17. [PMID: 37144627 DOI: 10.1080/14763141.2023.2208568] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The purpose of this study was to determine if running biomechanical variables measured by wearable technology were prospectively associated with running injuries in Active Duty Soldiers. A total of 171 Soldiers wore a shoe pod that collected data on running foot strike pattern, step rate, step length and contact time for 6 weeks. Running-related injuries were determined by medical record review 12 months post-study enrollment. Differences in running biomechanics between injured and non-injured runners were compared using independent t-tests or ANCOVA for continuous variables and chi-square analyses for the association of categorical variables. Kaplan-Meier survival curves were used to estimate the time to a running-related injury. Risk factors were carried forward to estimate hazard ratios using Cox proportional hazard regression models. Forty-one participants (24%) sustained a running-related injury. Injured participants had a lower step rate than non-injured participants, but step rate did not have a significant effect on time to injury. Participants with the longest contact time were at a 2.25 times greater risk for a running-related injury; they were also relatively slower, heavier, and older. Concomitant with known demographic risk factors for injury, contact time may be an additional indicator of a running-related injury risk in Active Duty Soldiers.
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Affiliation(s)
- Amy N Weart
- Department of Physical Therapy, Keller Army Community Hospital, West Point, NY, USA
| | - Erin M Miller
- Department of Physical Therapy, Keller Army Community Hospital, West Point, NY, USA
- Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, Keller Army Community Hospital, Baylor University, West Point, NY, USA
| | | | - Kevin R Ford
- Congdon School of Health Sciences, High Point University, High Point, NC, USA
| | - Donald L Goss
- Department of Physical Therapy, High Point University, High Point, NC, USA
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Wiegand K, Mercer JA, Navalta JW, Pharr J, Tandy R, Freedman Silvernail J. Running status and history: A self-report study. Phys Ther Sport 2019; 39:8-15. [PMID: 31202143 DOI: 10.1016/j.ptsp.2019.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/01/2019] [Accepted: 06/01/2019] [Indexed: 01/26/2023]
Abstract
OBJECTIVES The purpose of the current study was to compare injury and running history among current and former runners who consider themselves either injured or uninjured. DESIGN Cross-sectional survey. SETTING Online survey, available to any individuals over the age of 18 who currently run (runners) or who once ran regularly but are no longer running (former runners). PARTICIPANTS 312 participants (age 38 ± 12 years, 219 males, 89 females, 4 did not disclose) completed the survey. MAIN OUTCOME MEASURES This study assessed injury incidence, consequences of injury such as time off, and reported injury diagnoses and treatments. Chi-square and frequency analyses were calculated to describe running status, injury counts, and response to injury. RESULTS Most participants (80%) reported 1 + running injury. 775 total injuries were reported. The four most common injuries were iliotibial band syndrome (34%), plantar fasciitis (30%), strained thigh/hip muscle (25%), and medial tibial stress syndrome (22%). About 40% of participants continued to run with these injuries. CONCLUSIONS Injury frequencies (80%) agreed with those reported in the literature. The results of this study also support the notion that running injuries exist on a continuum of severity and that the individual response to injury is complex and determined by various factors.
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Mattock J, Steele JR, Mickle KJ. A protocol to prospectively assess risk factors for medial tibial stress syndrome in distance runners. BMC Sports Sci Med Rehabil 2018; 10:20. [PMID: 30479774 PMCID: PMC6251115 DOI: 10.1186/s13102-018-0109-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 11/05/2018] [Indexed: 12/25/2022]
Abstract
Background Medial tibial stress syndrome (MTSS) is a lower leg injury with a reported incidence rate of up to 35% in active individuals. Although numerous prospective studies have tried to identify risk factors for developing MTSS, managing the syndrome remains difficult. One risk factor yet to be extensively explored in MTSS development is reduced lower leg girth. Further investigation of reduced lower leg girth is required due to the important role lower leg musculature plays in attenuating ground reaction forces during the gait cycle. Therefore, the primary aim of this study is to ascertain whether lower leg muscle morphology and function contribute to the development of MTSS. Our ultimate aim is to identify potential risk factors for MTSS that can be targeted in future studies to better manage the injury or, preferably, prevent individuals developing MTSS. Methods This study will be prospective in design and will recruit asymptomatic distance runners. All participants will be tested at base line and participants will have their training data longitudinally tracked over the following 12 months to assess any individuals who develop MTSS symptoms. At base line, outcome measures will include bilateral measures of lower limb anthropometry; cross sectional area (CSA) and thickness of the tibialis anterior, peroneals, flexor digitorum longus, flexor hallucis longus and thickness of soleus, medial and lateral head of gastrocnemius. Tibial bone speed of sound, ankle dorsiflexion range of motion, strength of the six previously described muscles, foot alignment and ankle plantar flexor endurance will also be assessed. Participants will also complete a treadmill running protocol where three-dimensional kinematics, plantar pressure distribution and electromyography data will be collected. Discussion This study will aim to identify characteristics of individuals who develop MTSS and, in turn, identify modifiable risk factors that can be targeted to prevent individuals developing this injury.
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Affiliation(s)
- Joshua Mattock
- 1Biomechanics Research Laboratory, University of Wollongong, Wollongong, NSW Australia
| | - Julie R Steele
- 1Biomechanics Research Laboratory, University of Wollongong, Wollongong, NSW Australia
| | - Karen J Mickle
- 2Institute of Health and Sport, Victoria University, Melbourne, VIC Australia
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Fokkema T, de Vos RJ, van Ochten JM, Verhaar JA, Davis IS, Bindels PJ, Bierma-Zeinstra SM, van Middelkoop M. Preventing running-related injuries using evidence-based online advice: the design of a randomised-controlled trial. BMJ Open Sport Exerc Med 2017; 3:e000265. [PMID: 28761721 PMCID: PMC5530119 DOI: 10.1136/bmjsem-2017-000265] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2017] [Indexed: 12/04/2022] Open
Abstract
Introduction Running-related injuries (RRIs) are frequent and can lead to cessation of health promoting activities. Several risk factors for RRIs have been identified. However, no successful injury prevention programme has been developed so far. Therefore, the aim of the present study is to investigate the effect of an evidence-based online injury prevention programme on the number of RRIs. Methods and analysis The INSPIRE trial is a randomised-controlled trial with a 3-month follow-up. Both novice and more experienced runners, aged 18 years and older, who register for a running event (distances 5 km up to 42.195 km) will be asked to participate in this study. After completing the baseline questionnaire, participants will be randomised into either the intervention group or control group. Participants in the intervention group will get access to the online injury prevention programme. This prevention programme consists of information on evidence-based risk factors and advices to reduce the injury risk. The primary outcome measure is the number of self-reported RRIs in the time frame between registration for a running event and 1 month after the running event. Secondary outcome measures include the running days missed due to injuries, absence of work or school due to injuries, and the injury location. Ethics and dissemination An exemption for a comprehensive application is obtained by the Medical Ethical Committee of the Erasmus University Medical Centre Rotterdam, Netherlands. The results of the study will be published in peer-reviewed journals and presented on international congresses. Trial registration number NTR5998. Pre-results
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Affiliation(s)
- Tryntsje Fokkema
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Robert-Jan de Vos
- Department of Orthopaedics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - John M van Ochten
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jan An Verhaar
- Department of Orthopaedics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Irene S Davis
- Spaulding National Running Centre, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Patrick Je Bindels
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Sita Ma Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Marienke van Middelkoop
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Fischer KM, Willwacher S, Hamill J, Brüggemann GP. Tibial rotation in running: Does rearfoot adduction matter? Gait Posture 2017; 51:188-193. [PMID: 27810691 DOI: 10.1016/j.gaitpost.2016.10.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 10/19/2016] [Accepted: 10/23/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To quantify the magnitude of global rearfoot motion, in particular, rearfoot adduction and to investigate its relationship to tibial rotation. DESIGN One hundred and four participants ran barefoot on an Ethylene Vinyl Acetate (EVA) foam. Global range of motion values for the shank, rearfoot and medial metatarsal segment as well as foot motion within the transverse plane were determined using an optoelectric motion capture system. Relationships between parameters were assessed using partial correlation analysis. RESULTS Global rearfoot adduction amounts to 6.1° (±2.7). Furthermore global rearfoot adduction and rearfoot eversion were significantly related to internal tibial rotation (partial correlation: r=0.37, p<0.001 and r=-0.24, p=0.015, respectively). Furthermore, a strong relationship between rearfoot adduction and transverse within foot motion (r=-0.65, p<0.001) was found. CONCLUSION Next to rearfoot eversion, rearfoot adduction may be also important to the understanding of ankle joint coupling. Controlling rearfoot adduction and transverse within foot motion may be a mechanism to control excessive tibial rotation.
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Affiliation(s)
- Katina Mira Fischer
- Institute of Biomechanics and Orthopaedics, German Sport University, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany.
| | - Steffen Willwacher
- Institute of Biomechanics and Orthopaedics, German Sport University, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany.
| | - Joseph Hamill
- Biomechanics Laboratory, Department of Exercise Science, University of Massachusetts, Amherst, United States; Department of Kinesiology, University of Massachussetts, 23 Totman Building, Amherst, MA, 01003, United States.
| | - Gert-Peter Brüggemann
- Institute of Biomechanics and Orthopaedics, German Sport University, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany.
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Abstract
In terms of running, there is evidence that links mechanics with injury. This evidence provides the justification for altering these mechanics. Increased hip adduction and vertical impact loading have been most commonly associated with injury. More work is needed in order to understand the optimal way to retrain gait patterns in runners. The human body has a considerable ability to adapt. To provide individuals with the ability to alter faulty movement patterns in ways that can reduce injury risk is a powerful tool.
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Affiliation(s)
- Irene S Davis
- Department of Physical Medicine and Rehabilitation, Spaulding National Running Center, Spaulding-Cambridge Outpatient Center, Harvard Medical School, 1575 Cambridge Street, Cambridge, MA 02138, USA.
| | - Erin Futrell
- Center for Interprofessional Studies and Innovation, MGH Institute of Health Professions, 36, 1st Avenue, Charlestown Navy Yard, MA 02129, USA
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Esculier JF, Dubois B, Dionne CE, Leblond J, Roy JS. A consensus definition and rating scale for minimalist shoes. J Foot Ankle Res 2015; 8:42. [PMID: 26300981 DOI: 10.1186/s13047-015-0094-5] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 08/03/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND While minimalist running shoes may have an influence on running biomechanics and on the incidence of overuse injuries, the term "minimalist" is currently used without standardisation. The objectives of this study were to reach a consensus on a standard definition of minimalist running shoes, and to develop and validate a rating scale that could be used to determine the degree of minimalism of running shoes, the Minimalist Index (MI). METHODS For this modified Delphi study, 42 experts from 11 countries completed four electronic questionnaires on an optimal definition of minimalist shoes and on elements to include within the MI. Once MI was developed following consensus, 85 participants subjectively ranked randomly assigned footwear models from the most to the least minimalist and rated their degree of minimalism using visual analog scales (VAS), before evaluating the same footwear models using MI. A subsample of thirty participants reassessed the same shoes on another occasion. Construct validity and inter- and intra-rater reliability (intraclass correlation coefficients [ICC]; Gwet's AC1) of MI were evaluated. RESULTS The following definition of minimalist shoes was agreed upon by 95 % of participants: "Footwear providing minimal interference with the natural movement of the foot due to its high flexibility, low heel to toe drop, weight and stack height, and the absence of motion control and stability devices". Characteristics to be included in MI were weight, flexibility, heel to toe drop, stack height and motion control/stability devices, each subscale carrying equal weighing (20 %) on final score. Total MI score was highly correlated with VAS (r = 0.91). A significant rank effect (p < 0.001) confirmed the MI's discriminative validity. Excellent intra- and inter-rater reliability was found for total MI score (ICC = 0.84-0.99) and for weight, stack height, heel to toe drop and flexibility subscales (AC1 = 0.82-0.99), while good inter-rater reliability was found for technologies (AC1 = 0.73). CONCLUSION This standardised definition of minimalist shoes developed by an international panel of experts will improve future research on minimalist shoes and clinical recommendations. MI's adequate validity and reliability will allow distinguishing running shoes based on their degree of minimalism, and may help to decrease injuries related to footwear transition.
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Abstract
Background/Objective It is important to understand the factors that influence the impact force observed during running, since the impact force is likely to be related to overuse injuries. The purpose of this study was to compare the impact force during running when participants were instructed to use different foot strike patterns: obvious heel strike (Obvious-HS), subtle heel strike (Subtle-HS), midfoot strike (Mid-FS), and fore foot strike (Fore-FS) patterns. Methods Participants (n = 10, 25 ± 5.7 years, 70.2 ± 12.1 kg, 174.6 ± 7.2 cm) completed four foot strike patterns while running over ground: Obvious-HS, Subtle-HS, Mid-FS, and Fore-FS. Speed was controlled between conditions (random order). Vertical ground reaction forces were recorded (1000 Hz) along with the impact force, peak force, and stance time for analysis. A repeated measures analysis of variance was used to compare each variable across foot strike instructions, with post hoc comparisons contrasting Obvious-HS to each of the other conditions. Results Impact force was influenced by foot strike instructions, with Obvious-HS being greater than Subtle-HS and Fore-FS (p < 0.05) but not different from Mid-FS (p > 0.05). The peak force was not influenced by foot strike instructions (p > 0.05); stance time was longer during Obvious-HS than during Mid-FS or Fore-FS (p < 0.05), but not different from Subtle-HS (p > 0.05). Conclusion The unique observation of this study was that impact force was different when participants were instructed to run with either an Obvious-HS or a Subtle-HS at contact. Both these foot strike patterns would have been considered rear foot strike patterns, suggesting that something other than which specific part of the foot strikes the ground initially influenced impact force.
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Affiliation(s)
- John A Mercer
- Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, NV, USA
| | - Sarah Horsch
- Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, NV, USA
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Abstract
Stress fractures, were first described in military recruits but in recent years have increasingly been described in runners. In most surveys they comprise between 10 and 20% of all running injuries. The tibia is the most common site of all stress fractures although recent studies involving track and field athletes show an increased incidence of navicular stress fractures. The diagnosis is based on the clinical findings of a history of exercise-related bone pain with local bony tenderness on examination. The diagnosis is often confirmed by a typical appearance on an isotope bone scan or plain radiograph. In general, treatment consists of relative rest from the aggravating activity until symptom-free and then graduated resumption of activity. Attention also needs to be paid to correction of possible causative factors. These include excessive training, low bone density, low calcium intake, menstrual abnormalities in females and biomechanical features such as excessive sub-talar pronation. Certain stress fractures, such as those in the navicular, require specific management, e.g. six weeks non-weight bearing cast immobilization.
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Affiliation(s)
- P D Brukner
- Olympic Park Sports Medicine Centre, Swan Street, Melbourne, Australia
| | - K L Bennell
- Department of Human Biosciences, La Trobe University, Melbourne, Australia
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Abstract
Published articles on iliotibial band friction syndrome have been reviewed. These articles cover the epidemiology, etiology, anatomy, pathology, prevention, and treatment of the condition. This article describes (1) the various etiological models that have been proposed to explain iliotibial band friction syndrome; (2) some of the imaging methods, research studies, and clinical experiences that support or call into question these various models; (3) commonly proposed treatment methods for iliotibial band friction syndrome; and (4) the rationale behind these methods and the clinical outcome studies that support their efficacy.
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Abstract
Correct diagnosis and successful treatment of running related injuries are based on a firm understanding of the biomechanics of running. The sports medicine practitioner, knowing the principles of the bone and muscular interactions of the structures involved in running, can generate specific, accurate diagnosis and detailed, individualized treatment and prevention protocols. Intrinsic biomechanical factors and extrinsic influences will be examined for their effects on running and related injuries.
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Affiliation(s)
- S R Geiringer
- Wayne State University, Detroit, MI, USA Rehabilitation Institute of Michigan, Detroit, MI, USA
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13
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Abstract
Stress fractures, were first described in military recruits but in recent years have increasingly been described in runners. In most surveys they comprise between 10 and 20% of all running injuries. The tibia is the most common site of all stress fractures although recent studies involving track and field athletes show an increased incidence of navicular stress fractures. The diagnosis is based on the clinical findings of a history of exercise-related bone pain with local bony tenderness on examination. The diagnosis is often confirmed by a typical appearance on an isotope bone scan or plain radiograph. In general, treatment consists of relative rest from the aggravating activity until symptom-free and then graduated resumption of activity. Attention also needs to be paid to correction of possible causative factors. These include excessive training, low bone density, low calcium intake, menstrual abnormalities in females and biomechanical features such as excessive sub-talar pronation. Certain stress fractures, such as those in the navicular, require specific management, e.g. six weeks non-weight bearing cast immobilization.
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Affiliation(s)
- P D Brukner
- Olympic Park Sports Medicine Centre, Swan Street, Melbourne, Australia
| | - K L Bennell
- Department of Human Biosciences, La Trobe University, Melbourne, Australia
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