Identifying Sex-Specific Risk Factors for Stress Fractures in Adolescent Runners (original) (raw)
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Risk factors for stress fracture among young female cross-country runners
Medicine and Science in Sports and Exercise, 2007
Purpose: To identify risk factors for stress fracture among young female distance runners. Methods: Participants were 127 competitive female distance runners, aged 18-26, who provided at least some followup data in a randomized trial among 150 runners of the effects of oral contraceptives on bone health. After completing a baseline questionnaire and undergoing bone densitometry, they were followed an average of 1.85 yr. Results: Eighteen participants had at least one stress fracture during follow-up. Baseline characteristics associated (P G 0.10) in multivariate analysis with stress fracture occurrence were one or more previous stress fractures rate ratio [RR] [95% confidence interval] = 6.42 (1.80-22.87), lower wholebody bone mineral content (RR = 2.70 [1.26-5.88] per 1-SD [293.2 g] decrease), younger chronologic age (RR = 1.42 [1.05-1.92] per 1-yr decrease), lower dietary calcium intake (RR = 1.11 [0.98-1.25] per 100-mg decrease), and younger age at menarche (RR = 1.92 [1.15-3.23] per 1-yr decrease)
Lower Extremity Stress Fracture in Runners: Risk Factors and Prevention
International Journal of Athletic Therapy & Training
There are more than 16 million runners in the United States who train a minimum 100 days per year. 1 Runners can be separated into the following three categories on the basis of training frequency: (a) core participants (>50 runs/yr), (b) frequent runners (>100 runs/ yr), and (c) core runners (>224 runs/yr). 1 The core runner category includes most competi-tive high school and collegiate runners in the United States as well as recreational runners training for distances ranging from 5 km to half-marathons (13.1 miles). In addition to the high running fre-quency per year, the core runner averages 31 miles per week. 1 Given the repeated s t re s s e s a n d h i g h impact loads of running, up to 46% of run-ners suffer a running-related injury each year. 2 Further, lower extremity stress frac-tures (LESFs) are reported to account for up to 20% of all injuries in athletes, with runners and track athletes experiencing the greatest incidence. 3 Among runners, the tibia is highly ...
Effects of Ball Sports on Future Risk of Stress Fracture in Runners
Clinical Journal of Sport Medicine, 2005
Interventions: A 1-page questionnaire was used to collect data regarding ages during which athletes played basketball and soccer, as well as other important covariates and outcomes. Outcome Measurements: Athletes reported the ages when stress fractures occurred. Time to event was defined as the number of years from beginning competitive running to the first stress fracture or to current age, if no fracture had occurred. Results: In both men and women, playing ball sports in youth correlated with reduced stress fracture incidence later in life by almost half, controlling for possible confounders. In men, each additional year of playing ball sports conferred a 13% decreased incidence of stress fracture (adjusted hazard ratio [HR] and 95% confidence interval, 0.87 [0.79-0.95]. Among women with regular menses, the HR for each additional year of playing ball sports was similar: 0.87 (0.75-1.00); however, there was no effect of length of time played among women with irregular menses (HR, 1.03 [0.92-1.16]). In men, younger ages of playing ball sports conferred more protection against stress fractures (HR for each 1-year-older age at first exposure, 1.29 [1.14, 1.45]). Conclusions: Runners who participate during childhood and adolescence in ball sports may develop bone with greater and more symmetrically distributed bone mass, and with enhanced protection from future stress fractures.
Sports
Physical activity is known to be beneficial for bone; however, some athletes who train intensely are at risk of bone stress injury (BSI). Incidence in adolescent athlete populations is between 3.9 and 19% with recurrence rates as high as 21%. Participation in physical training can be highly skeletally demanding, particularly during periods of rapid growth in adolescence, and when competition and training demands are heaviest. Sports involving running and jumping are associated with a higher incidence of BSI and some athletes appear to be more susceptible than others. Maintaining a very lean physique in aesthetic sports (gymnastics, figure skating and ballet) or a prolonged negative energy balance in extreme endurance events (long distance running and triathlon) may compound the risk of BSI with repetitive mechanical loading of bone, due to the additional negative effects of hormonal disturbances. The following review presents a summary of the epidemiology of BSI in the adolescent at...
The American Journal of Sports Medicine, 1996
Background: Modern professional tennis involves powerful movements repeatedly subjecting the musculoskeletal system to heavy mechanical load. Thus tennis players are exposed to high risk of overuse injuries including stress fractures. Objective: To determine the incidence and distribution of stress fractures in elite tennis players. Study design: Retrospective cohort study. Methods: The cohort study population consisted of 139 elite players (mean (SD) age, 20.0 (5.0) years; 48 female, 91 male). Stress fractures were identified and confirmed radiologically from medical records during a two year period. Injuries were analysed according to age, sex, site, severity, delay in diagnosis, and time needed to return to sports. Results: 15 players sustained 18 stress fractures, corresponding to an overall case incidence of 12.9% (95% confidence interval (CI), 8.1 to 20.0). The tarsal navicular was most affected (n = 5; 27%), followed by the pars interarticularis (n = 3; 16%), the metatarsals (n = 3; 16%), the tibia (n = 2; 11%) and the lunate (n = 2; 11%). Magnetic resonance imaging showed a greater incidence of ''high grade'' lesions (94.4%). Stress fracture incidence was significantly higher in juniors (20.3% (95% CI, 11.4 to 33.2)) than in professional players (7.5% (2.8 to 15.6)) (p = 0.045).
The incidence and distribution of stress fractures in competitive track and field athletes
… American Journal of …, 1996
Background: Modern professional tennis involves powerful movements repeatedly subjecting the musculoskeletal system to heavy mechanical load. Thus tennis players are exposed to high risk of overuse injuries including stress fractures. Objective: To determine the incidence and distribution of stress fractures in elite tennis players. Study design: Retrospective cohort study. Methods: The cohort study population consisted of 139 elite players (mean (SD) age, 20.0 (5.0) years; 48 female, 91 male). Stress fractures were identified and confirmed radiologically from medical records during a two year period. Injuries were analysed according to age, sex, site, severity, delay in diagnosis, and time needed to return to sports. Results: 15 players sustained 18 stress fractures, corresponding to an overall case incidence of 12.9% (95% confidence interval (CI), 8.1 to 20.0). The tarsal navicular was most affected (n = 5; 27%), followed by the pars interarticularis (n = 3; 16%), the metatarsals (n = 3; 16%), the tibia (n = 2; 11%) and the lunate (n = 2; 11%). Magnetic resonance imaging showed a greater incidence of ''high grade'' lesions (94.4%). Stress fracture incidence was significantly higher in juniors (20.3% (95% CI, 11.4 to 33.2)) than in professional players (7.5% (2.8 to 15.6)) (p = 0.045).
Update on stress fractures in female athletes: epidemiology, treatment, and prevention
Current Reviews in Musculoskeletal Medicine, 2013
Stress fractures are a common type of overuse injury in athletes. Females have unique risk factors such as the female athlete triad that contribute to stress fracture injuries. We review the current literature on risk factors for stress fractures, including the role of sports participation and nutrition factors. Discussion of the management of stress fractures is focused on radiographic criteria and anatomic location and how these contribute to return to play guidelines. We outline the current recommendations for evaluating and treatment of female athlete triad. Technologies that may aid in recovery from a stress fracture including use of anti-gravity treadmills are discussed. Prevention strategies may include early screening of female athlete triad, promoting early participation in activities that improve bone health, nutritional strategies, gait modification, and orthotics.
Sports Health: A Multidisciplinary Approach, 2019
Background:Bony stress injuries (BSIs) are common among adolescents involved in high school sports. A better understanding of factors that contribute to adolescent BSI is needed to target preventative measures.Hypothesis:Individuals who suffer a BSI will demonstrate significant differences in training methods, sleep, diet, and history of injury compared with a healthy, noninjured control group.Study Design:Descriptive epidemiologic study.Methods:Data from the National High School Stress Fracture Registry (NHSSFR), an internet-based adolescent BSI survey, were used to identify variables reported with adolescent (13-18 years of age) BSI. These findings were compared with a survey of 100 (50 males, 50 females) healthy athletic controls to identify significant differences between healthy adolescents and those with BSI.Results:A total of 346 stress fractures were reported in 314 (206 females, 108 males) athletes within the NHSSFR. Comparison with healthy control participants demonstrated...
Scandinavian journal of medicine & science in sports, 2015
Studies of stress fracture (SF) incidence are limited in number and geographical location; this study determined the incidence of SF injury in female endurance athletes based in the United Kingdom. A total of 70 athletes aged between 18 and 45 years were recruited and prospectively monitored for 12 months. Questionnaires at baseline and 12 months assessed SF, menstrual and training history, eating psychopathology, and compulsive exercise. Peak lower leg muscle strength was assessed in both legs using an isometric muscle rig. Bone mineral density (BMD) of total body, spine, hip, and radius was assessed using dual X-ray absorptiometry. Among the 61 athletes who completed the 12-month monitoring, two sustained a SF diagnosed by magnetic resonance imaging, giving an incidence rate (95% confidence intervals) of 3.3 (0.8, 13.1) % of the study population sustaining a SF over 12 months. The SF cases were 800 m runners aged 19 and 22 years, training on average 14.2 h a week, eumenorrheic wit...