Bone Stress Injuries Research Articles

Tarsal Navicular Bone Stress Injuries: A Multicenter Case Series Investigating Clinical Presentation, Diagnostic Approach, Treatment, and Return to Sport in Adolescent Athletes

Background: Tarsal navicular bone stress injuries (BSIs) are considered “high risk” because of prolonged healing times and higher rates of nonunion in adult populations but, to our knowledge, have not been comprehensively examined in adolescent athletes. Purpose: To describe the characteristics of tarsal navicular BSIs in adolescents. Study Design: Case series; Level of evidence, 4. Methods: A retrospective analysis of patients aged 10 to 19 years with a radiographically diagnosed tarsal navicular BSI was performed at 8 academic centers over a 9-year study period. Age, sex, body mass index (BMI), primary sport, physical examination findings, imaging, treatment, surgical technique, return-to-sport time, and complications were analyzed. Results: Among 110 patients (mean age, 14.7 ± 2.7 years; 65% female), common primary sports were cross-country/track and field (29/92 [32%]) and gymnastics/dance (25/92 [27%]). Grade 4 BSIs were identified in 44% (48/110) of patients, with fracture lines present on radiography or magnetic resonance imaging. Nonoperative treatment (mean age, 14.4 ± 2.6 years), consisting of protected weightbearing and either a protective boot (69/88 [78%]) or a cast (19/88 [22%]), was trialed in all patients and was successful in 94 patients (85%). Operative treatment (mean age, 17.1 ± 1.4 years) was ultimately pursued for 16 patients (15%). Patients who required surgery had a higher BMI and a higher percentage of fracture lines present on imaging (nonoperative: 36/94 [38%]; operative: 14/16 [88%]). The median time to return to weightbearing, running, and full sport was significantly longer in duration for the operative group than the nonoperative group (P <.05). Complications associated with surgery included 1 case each of delayed union, nonunion, and painful implants, the latter of which required secondary surgery. Conclusion: Adolescent tarsal navicular BSIs were identified most commonly in female patients in leanness sports. Adolescents who required surgery were more likely to be older, have higher BMIs, and have grade 4 BSIs, and they returned to sport within a median of 5 months after single- or double-screw fixation with a low risk of postoperative complications. A better understanding of the presenting signs and symptoms and appropriate diagnostic imaging of navicular BSIs may lead to an earlier diagnosis and improved outcomes.

Relative energy deficiency in sport and the role of ultrarunning coaches according to two female ultrarunners

Relative Energy Deficiency in Sport (RED-S) is a complex syndrome that occurs as a result of prolonged Low Energy Availability (LEA) leading to health and performance impairments. However, whilst the coach plays an important role when working with athletes with RED-S, no research exists specifically exploring their role. Therefore, this study investigates the role of the coach from the athletes’ perspective within an ultrarunning context. Ultrarunners are at risk of LEA due to large training volumes and record high incidences of psychological and physiological conditions linked to RED-S, such as disordered eating and bone stress injuries. Two female ultrarunners who had experience with RED-S each participated in three semi-structured interviews. The findings highlight the multifaceted role of the coach which changes depending on the stage of the athletes’ RED-S Journey. Of primary importance was that the coach should be educated on RED-S in order to provide value throughout. Secondly, for effective recovery, the coach should embrace working with a multidisciplinary support team of experts. Thirdly, the coach should actively work on establishing strong relationships with the athlete and their support network. This will propagate trust and honest conversations, a key requirement for recovery from, and ongoing training post, RED-S.

Current risks factors and emerging biomarkers for bone stress injuries in military personnel.

Bone stress injuries (BSIs) have plagued the military for over 150 years; they afflict around 5 to 10% of military recruits, more so in women, and continue to place a medical and financial burden on defence. While the tibia generally adapts to the rigours of basic military training, the putative mechanisms for bone maladaptation are still unclear. This paper provides a review of the published literature on current risk factors and emerging biomarkers for BSIs in military personnel; the potential for biochemical markers of bone metabolism to monitor the response to military training; and, the association of novel biochemical 'exerkines' with bone health. The primary risk factor for BSI in military (and athletic) populations is too much training, too soon. Appropriate physical preparation before training will likely be most protective, but routine biomarkers will not yet identify those at risk. Nutritional interventions will support a bone anabolic response to training, but exposure to stress, sleep loss, and medication is likely harmful to bone. Monitoring physiology using wearables-ovulation, sleep and stress-offer potential to inform prevention strategies. The risk factors for BSIs are well described, but their aetiology is very complex particularly in the multi-stressor military environment. Our understanding of the skeletal responses to military training is improving as technology advances, and potential biomarkers are constantly emerging, but sophisticated and integrated approaches to prevention of BSI are warranted.

Preliminary study of bone biomarkers in elite female ballet dancers

Elite female ballet dancers are at high-risk of bone stress injuries (BSI) due to high-levels of weight-bearing exercise causing micro-cracks to form in the bone. The consistently high volumes of weight-bearing exercise may lead to a low BMI which reduces oestrogen levels by suppressing the gonadotrophin axis. The combination of high-levels of weight-bearing exercise and low oestrogen may be associated with increased bone remodelling. Investigating the relationship between exercise, BMI, oestrogen, and bone remodelling is crucial for developing prevention and management strategies for BSI. We conducted a pilot study of 4 weeks in a group of elite female professional ballet dancers and in female controls: the study subjects were monitored for self-reported weekly exercise, BMI, urinary oestrogen metabolites (2OHE1 and 16OHE1) and urinary NTX, a marker of bone resorption and proxy for remodelling. Measurements were collected at baseline, week 2 and 4. Dancers exhibited significantly higher hours of exercise per week (p = 0.004), and a BMI significantly lower (p = 0.030) than that of age-matched controls. In contrast, the levels of oestrogen metabolites (p = 0.050) and NTX (p = 0.460) were comparable in the two groups. Using NTX as a biomarker of bone remodelling, these results suggest that despite intense weight-bearing exercise, ballet dancers may not undergo higher bone remodelling than controls. The resulting insufficiency of bone remodelling may increase the risk of BSI because micro-cracks might accumulate in the bone faster than damaged tissue could be replaced. Based on these findings, larger studies will be designed to assess the effect of bone remodelling on BSI risk and recovery in professional ballet dancers, to develop a platform of prevention and treatment strategies including screening programmes to identify dancers at risk.

Healthy Runner Project: a 7-year, multisite nutrition education intervention to reduce bone stress injury incidence in collegiate distance runners

ObjectivesWe evaluated the effect of a nutrition education intervention on bone stress injury (BSI) incidence among female distance runners at two NCAA Division I institutions.MethodsHistorical BSI rates were measured retrospectively...

The Relationship Between Eating Disorders, Disordered Eating, and Injury in Athletes: A Critically Appraised Topic.

Eating disorders (EDs) and disordered eating (DE) result in numerous physical and psychological complications for female and male athletes. Besides bone-related injury, little research exists investigating what injuries EDs and/or DE contribute to. Are EDs and/or DE a risk factor for injury incidence in athletes? We searched for prospective studies assessing EDs or DE as a risk factor for injury in female or male athletes high school age and older. Our search returned 5 studies. One study found Eds, or DE were not a risk for any type of injury in female cross-country and track-and-field athletes. Two studies found a possible relationship between EDs or DE, as one contributing factor of others, in the incidence of bone stress injuries (BSIs) in female athletes who compete in various sports. One study found female, but not male, cross-country and track-and-field athletes with a history of EDs were more at risk for stress fractures than those without a history. One study found Eds, or DE were not a risk for BSI in female runners and triathletes. Large and important gaps in the literature exist investigating injuries related to EDs or DE outside of BSIs. There is low-moderate evidence that EDs and/or DE are either a sole, or contributing, risk factor for BSIs in female athletes. Grade B evidence exists to support the idea that EDs and/or DE are a risk factor for a specific type of injury (BSI) in female athletes only.

Link Between the Female Athlete Triad and Gymnastics-Related Injury in Retired Collegiate Gymnasts.

To compare gymnastics-related injuries between former collegiate gymnasts who did and did not report components of the female athlete triad (Triad) during college, including disordered eating or menstrual irregularity. We hypothesized that athletes reporting these 2 triad symptoms would have higher rates of time loss injury and injuries requiring surgery. Retrospective case-control. Online survey. Four hundred seventy former collegiate gymnasts. Athletes completed online survey distributed through social media. Participants were grouped based on self-reported menstrual irregularity and disordered eating during college. We compared time loss injuries, injuries resulting in surgery, and injury locations between the groups using χ2 analyses. Seventy percent (n = 328) of participants in this study reported a time loss college injury without surgery, and 42% (n = 199) reported an injury during college that required surgical treatment. A significantly greater proportion of gymnasts with only disordered eating reported a time loss gymnastics injury (without surgery) compared with those who reported only menstrual irregularity during college (79% vs 64%; P =0 .03). A significantly greater proportion of the disordered eating-only group reported a spine injury compared with the menstrual irregularity-only group (P = 0.007) and the group who reported neither menstrual irregularity nor disordered eating (P = 0.006). College gymnasts who experienced disordered eating were more likely to experience a nonsurgical time loss injury while in college, as well as spine injury compared with those with menstrual irregularity. Sports medicine providers should be aware of the association between injuries and individual components of Triad in gymnasts beyond bone stress injuries.

Male Runners With Lower Energy Availability Have Impaired Skeletal Integrity Compared to Nonathletes.

Female athletes, particularly runners, with insufficient caloric intake for their energy expenditure [low energy availability (EA) or relative energy deficiency] are at risk for impaired skeletal integrity. Data are lacking in male runners. To determine whether male runners at risk for energy deficit have impaired bone mineral density (BMD), microarchitecture, and estimated strength. Cross-sectional. Clinical research center. 39 men (20 runners, 19 controls), ages 16-30 years. Areal BMD (dual-energy x-ray absorptiometry); tibia and radius volumetric BMD and microarchitecture (high-resolution peripheral quantitative computed tomography); failure load (microfinite element analysis); serum testosterone, estradiol, leptin; energy availability. Mean age (24.5 ± 3.8 y), lean mass, testosterone, and estradiol levels were similar; body mass index, percent fat mass, leptin, and lumbar spine BMD Z-score (-1.4 ± 0.8 vs -0.8 ± 0.8) lower (P < .05); and calcium intake and running mileage higher (P ≤ .01) in runners vs controls. Runners with EA <median had lower lumbar spine (-1.5 ± 0.7, P = .028), while runners with EA ≥median had higher hip (0.3 ± 0.7 vs -0.4 ± 0.5, P = .002), BMD Z-scores vs controls. After adjusting for calcium intake and running mileage, runners with EA <median had lower mean tibial total and trabecular volumetric BMD, trabecular bone volume fraction, cortical porosity, and apparent modulus vs controls (P < .05). Appendicular lean mass and serum estradiol (R ≥ 0.45, P ≤ .046), but not testosterone, were positively associated with tibial failure load among runners. Despite weight-bearing activity, skeletal integrity is impaired in male runners with lower caloric intake relative to exercise energy expenditure, which may increase bone stress injury risk. Lower estradiol and lean mass are associated with lower tibial strength in runners.

Stress reactions and stress fractures

Bone stress injuries is an umbrella term that encompasses repetitive microtraumatic events that accumulate to surpass the threshold of bone failure, which can range from bone marrow edema to frank stress fracture as the end point. Due to nonspecific clinical complaints and physical findings, imaging plays acentral role in the diagnostic workup of these entities. Magnetic resonance imaging (MRI) is the most important imaging modality with ahigh sensitivity and specificity and allows for differential diagnosis of other diseases. Edema-sensitive with fat suppression and T1-weighted sequences are the core sequence types, and contrast-enhanced imaging-albeit displaying subtle fractures much more easily-is rarely necessary. Furthermore, MRI enables differentiation of injury severity, which has an impact on length of rehabilitation, therapeutic regimen, and the time to return to sports in athletes.

Lumbar Bone Stress Injuries and Nonunited Defects in Elite Australian Cricket Players.

To describe the presentation and management of lumbar bone stress injuries (LBSI), recurrent LBSI, and lumbar nonunited defects in elite Australian male and female cricket players. Retrospective case series. Professional domestic and international cricket teams over 13 seasons. Elite Australian cricket players. Symptomatic LBSI requiring time off cricket and lumbar nonunited defects, both confirmed by imaging. Incidence, presentation, history, healing, and management. 211 LBSI were identified at an average incidence of 5.4 per 100 players per season. LBSI were most common in male pace bowlers younger than 20 years of age (58.1 per 100 players per season), however, were also observed in older players, females, and non-pace bowlers. Recurrent LBSI accounted for 33% (27%-40%) of all LBSI. Median days to return to match availability was 182 (128-251) days for all LBSI, with a shorter time frame observed for new and less severe injuries, and male spin bowlers. Healing was demonstrated in 87% (81%-91%) of all LBSI cases. 29 nonunited defects were identified and predisposed subsequent pain, LBSI, and spondylolisthesis. LBSI are experienced by approximately 5.4 in every 100 elite Australian cricket players per season, with a high time cost of approximately 4 to 8 months. Nonunited defects also have a high time cost with associated subsequent lumbar spine issues. The findings of this study reinforce the importance of early detection and conservative management of LBSI, particularly for younger male pace bowlers and players with recurrent LBSI, which may be supported by MRI.

Menstrual Function, Eating Disorders, Low Energy Availability, and Musculoskeletal Injuries in British Servicewomen.

This study aimed to investigate associations between menstrual function, eating disorders, and risk of low energy availability with musculoskeletal injuries in British servicewomen. All women younger than 45 yr in the UK Armed Forces were invited to complete a survey about menstrual function, eating behaviors, exercise behaviors, and injury history. A total of 3022 women participated; 2% had a bone stress injury in the last 12 months, 20% had ever had a bone stress injury, 40% had a time-loss musculoskeletal injury in the last 12 months, and 11% were medically downgraded for a musculoskeletal injury. Menstrual disturbances (oligomenorrhea/amenorrhea, history of amenorrhea, and delayed menarche) were not associated with injury. Women at high risk of disordered eating (Female Athlete Screening Tool score >94) were at higher risk of history of a bone stress injury (odds ratio (OR; 95% confidence interval (CI)), 2.29 (1.67-3.14); P < 0.001) and time-loss injury in the last 12 months (OR (95% CI), 1.56 (1.21-2.03); P < 0.001) than women at low risk of disordered eating. Women at high risk of low energy availability (Low Energy Availability in Females Questionnaire score ≥8) were at higher risk of bone stress injury in the last 12 months (OR (95% CI), 3.62 (2.07-6.49); P < 0.001), history of a bone stress injury (OR (95% CI), 2.08 (1.66-2.59); P < 0.001), a time-loss injury in the last 12 months (OR (95% CI), 9.69 (7.90-11.9); P < 0.001), and being medically downgraded with an injury (OR (95% CI), 3.78 (2.84-5.04); P < 0.001) than women at low risk of low energy availability. Eating disorders and risk of low energy availability provide targets for protecting against musculoskeletal injuries in servicewomen.

Bone Stress Injuries in Runners Using Carbon Fiber Plate Footwear

The introduction of carbon fiber plate footwear has led to performance benefits in runners. The mechanism for these changes in running economy includes altered biomechanics of the foot and ankle. The association of this footwear with injuries has been a topic of debate clinically, but not described in the literature. In this Current Opinion article, illustrated by a case series of five navicular bone stress injuries in highly competitive running athletes, we discuss the development of running-related injuries in association with the use of carbon fiber plate footwear. While the performance benefits of this footwear are considerable, sports medicine providers should consider injuries possibly related to altered biomechanical demands affecting athletes who use carbon fiber plate footwear. Given the introduction of carbon fiber plate footwear into athletics and other endurance sports, strategies may be required to reduce risk of injury due to altered foot and ankle mechanics. This article is intended (1) to raise awareness on possible health concerns around the use of carbon fiber plate footwear, (2) to suggest a slow gradual transition from habitual to carbon fiber plate footwear, and (3) to foster medical research related to carbon fiber plate technology and injuries.

Bone stress injuries

Bone stress injuries, commonly referred to as stress reactions or stress fractures, are caused by overuse and are prevalent conditions in athletes. These injuries are often seen in sports with high cumulative skeletal loading such as running, athletics, gymnastics, basketball, cricket, or soccer. The main injury pathophysiology is an imbalance between bone microdamage formation and its removal and replacement. A detailed medical history and clinical examination are important for diagnosis, with magnetic resonance imaging representing the gold standard for radiographic confirmation. Treatment and return-to-sport decisions should be individualized and based on injury location, severity, aspects of sports participation, and patient preferences. Initial management includes activity modification, protected weight-bearing, immobilization, optimizing nutrition (caloric intake, dietary calcium, and vitamin D supplementation), and in a few cases surgery. Following initial treatment, progressive loading and return-to-activity are initiated. Overall, a high rate of return-to-sports can be expected. Numerous risk factors that alter bone loading or bone health have been described and their identification is a crucial step towards prevention of future injury.

Return to sport following low-risk and high-risk bone stress injuries: a systematic review and meta-analysis

ObjectiveBone stress injuries (BSIs) are classified in clinical practice as being at low- or high-risk for complication based on the injury location. However, this dichotomous approach has not been sufficiently...

Risk Factors for Symptomatic Bilateral Lumbar Bone Stress Injury in Adolescent Soccer Players: A Prospective Cohort Study

Background: Lumbar bone stress injury (BSI) is a high-risk long time—loss injury for adolescent soccer players. However, the risk factors for lumbar BSI are unclear. Purpose: To identify the risk factors for bilateral lumbar BSI for adolescent soccer players. Study Design: Case-control study; Level of evidence, 3. Methods: Adolescent soccer players underwent orthopaedic examination, whole-body dual energy x-ray scan, lumbar magnetic resonance imaging (MRI), and muscle tightness testing at baseline. Lumbar lordosis (LL), sacral slope, maturity stage of lumbar vertebral body, and bone marrow edema (BME) at the L5 were examined via MRI. In addition, bone mineral density and content; trunk lean body mass via dual energy x-ray scan; and bilateral muscle tightness including the iliopsoas, hamstrings, and quadriceps were measured. Lumbar BSI was diagnosed as positive bilateral BME and extension-based lumbar pain. All participants were examined twice, one at 6 months and one at 1 year, after the baseline examination. Multivariate logistic regression analysis was performed to identify the risk factors for bilateral lumbar BSI. Results: A total of 69 (26.3%) players were diagnosed with bilateral lumbar BSI. Asymptomatic BME (odds ratio [OR], 4.260; 95% CI, 2.153-8.431), apophyseal stage of the lumbar vertebral body (OR, 3.438; 95% CI, 1.698-6.959), sacral slope relative to LL ≥5° (OR, 4.067; 95% CI, 2.021-8.181), and hamstring tightness ≥50° (OR, 3.221; 95% CI, 1.385-7.489) were significantly associated with bilateral lumbar BSI. Conclusion: The incidence of bilateral lumbar BSI was common at 26.2%. Asymptomatic BME, sacral anterior tilt relative to LL, immature lumbar epiphyses, and hamstring tightness were found to be risk factors for bilateral lumbar BSI. The results of this study suggest that regular MRI examination could facilitate the early detection of BME, and improvement in hamstring flexibility and lumbosacral alignment may prevent bilateral lumbar BSI in young athletes.

The Presence of Hip Joint Effusion on MRI Is Predictive of a Grade 4 Femoral Neck Stress Injury.

One of the most debilitating types of bone stress injuries is those occurring at the femoral neck. This problem occurs in the military population with much higher incidence than in the normal population and is of great concern to military medical providers. Early detection and accurate diagnosis are key in protecting soldiers and recruits from sustaining a potentially career-ending fracture. In a case study, a 16-year-old elite male distance runner presented with hip pain. MRI found hip joint effusion but was unremarkable for marrow edema and a low-signal fracture line. The initial diagnosis was acute arthritis; however, a follow-up radiograph 1 month later, after the patient had been refraining from running, confirmed a significant non-displaced compression-side Grade 4 femoral neck stress injury (FNSI). In light of the case study and our similar clinical experience, we tested the hypothesis that an MRI study positive for an FNSI, combined with the evidence of a hip joint effusion, is indicative of a Grade 4 FNSI, even without visualization of a low-signal intensity fracture line on T1 or short tau inversion recovery images. Recruits in Army Basic Combat Training were included in the investigation if 1) diagnosed with a unilateral FNSI, 2) had an initial positive MRI for an FNSI, 3) had a positive bone scan for uptake in the femoral neck area (to validate the diagnosis), 4) had no other hip/pelvis injuries, and 5) had a follow-up MRI within 60 days. Hip joint effusion was defined as 1) ≥2-mm measurable difference in the thickness of fluid along the length of the involved femoral neck when compared to the contralateral uninvolved femoral neck on the initial MRI; 2) visibly assessed as a prominent collection of fluid distending the posterior hip joint capsule on the initial MRI coronal short tau inversion recovery sequence (called the "flash sign"). A total of 162 recruits met the study inclusion criteria. For the detection of a Grade 4 FNSI on the first MRI, the sensitivity, specificity, and positive predictive value of the measured joint effusion criteria were 0.52, 0.94, and 0.89, respectively. or the non-measured flash sign, these values were 0.70, 0.83, and 0.80, respectively. Both the measured hip joint effusion criteria and the non-measured flash sign were predictive of a Grade 4 FNSI and may be useful in clinical evaluation.

How Advancement in Bone Science Should Inform the Examination and Treatment of Femoral Shaft Bone Stress Injuries in Running Athletes.

Stress fractures likely have a 1-2% incidence in athletes in general. In runners, a more vulnerable population, incidence rates likely range between 3.2 and 21% with female runners having greater susceptibility. The incidence of femoral shaft stress fractures is less well known. New basic and translational science research may impact the way clinicians diagnose and treat femoral stress fractures. By using a fictitious case study, this paper applies bone science to suggest new approaches to evaluating and treating femoral shaft stress fractures in the running population.

Signs of low energy availability in elite male volleyball athletes but no association with risk of bone stress injury and patellar tendinopathy

ABSTRACT Relative Energy Deficiency in Sport (RED-S) syndrome is associated with undesirable health and performance outcomes. The aetiology of RED-S syndrome is low energy availability (LEA). LEA has been reported in male athletes in various sports, but there is little information in team sports. Therefore, the aims of this study were to assess the point-prevalence of surrogate markers of LEA in elite male volleyball players and examine the association between low and normal total-testosterone (TES) on endocrine markers, resting metabolic rate, bone mineral density (BMD), and history of injury/illness. Using a cross-sectional design, 22 elite male volleyball players underwent anthropometric, dual-energy X-ray absorptiometry (DEXA or DXA) and resting metabolic rate testing, bloodwork, dietary analysis, the three-factor eating questionnaire–R18, injury/illness questionnaire and Victorian Institute of Sport Assessment – patellar tendon questionnaire. The primary finding of this investigation was that 36% of athletes had ≥2 surrogate markers of LEA. Although fasted insulin was lower and cortisol was higher in players with low-total TES, low BMD, low RMR and various other endocrine markers linked to LEA were not observed. More research is required to define surrogate markers of LEA in male athletes. HIGHLIGHTS Thirty-six percent of volleyball players had ≥2 surrogate markers of LEA. The Cunningham, 1991 predictive RMR equation and/or the cut-off point (<0.9) may be unsuitable for detecting energy conservation associated with LEA in large male athletes. There was no association between total-TES and risk of bone stress injury, illness and patellar tendinopathy.

Correlation between Abnormal Gait Pattern With Femoral Neck Stress Fracture In Athletes: A Systematic Review

Backgrounds: Stress fractures are common overuse injuries in the lower extremities. Repetitive episodes of high-intensity or extended-duration axial load to the leg place the bone at risk of stress-related injury. The femoral neck is an uncommon location for stress fracture (less than 5% of all stress fractures). Fracture location, type, and grade permits generic dichotomized classification of “low-risk” and “high-risk” fractures. Tension-side femoral neck stress fractures are considered “high-risk” because of their potential for displacement, nonunion, and avascular necrosis if displaced. Fractures in locations prone to these 3 outcomes are categorized as “high risk.” These include anterior tibial cortex, medial malleolus, talar neck, dorsal tarsal navicular, proximal fifth metatarsal metaphysis, tension side patella, and tension side of the femoral neck. The risk of avascular necrosis following treatment of displaced femoral neck fractures in adults may be as high as 45%. In runners, pain typically begins with onset of weight bearing early in the run. Pain may progressively increase and does not remit until the run ends. In some athletes, the desire to train or perform may supersede the pain. This may lead to disastrous consequences if a femoral neck stress fracture completes itself and displaces. This paper describes side effects abnormal gait pattern to femoral neck stress fractures in athlete. Methods: Our trial was an international, expertise-based, randomized, controlled trial. Details of the trial objectives and design have been published previously. Additional information about the eligibility criteria, interventions, follow-up, outcome definitions, and statistical analysis. To identify studies pertaining to the clinical results about Correlation between Abnormal Running Gait Pattern and Femoral Neck Stress Fracture, we reviewed the Cochrane, Pubmed, Embase databases for relevant articles published up to July 2022. We also reviewed the references of all identified articles to identify additional studies. Search terms were as follows: femoral neck stress fracture, femoral fracture, running gait. Following the PICOS (Participants, Interventions, Comparisons, Outcomes and Study design) principle, the key search terms included (P) patients were runner with FNSFs; (I) patients were running as a recreational sport, and or professional athlete; (C/O) the outcomes including sign and symptoms, femoral neck stress fracture, length of rehabilitation, time to get back in early performance in sport; (S) RTC, cohort study, or case control study. Results: A total of 13 RCTs, meta- analysis and systematic review correlation abnormal running gait with femoral neck stress fractures. Discussions: There are correlations between abnormal running gait with femoral neck fractures, because abnormal running gait with high intense could make bone stress injury. However, bone stress injury at neck femoral is one of many factors that commonly happen become a femoral neck stress fractures. Conclusions: Abnormal running gait combining with high intense training are etiology of bone stress injuries in athletes. Bone stress injuries in femoral neck could possibly become femoral neck stress fractures.

Running-Related Injuries Captured Using Wearable Technology during a Cross-Country Season: A Preliminary Study

ABSTRACT Introduction/Purpose Running-related injuries are prevalent among competitive runners. In a previous prospective descriptive assessment of in situ running biomechanics in collegiate cross-country athletes, a subset of athletes developed repetitive stress lower extremity injuries during study participation. The purpose of this preliminary, observational study was to assess sensor-derived biomechanics in the several days leading up to injury (n = 8; 4 female, 4 male) compared with runners who remained healthy (n = 14; 9 female, 5 male) over a single cross-country season. Methods Wearable sensors were used to collect running biomechanics during two weekly runs, and surveys were used to capture wellness and injury. Individual z scores of biomechanical measures were assessed for runners who developed injuries and compared against healthy male and female z scores. Results Of the eight injuries, four were categorized as bone stress injuries (three female, one male), and four as soft tissue injuries (one female, three male). Bone injury cases had increased contact time, loading, and pronation, and decreased cadence and stride length preceding injury. Hamstring injury cases (n = 2) had increased stride length, whereas foot and ankle soft tissue injuries had increased pronation velocity and decreased shock and braking. Conclusions This assessment of injury cases illuminates several biomechanical patterns associated with running-related injury development. This study sets the precedent for larger-scale prospective running-related injury evaluations.