Bone stress in runners with tibial stress fracture

Meardon, Stacey A.; Willson, John D.; Gries, Samantha R.; Kernozek, Thomas W.; Derrick, Timothy R.

doi:10.1016/j.clinbiomech.2015.07.012

Cited by 48 publications

(64 citation statements)

References 42 publications

(55 reference statements)

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“…Existing studies have provided contradictory information regarding the net direction of bending during the support phase of the human running gait cycle (18)(19)(20)(21)(22)(23). Most recent studies (18,22,23), including one that directly measured bone deformation using surgically implanted bone screws (21), have indicated that the resultant bending moment (due to the combined effect of the internal muscular forces and external reaction forces) about the medial-lateral axis tends to bend the tibia in a concave posterior manner during running stance, thus placing the posterior tibia under compression. Experimental data, including in vivo bone strain estimates, have shown increased bone strain following prolonged physical activity (24)(25)(26),…”

Section: Introductionmentioning

confidence: 99%

“…Biomechanical models provide a valuable non-invasive alternative that allow specific research questions to be addressed. Existing tibial modelling approaches have used beam theory to estimate tibial bending (19,20) and stress (18,22,23), where a cross-section of the tibia was modelled as a hollow ellipse. Peak tibial stress estimates obtained using beam theory were highly correlated with more computationally expensive finite element model estimates during walking (r > 0.9), but were found to underestimate the values (23).…”

Section: Introductionmentioning

confidence: 99%

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Estimating Tibial Stress throughout the Duration of a Treadmill Run

Rice

Weir

Trudeau³

et al. 2019

Medicine &Amp; Science in Sports &Amp; Exercise

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Introduction: Stress fractures of the tibia are a problematic injury amongst runners of all levels. Quantifying tibial stress using a modelling approach provides an alternative to invasive assessments that may be used to detect changes in tibial stress during running. This study aimed to assess the repeatability of a tibial stress model and to use this model to quantify changes in tibial stress that occur throughout the course of a 40-minute prolonged treadmill run. Methods: Synchronised force and kinematic data were collected during prolonged treadmill running from fourteen recreational male rearfoot runners on two separate occasions. During each session, participants ran at their preferred speed for two consecutive 20-minute runs, separated by a 2-minute pause. The tibia was modelled as a hollow ellipse and bending moments and stresses at the distal 1/3 of the tibia were estimated using beam theory combined with inverse dynamics and musculoskeletal modelling. Results: Intraclass correlation coefficients indicated good-to-excellent repeatability for peak stress values between sessions. Peak anterior and posterior stresses increased following 20 minutes of prolonged treadmill running and were 15% and 12% greater respectively after 40 minutes of running compared with the start of the run. Conclusion: The hollow elliptical tibial model presented is a repeatable tool that can be utilised to assess within-participant changes in peak tibial stress during running. The increased stresses observed during a prolonged treadmill run may have implications for the development of tibial stress fracture.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Estimating Tibial Stress throughout the Duration of a Treadmill Run

Rice

Weir

Trudeau³

et al. 2019

Medicine &Amp; Science in Sports &Amp; Exercise

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show abstract

“…However, Edwards [14] suggested that overuse injuries in bone are not the result of high rates of loading, but rather a mechanical fatigue phenomenon highly dependent on loading magnitude. Meardon et al [18] found that runners with a history of stress fracture had smaller bone geometry and greater bending moments in the tibia during midstance-much later in the running cycle 1 3 than impact. These results suggest that additional research is needed to clearly understand the details of this injury.…”

Section: Introductionmentioning

confidence: 99%

Joint Contact Forces with Changes in Running Stride Length and Midsole Stiffness

Thomas

Edwards

Derrick

2019

J. of SCI. IN SPORT AND EXERCISE

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The purpose of this study was to determine if lower extremity joint loading was influenced by stride length or shoe midsole cushioning. Ten subjects completed 10 trials of overground running at an average speed of 4.43 m/s in each of three conditions: normal running, running with a stride length (SL) reduced by 10% of normal, and running with a cushioned midsole stiffness (i.e., mechanical impact reduction of 13.7-10.9 g). Reaction forces calculated from inverse dynamics were summed with muscle forces estimated from a musculoskeletal model using static optimization to obtain joint contact forces at the hip, knee and ankle joints. Peak components of the contact forces [axial, anterior-posterior, and medial-lateral (ML)] were examined using parametric statistics (α = 0.05). Reducing stride length resulted in significant decreases in absolute peak ankle contact forces in the axial direction (normal: − 14.5 ± 1.5 BW; reduced SL: − 14.0 ± 1.6 BW) and the ML direction (normal: 0.67 ± 0.23 BW; reduced SL: 0.61 ± 0.21 BW). Reducing stride length also reduced the peak absolute axial forces at the knee (normal: − 10.6 ± 1.3 BW; reduced SL: − 9.8 ± 1.2 BW) and the hip (normal: − 7.26 ± 2.24 BW; reduced SL: − 6.75 ± 2.10 BW). The cushioned shoe did not statistically reduce the peak absolute contact forces from the normal stride condition at any of the joints. Post hoc stress analysis suggested that the observed changes in anterior hip force would increase stress more than any of the other statistically significant results. Reductions in stride length appear to decrease some joint contact variables but cushioning in the heel region of the shoe does not.

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“…BSI at the tibia are most commonly reported within the posteromedial border of the tibial shaft . From a biomechanical point of view, the posteromedial border of the tibia seems to be a predilection site for the occurrence of BSI, as this region is subject to the highest compressive stress and axial loading …”

Section: Discussionmentioning

confidence: 99%

Bone Stress Injuries Are Associated With Differences in Bone Microarchitecture in Male Professional Soldiers

Schanda

Kocijan

Resch

et al. 2019

Journal Orthopaedic Research

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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.

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Bone stress in runners with tibial stress fracture

Cited by 48 publications

References 42 publications

Estimating Tibial Stress throughout the Duration of a Treadmill Run

Estimating Tibial Stress throughout the Duration of a Treadmill Run

Joint Contact Forces with Changes in Running Stride Length and Midsole Stiffness

Bone Stress Injuries Are Associated With Differences in Bone Microarchitecture in Male Professional Soldiers

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