Interventions for preventing and treating stress fractures and stress reactions of bone of the lower limbs in young adults. Cochrane Database Syst Rev 2:CD000450

Teesside Centre for Rehabilitation Sciences, University of Teesside, James Cook University Hospital, Marton Road, Middlesbrough, Tees Valley, UK, TS4 3BW.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2005; 2(2):CD000450. DOI: 10.1002/14651858.CD000450.pub2
Source: PubMed


Stress fractures are a type of overuse injury. They can be very painful and debilitating. Lower limb stress fractures are common in people undergoing military training and in athletes, particularly long distance runners. Measures to prevent stress fractures include modifications to footwear and changes to training schedules. We found some evidence that shock absorbing boot inserts help prevent stress fractures during military training. It is not clear what is the best design to use. Treatment of stress fractures generally involves a long period of activity restriction. We found some evidence that pneumatic braces may speed recovery of tibial stress fracture.

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    • "If the fracture occurs in normal bone of a healthy individual, it is defined as a fatigue fracture . These fractures are common in athletes, dancers, and military personnel [9]. Insufficiency fractures are another type of stress fracture, which is the result of normal stresses on a bone with reduced strength. "
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    ABSTRACT: Introduction Bilateral femoral neck fractures without major trauma are rare and related to several conditions. Insufficiency fractures due to the use of anti-epileptic drug are one of the rare causes. This case study is about bilateral femoral neck insufficiency fractures resulting from chronic use of anti-epileptic drug. Presentation of case A 26-year-old woman was referred to our emergency department with a complaint of bilateral groin pain and a 12-year history of irregular carbamazepine use. The diagnosis was bilateral femoral neck insufficiency fractures due to irregular long-term carbamazepine use. One-stage bilateral dynamic hip screw osteosynthesis was performed. After 2 years of follow up, good result was obtained. Discussion There are several risk factors for insufficiency fracture, and antiepileptic drug related osteoporosis is one of the reason. These drugs have negative effect on bone methabolism and bone mineral density. Conclusion To our knowledge, this is the first case in the literature of bilateral femoral neck insufficiency fracture due to chronic carbamazepine use. Joint and bone pain with a history of long-term use of anti-epileptic drug should be investigated carefully, and insufficiency fractures should be kept in mind.
    International Journal of Surgery Case Reports 12/2014; 59. DOI:10.1016/j.ijscr.2014.12.019
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    • "Stress fractures associated with load carriage For the military, stress fractures are of particular concern due to their protracted recovery periods (Kelly, Jonson, Cohen, & Shaffer, 2000; O'Connor, 2000; Pope, 1999; Rome, Handoll, & Ashford, 2005; Ross, 2002). Stress or fatigue fractures are attributable to repetitive overloading of the bones where the bone remodelling balance is upset and bone remodelling is outpaced by bone stress and fatigue (Knapik et al., 2004; Nordin & Frankel, 2001; Rome et al., 2005). Common stress fracture sites of military personnel include the pelvis, tibia (shaft and condyles), calcaneus and metatarsals (Greaney et al., 1983; Kelly et al., 2000; Milgrom et al., 1985; Pester & Smith, 1992; Pope, Herbert, Kirwan, & Graham, 1999; van Dijk, 2009). "
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    ABSTRACT: This narrative review examines injuries sustained by soldiers undertaking occupational load carriage tasks. Military soldiers are required to carry increasingly heavier occupational loads. These loads have been found to increase the physiological cost to the soldier and alter their gait mechanics. Aggregated research findings suggest that the lower limbs are the most frequent anatomical site of injury associated with load carriage. While foot blisters are common, other prevalent lower limb injuries include stress fractures, knee and foot pain, and neuropathies, like digitalgia and meralgia. Shoulder neuropathies (brachial plexus palsy) and lower back injuries are not uncommon. Soldier occupational load carriage has the potential to cause injuries that impact on force generation and force sustainment. Through understanding the nature of these injuries targeted interventions, like improved physical conditioning and support to specialised organisations, can be employed.
    International Journal of Injury Control and Safety Promotion 09/2013; 21(4). DOI:10.1080/17457300.2013.833944 · 0.67 Impact Factor
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    • "One hypothesis is that patients with MCs treated with exercise are unlikely to improve because vigorous weight-bearing exercise might inhibit microfracture healing. This hypothesis is based on knowledge of treating microfractures in other parts of the body, for example in stress fractures in the lower extremity [19,20]. The extension of this hypothesis is that patients with LBP and MCs constitute a specific subgroup, which should not be treated with physical activity. "
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    ABSTRACT: Clinical experience suggests that many patients with Modic changes have relatively severe and persistent low back pain (LBP), which typically appears to be resistant to treatment. Exercise therapy is the recommended treatment for chronic LBP, however, due to their underlying pathology, Modic changes might be a diagnostic subgroup that does not benefit from exercise. The objective of this study was to compare the current state-of-the art treatment approach (exercise and staying active) with a new approach (load reduction and daily rest) for people with Modic changes using a randomized controlled trial design. Participants were patients from an outpatient clinic with persistent LBP and Modic changes. They were allocated using minimization to either rest therapy for 10 weeks with a recommendation to rest for two hours daily and the option of using a flexible lumbar belt or exercise therapy once a week for 10 weeks. Follow-up was at 10 weeks after recruitment and 52 weeks after intervention and the clinical outcome measures were pain, disability, general health and global assessment, supplemented by weekly information on low back problems and sick leave measured by short text message (SMS) tracking. In total, 100 patients were included in the study. Data on 87 patients at 10 weeks and 96 patients at one-year follow-up were available and were used in the intention-to-treat analysis. No statistically significant differences were found between the two intervention groups on any outcome. No differences were found between the two treatment approaches, 'rest and reduced load' and 'exercise and staying active', in patients with persistent LBP and Modic changes. NCT00454792.
    BMC Medicine 02/2012; 10(1):22. DOI:10.1186/1741-7015-10-22 · 7.25 Impact Factor
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