Article

The relationship between lower-extremity stress fractures and the ground reaction force: A systematic review

Department of Biomechanical Engineering, Delf University of Technology, The Netherlands.
Clinical biomechanics (Bristol, Avon) (Impact Factor: 1.97). 01/2011; 26(1):23-8. DOI: 10.1016/j.clinbiomech.2010.08.005
Source: PubMed

ABSTRACT

lower-limb stress fracture is one of the most common types of running injuries. There have been several studies focusing on the association between stress fractures and biomechanical factors. In the current study, the ground reaction force and loading rate are examined. There is disagreement in the literature about whether the history of stress fractures is associated with ground reaction forces (either higher or lower than control), or with loading rates.
a systematic review of the literature was conducted on the relationship between the history of tibial and/or metatarsal stress fracture and the magnitude of the ground reaction force and loading rate. Fixed-effect meta-analysis techniques were applied to determine whether or not the ground reaction force and/or loading rate are different between the stress fracture and control groups.
thirteen articles were identified through a systematic search of the literature. About 54% of these articles reported significantly different vertical ground reaction force and/or loading rate between the stress fracture and control groups. Other studies (~46%) did not observe any significant difference between the two groups. Meta-analysis results showed no significant differences between the ground reaction force of the lower-limb stress fracture and control groups (P>0.05). However, significant differences were observed for the average and instantaneous vertical loading rates (P<0.05).
the currently available data does not support the hypothesis that there is a significant difference between the ground reaction force of subjects experiencing lower-limb stress fracture and control groups. Instead, the vertical loading rate was found to be significantly different between the two groups.

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    • "Finally, contrary to our hypothesis, LR was not different between the injured and uninjured groups. Higher LR has been linked to specific retrospective RRIs such as tibial stress fractures (Hreljac et al., 2000;Milner et al., 2006;Zadpoor &amp; Nikooyan, 2011). In the current study, our injured group developed different types of injuries. "
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    • "A recent systematic review of the tibial stress fracture literature examined the relationship between the vertical ground reaction and stress fracture. This meta-analysis suggested that the vertical ground reaction forces during running were not greater in runners with stress fracture; however, average and instantaneous vertical loading rates associated with the impact peak during the stance phase did tend to be greater in those individuals with a history of stress fracture (Zadpoor and Nikooyan, 2011). Other measures of external load, including the peak free moment (Pohl et al., 2008) and the direction of the mediolateral ground reaction force relative to vertical have also been linked to tibial stress fracture (Creaby and Dixon, 2008). "
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