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


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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Available from: Ali A Nikooyan
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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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    ABSTRACT: Biomechanical comparative studies on running-related injuries have included either currently or retrospectively injured runners. The purpose of this study was to prospectively compare ankle joint and ground reaction force variables between collegiate runners who developed injuries during the cross country season and those who did not. Running gait analyses using a motion capture system and force platform were conducted on 19 collegiate runners prior to the start of their cross country season. Ten runners sustained running-related injuries and 9 remained healthy during the course of the season. Strike index, peak loading rate of the vertical ground reaction force, dorsiflexion range of motion (ROM), eversion ROM, peak eversion angle, peak eversion velocity, and eversion duration from the start of the season were compared between injury groups. Ankle eversion ROM and peak eversion velocity were greater in uninjured runners while peak eversion angle was greater in injured runners. Greater ankle eversion ROM and eversion velocity with lower peak eversion angle may be beneficial in reducing injury risk in collegiate runners. The current data may only be applicable to collegiate cross country runners with similar training and racing schedules and threshold magnitudes of ankle kinematic variables to predict injury risk are still unknown.
    Full-text · Article · Jan 2016 · Human movement science
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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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    ABSTRACT: Combinations of smaller bone geometry and greater applied loads may contribute to tibial stress fracture. We examined tibial bone stress, accounting for geometry and applied loads, in runners with stress fracture. 23 runners with a history of tibial stress fracture & 23 matched controls ran over a force platform while 3-D kinematic and kinetic data were collected. An elliptical model of the distal 1/3 tibia cross section was used to estimate stress at 4 locations (anterior, posterior, medial and lateral). Inner and outer radii for the model were obtained from 2 planar x-ray images. Bone stress differences were assessed using two-factor ANOVA (α=0.05). Key contributors to observed stress differences between groups were examined using stepwise regression. Runners with tibial stress fracture experienced greater anterior tension and posterior compression at the distal tibia. Location, but not group, differences in shear stress were observed. Stepwise regression revealed that anterior-posterior outer diameter of the tibia and the sagittal plane bending moment explained >80% of the variance in anterior and posterior bone stress. Runners with tibial stress fracture displayed greater stress anteriorly and posteriorly at the distal tibia. Elevated tibial stress was associated with smaller bone geometry and greater bending moments about the medial-lateral axis of the tibia. Future research needs to identify key running mechanics associated with the sagittal plane bending moment at the distal tibia as well as to identify ways to improve bone geometry in runners in order to better guide preventative and rehabilitative efforts. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Full-text · Article · Aug 2015 · Clinical biomechanics (Bristol, Avon)
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    • "Barefoot runners may switch from a RFSP to NRFSP due to increased heel sensitivity for vibration stimuli [46]. Zadpoor and Nikooyan [15] postulated that the central nervous system uses muscle input and changes in kinematics to keep ground reaction forces (GRFs) and level of vibrations of the human body within a narrow range regardless of shoe hardness during running. Contrary to this theory, Hamill et al. [13] and Chambon et al. [19] have proposed that FSP is more affected by the heel to toe drop rather than by the thickness of the shoe. "
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    ABSTRACT: Claims of injury reduction related to barefoot running has resulted in interest from the running public; however, its risks are not well understood for those who typically wear cushioned footwear. Examine how plantar loading changes during barefoot running in a group of runners that ordinarily wear cushioned footwear and demonstrate a rearfoot strike pattern (RFSP) without cueing or feedback alter their foot strike pattern and plantar loading when asked to run barefoot at different speeds down a runway. Forty-one subjects ran barefoot at three different speeds across a pedography platform which collected plantar loading variables for 10 regions of the foot; data were analyzed using two-way mixed multivariate analysis of variance (MANOVA). A significant foot strike position (FSP)×speed interaction in each of the foot regions indicated that plantar loading differed based on FSP across the different speeds. The RFSP provided the highest total forces across the foot while the pressures displayed in subjects with a non-rearfoot strike pattern (NRFSP) was more similar between each of the metatarsals. The majority of subjects ran barefoot with a NRFSP and demonstrated lower total forces and more uniform force distribution across the metatarsal regions. This may have an influence in injuries sustained in barefoot running. Copyright © 2015 Elsevier Ltd. All rights reserved.
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