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 & Nikooyan, 2011). In the current study, our injured group developed different types of injuries. "
[Show abstract][Hide abstract] 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
"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). "
"Barefoot runners may switch from a RFSP to NRFSP due to increased heel sensitivity for vibration stimuli . Zadpoor and Nikooyan  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.  and Chambon et al.  have proposed that FSP is more affected by the heel to toe drop rather than by the thickness of the shoe. "