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Are overground or treadmill runners more likely to sustain tibial stress fracture?
  1. C Milgrom1,
  2. A Finestone2,
  3. S Segev2,
  4. C Olin3,
  5. T Arndt3,
  6. I Ekenman3
  1. 1Department of Orthopaedics, Hadassah University Hospital, Ein Kerem, Jerusalem, Israel
  2. 2Department of Orthopaedics, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel
  3. 3Department of Orthopaedics, Huddinge University Hospital, Huddinge, Sweden
  1. Correspondence to:
 Dr Milgrom, Department of Orthopaedics, Hadassah University Hospital, Ein Kerem, PO Box 12000, Jerusalem, Israel; 


Background: Repetitive high bone strain and/or strain rates, such as those that occur during running, contribute to stress fractures as well as promoting maintenance of or increase in bone mass. Kinematic differences are known to exist between overground and treadmill running and these may be reflected in different bone strains and strain rates during the two running techniques.

Aim: To measure in vivo strains and strain rates in human tibia during treadmill and overground running and determine if there are significant differences in strain and strain rate levels between the two running techniques.

Methods: A strain gauged bone staple was mounted percutaneously along the axial direction in the mid diaphysis of the medial tibia in three subjects, and in vivo tibial strains were measured during treadmill and overground running at 11 km/h.

Results: Axial compression strains (p<0.0001), tension strains (p<0.001), compression strain rates (p<0.0001), and tension strain rates (p<0.0001) were 48–285% higher during overground running than during treadmill running.

Conclusions: On the basis of lower in vivo strains and strain rates, treadmill runners are at lower risk of developing tibial stress fractures, but less likely to achieve tibial bone strengthening, than overground runners.

  • running
  • bone
  • strain
  • stress fracture
  • bone mass

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