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  • Lower step rate is associated with a higher risk of bone stress injury: a prospective study of collegiate cross country runners

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Original research
Lower step rate is associated with a higher risk of bone stress injury: a prospective study of collegiate cross country runners
  1. Stephanie A Kliethermes1,2,
  2. Mikel R Stiffler-Joachim1,2,
  3. Christa M Wille1,2,3,
  4. Jennifer L Sanfilippo2,
  5. Pedro Zavala2,
  6. Bryan C Heiderscheit1,2,3
  1. 1 Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
  2. 2 Badger Athletic Performance, University of Wisconsin Madison, Madison, Wisconsin, USA
  3. 3 Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
  1. Correspondence to Dr Stephanie A Kliethermes, Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI 53705, USA; kliethermes{at}ortho.wisc.edu

Abstract

Objectives To determine if running biomechanics and bone mineral density (BMD) were independently associated with bone stress injury (BSI) in a cohort of National Collegiate Athletic Association Division I cross country runners.

Methods This was a prospective, observational study of 54 healthy collegiate cross country runners over three consecutive seasons. Whole body kinematics, ground reaction forces (GRFs) and BMD measures were collected during the preseason over 3 years via motion capture on an instrumented treadmill and total body densitometer scans. All medically diagnosed BSIs up to 12 months following preseason data collection were recorded. Generalised estimating equations were used to identify independent risk factors of BSI.

Results Univariably, step rate, centre of mass vertical excursion, peak vertical GRF and vertical GRF impulse were associated with BSI incidence. After adjusting for history of BSI and sex in a multivariable model, a higher step rate was independently associated with a decreased risk of BSI. BSI risk decreased by 5% (relative risk (RR): 0.95; 95% CI 0.91 to 0.98) with each one step/min increase in step rate. BMD z-score was not a statistically significant risk predictor in the final multivariable model (RR: 0.93, 95% CI 0.85 to 1.03). No other biomechanical variables were found to be associated with BSI risk.

Conclusion Low step rate is an important risk factor for BSI among collegiate cross country runners and should be considered when developing comprehensive programmes to mitigate BSI risk in distance runners.

  • bone mineral density
  • biomechanics
  • running
  • injuries

Data availability statement

Data are available upon reasonable request. Requests for data sharing from appropriate researchers and entities will be considered on a case-by-case basis. Interested parties should contact Dr Heiderscheit (heiderscheit@ortho.wisc.edu).

https://doi.org/10.1136/bjsports-2020-103833

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    Data availability statement

    Data are available upon reasonable request. Requests for data sharing from appropriate researchers and entities will be considered on a case-by-case basis. Interested parties should contact Dr Heiderscheit (heiderscheit@ortho.wisc.edu).

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    Footnotes

    • Twitter @stephklie2, @MikelJoachim, @ChristaWille

    • Contributors BH, MRS-J, CMW and SAK designed the study, interpreted the results and drafted the initial manuscript. MRS-J, JLS and PZ collected the data and prepared it for analysis. SAK performed the statistical analyses. All authors provided critical reviews for the manuscript and all authors reviewed and approved the final draft of this manuscript prior to submission.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests SAK is currently an associate editor for BJSM.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.