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Reinking MF, Austin TM, Bennett J, et al. Lower extremity overuse bone injury risk factors in collegiate athletes: a pilot study. Int J Sports Phys Ther. 2015;10(2):155-67
Reinking, M. F., Austin, T. M., Bennett, J., Hayes, A. M., & Mitchell, W. A. (2015). Lower extremity overuse bone injury risk factors in collegiate athletes: a pilot study. International journal of sports physical therapy, 10(2), 155-67.
Reinking, Mark F, et al. "Lower extremity overuse bone injury risk factors in collegiate athletes: a pilot study." International journal of sports physical therapy vol. 10,2 (2015): 155-67.
Reinking MF, Austin TM, Bennett J, Hayes AM, Mitchell WA. Lower extremity overuse bone injury risk factors in collegiate athletes: a pilot study. Int J Sports Phys Ther. 2015 Apr;10(2):155-67. PMID: 25883864; PMCID: PMC4387723.
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Int J Sports Phys Ther. 2015 Apr;10(2):155-67.

Lower extremity overuse bone injury risk factors in collegiate athletes: a pilot study.

International journal of sports physical therapy

Mark F Reinking, Tricia M Austin, Jason Bennett, Ann M Hayes, William A Mitchell

Affiliations

  1. Department of Physical Therapy & Athletic Training, Saint Louis University, Saint Louis, MO, USA.
  2. Department of Family & Community Medicine, Saint Louis University, Saint Louis, MO, USA.

PMID: 25883864 PMCID: PMC4387723

Abstract

BACKGROUND AND PURPOSE: There is limited evidence regarding risk factors for lower extremity overuse bone injury (LEOBI) in collegiate athletes. The purposes of the study were to: 1) determine incidence of LEOBI in selected sports and its impact on athletic participation and ADL, 2) assess risk relationships between LEOBI and selected risk factors, and 3) establish the viability of using calcaneal densitometry as a screening tool to identify risk for LEOBI.

STUDY DESIGN: Prospective analytical cohort design.

METHODS: Collegiate athletes in selected sports (swimming/diving, women's soccer, field hockey, cross-country/track) at one university were invited to participate. Consenting athletes completed an initial questionnaire including demographic information, history, and menstrual function. Measurements included height/weight, hip abductor strength, foot posture index, and calcaneal bone mineral density. Athletes were monitored for potential LEOBI for nine months and an algorithm was used to determine if physician referral was required. The primary outcome of interest was the occurrence of physician-diagnosed LEOBI. If LEOBI was diagnosed by the physician, the athlete completed a follow-up visit including a repeat bone mineral density scan. All athletes were invited for a repeat scan at the end of the year and completed a final questionnaire. Athlete demographics were summarized using descriptive statistics and differences in continuous risk factors were analyzed using t-tests and ANOVA. Finally, risk relationships for categorical variables were analyzed using chi-square and relative risk.

RESULTS: 84 athletes (64 female, 20 male) consented to participate. Over the study period, eight athletes (one male, seven females) were diagnosed with LEOBI (LEOBI group), five with stress fractures and three with medial tibial stress syndrome. The other 76 athletes who did not have a diagnosis of LEOBI were placed in the non-LEOBI group. Five of the eight were cross-country/track athletes; no swimming/diving athletes had bone injury. Sport (cross-country/track) had a significant relative risk value of 2.26 (95% CI = 1.18-4.32) for LEOBI. There was no association between LEOBI occurrence and sex, hip abductor strength, body mass index, foot type, and menstrual function. There was no difference in bone mineral density at initial or follow-up measures between LEOBI and non-LEOBI groups (p>.05) when analyzing all athletes. When analyzing ground-based athletes only at follow-up (n=44), athletes with LEOBI had lower bone mineral density of right (p = .05) and left (p =.07) calcaneus. The relative risk for developing LEOBI based on calcaneal bone mineral density below the mean of the study participants was 2.1 (95%CI = 1.09-3.35) on the left and 1.53 (95% CI=.80- 3.06) on the right.

CONCLUSION: The incidence of LEOBI in this population of athletes was approximately 10%. Risk factors were sport (cross-country/track) and decreased left calcaneal bone mineral density. This study supports the use of calcaneal bone mineral density as a screening measurement for LEOBI risk and suggests the need for further investigation into additional LEOBI risk factors.

LEVEL OF EVIDENCE: 2.

Keywords: Bone density; medial tibial stress syndrome; overuse injury; risk; stress fracture

References

  1. Sports Med. 1999 Aug;28(2):91-122 - PubMed
  2. Med Sci Sports Exerc. 2000 Mar;32(3 Suppl):S27-33 - PubMed
  3. Clin J Sport Med. 2000 Apr;10(2):110-6 - PubMed
  4. J Sci Med Sport. 2000 Sep;3(3):268-79 - PubMed
  5. J Bone Miner Res. 2001 Feb;16(2):406-16 - PubMed
  6. Am J Sports Med. 2001 May-Jun;29(3):304-10 - PubMed
  7. Br J Radiol. 2001 Jul;74(883):602-6 - PubMed
  8. J Orthop Sports Phys Ther. 2001 Sep;31(9):504-10 - PubMed
  9. Am J Sports Med. 2001 Nov-Dec;29(6):712-5 - PubMed
  10. Med Sci Sports Exerc. 2002 Jan;34(1):32-40 - PubMed
  11. Arch Intern Med. 2002 Jan 14;162(1):33-6 - PubMed
  12. Osteoporos Int. 2002;13(4):337-41 - PubMed
  13. J Sports Med Phys Fitness. 2002 Jun;42(2):198-206 - PubMed
  14. Am J Sports Med. 2003 Jul-Aug;31(4):596-600 - PubMed
  15. Clin Sports Med. 1992 Oct;11(4):851-70 - PubMed
  16. Eur J Clin Invest. 2004 Feb;34(2):137-42 - PubMed
  17. Sports Med. 1992 Aug;14(2):82-99 - PubMed
  18. Clin J Sport Med. 2005 Jan;15(1):14-21 - PubMed
  19. J Bone Miner Res. 2005 Apr;20(4):571-8 - PubMed
  20. Pediatrics. 2005 Apr;115(4):e399-406 - PubMed
  21. J Am Podiatr Med Assoc. 2005 May-Jun;95(3):235-41 - PubMed
  22. Clin Biomech (Bristol, Avon). 2006 Jan;21(1):89-98 - PubMed
  23. Gait Posture. 2006 Jan;23(1):91-8 - PubMed
  24. Clin J Sport Med. 2006 Jan;16(1):10-4 - PubMed
  25. Am J Sports Med. 2006 Sep;34(9):1500-7 - PubMed
  26. AJR Am J Roentgenol. 2006 Sep;187(3):789-93 - PubMed
  27. J Sci Med Sport. 2007 Oct;10(5):311-9 - PubMed
  28. Eur Radiol. 2007 Jun;17(6):1591-602 - PubMed
  29. Med Sci Sports Exerc. 2007 Feb;39(2):330-9 - PubMed
  30. J Orthop Sports Phys Ther. 2007 Feb;37(2):40-7 - PubMed
  31. J Orthop Sports Phys Ther. 2007 Nov;37(11):670-8 - PubMed
  32. Am J Sports Med. 2008 Jun;36(6):1179-89 - PubMed
  33. Int J Sports Med. 2008 Nov;29(11):922-6 - PubMed
  34. J Orthop Sports Phys Ther. 1980;2(2):55-9 - PubMed
  35. J Am Podiatr Med Assoc. 2008 Nov-Dec;98(6):436-44 - PubMed
  36. Sports Med. 2009;39(7):523-46 - PubMed
  37. Ann Intern Med. 1990 Nov 15;113(10):754-9 - PubMed
  38. J Athl Train. 2010 Jan-Feb;45(1):51-7 - PubMed
  39. N Am J Sports Phys Ther. 2007 Aug;2(3):170-80 - PubMed
  40. Br J Sports Med. 2014 Nov;48(21):1564-9 - PubMed
  41. Br J Sports Med. 2014 Mar;48(6):440-7 - PubMed
  42. Int J Sports Phys Ther. 2013 Jun;8(3):269-76 - PubMed
  43. Int J Sports Phys Ther. 2013 Aug;8(4):407-15 - PubMed
  44. Open Access J Sports Med. 2013 Nov 13;4:229-41 - PubMed
  45. Phys Sportsmed. 1994 Mar;22(3):68-78 - PubMed
  46. Foot Ankle. 1989 Aug;10(1):25-9 - PubMed
  47. Am J Sports Med. 1983 May-Jun;11(3):125-30 - PubMed
  48. Clin J Sport Med. 1995 Oct;5(4):229-35 - PubMed
  49. J Am Podiatry Assoc. 1979 Mar;69(3):211-7 - PubMed
  50. Med Sci Sports Exerc. 1995 Jun;27(6):800-4 - PubMed
  51. Am J Sports Med. 1994 Mar-Apr;22(2):248-56 - PubMed
  52. Am J Sports Med. 1996 Mar-Apr;24(2):211-7 - PubMed
  53. Am J Sports Med. 1996 Nov-Dec;24(6):810-8 - PubMed
  54. Calcif Tissue Int. 1998 Jul;63(1):80-5 - PubMed
  55. Sports Med. 1998 Oct;26(4):253-63 - PubMed

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