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 Having had a stress fracture in the past raised the risk of having
them again by five-fold and being female more than doubled it,
researchers reported in the British Journal of Sports Medicine.
But only a few studies met the criteria for review, the authors
note, so more research is needed to evaluate other factors that
might play a role.
Most surprising, the authors write, was the lack of evidence for
things related to running itself, such as the surface or the
intensity of the workout.
"Importantly, even though there is currently no evidence that these
'other factors' are not risk factors . . . that may be simply
because they have not been adequately studied," said senior study
author Dr. James Smoliga of High Point University in North Carolina.
"It is plausible that running high mileage or running on concrete
could increase risk of stress fractures, but the data to demonstrate
that are insufficient at this time, especially because prospective
studies are difficult to perform," he told Reuters Health in an
email.
Dr. Steven Haddad, an orthopedic surgeon in private practice in
Glenview, Illinois, believes that training surfaces do matter,
especially changes in the training surface.
"Stress fractures rarely occur in individuals training consistently
on the same surface," he told Reuters Health by email. "It is a
change in surfaces, or a sudden change in distance, that can create
stress fractures."
Stress fractures are common, especially among athletes. They are
caused by repetitive “microtrauma” to an area, and usually develop
over a period of days, weeks or months.
One very common site for stress fractures is the metatarsals, a
group of five long bones that connect the ankle to the toes. Stress
fractures are common in the second and third metatarsal, said
Haddad, a past president of the American Orthopaedic Foot and Ankle
Society who was not involved in the current study.
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Those bones are thinner and often longer than the first metatarsal,
and the most “stress” is placed on them when walking or running, he
said.
For their analysis, Smoliga and colleagues were able to find just
eight studies that were specifically about runners and used
scientific methods to examine the relationship between various
factors and stress fracture risk. Those factors included training
regimen, dietary habits, use of oral contraceptives, bone density,
sex and previous history of stress fracture.
One study found that running more than 20 miles a week was a risk
factor, although this was a relatively low amount, and one that's
usually exceeded by most runners.
Overall, there was little evidence for most of the things that are
considered to be risk factors for stress fractures.
“I think the best way runners can avoid stress fractures, and many
overuse injuries, is by listening to one’s body and not pushing
through training when one is not feeling well,” Smoglia said.
“Overuse injuries do not appear out of nowhere – there are generally
signs indicating some level of overuse, which occur well before it
becomes a full blown injury that forces training to be severely
reduced or discontinued for a long period of time,” he added. “Thus,
many of these overuse injuries are avoidable if they are caught
early enough.”
SOURCE: http://bit.ly/1L9c3BW British Journal of Sports Medicine,
online July 17, 2015.
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