Risk Factors for Stress Fractures in Athletes

by

INDEX

SYSTEMATIC REVIEW1

Abstract1

Introduction1

Hypothesis and Aims of the Project4

METHODOLOGY5

Inclusion and Exclusion Criteria5

Studies Design and Sample Design5

Ethics consent10

Data Handling & Statistical Methods11

RESULTS14

The Data14

Figures to Support the Text16

DISCUSSION24

Interpretation of Results Obtained24

Clinical Importance and Conclusion28

REFERENCES32

APPENDIX35

SYSTEMATIC REVIEW

Abstract

This paper systematically analyses various articles and research paper, critically appraising the literature highlighting the risk factors for stress fractures in athletes. This study analyses the role of factors that cause stress fractures. A Systematic review is chosen as the research method; this will not only help in summarising the evidence but will also give path for further practice in stress fractures.

Introduction

A stress fracture represents the inability of the skeleton to withstand repetitive mechanical loading, which results in structural fatigue, causing localised pain and tenderness for the individual1. Stress fractures are a common injury amongst the recreationally active and athletic population, particularly in sports such as athletics and ballet. In athletes it comprises of 10% of all injuries sustained34. It also holds a great significance to the military population in various countries across the world.

Stress fracture aetiology is multifactorial. It comprises of both intrinsic factors, unique to the athletes, such as biomechanics, age, bone density, hormonal levels and physical fitness. But also extrinsic factors such as, ground surface, footwear and training type, all of which can vary greatly. It is our understanding of this complex causational model that holds the key future methods of prevention. Research that targets these factors allows the further development of management and prevention strategies that can be employed and can enhance the scientific community's data base on bone homeostasis with respect to remodelling and adaption. This has a wider implication than athletic population as it offers insights into various fields, where fracture fatigue is of importance, for example osteoporosis and post-athroplasty

Central to the aietology of stress fractures in bone re-modelling, a key adaptive feature of bone which occurs in response to repetitive and cyclical loading, to ensure mechanical and structural Integrity (Wolff's Law+) This process is mediated through the balance of reabsorption and deposition by osteoclasts and osteoblasts respectively, with the added complication of material fatigue23. Exercise remodelling as a rule is thought to strength bone, however during exercise an athlete's bone is subjected to numerous high intensity forces of load and torsion over significantly extended periods of time. Bone strength is thought to be measurable from the cycles of repetitive load that can be withstood before fatigue, often referred to as fatigue life. In vitro bone studies have shown that after physiological and hyper-physiological cyclical loading a number of changes within the bone occur such as loss of bone stiffness, a marked increase in non-linearity and hysteresis of the stress-strain curve which leads to the reduction ultimately in overall strength 37/38/39/40.

Structurally this repetitive loading leads to excessive build up micro-damage within the bone which without protective remodelling can cause macro cracks that may eventually lead to a stress fracture for the athlete44. There are many factors that influence the progression of these micro-damages and consequently ...