Four biomechanical and anthropometric measures predict tibial stress fracture: a prospective study of 1065 Royal Marines

Nunns, Michael; House, Carol; Rice, Hannah; Mostazir, Mohammod; Davey, T. F.; Stiles, Victoria; Fallowfield, Joanne L.; Allsopp, Adrian; Dixon, Sharon

doi:10.1136/bjsports-2015-095394

Cited by 32 publications

(40 citation statements)

References 45 publications

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“…It is important to consider that the variables identified in the present study as contributors to increased risk of ankle inversion injury, may contribute to either increased or decreased risk of injury of other lower limb structures. Indeed, a smaller bimalleolar width and lower BMI were additionally associated with increased risk of tibial stress fractures in this population (Nunns et al, 2016). It was not possible to assess all lower limb injuries of interest in this study, due to insufficient cases for adequate statistical power.…”

Section: Discussionmentioning

confidence: 89%

“…Bimalleolar width was included in this study to provide an indicator of the length of the invertor moment arm. Bimalleolar width was an important variable in the larger study, as it was hypothesised to be lower in recruits who sustained a tibial stress fracture during training (Nunns et al, 2016). Calf girth and skinfold were measured at maximum circumference while the recruit stood with one foot placed on the seat of a chair, with the knee flexed.…”

Section: Data Collectionmentioning

confidence: 99%

“…This study was part of a large, prospective study of Royal Marine recruits, designed to identify anthropometric and gait characteristics associated with lower limb injuries (Nunns et al, 2016). The present study aimed specifically to identify baseline characteristics of Royal Marine recruits who sustained an ankle inversion injury during training.…”

Section: Introductionmentioning

confidence: 99%

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A narrow bimalleolar width is a risk factor for ankle inversion injury in male military recruits: A prospective study

Rice

Nunns

House

et al. 2017

Clinical Biomechanics

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Background: Ankle inversion injuries are one of the most common and burdensome injuries in athletic populations. Research that prospectively identifies characteristics associated with this injury is lacking. This prospective study compared baseline anthropometric and biomechanical gait characteristics of military recruits who sustained an ankle inversion injury during training, with those who remained injury-free. Methods: Bilateral plantar pressure and three-dimensional lower limb kinematics were recorded in 1065 male, injury-free military recruits, during barefoot running. Injuries that occurred during the 32-week recruit training programme were subsequently recorded. Data were compared between recruits who sustained an ankle inversion injury during training (n=27) and a sample (n=120) of those who completed training injury-free. A logistic regression analysis was used to identify risk factors for this injury. Findings: A narrower bimalleolar width and an earlier peak pressure under the fifth metatarsal were predictors of ankle inversion injury. Those who sustained an ankle inversion injury also had a lower body mass, body mass index, and a smaller calf girth than those who completed training injury-free. Interpretation: Anthropometric and dynamic gait characteristics have been identified that may predispose recruits to an ankle inversion injury during Royal Marine recruit training, allowing identification of recruits at higher risk at the start of training.

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Section: Discussionmentioning

confidence: 89%

Section: Data Collectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A narrow bimalleolar width is a risk factor for ankle inversion injury in male military recruits: A prospective study

Rice

Nunns

House

et al. 2017

Clinical Biomechanics

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“…However, there are only a few data assessing risk factors during longer training programs such as RM training. 9 , 10 , 36 Previous systematic reviews 18 , 37 , 57 have identified the following SF risk factors: older age, female sex, lifestyle habits (smoking and alcohol ingestion), low bone mineral density (BMD), previous lower limb injury, and poor nutrition. Because these variables are of limited predictive value when considered in isolation, the combination of them is needed for better predictive accuracy.…”

mentioning

confidence: 99%

Development of a Prediction Model for Stress Fracture During an Intensive Physical Training Program: The Royal Marines Commandos

Sanchez‐Santos

Davey²,

Leyland

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Stress fractures (SFs) are one of the more severe overuse injuries in military training, and therefore, knowledge of potential risk factors is needed to assist in developing mitigating strategies.Purpose:To develop a prediction model for risk of SF in Royal Marines (RM) recruits during an arduous military training program.Study Design:Case-control study; Level of evidence, 3.Methods:RM recruits (N = 1082; age range, 16-33 years) who enrolled between September 2009 and July 2010 were prospectively followed through the 32-week RM training program. SF diagnosis was confirmed from a positive radiograph or magnetic resonance imaging scan. Potential risk factors assessed at week 1 included recruit characteristics, anthropometric assessment, dietary supplement use, lifestyle habits, fitness assessment, blood samples, 25(OH)D, bone strength as measured by heel broadband ultrasound attention, history of physical activity, and previous and current food intake. A logistic least absolute shrinkage and selection operator (LASSO) regression with 10-fold cross-validation was used to select potential predictors among 47 candidate variables. Model performance was assessed using measures of discrimination (c-index) and calibration. Bootstrapping was used for internal validation of the developed model and to quantify optimism.Results:A total of 86 (8%) volunteer recruits presented at least 1 SF during training. Twelve variables were identified as the most important risk factors of SF. Variables strongly associated with SF were age, body weight, pretraining weightbearing exercise, pretraining cycling, and childhood intake of milk and milk products. The c-index for the prediction model, which represents the model performance in future volunteers, was 0.73 (optimism-corrected c-index, 0.68). Although 25(OH)D and VO2max had only a borderline statistically significant association with SF, the inclusion of these factors improved the performance of the model.Conclusion:These findings will assist in identifying recruits at greater risk of SF during training and will support interventions to mitigate this injury risk. However, external validation of the model is still required.

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“…No obstante, los autores indican que el mecanismo por el cual estos factores de riesgo influyen en el desarrollo de MTSS sigue sin estar claro. Nunns et al (2016) asocian el riesgo de fractura por estrés tibial a una capacidad reducida para amortiguar los impactos durante la carrera. En su estudio prospectivo de 1065 marines, identifican cuatro variables relacionadas con el riesgo de lesión por estrés:…”

Section: Mtssunclassified

Estudio del estado de fatiga en corredores de fondo a partir de patrones biomecánicos. Monitorización mediante sistemas integrados en el calzado

Ripoll¹,

Enríque²

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A mi director de tesis, Dr. Álvaro Page del Pozo, por animarme a realizar esta tesis, por su tutela y ayuda constante durante estos cuatro años. A todos los corredores que han participado en los ensayos y a los compañeros que me ayudaron con la experimentación y la toma de medidas: Bruno, Nicolás y Cristian. Al 7º Programa Marco de la Unión Europea por la financiación del proyecto europeo Runsafer (FP7-SME-2011-1) que ha soportado junto con el IBV la fase experimental de esta tesis. Al IBV, por todos estos años de trabajo, formación y por impulsar la realización de esta tesis.

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Four biomechanical and anthropometric measures predict tibial stress fracture: a prospective study of 1065 Royal Marines

Abstract: Reduced impact attenuation and ability to withstand load were implicated in tibial stress fracture risk.

Cited by 32 publications

References 45 publications

A narrow bimalleolar width is a risk factor for ankle inversion injury in male military recruits: A prospective study

A narrow bimalleolar width is a risk factor for ankle inversion injury in male military recruits: A prospective study

Development of a Prediction Model for Stress Fracture During an Intensive Physical Training Program: The Royal Marines Commandos

Estudio del estado de fatiga en corredores de fondo a partir de patrones biomecánicos. Monitorización mediante sistemas integrados en el calzado

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