Higher Incidence of Bone Stress Injuries With Increasing Female Athlete Triad–Related Risk Factors

Barrack, Michelle T.; Gibbs, Jenna C.; Souza, Mary Jane De; Williams, Nancy I.; Nichols, Jeanne F.; Rauh, Mitchell J.; Nattiv, Aurelia

doi:10.1177/0363546513520295

Cited by 272 publications

(222 citation statements)

References 53 publications

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“…22 Among distance runners, concern about energy deficits is heightened because of the prevalence of eating disorders and the female athlete triad, both of which may contribute to bone loss and bone injury. 11,[23][24][25][26] We did not formally evaluate the female athlete triad, although the number of reported fractures and stress fractures is small. Nevertheless, primary prevention of disordered eating is an important strategy for risk reduction related to compromised bone density and other physiologic health consequences of inadequate energy intake.…”

Section: Overuse and Ntl Injuriesmentioning

confidence: 99%

Epidemiology of National Collegiate Athletic Association Men's and Women's Cross-Country Injuries, 2009–2010 Through 2013–2014

Kerr

Kroshus

Grant

et al. 2016

Journal of Athletic Training

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Context: Recent injury-surveillance data for collegiate-level cross-country athletes are limited.Objective: To describe the epidemiology of National Collegiate Athletic Association (NCAA) men's and women's crosscountry injuries during the 2009-2010 through 2013-2014 academic years.Design: Descriptive epidemiology study. Setting: Aggregate injury and exposure data collected from 25 men's and 22 women's cross-country programs, providing 47 and 43 seasons of data, respectively.Patients or Other Participants: Collegiate student-athletes participating in men's and women's cross-country during the 2009-2010 through 2013-2014 academic years.Main Outcome Measure(s): Injury rates; injury rate ratios (RRs); injury proportions by body site, diagnosis, and apparatus; and injury proportion ratios were reported with 95% confidence intervals (CIs).Results: The Injury Surveillance Program captured 216 injuries from men's cross-country and 260 injuries from women's cross-country, leading to injury rates of 4.66/1000 athleteexposures (AEs) for men (95% CI ¼ 4.04, 5.28) and 5.85/1000 AEs for women (95% CI ¼ 5.14, 6.56). The injury rate in women's cross-country was 1.25 times that of men's cross-country (95% CI ¼ 1.05, 1.50). Most injuries affected the lower extremity (men ¼ 90.3%, women ¼ 81.9%). The hip/groin-injury rate in women (0.65/1000 AEs) was higher than that in men (0.15/1000 AEs; RR ¼ 4.32; 95% CI ¼ 1.89, 9.85). The ankle-injury rate in men (0.60/ 1000 AEs) was higher than that in women (0.29/1000 AEs; RR ¼ 2.07; 95% CI ¼ 1.07, 3.99). Common diagnoses were strains (men ¼ 19.9%, women ¼ 20.4%) and inflammation (men ¼ 18.1%, women ¼ 23.8%). The majority of injuries were classified as overuse (men ¼ 57.6%, women ¼ 53.3%).Conclusions: Consistent with prior research, injury distributions varied between male and female athletes, and the injury rate among females was higher. Understanding the epidemiology of these cross-country injuries may be important for developing appropriate preventive interventions.Key Words: injury prevention, collegiate sports, distance running Key PointsOur findings indicate a lower injury burden in men's and women's cross-country than previously reported. The injury rate in women's cross-country was 1.25 times that of men's cross-country. Most injuries affected the lower extremity and were diagnosed as strains and inflammation.

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Section: Overuse and Ntl Injuriesmentioning

confidence: 99%

Epidemiology of National Collegiate Athletic Association Men's and Women's Cross-Country Injuries, 2009–2010 Through 2013–2014

Kerr

Kroshus

Grant

et al. 2016

Journal of Athletic Training

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“…It is especially important to evaluate for the female triad: irregular menses, eating disorders, and decreased bone mineral density. Recent research revealed that the presence of female triad-related risk factors increases female patient risk of bony stress injury, especially low bone mineral density and participation of greater than 12 h of exercise per week [22]. Furthermore, there appears to be an additive effect, with more risk factors associated with greater risk of stress reaction.…”

Section: Risk Factorsmentioning

confidence: 99%

Tarsal navicular stress fractures

Shakked

Walters

O’Malley

2017

Curr Rev Musculoskelet Med

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Purpose of review Navicular stress fractures are common in athletes and management is debated. This article will review the evaluation and management of navicular stress fractures. Recent findings Various operative and non-operative adjunctive treatment modalities are reviewed including the relevance of vitamin D levels, use of shock wave therapy and bone marrow aspirate concentrate (BMAC), and administration of teriparatide. Surgical treatment may be associated with earlier return to sports. Summary The author's preferred treatment algorithm with corresponding images is presented which allows for safe and rapid return to activities in the athletic patient. Future research is needed in evaluating the preventative effects of vitamin D and use of other adjunctive treatments to increase the healing rates of this fracture.

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“…In competitive track and field athletes, 21% of all athletes sustained a stress fracture in a 1-year period, with no difference between male and female athletes (56). However, young female athletes with risk factors called the "female athlete triad" (eating disorders, amenorrhea, and decreased bone density) have a cumulative higher risk for stress fractures with each of these risk factors-up to 20% for a single factor and 30%-50% for combined risk factors (57). Around the hip joint, common sites for stress fractures in athletes are the acetabulum and the femur.…”

Section: State Of the Art: Hip Imaging In Athletes Agten Et Almentioning

confidence: 99%

Hip Imaging in Athletes: Sports Imaging Series

et al. 2016

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Hip or groin pain in athletes is common and clinical presentation is often nonspecific. Imaging is a very important diagnostic step in the work-up of athletes with hip pain. This review article provides an overview on hip biomechanics and discusses strategies for hip imaging modalities such as radiography, ultrasonography, computed tomography, and magnetic resonance (MR) imaging (MR arthrography and traction MR arthrography). The authors explain current concepts of femoroacetabular impingement and the problem of high prevalence of cam-and pincer-type morphology in asymptomatic persons. With the main focus on MR imaging, the authors present abnormalities of the hip joint and the surrounding soft tissues that can occur in athletes: intraarticular and extraarticular hip impingement syndromes, labral and cartilage disease, microinstability of the hip, myotendinous injuries, and athletic pubalgia. Hip or groin pain in athletes is common and clinical presentation is often nonspecific. Imaging is a very important diagnostic step in the work-up of athletes with hip pain. This review article provides an overview on hip biomechanics and discusses strategies for hip imaging modalities such as radiography, ultrasonography, computed tomography, and magnetic resonance (MR) imaging (MR arthrography and traction MR arthrography). The authors explain current concepts of femoroacetabular impingement and the problem of high prevalence of cam-and pincer-type morphology in asymptomatic persons. With the main focus on MR imaging, the authors present abnormalities of the hip joint and the surrounding soft tissues that can occur in athletes: intraarticular and extraarticular hip impingement syndromes, labral and cartilage disease, microinstability of the hip, myotendinous injuries, and athletic pubalgia. After reading the article and taking the test, the reader will be able to:n Describe biomechanical implications of torsional malalignment and other atypical forms of hip impingement n Describe the most common MR imaging findings in femoroacetabular impingement and identify anatomic variants n Describe imaging characteristics of a Morel-Lavallée lesion and identify the anatomic compartment where this lesion typically occurs n Identify common stress fractures around the hip joint in athletes and discuss potential complications n Describe features of myotendinous injuries around the hip n Describe the anatomic relationship of the sacrotuberous ligament and the origin of the hamstring tendons n Describe the anatomic structures involved in an athletic pubalgia Accreditation and Designation Statement The RSNA is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The RSNA designates this journal-based SA-CME activity for a maximum of 1.0 AMA PRA Category 1 Credit ™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity. Disclosure StatementThe ACCME requires that the RSNA, as an accredited prov...

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Higher Incidence of Bone Stress Injuries With Increasing Female Athlete Triad–Related Risk Factors

Cited by 272 publications

References 53 publications

Epidemiology of National Collegiate Athletic Association Men's and Women's Cross-Country Injuries, 2009–2010 Through 2013–2014

Epidemiology of National Collegiate Athletic Association Men's and Women's Cross-Country Injuries, 2009–2010 Through 2013–2014

Tarsal navicular stress fractures

Hip Imaging in Athletes: Sports Imaging Series

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