Johnston Therese E, Jakavick Allison E, Mancuso Caroline A, McGee Kathleen C, Wei Lily, Wright Morgan L, Close Jeremy, Shimada Ayako, Leiby Benjamin E
Thomas Jefferson University, Jefferson College of Rehabilitation Sciences, Department of Physical Therapy, Philadelphia, PA, USA.
Thomas Jefferson University, Department of Family and Community Medicine, Philadelphia, PA, USA.
Int J Sports Phys Ther. 2021 Feb 2;16(1):72-86. doi: 10.26603/001c.18806.
Few studies compare women with and without stress fractures and most focus on younger, elite runners.
HYPOTHESIS/PURPOSE: Compare risk factors between female runners with and without a stress fracture history.
Case control.
An online survey targeting women age ≥18 years was distributed primarily via social media. Questions included demographics, running details, cross training, nutrition, injury history, medical/menstrual history, and medications. Women with stress fracture histories answered questions about location, number, and changes made. Data were compared between groups using t-tests, chi-square tests, or Fisher's exact tests. Multivariable logistic regression models simultaneously investigated associations of multiple factors using backward variable selection.
Data from 1648 respondents were analyzed. Mean age was 40 years, and 25.4% reported stress fractures. Significant differences were found between groups for days/week running, mileage/week, running pace, years running, having a coach, cycling or swimming, calorie consumption for activity, other running injuries, medical history, medication/supplement intake, age at menarche, and going ≥6 months without a menstrual period. Odds of having a stress fracture were increased with osteopenia (OR 4.14), shin splints (OR 3.24), tendon injuries (OR 1.49), running >20 miles/week (OR 1.74-1.77) compared to 11-20 miles/week, having a coach (OR 1.86), and cycling (OR 1.15). Women running 11:00-11:59 minutes/mile or slower were less likely to have a stress fracture compared to those running 9:00-9:59 minutes/mile (OR 0.43-0.54). The odds of having a stress fracture were 1.43 times higher for going ≥ 6 months without a menstrual period. Use of calcium, probiotics, and vitamin D increased odds. Post fracture, common changes made were with cross training (49%), mileage (49%), and strength training (35%).
Multiple intrinsic and extrinsic factors were identified for female runners who sustained one or more stress fracture during running. Prospective studies are warranted to infer a cause and effect relationship amongst these variables and stress fracture risk.
Level IV.
很少有研究对有和没有应力性骨折的女性进行比较，且大多数研究聚焦于年轻的精英跑步者。
假设/目的：比较有和没有应力性骨折病史的女性跑步者之间的风险因素。
病例对照研究。
一项针对年龄≥18岁女性的在线调查主要通过社交媒体进行分发。问题包括人口统计学信息、跑步细节、交叉训练、营养、受伤史、医疗/月经史以及用药情况。有应力性骨折病史的女性回答了关于骨折部位、数量以及所做改变的问题。使用t检验、卡方检验或费舍尔精确检验对两组数据进行比较。多变量逻辑回归模型使用向后变量选择法同时研究多个因素之间的关联。
对1648名受访者的数据进行了分析。平均年龄为40岁，25.4%的人报告有应力性骨折。两组在每周跑步天数、每周里程数、跑步配速、跑步年限、是否有教练指导、是否进行骑行或游泳、活动时的卡路里消耗、其他跑步损伤、病史、药物/补充剂摄入、初潮年龄以及闭经≥6个月等方面存在显著差异。与每周跑11 - 20英里相比，患有骨质减少（比值比4.14）、胫骨夹板（比值比3.24）、肌腱损伤（比值比1.49）、每周跑步超过20英里（比值比1.74 - 1.77）、有教练指导（比值比1.86）以及进行骑行（比值比1.15）的女性发生应力性骨折的几率增加。与每英里跑9:00 - 9:59分钟的女性相比，每英里跑11:00 - 11:59分钟或更慢的女性发生应力性骨折的可能性较小（比值比0.43 - 0.54）。闭经≥6个月的女性发生应力性骨折的几率高出1.43倍。使用钙、益生菌和维生素D会增加发生几率。骨折后，常见的改变包括交叉训练（49%）、里程数（49%）和力量训练（35%）。
确定了在跑步过程中发生过一次或多次应力性骨折的女性跑步者的多种内在和外在因素。有必要进行前瞻性研究以推断这些变量与应力性骨折风险之间的因果关系。
四级。
