Thursday, December 3, 2009

How to Beat Stress Fractures

Phys Ed: How to Prevent Stress Fractures


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Stress fractures are one of the more pernicious injuries in sports, afflicting the experienced and the aspiring, with no regard for competitive timing. Last year, Tiger Woods managed to win the U.S. Open despite suffering from stress fractures in his left leg (as well as other leg and knee injuries), while the great British marathoner Paula Radcliffe struggled through the Beijing Olympics Marathon on a leg barely recovered from a stress fracture, one of several she’s suffered. The International Association of Athletics Federations, the world governing body for track and field, recently described stress fractures, with a kind of grim resignation, as “the curse of athletes.”

But studies published in this month’s issue of the journal Medicine & Science in Sports & Exercise offer hope that, at least for runners, simple alterations in their stride or in the strength of their legs might reduce their risk for the most common type of stress fracture.

In one of the studies, undertaken at the University of Minnesota, researchers recruited 39 competitive women runners, ages 18 to 35, and started measuring them. In particular, the scientists wanted to examine the size and shape of their shinbones, or tibias. About half of all stress fractures occur in the tibia, studies show. When you run or jump, that bone is pulled and bent. Sometimes, microscopic fissures form. In most cases, these tiny cracks heal quickly. But, sometimes, continued activity overwhelms the bone’s capacity to recover. The cracks grow and combine into a fracture.

The Minnesota researchers wanted to see whether the shinbones of the runners with a history of stress fractures were weaker than those without. Earlier studies suggested that this would be the case. But few studies have examined the size of the runners’ calf muscles. Bones tend to adapt to the muscles around them; puny muscles can mean puny bones. The Minnesota scientists, using a new machine that examines bone in three dimensions and measuring the runners’ leg muscles, found that, surprisingly, the injured runners’ bones were as strong, in relation to their muscle size as the bones in the uninjured runners. But the injured runners had significantly smaller calf muscles and therefore also slighter bones. The primary difference, the researchers concluded, between the women who suffered stress fractures and those who hadn’t was the size (and presumably strength) of their calf muscles.

This finding should be encouraging to anyone who has had a tibial stress fracture or would prefer not to. “It does seem as if strengthening the calf muscles may be a very easy way” to reduce fracture risk, says Moira Petit, an associate professor of kinesiology at the University of Minnesota and an author of the study. In addition, she said, “our data suggest that you don’t have to strengthen the muscle by much.” A small increase of bulk, achievable by, for instance, rising up on to your toes and sinking back to the floor 10 or 12 times every day, might be enough. Adding even a small amount of calf muscle “serves two purposes,” Ms. Petit says. First, “the strength of the bone will usually increase” in response to the added muscle. And, as a bonus, the new muscle “can absorb more” of the forces generated when you run. So even as the tibia strengthens in response to the new muscle, it also is subjected to less shock. “Really, there’s no downside to this,” Ms. Petit says.

Her results, though, may apply primarily to women; she’s studying male runners, but so far, she says, isn’t seeing the same relationship between their calf-muscle size and bone strength. The other study in the current Medicine & Science in Sports & Exercise, however, did focus on men and their stress fractures, although, in this case, the lead researcher suggests that the findings would be true in women as well. In the work, from Iowa State University in Ames, computer modeling was used to predict what would happen to stress fracture risk if runners changed their strides. The researchers attached reflective markers to the bodies of 10 former or current collegiate-level cross-country runners and had them run repeatedly down a runway nearly 30 meters long, making sure to step onto a force plate that measured how hard they were striking the ground. During successive runs, the men were asked to shorten their natural strides, while maintaining their pace. The scientists entered the data into computer programs that calculated just how much force was being applied to the shinbone under different striding conditions. The researchers determined that reducing stride length by about 10 percent seemed to reduce the stress on the tibia enough to lower the risk of a stress fracture.

Why, though, should shortening your stride affect your tibia at all? “Think of it this way,” says Brent Edwards, lead author of the study and now a post-doctoral research fellow in the Department of Kinesiology and Nutrition at the University of Illinois, in Chicago. “If you spend less time in the flight phase of running” — meaning in the air — “you’ll hit the ground with less force.” On the other hand, you’ll hit the ground more often. But in Mr. Edwards’s models, the reduction in pounding from an abbreviated stride outweighed the shock from a few additional strides per mile.

Even for those of us without a biomechanical expert in the house, gauging a 10 percent reduction in stride is not difficult, Mr. Edwards says. “Ten percent is about as much as you can shorten your stride without it beginning to feel quite uncomfortable,” he says. And absolute precision isn’t necessary. “Seven or eight or nine percent is fine,” he says.

Neither Ms. Petit nor Mr. Edwards suggests, of course, that any, single prevention approach will end all tibial stress fractures. “There are so many elements involved,” Ms. Petit says. Training, hormones, genetics, diet and shoe choice probably all play a role. “But if there’s something easy and benign that you can do to lessen the risk,” she asks, “why not?”

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