Perceptions of risk for stress fractures: A qualitative study of female runners with and without stress fracture histories.

OBJECTIVES: To gain insight into perceived factors related to bone health and stress fracture (SF) prevention for female runners and to understand their experiences within the medical community. DESIGN: Cohort qualitative study. SETTING: University health system. PARTICIPANTS: Forty female runners, 20 who had SF histories and 20 age-and-running-distance matched women without SF. MAIN OUTCOME MEASURES: Women participated in audiotaped qualitative semi-structured interviews. For women with a SF history, questions sought their perspectives on factors that they felt contributed to SF, experiences with the medical community, and changes made post SF. For women without a SF history, questions sought perspectives on factors felt important to perceived running-related bone health. RESULTS: Six themes emerged; 1) Previous/Recurrent Musculoskeletal Injuries, 2) Activity Patterns and Training Regimens, 3) Nutrition, 4) Prevention and Intervention, 5) Pain, and 6) Mindset. Within these themes, between group differences are characterized by differences in knowledge and/or application of knowledge for health and wellness. Compared to women without SF, women with SF histories increased training load more quickly, had poorer nutrition, performed less cross-training, and kept running despite pain. CONCLUSIONS: More education is needed for female runners to decrease risks for SF.

Physical and psychological stressors linked with stress fractures in recruit training.

This study aimed to measure ambulation in infantry army basic training, and to evaluate if covering more distance can explain stress fractures in a stressor-stress model. Forty-four male combat recruits (18.7 ± 0.7 years) participated in a 6-month rigorous high intensity combat training program. Baseline data included anthropometric measurements, VO(2)max, and psychological questionnaires. Actual distance covered was measured using a pedometer over an 11-week training period. Psychological questionnaires were repeated after 2 months. Sixteen recruits were diagnosed with stress fractures by imaging (SFi = 36.4%). Statistical analysis included comparing measured variables between SFi and those without stress fractures (NSF). The recruits covered 796 ± 157 km, twofold the distance planned of 378 km (P < 0.001). The SFi group covered a distance 16.4% greater than that of the NSF group (866 ± 136 and 744 ± 161 km, respectively, P < 0.01), and also demonstrated greater psychological stress. These data reveal the importance of adherence to or enforcement of military training programs. In the light of these data, the Israeli Defense Forces program needs reappraisal. A stressor-stress response might explain the susceptibility of certain recruits for injury. Using advanced technology, monitoring ambulation may prevent stress fracture development by limiting subjects exceeding a certain level. Psychological profile may also play a role in predicting stress fracture development.

Motivation, cohesion, satisfaction, and their relation to stress fracture among female military recruits.

The purpose of this study was to compare ratings of motivation, satisfaction, self-efficacy, and cohesion between male and female soldiers undergoing basic training (BT) in a gender-integrated unit and to study whether the ratings differ in a subgroup of women who suffered stress fractures (SF) during the course of training. Data were collected from 3 different companies of an integrated combat unit using questionnaires that were completed by 41 male and 160 female soldiers (age 18.5 +/- 0.4 years) at 3 phases during their BT (0, 2, and 4 months). In these questionnaires, the subjects were asked to evaluate their motivation, cohesion, satisfaction and self-efficacy. The presence or absence of bone overuse injuries was assessed by magnetic resonance imaging (MRI) or bone scintigraphy (BS). In addition to comparing parameters between females and males, female soldiers who sustained SF during BT (n = 18) were analyzed as a separate sub-group (FSF). In general, females in a gender-integrated combat unit were more motivated and satisfied with their service than their male counterparts. Overall, the stress fractures were associated with lower ratings of motivation, self-efficacy, and satisfaction expressed by the FSF sub-group.

[The assessment of the reliability and the validity of the EOQOL questionnaire of osteoporotics--QOL assessment of elderly osteoporotics by EOQOL].

We presented a novel and specific questionnaire for quality of life of elderly subjects with osteoporosis (EOQOL), and analyzed its reliability and validity. Based on the discussions with elderly people of osteoporosis, we extracted key words related to complaints of patients with vertebral fractures. A 49 questionnaire was developed on concepts derived from key words. The subdirectories of the questionnaire for elderly osteoporotic subjects consisted of pain, daily activity, movement, physiological activity, duty, recreation and well-being. To analyze the reliability and the validity of EOQOL, it was evaluated in 101 elderly subjects with osteoporosis. Crohnbach's alpha coeffient was 0.82 for pain, 0.86 for daily activity, 0.73 for movement, 0.83 for mood, 0.78 for anxiety against falls, 0.84 for physiological activity, 0.85 for duty, 0.66 for free time, 0.78 for a nice feeling about life. These results indicated that EOQOL is useful as a disease specific questionnaire for elderly osteoporotic patients with osteoporosis.

Stress fractures of the tibia: can personality traits help us detect the injury-prone athlete?

One of the few serious drawbacks associated with running is overuse injuries such as stress fractures of the tibia, which cause local pain and swelling, often resulting in a temporary cessation of training. Whereas some runners rarely become injured, others experience recurrent injuries even during fairly short periods of time. The aim of the present study was to compare selected personality traits in a group of runners who had sustained a previous tibial stress fracture (n=17), with a matched group of runners (n=17) who had never experienced stress fractures. The results indicated that the injured runners, especially the women, scored higher than the non-injured runners did on inventories measuring both the Type A behavior pattern and exercise dependency. Since motivation, ambitiousness, and competitiveness are integral parts of these inventories, high scoring individuals might be part of a high-risk population for running injuries, the more so if the individual also feels dependent on regular running for managing stress related mood states, which was the case particularly for the injured women in the present study. However, the somewhat limited number of runners who had had a confirmatory scintigram, which was a criterion for inclusion in the study, warrants a cautious interpretation of the results. The findings nevertheless suggest that in order to prevent recurrent injuries, health education professionals and clinicians ought to focus on conveying the importance of detecting precursors of injury, and the subsequent steps which should be taken to avoid developing a serious injury.