title: Tibial flexural wave propagation in vivo: potential for bone stress injury risk assessment.
abstract: OBJECTIVE
  To determine the reliability of tibial flexural wave propagation velocity (FWPV) and the effect of overlying soft-tissues on the result.
  
  
  METHODS
  The velocity of tibial flexural wave propagation was repeatedly measured in healthy subjects.
  
  
  BACKGROUND
  The tibia is the most frequently stress-fractured bone of runners and in military training populations. Developing techniques to measure tibial bone strength and, thereby, fracture resistance may be useful in pre-participation examinations in order to identify at-risk individuals. One such method, tibial flexural wave propagation velocity (FWPV) has been reported to be a measure of tibial stiffness.
  
  
  METHODS
  The tibial FWPV was measured 80 times per subject (10 trials X 2 setups/day X 4 days) in a sample of 25 young women. Two methods of calculating FWPV were used (Peak method time domain and Phase method frequency domain). Intraclass correlations (ICCs) were calculated.
  
  
  RESULTS
  The results demonstrated that the peak method was more reliable then the phase method. The ICCs ranged from 0.81-0.96 for the peak method and from 0.59-0.89 for the phase method. The 95% confidence intervals demonstrated that the FWPV could discriminate between subjects with low, medium, or high velocity values with reasonable accuracy and confidence. The soft-tissue overlying the tibia was not significantly (p = 0.63) correlated with FWPV.
  
  
  CONCLUSIONS
  In summary, it is possible to discriminate between varying levels of tibial FWPV. Furthermore, if FWPV is related to bone stress fracture resistance, then this method may be useful in determining stress fracture risk prior to intensive physical activity.
  
  
  CONCLUSIONS
  The tibia is the most frequently stress-fractured bone of runners and in military training populations. This study explores the feasibility of tibial FWPV as a potential method to assess tibial stress fracture resistance.
authors.affiliation: US Army-Baylor Graduate Program in Physical Therapy, Fort Sam Houston, TX, USA. timothy.flynn@cen.amedd.army.mil
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Flynn
authors.forename: Peter R
authors.initials: PR
authors.lastname: Cavanagh
authors.forename: H Joseph
authors.initials: HJ
authors.lastname: Sommer
authors.forename: Janice A
authors.initials: JA
authors.lastname: Derr
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D005260:Female; D015775:Fractures, Stress / Q000209:etiology*; D006801:Humans; D008889:Military Personnel; D015203:Reproducibility of Results; D013977:Tibia / Q000293:injuries*