title: Preventive osteopathic manipulative treatment and stress fracture incidence among collegiate cross-country athletes.
abstract: BACKGROUND
  Stress fractures are common among athletes, particularly distance runners, with many theories regarding the etiologic process of stress fractures and various studies identifying risk factors or suggesting preventive techniques. To our knowledge, no previous studies have discussed the possible causative effects of somatic dysfunction or the preventive capabilities of osteopathic manipulative treatment (OMT).
  
  
  OBJECTIVE
  To apply a preventive OMT protocol for cross-country athletes to reduce the incidence of stress fractures.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Examinations of cross-country athletes at an NCAA (National Collegiate Athletic Association) Division I university were performed by supervising physician-examiners and first- and second-year osteopathic medical students during several consecutive academic years. Athletes re-enrolled in the study each year they continued to be eligible. The intervention included osteopathic structural examination and OMT that focused on somatic dysfunction identified in the pelvis, sacrum, and lower extremities.
  
  
  RESULTS
  More than 1800 participant examinations were performed on 124 male and female participants by 3 supervising physician-examiners and 141 osteopathic medical students over the course of 5 consecutive academic years (2004-2005 to 2008-2009). Data from these academic years were compared with data from the previous 8 academic years (1996-1997 to 2003-2004). An average of 20 new participants enrolled yearly. The number of annual stress fractures per team ranged from 0 to 6 for male participants and 1 to 6 for female participants. The cumulative annual incidence of stress fractures for male participants demonstrated a statistically significant decrease from 13.9% (20 of 144) before intervention to 1.0% (1 of 105) after intervention, resulting in a 98.7% relative reduction in stress-fracture diagnosis (P=.019). The cumulative annual incidence for female participants showed a minimal decrease from 12.9% (23 of 178) before intervention to 12.0% (17 of 142) after intervention, an 8.5% relative reduction in stress-fracture diagnosis (P=.671). The cumulative annual incidence of all participants decreased from 13.4% (43 of 322) before intervention to 7.3% (18 of 247) after intervention, a 45% relative reduction in stress-fracture diagnosis (P=.156).
  
  
  CONCLUSIONS
  There was a statistically significant decrease in the cumulative annual incidence of stress fractures in male, but not female, cross-country athletes after receiving OMT.
authors.affiliation: ATC, University of New England College of Osteopathic Medicine, Department of Osteopathic Manipulative Medicine, Alfond Center, 11 Hills Beach Rd, Biddeford, ME 04005-9526. janiskic@msu.edu.
authors.forename: Lynn F
authors.initials: LF
authors.lastname: Brumm
authors.forename: Carrie
authors.initials: C
authors.lastname: Janiski
authors.forename: Jenifer L
authors.initials: JL
authors.lastname: Balawender
authors.forename: Adam
authors.initials: A
authors.lastname: Feinstein
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D015775:Fractures, Stress / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D015994:Incidence; D008297:Male; D026301:Manipulation, Osteopathic / Q000379:methods*; D008487:Medical History Taking; D010808:Physical Examination / Q000379:methods* / Q000706:statistics & numerical data; D011322:Primary Prevention / Q000379:methods; D012420:Running / Q000293:injuries*; D017678:Sex Distribution; D012737:Sex Factors; D013337:Students, Medical / Q000706:statistics & numerical data; D055815:Young Adult