title: Risk factors for tibial stress injuries: a case-control study.
abstract: OBJECTIVE
  To identify physical and behavioral characteristics related to the incidence of tibial stress injuries (TSIs).
  
  
  METHODS
  Case-control study. No clinical care was conducted.
  
  
  METHODS
  Research laboratories in the San Francisco (the United States) and Gold Coast (Australia) areas.
  
  
  METHODS
  Forty-eight patients (21 men and 27 women) with acute TSI, and 36 (16 men and 20 women) age-matched, sex-matched, height-matched, weight-matched, and activity-matched controls with no history of TSI.
  
  
  METHODS
  Height, weight, body mass index, bone, lean and fat mass, lower limb alignment anomalies, foot type, orthotics, calcium, recent weight change, menstrual history, oral contraceptive use, medications, smoking, alcohol, sleep, training type, and intensity. Differences in continuous variables were tested using 1-way analysis of variance. Categorical variable comparisons were performed with Fisher exact test.
  
  
  METHODS
  Tibial stress injury.
  
  
  RESULTS
  Tibial stress injury cases had 2.7% more fat (P < 0.001) and 2.6% less muscle (P < 0.001) as well as lower trochanteric bone mineral content (BMC) (P < 0.001), lumbar spine (LS) area (P < 0.001), femoral neck BMC (P < 0.001), length (P < 0.05), area (P < 0.001), cortical width (P < 0.01), cross-sectional moment of inertia (P < 0.001), and index of bending strength (P < 0.001) than controls. Controls had lower LS BMC (P < 0.01), length (P < 0.001), and broadband ultrasound attenuation (P < 0.001). The use of orthotic insoles was more prevalent in TSI cases than controls (25% vs 5.6%, respectively; P < 0.02), as were foot anomalies (56.3% vs 27.8%, respectively; P = 0.01).
  
  
  CONCLUSIONS
  Tibial stress injury cases had lower lean and higher fat mass, a tendency for smaller bones, and for foot anomalies compared with uninjured matched controls. bone mineral density was normal for both groups.
  
  
  CONCLUSIONS
  Enhancing lean mass and limiting gains in fat may provide some protection against TSI. Individuals with small skeletal frames are advised to increase training loads particularly gradually and to reduce training intensity at the first sign of pain in the shins.
authors: *School of Allied Health Sciences, Griffith University, Gold Coast, Australia; †Department of Orthopaedics, School of Medicine, Stanford University/Palo Alto VA Health Care System, Stanford, California; and ‡Radsource Imaging Specialists, Brentwood, Tennessee.
authors: Belinda R
authors: BR
authors: Beck
authors: Katrin
authors: K
authors: Rudolph
authors: Gordon O
authors: GO
authors: Matheson
authors: A Gabrielle
authors: AG
authors: Bergman
authors: Tracey L
authors: TL
authors: Norling
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D015775:Fractures, Stress / Q000453:epidemiology*; D006801:Humans; D008297:Male; D012307:Risk Factors; D013978:Tibial Fractures / Q000453:epidemiology*; D055815:Young Adult