title: Four biomechanical and anthropometric measures predict tibial stress fracture: a prospective study of 1065 Royal Marines.
abstract: BACKGROUND
  Tibial stress fractures (TSFs) cause a significant burden to Royal Marines recruits. No prospective running gait analyses have previously been performed in military settings.
  
  
  OBJECTIVE
  We aimed to identify biomechanical gait factors and anthropometric variables associated with increased risk of TSF.
  
  
  METHODS
  1065 Royal Marines recruits were assessed in week 2 of training. Bilateral plantar pressure and three-dimensional lower limb kinematics were obtained for barefoot running at 3.6 m/s, providing dynamic arch index, peak heel pressure and lower limb joint angles. Age, bimalleolar breadth, calf girth, passive hip internal/external range of motion and body mass index (BMI) were also recorded. 10 recruits who sustained a TSF during training were compared with 120 recruits who completed training injury-free using a binary logistic regression model to identify injury risk factors.
  
  
  RESULTS
  4 variables significantly (p<0.05) predicted increased risk of TSF (ORs and 95% CI): smaller bimalleolar width (0.73, 0.58 to 0.93), lower BMI (0.56, 0.33 to 0.95), greater peak heel pressure (1.25, 1.07 to 1.46) and lower range of tibial rotation (0.78, 0.63 to 0.96).
  
  
  CONCLUSIONS
  Reduced impact attenuation and ability to withstand load were implicated in tibial stress fracture risk.
authors.affiliation: Department of Biomechanics Research Team, College of Life and Environmental Sciences, University of Exeter, Exeter, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Nunns
authors.affiliation: Department of Environmental Medicine and Science, Institute of Naval Medicine, Alverstoke, UK.
authors.forename: Carol
authors.initials: C
authors.lastname: House
authors.affiliation: Department of Biomechanics Research Team, College of Life and Environmental Sciences, University of Exeter, Exeter, UK.
authors.forename: Hannah
authors.initials: H
authors.lastname: Rice
authors.affiliation: Wellcome Trust Biomedical Informatics Hub, College of Life and Environmental Sciences, University of Exeter, Exeter, UK.
authors.forename: Mohammod
authors.initials: M
authors.lastname: Mostazir
authors.affiliation: Department of Environmental Medicine and Science, Institute of Naval Medicine, Alverstoke, UK.
authors.forename: Trish
authors.initials: T
authors.lastname: Davey
authors.affiliation: Department of Biomechanics Research Team, College of Life and Environmental Sciences, University of Exeter, Exeter, UK.
authors.forename: Victoria
authors.initials: V
authors.lastname: Stiles
authors.affiliation: Department of Environmental Medicine and Science, Institute of Naval Medicine, Alverstoke, UK.
authors.forename: Joanne
authors.initials: J
authors.lastname: Fallowfield
authors.affiliation: Department of Environmental Medicine and Science, Institute of Naval Medicine, Alverstoke, UK.
authors.forename: Adrian
authors.initials: A
authors.lastname: Allsopp
authors.affiliation: Department of Biomechanics Research Team, College of Life and Environmental Sciences, University of Exeter, Exeter, UK.
authors.forename: Sharon
authors.initials: S
authors.lastname: Dixon
mesh_terms: D000293:Adolescent; D000886:Anthropometry; D001696:Biomechanical Phenomena; D015775:Fractures, Stress / Q000175:diagnosis*; D005684:Gait; D006801:Humans; D016015:Logistic Models; D008297:Male; D008889:Military Personnel; D011312:Pressure; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012307:Risk Factors; D012420:Running / Q000293:injuries*; D013978:Tibial Fractures / Q000175:diagnosis*; D016474:Weight-Bearing; D055815:Young Adult
keywords: Biomechanics; Gait analysis; Overuse injury; Prospective; Stress fracture