lower extremity stress fractures in female athletes a clinical review n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Lower Extremity Stress fractures in Female athletes: A clinical Review PowerPoint Presentation
Download Presentation
Lower Extremity Stress fractures in Female athletes: A clinical Review

Loading in 2 Seconds...

play fullscreen
1 / 17

Lower Extremity Stress fractures in Female athletes: A clinical Review - PowerPoint PPT Presentation


  • 145 Views
  • Uploaded on

Lower Extremity Stress fractures in Female athletes: A clinical Review. Brandon Mitchell, ATC Stony Brook university sports medicine. Learning opportunities. Review onset and diagnosis Risk factures associated with stress fractures Meanings for clinicians. Incidence of occurrence .

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Lower Extremity Stress fractures in Female athletes: A clinical Review' - kamala


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
lower extremity stress fractures in female athletes a clinical review

Lower Extremity Stress fractures in Female athletes: A clinical Review

Brandon Mitchell, ATC

Stony Brook university sports medicine

learning opportunities
Learning opportunities
  • Review onset and diagnosis
  • Risk factures associated with stress fractures
  • Meanings for clinicians
incidence of occurrence
Incidence of occurrence
  • Female > Male (2, 9)
    • 9.2% vs 3.0% Military
    • 9.7% vs 6.5% Athletes
  • Longer Training > Shorter Training (3, 5)
    • > 16 hrs per week were ~2x likely to have a stress fx than < 4 hrs per week
  • Active > Sedentary (8, 9)

24% occurred in 1st 3 wks Military training

76% occurred weeks 4-9 Military training

symptoms
Symptoms
  • Gradual onset
  • Increase in pain with load bearing activity
  • Typically localized
  • Pain with Standing Heel Raise
  • Pain ascending/descending stairs
diagnosis
Diagnosis
  • Clinical Exam
  • X-Ray
  • MRI
female athlete triad
Female Athlete Triad
  • Amenorrhea / Oligomenorrhea
  • Low Bone Mineral Density / Osteoporosis
  • Disordered Eating / Low Energy Availability

http://www.femaleathletetriad.org/for-athletes-coaches/what-is-the-triad/

risk factors
Risk factors
  • External Factors
    • Training Regiment
    • Training surface
    • Lower Body Alignment
  • Internal Factors
    • Foot Structure
    • Nutrition
    • Bone Density
    • Hormone Balance
training
Training
  • Regiment
    • Routine
    • Distance
    • Pace
    • Cross Training & Off Days  Supplemental Training
  • Surface
    • Soft surface
    • Wood Floor
    • Roads / Asphalt
    • Track
    • Trails
lower body alignment somatic dysfunctions
Lower body alignment- somatic dysfunctions
  • Sacroiliac Joint Rotations and restrictions
  • Pelvic Rotations
  • Pelvic Upslips
  • Leg Length Discrepancy
    • False positive
    • Actual Discrepancy
foot structure mechanics
Foot Structure & Mechanics
  • Supinating Foot
    • More rigid
    • Less compensatory biomechanics
    • “Normal” motion through foot and ankle joints
    • Stress dispersed through foot, ankle, and low leg
  • Pronating Foot
    • More mobile
    • Limited Dorsiflexion at Ankle
    • Mobility at midfoot to compensate
    • Depression of Navicular (fallen medial arch)
    • Internal Rotation of Tibia

Clinical Corrections: Clinical Corrections:

Neutral Shoe Overpronator Shoe (stability)

Low leg stretching Arch Supports

Maintain foot & ankle motion Orthotics

Ankle mobility

nutrition
Nutrition
  • Balanced Diet
    • You are what you eat!
  • Macronutrients (proteins, carbs, fats)
  • Micronutrients
    • Calcium
    • Vitamin D
    • Iron (Fe)
bone density
Bone Density
  • Measured by Dual Energy Xray Absorptiometry (DEXA)
    • T Score
    • Z Score
  • Impacted by Nutrition and Hormone Balance (4, 10)
    • <Ca & Vitamin D  < BMD
    • Dysmenorrhea  < BMD
  • Reptitive impact < odd impact (4, 7)
  • Runners lowest total body BMD (6, 7)

Wolman, pg 1015

hormone balance
Hormone balance
  • Amenorrhea
    • Absence of menstrual cycle  low BMD, early onset menopause (4, 10)
  • Oligomenorrhea
    • Infrequent menstrual cycle  low BMD, fluctuation of weight (4, 10)
    • Dysmenorrhea  Increase risk of injury (1, 10)
  • Oral Contraceptives
    • Good or Bad?
repeated stress fractures
Repeated Stress Fractures
  • Labwork
  • DEXA Scan
  • Conservative management
  • Bone Stimulation modality
references
References

1. Barrow GW, Saha S. Menstrual irregularity and stress fractures in collegiate female distance runners. Am J Sports Med. 1988; 16(3): 209-216.

2. BruknerP, Bennell K. Stress fractures in female athletes. Sports Med. 1997; 24(6): 419-429.

3. Chen YT, Tenforde AS, Fredericson M. Update on stress fractures in female athletes: epidemiology, treatment, and prevention. Curr Rev Musculoskelet Med. 2013; 6: 173–181.

4. CuttiP, Steele R, Shrier I, et al. Re-defining normal: bone mineral density in elite female athletes. Br J Sports Med. 2011; 45: 341.

5. Loud KJ, Gordon CM, Micheli LJ, Field AE. Correlates of stress fractures among preadolescent and adolescent girls. Pediatrics. 2005; 115(4): 399 -406.

6. MuddLM, Fornetti W, Pivarnik JM. Bone mineral density in collegiate female athletes: comparisons among sports. J Athl Train. 2007; 42(3): 403–408.

7. Nichols JF, Rauh MJ, Barrack MT, Barkai HS. Bone mineral density in female high school athletes: interactions of menstrual function and type of mechanical loading. Bone. 2007;41(3): 371-377.

8. Shaffer RA, Brodine SK, Almeida SA, Maxwell-Williams K, Ronaghy S. Use of simple measures of physical activity to predict stress fractures in young men undergoing a rigorous physical training program. Am. J. Epidemiol. 1999; 149(3): 236-242.

9. Wentz L, Liu PY, Haymes E, Ilich JZ. Females have a greater incidence of stress fractures than males in both military and athletic populations: a systemic review. Military Medicine. 2011; 176(4): 420-430.

10, Wolman RL. Bone mineral density levels in elite female athletes. Ann Rheum Dis. 1990; 49(12): 1013–1016.