Discrepancies in the prevalence, risk factors, diagnosis, and treatment of stress fractures between long-distance runners and sprinters: A qualitative review of systematic reviews
Noah Emil Glisik
,
Noah Emil Glisik
University of Maribor, Faculty of Medicine, Maribor, Slovenia,
This qualitative review of systematic reviews consolidates current knowledge on stress fractures among endurance athletes and sprinters, including epidemiology, risk factors, diagnosis, and treatment strategies. A search across PubMed, Web of Science, SCOPUS, Science Direct, and Google Scholar, limiting results to articles published within the last year, yielded 90 relevant articles. Initial search results were narrowed down to 56 articles following abstract screening, with an additional article obtained through direct author correspondence. Stress fractures, a subset of bone stress injuries, result from persistent mechanical pressure surpassing bone regeneration capacity. They predominantly affect lower extremities, notably the tibia and metatarsals in endurance runners, and the toe phalanx in sprinters. Various risk factors contribute to stress fracture susceptibility, including gender, nutritional deficiencies, biomechanical factors, and psychological aspects like perfectionism and fear of failure. Diagnosis involves detailed patient history, clinical examination, and imaging modalities such as MRI, which remains the gold standard. Treatment emphasizes rest, gradual return to activity, and addressing underlying risk factors. Surgical intervention is reserved for high-risk fractures or cases of non-union. Preventive measures encompass nutritional optimization, biomechanical assessment, appropriate footwear, and psychological support. Notably, strategies targeting the Female Athlete Triad and ensuring adequate energy availability are crucial in both endurance and sprinting athletes. While more research directly comparing distance runners to sprinters is warranted, along with more sprinting-related research in general, this review provides a comprehensive understanding of stress fractures in endurance athletes and sprinters, aiding clinicians in diagnosis, management, and prevention strategies to optimize athlete health and performance.
Abbott A, Wang C, Stamm M, Mulcahey M. Part II: Risk Factors for Stress Fractures in Female Military Recruits. Mil Med. 2023. p. 93–9.
4.
Armento A, Heronemus M, Truong D, Swanson C. Bone Health in Young Athletes: a Narrative Review of the Recent Literature. Current Osteoporosis Reports. 2023. p. 447–58.
5.
Burke L, Hawley J, Wong S, Jeukendrup A. Carbohydrates for training and competition. J Sports Sci. 2011. p. 17–27.
6.
Capozzi A, Scambia G, Lello S. Calcium, vitamin D, vitamin K2, and magnesium supplementation and skeletal health. Maturitas. 2020. p. 55–63.
7.
Chen L, Lu Y, Zhou YF, Wang Y, Zhan HF, Zhao YT, et al. The effects of weight loss-related amenorrhea on women’s health and the therapeutic approaches: a narrative review. Annals of Translational Medicine. 2023. p. 132.
8.
Coslick A, Lestersmith D, Chiang C, Scura D, Wilckens J, Emam M. Lower Extremity Bone Stress Injuries in Athletes: an Update on Current Guidelines. Current Physical Medicine and Rehabilitation Reports. 2024. p. 39–49.
9.
Dutton R. Stress Fractures of the Hip and Pelvis. Clin Sports Med. 2021. p. 363–74.
10.
Friedl K, Looney D. Activity biomarkers signal important health and performance outcomes. J Sci Med Sport. 2023. p. 3–8.
11.
George E, Sheerin K, Reid D. Guidelines for returning females to running following a tibial bone stress injury. 2022.
12.
Hadjispyrou S, Hadjimichael A, Kaspiris A, Leptos P, J. Treatment and Rehabilitation Approaches for Stress Fractures in Long-Distance Runners: A Literature Review. Cureus. 2023. p. 49397.
13.
Hart N, Newton R, Tan J, Rantalainen T, Chivers P, Siafarikas A, et al. Biological basis of bone strength: anatomy, physiology and measurement. J Musculoskelet Neuronal Interact. 2020. p. 347–71.
14.
Heikura I, Stellingwerff T, Areta J. Low energy availability in female athletes: From the lab to the field. Eur J Sport Sci. 2022. p. 709–19.
15.
Herzog W. The secrets to running economy. J Sport Health Sci. 2022. p. 273–4.
16.
Hoitz F, Mohr M, Asmussen M, Lam WK, Nigg S, Nigg B. The effects of systematically altered footwear features on biomechanics, injury, performance, and preference in runners of different skill level: a systematic review. Footwear Science. 2020. p. 193–215.
17.
Holtzman B, Ackerman K. Recommendations and Nutritional Considerations for Female Athletes: Health and Performance. Sports Med. 2021. p. 43–57.
18.
Kahanov L, Eberman L, Games K, Wasik M. Diagnosis, treatment, and rehabilitation of stress fractures in the lower extremity in runners. Open Access J Sports Med. 2015. p. 87–95.
19.
Kaiser P, Guss D, Digiovanni C. Republication of "Stress Fractures of the Foot and Ankle in Athletes. Foot & Ankle Orthopaedics. 2023. p. 24730114231195044.
Lussiana T, Patoz A, Gindre C, Mourot L, Hébert-Losier K. The implications of time on the ground on running economy: less is not always better. Journal of Experimental Biology. 2019. p. 222.
22.
Mcdaniel M, Eltman N, Pan J, Swanson R. Evaluation of Low-Intensity Pulsed Ultrasound on Stress Fractures to Reduce the Time to Return to Sport or Activity in the Physically Active Population: A Systematic Review. Cureus. 2023. p. 49129.
23.
Melin A, Areta J, Heikura I, Stellingwerff T, Torstveit M, Hackney A. Direct and indirect impact of low energy availability on sports performance. Scand J Med Sci Sports. 2024. p. 14327.
24.
Miller T, Jamieson M, Everson S, Siegel C. Expected Time to Return to Athletic Participation After Stress Fracture in Division I Collegiate Athletes. Sports Health. 2018. p. 340–4.
25.
Milner C, Foch E, Gonzales J, Petersen D. Biomechanics associated with tibial stress fracture in runners: A systematic review and metaanalysis. J Sport Health Sci. 2023. p. 333–42.
26.
Moreira M, De Araújo I, De Molfetta G, Silva W, Jr, De Paula F. Repetitive stress fracture: a warning sign of genetic susceptibility to fracture? A case report of a heterozygous variant in SERPINF1. Arch Endocrinol Metab. 2021. p. 500–4.
27.
Mousavi S, Khorramroo F, Jafarnezhadgero A. Gait retraining targeting foot pronation: A systematic review and meta-analysis. PLOS ONE. 2024. p. 298646.
28.
Nussbaum E, Gatt C, Jr, Bjornarra J, Yang C. Evaluating the Clinical Tests for Adolescent Tibial Bone Stress Injuries. Sports Health. 2021. p. 502–10.
29.
Oh Y, Yamamoto K, Yoshii T, Kitagawa M, Okawa A. Current concept of stress fractures with an additional category of atypical fractures: a perspective review with representative images. Ther Exercise and Quality of Life Journal. 2021. p. 49–60.
30.
Adv Endocrinol Metab. 20420188211049620.
31.
Petisco-Rodríguez C, Sánchez-Sánchez L, Fernández-García R, Sánchez-Sánchez J, García-Montes J. Disordered Eating Attitudes, Anxiety, Self-Esteem and Perfectionism in Young Athletes and Non-Athletes. Int J Environ Res Public Health. 2020. p. 17.
32.
Puvvada C, Soomro F, Osman H, Haridi M, Gonzalez N, Dayo S, et al. Efficacy and Safety of Teriparatide in Improving Fracture Healing and Callus Formation: A Systematic Review. Cureus. 2023. p. 37478.
33.
Robertson G, Sinha A, Hodkinson T, Koç T. Return to sport following toe phalanx fractures: A systematic review. World J Orthop. 2023. p. 471–84.
34.
Romero-Morales C, López-López D, Almazán-Polo J, Mogedano-Cruz S, Sosa-Reina M, García-Pérez-De-Sevilla G, et al. Prevalence, diagnosis and management of musculoskeletal disorders in elite athletes: A mini-review. Dis Mon. 2024. p. 101629.
35.
Ross B, Lupica G, Dymock Z, Miskimin C, Mulcahey M. Sex-related differences in hip and groin injuries in adult runners: a systematic review. The Physician and Sportsmedicine. 2023. p. 107–20.
36.
Ruiz-Alias S, Molina-Molina A, Soto-Hermoso V, García-Pinillos F. A systematic review of the effect of running shoes on running economy, performance and biomechanics: analysis by brand and model. Sports Biomech. 2023. p. 388–409.
37.
Schundler S, Jackson G, Mccormick J, Tuthill T, Lee J, Batra A, et al. Nonoperative Management of Tibial Stress Fractures Result in Higher Return to Sport Rates Despite Increased Failure Versus Operative Management: A Systematic Review. Arthrosc Sports Med Rehabil. 2023. p. 881-e889.
38.
Stellingwerff T, Heikura I, Meeusen R, Bermon S, Seiler S, Mountjoy M, et al. Overtraining Syndrome (OTS) and Relative Energy Deficiency in Sport (RED-S): Shared Pathways, Symptoms and Complexities. Sports Medicine. 2021. p. 51.
39.
Tarabishi M, Almigdad A, Almonaie S, Farr S, Mansfield C. Chronic Exertional Compartment Syndrome in Athletes: An Overview of the Current Literature. Cureus. 2023. p. 47797.
40.
Tingan A, Bowen A, Salas-Tam C, Roland M, Srivastav A. Current Concepts in the Evaluation, Management, and Prevention of Common Foot and Ankle Injuries in the Runner. Current Physical Medicine and Rehabilitation Reports. 2024.
41.
Touzell A. Foot pain from exercise: Diagnosis and treatment. Australian Journal for General Practitioners. 2024. p. 116–20.
42.
Vasiliadis A. Common stress fractures in runners: An analysis. Saudi Journal of Sports Medicine. 2017. p. 1–6.
43.
Zandbergen M, Marotta L, Bulthuis R, Buurke J, Veltink P, Reenalda J. Effects of level running-induced fatigue on running kinematics: A systematic review and meta-analysis. Gait & Posture. 2023. p. 60–75.
The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.
,
