Biomedical subjects

K L Bennell

Publications and source records attributed to K L Bennell.

At least 37 records · Page 2Linked to original sources

PubMed2001

Delayed onset of electromyographic activity of vastus medialis obliquus relative to vastus lateralis in subjects with patellofemoral pain syndrome.

OBJECTIVE: To determine whether electromyographic (EMG) onsets of vastus medialis obliquus (VMO) and vastus lateralis (VL) are altered in the presence of patellofemoral pain syndrome (PFPS) during the functional task of stair stepping. DESIGN: Cross-sectional. SETTING: University laboratory. PATIENTS: Thirty-three subjects with PFPS and 33 asymptomatic controls. INTERVENTIONS: Subjects ascended and descended a set of stairs-2 steps, each 20-cm high-at usual stair-stepping pace. EMG readings of VMO and VL taken on middle stair during step up (concentric contraction) and step down (eccentric contraction). MAIN OUTCOME MEASURES: Relative difference in onset of surface EMG activity of VMO compared with VL during a stair-stepping task. EMG onsets were determined by using a computer algorithm and were verified visually. RESULTS: In the PFPS population, the EMG onset of VL occurred before that of VMO in both the step up and step down phases of the stair-stepping task (p <.05). In contrast, no such differences occurred in the onsets of EMG activity of VMO and VL in either phase of the task for the control subjects. CONCLUSION: This finding supports the hypothesized relationship between changes in the timing of activity of the vastimuscles and PFPS. This finding provides theoretical rationale to support physiotherapy treatment commonly used in the management of PFPS.

Adult↗

PubMed2001

Changes in hip and ankle range of motion and hip muscle strength in 8-11 year old novice female ballet dancers and controls: a 12 month follow up study.

OBJECTIVES: To evaluate in a 12 month longitudinal study changes in hip and ankle range of motion and hip muscle strength in young female novice ballet dancers. METHODS: Fifty three of the original 77 (69%) female dancers aged 8-11 years and 40 of the original 49 (82%) controls returned for follow up measurements one year later. Supine right active hip external (ER) and internal (IR) rotation were measured using an inclinometer. A turnout protractor was used to assess standing active turnout range. Range of right weight bearing ankle dorsiflexion and calf muscle length were measured in a standing lunge position using an inclinometer. A manual muscle tester was used to assess right hip flexor, IR, ER, abductor and adductor strength. RESULTS: The mean (SD) 12 month change in hip ER did not differ between dancers (11.7 (11.3)degrees) and controls (8.1 (17.6)degrees). Dancers gained 12.5 (13.5)degrees hip IR which was significantly greater than controls (0.5 (13.9)degrees). Greater IR change was associated with improved IR strength (r = 0.34, p<0.001). Dancers increased total turnout (12.0 (16.7)degrees) significantly more than controls (2.2 (20.0)degrees). There was no significant change in ankle dorsiflexion range in either group. Dancers and controls increased in all measures of hip muscle strength (p<0.001) and dancers achieved significantly greater gains in three out of five muscle groups (all, p<0.05). CONCLUSIONS: Total hip range of motion increased in both ballet students and controls at this young age. However, ankle dorsiflexion did not, which is probably due to this movement being blocked by bony apposition, rather than soft tissue stretch. This has implications for ballet teachers, as it has long been accepted that this movement could be improved with training. Dancers had greater increases in hip strength after 12 months compared with controls in muscles specific for ballet, suggesting that hip strength can be trained at this young age. Whether these gains are permanent requires further study.

Analysis of Variance↗

PubMed2001

The effects of +Gz force on the bone mineral density of fighter pilots.

HYPOTHESIS: Bone is a metabolically active tissue which responds to high strain loading. The purpose of this study was to examine the bone response to high +Gz force loading generated during high performance flying. METHODS: The bone response to +Gz force loading was monitored in 10 high performance RAAF pilots and 10 gender-, age-, height-, weight-matched control subjects. The pilots were stationed at the RAAF base at Pearce, Western Australia, all completing the 1-yr flight training course. The pilots flew the Pilatus PC-9 aircraft, routinely sustaining between 2.0 and 6.0 +Gz. Bone mineral density (BMD) and bone mineral content (BMC) were measured at baseline and 12 mo, using the Hologic QDR 2000+ bone densitometer. RESULTS: After controlling for change in total body weight and fat mass, the pilots experienced a significant increase in BMD and BMC for thoracic spine, pelvis, and total body, in the magnitude of 11.0%, 4.9%, and 3.7%, respectively. However, no significant changes in bone mineral were observed in the pilots lumbar spine, arms or legs. The control group experienced a significant decrease in pelvic BMC, with no other bone mineral changes observed at any site. CONCLUSIONS: These findings suggest that site specific BMD is increased in response to high +Gz forces generated during high performance flying in a PC-9.

Adaptation, Physiological↗

PubMed2000

Acceleration of fresh fracture repair using the sonic accelerated fracture healing system (SAFHS): a review.

The Sonic Accelerated Fracture Healing System (SAFHS) is a relatively new fracture management tool which incorporates the application of a specifically modified diagnostic ultrasound unit to healing fractures with the intention of accelerating repair. In an animal fracture model, this device has been shown to accelerate the rate of biomechanical healing by a factor of 1.4-1.6. In two randomized, controlled trials in humans, the same unit has been shown to reduce the time frame of clinical and radiographic healing by 38%. In the two fracture regions investigated, tibial diaphysis and distal radius, this represented a 58 day and 37 day reduction in healing time, respectively. Despite its effect on the entire process of fresh fracture repair, the effect of the SAFHS on the individual stages and processes involved has not been established. This paper reviews these stages and processes, and discusses the clinical and practical implications of the effect of the SAFHS on fracture repair and the need for further research into this modality.

Animals↗

PubMed2000

Does childhood and adolescence provide a unique opportunity for exercise to strengthen the skeleton?

Osteoporosis is a major, and increasing, public health problem. In this review we examine the evidence that childhood physical activity is an important determinant of bone mineral in adult years, and as such, may help to prevent osteoporosis. Animal studies provide incontrovertible evidence that growing bone has a greater capacity to add new bone to the skeleton than does adult bone. Observational studies in children undertaking routine physical activity and cross-sectional athlete studies in young sportspeople both reveal that activity is positively associated with bone mineral density (BMD). Longitudinal studies in pre- and peripubertal gymnasts reveal BMD gains far in excess of those that can be achieved in adulthood. However, such studies permit only limited conclusions as they contain the potential for selection bias and can be confounded by other determinants of bone mineral (e.g. dietary and lifestyle factors). Thus, research comparing inter-individual playing-to-nonplaying arm differences in bone mineral (e.g., in racquet sports) have proven to be extremely useful. These studies suggest that the BMD differences are clearly greater when bone is subjected to mechanical loading prior to the end of puberty and longitudinal growth of the body (in women, before menarche) rather than after it. Tanner stage II and III appears to be the maturational stage when the association between exercise and BMD becomes manifest in most adolescents. Do conclusions drawn from athlete studies apply to the general population? Randomised intervention studies of physical activity and bone mineral accrual in normal children confirm that childhood activity is strongly associated with bone mineral accrual. Furthermore, some retired athlete studies and a detraining study suggest that adolescent bone gain may, at least partly, persist despite reduced adult physical activity. Mechanisms that may underlie the association between childhood physical activity and bone mineral accrual are outlined. Thus, it appears that physical activity during the most active period of maturity (with respect to longitudinal growth of the body) plays a vital role in optimising peak bone mass and that benefits may extend into adulthood.

Adult↗

PubMed2000

Patellar taping: is clinical success supported by scientific evidence?

Patellofemoral pain syndrome (PFPS) is a common condition presenting to physiotherapy and sports medicine practices. Despite its prevalence, the aetiology, pathogenesis, and recommended treatment remain unclear. One component of treatment for PFPS that has been subjected to scrutiny is patellar taping. This taping was designed to realign the patella within the femoral trochlea, thus reducing pain from PFPS and improving both quadriceps and patellofemoral joint function. Clinical and research findings confirm that the pain associated with PFPS is significantly reduced with patellar taping. Therefore, research has aimed at determining the mechanisms of this pain relief. The means by which patellar tape can relieve pain may provide insight into the aetiology and risk factors for PFPS, thus allowing more appropriately designed treatment regimes and preventative strategies. There is evidence to suggest that patellar tape improves patella alignment (measured radiographically) and quadriceps function (torque production and extensor moments). Evidence that patellar tape enhances the activation of individual vastii (magnitude or timing) is limited in quality and quantity, which probably reflects the difficulties inherent in measuring this complex question. There is preliminary evidence for improved knee control during gait in association with patellar tape. This paper critically reviews the studies that have examined the effects of patellar taping and makes informed recommendations for further research and clinical practice.

Arthralgia↗

PubMed2000

A technique for restraining rodents during hindlimb interventions.

Recently interest has grown in the skeletal effects of external electrophysical modalities. To introduce these modalities into the rodent hindlimb, restraining the animals is often necessary. This report describes a novel restraint device that was highly successful when used on 10 Sprague-Dawley rats for 20 min daily for 6 days each week over a period of 12 weeks. The restrained animals gained less weight than did 10 cage control animals, suggesting that animals experienced stress. However, this weight loss was significant (p < 0.05) only during the first six weeks, suggesting a degree of acclimatization. Restraint had no observable effect on measures of bone mineral content of the hindlimb. The restraint device we developed restrained animals without the need for anesthetics, enabling our device to be used in future studies investigating the skeletal effect of external electrophysical modalities on the rodent hindlimb.

Animal Husbandry↗

PubMed1999

The coordinated movement of the lumbo-pelvic-hip complex during running: a literature review.

The purpose of this review article is to summarise the literature to date regarding the movement of the lumbar spine, pelvis and hips during running gait. Both two-dimensional and three-dimensional studies are analysed to illustrate the apparent coordination in the angular kinematics of each of these segments during running. Knowledge of this coordination is essential in order to facilitate the successful rehabilitation of running injuries to the back, pelvis, hip and thigh.

Back Injuries↗

PubMed1999

Ground reaction forces, bone characteristics, and tibial stress fracture in male runners.

PURPOSE: Tibial stress fracture is a common overuse running injury resulting from repetitive mechanical loading. This research project aimed to determine whether runners with a history of tibial stress fracture (TSF) differ in tibial bone geometry, tibial bone mass, and ground reaction force (GRF) parameters during running from those who have never sustained a stress fracture (NSF). METHODS: Forty-six male running athletes (23 TSF; 23 NSF) ranging in age from 18 to 42 yr were recruited for this cross-sectional study. A force platform was used to measure selected GRF parameters (peak and time to peak for vertical impact force, vertical active force, and horizontal braking force) during running at 4.0 m x s(-1). Tibial bone geometry (cross-sectional dimensions and area) was calculated from a computerized tomography (CT) scan at the junction of the middle and distal thirds. Dual energy x-ray absorptiometry (DXA) provided measurements of tibial bone area, bone mineral content (BMC), and bone mineral density (BMD). RESULTS: The TSF group had significantly smaller tibial cross-sectional area (P = 0.02) and DXA tibial bone area (P = 0.02), after adjusting for height and weight, than the NSF group. There were no significant differences between groups for GRF, tibial BMC, or tibial BMD. CONCLUSION: These findings support the contention that bone geometry plays a role in stress fracture development and that male athletes with smaller bones in relation to body size are at greater risk for this bony injury.

Absorptiometry, Photon↗

PubMed1999

Comparison of Abshaper and conventionally performed abdominal exercises using surface electromyography.

PURPOSE: Many commercially available pieces of abdominal exercise equipment have been introduced to facilitate endurance training of the abdominal musculature. One of the latest devices is the Abshaper. The aim of this study was to investigate whether there is any difference between abdominal exercises performed while using the Abshaper compared with those performed conventionally. METHODS: Using surface electromyography (EMG), the upper and lower regions of rectus abdominis (RA), the external oblique (EO), and sternocleidomastoid (SCM) muscles of 22 first-year physical therapy students were assessed. Each participant performed five straight trunk curls and five side trunk curls both with the Abshaper and conventionally. To test for differences in relative peak and mean EMG activity between the two modes of exercise execution, paired t-tests (alpha = 0.05) were performed. Differences in the average time percentile at which peak EMG activity occurred were assessed by repeated measures ANOVA (alpha = 0.05). RESULTS: Exercises performed while using the Abshaper resulted in significantly greater relative peak and mean EMG activity within the upper portion of RA. For both the lower portion of RA and the EO muscles, no differences were found between the two modes of exercise execution. For SCM, Abshaper exercises resulted in significantly lower relative peak and mean EMG activity. In respect to the timing of peak EMG activity, no difference was found between the two modes of exercise execution for either the upper portion of RA, the EO, or SCM muscles. For lower RA, peak EMG activity occurred significantly earlier during conventional abdominal exercises in comparison with those performed while using the Abshaper. CONCLUSIONS: The Abshaper has a role in exercising the abdominal musculature.

Abdominal Muscles↗

PubMed1998

Self-reported ballet classes undertaken at age 10-12 years and hip bone mineral density in later life.

The major effect of weightbearing exercise on adult bone mass may be exerted during childhood. We examined the relationship between reported hours of ballet classes per week undertaken as a child and adult bone mineral density (BMD) at the hip, spine, and forearm. We performed a retrospective cohort study in 99 female retired dancers (mean age 51 years, SD 14 years) and 99 normal controls, derived from a twin study, matched hierarchically for age, height, weight and menopausal status. Starting age of ballet was recalled and weekly hours of ballet as a child was self-reported on two occasions. BMD was measured using dualenergy X-ray absorptiometry and reported as a Z-score. Self-reported hours of ballet class undertaken per week at each age between 10 and 12 years was positively associated with a difference in BMD between dancers and controls at both the femoral neck site (beta = 0.73, p = 0.001) and the total hip site (beta = 0.55, p < 0.01). These associations were unaffected by adjustment for covariates including measures of adult activity (current physical activity, years of fulltime ballet), measures of menstrual disturbance (age of menarche, history of irregular menses), dietary history (calcium intake as a child, adolescent or adult) or lifestyle factors (lifetime smoking, lifetime alcohol). Although starting age of ballet was negatively associated with weight-adjusted within-pair hip BMD difference, it was no longer associated after adjustment for weekly hours of ballet. There was no relationship between hours of ballet undertaken as a child and differences in BMD at the lumbar spine or upper limb, at any age. Our data suggest that classical ballet classes undertaken between the ages of 10 and 12 years are independently and positively associated with a difference in hip BMD between dancers and controls. The findings are consistent with the hypothesis that this age range identifies a stage of development when the proximal femur is particularly responsive to weightbearing exercise.

Adolescent↗

PubMed1998

A 12-month prospective study of the relationship between stress fractures and bone turnover in athletes.

Bone remodeling may be involved in the pathogenesis of stress fractures in athletes. We conducted a 12-month prospective study to evaluate bone turnover in 46 female and 49 male track and field athletes aged 17-26 years (mean age 20.3; SD 2.0) 20 of whom developed a stress fracture. Baseline levels of bone turnover were evaluated in all athletes and monthly bone turnover levels were evaluated in a subset consisting of the 20 athletes who sustained a stress fracture and a matched comparison group who did not sustain a stress fracture. Bone formation was assessed using serum osteocalcin (OC) measured by human immunoradiometric assay and bone resorption by urinary excretion of pyridinium cross-links (Pyr and D-Pyr); high performance liquid chromatography and N-telopeptides of type 1 collagen (NTx) using ELISA assay. Athletes who developed stress fractures had similar baseline levels of bone turnover compared with their nonstress fracture counterparts (P > 0.10). Results of serial measurements showed no differences in average levels of Pyr, D-Pyr, or OC in those who developed stress fractures (P = 0.10) compared with the control group. In the athletes with stress fractures, there was also no difference in bone turnover levels prior to or following the onset of bony pain. Our results show that single and multiple measurements of bone turnover are not clinically useful in predicting the likelihood of stress fractures in athletes. Furthermore, there were no consistent temporal changes in bone turnover associated with stress fracture development. However, our results do not negate the possible pathogenetic role of local changes in bone remodeling at stress fracture sites, given the high biological variability of bone turnover markers and the fact that levels of bone turnover reflect the integration of all bone remodeling throughout the skeleton.

Adolescent↗

PubMed1998

Acute and subacute changes in the ultrasound measurements of the calcaneus following intense exercise.

The amount of exercise necessary to cause bone structural change in humans is unknown. We examined whether a single bout of intense exercise in vivo leads to acute and subacute changes in the physical properties of bone as measured by ultrasound. It was hypothesized that structural changes such as accumulation of fatigue microdamage would result in a decrease in velocity of sound (VOS) and broadband ultrasound attenuation (BUA) across the calcaneus. We performed a prospective cohort study in 111 (97 M, 14 F) entrants of the 1996 Melbourne marathon (42.3 km) and 28 (10 M, 18 F) nonrunning controls. Runners had a mean (SD) age of 45.3 +/- 11.4 years (range 20-75), had completed 15.2 +/- 17.3 prior marathons (0-88), and had been running regularly for 14.2 +/- 9.2 years (0.25-50). An ultrasound densitometer (Cuba Clinical, McCue) was used to measure VOS and BUA across the right calcaneus. Runners were tested on three occasions: 1-3 days prior to, immediately after (<2 hours), and 5-6 days following the marathon. Seventy-three (66%) runners presented for all three measurements. Controls were tested on three occasions with the same time intervals as the runners. BUA values in the runners were significantly elevated by 5.0% immediately after the marathon but returned to baseline levels by the third test session (P = 0. 0001). Changes in BUA values in the controls were not significant and all were less than 0.7% (P = 0.88). Age was a significant independent predictor of the BUA change between test 1 and test 2 in the runners (beta = 0.2094; SE = 0.0917; P = 0.03). VOS measurements were not significantly different across the three testing sessions in both the runners (P = 0.07) and the controls (P = 0.33). Therefore, ultrasound measurements of BUA and VOS did not detect evidence of lasting structural change in the calcaneus following a marathon.

Adult↗

PubMed1997

Epidemiology and site specificity of stress fractures.

Clinically, stress fractures appear to be a common overuse injury among athletes and in military recruits undertaking basic training; however, there is a lack of sound epidemiologic studies describing stress fracture occurrence in athletes. Few have directly compared stress fracture rates between sports to establish which poses the greatest risk for this injury. Furthermore, incidence rates, expressed in terms of exposure, have rarely been reported for stress fractures in athletes. Nevertheless, available data suggest that runners and ballet dancers are at relatively high risk for stress fractures. Although a gender difference in rates is clearly evident in military populations, this is less apparent in athletes. Other participant characteristics, such as age and race, may also influence stress fracture risk. The most common site of stress fracture in athletes is the tibia, although the site reflects the nature of the load applied to the skeleton. Stress fracture morbidity, expressed as the time until return to sport or activity, varies depending on the site. Generally, a period of 6 to 8 weeks is needed for healing; however, stress fractures at certain sites, such as the navicular and anterior tibial cortex, are often associated with protracted recovery and, in some cases, termination of sporting pursuits.

Adolescent↗

PubMed1997

Bone mass and bone turnover in power athletes, endurance athletes, and controls: a 12-month longitudinal study.

Strain magnitude may be more important than the number of loading cycles in controlling bone adaptation to loading. To test this hypothesis, we performed a 12 month longitudinal cohort study comparing bone mass and bone turnover in elite and subelite track and field athletes and less active controls. The cohort comprised 50 power athletes (sprinters, jumpers, hurdlers, multievent athletes; 23 women, 27 men), 61 endurance athletes (middle-distance runners, distance runners; 30 women, 31 men), and 55 nonathlete controls (28 women, 27 men) aged 17-26 years. Total bone mineral content (BMC), regional bone mineral density (BMD), and soft tissue composition were measured by dual-energy X-ray absorptiometry. Bone turnover was assessed by serum osteocalcin (human immunoradiometric assay) indicative of bone formation, and urinary pyridinium crosslinks (high-performance liquid chromatography) indicative of bone resorption. Questionnaires quantified menstrual, dietary and physical activity characteristics. Baseline results showed that power athletes had higher regional BMD at lower limb, lumbar spine, and upper limb sites compared with controls (p < 0.05). Endurance athletes had higher BMD than controls in lower limb sites only (p < 0.05). Maximal differences in BMD between athletes and controls were noted at sites loaded by exercise. Male and female power athletes had greater bone density at the lumbar spine than endurance athletes. Over the 12 months, both athletes and controls showed modest but significant increases in total body BMC and femur BMD (p < 0.001). Changes in bone density were independent of exercise status except at the lumbar spine. At this site, power athletes gained significantly more bone density than the other groups. Levels of bone formation were not elevated in athletes and levels of bone turnover were not predictive of subsequent changes in bone mass. Our results provide further support for the concept that bone response to mechanical loading depends upon the bone site and the mode of exercise.

Adolescent↗

PubMed1997

Skeletal effects of menstrual disturbances in athletes.

This article reviews the skeletal effects and clinical implications of menstrual disturbances in active women. At the lumbar spine, menstrual disturbances are associated with premature bone loss or failure to reach peak bone mass, while appendicular sites are less affected. This suggests that trabecular bone is more sensitive to hormonal stimuli and less responsive to mechanical loading than cortical bone. Although the mechanisms responsible for the detrimental effects of menstrual disturbances are likely to be multifactorial, low circulating levels of oestrogen are thought to be the main cause. The clinical significance of menstrual disturbances depends upon a number of factors, including type of sport, genetic background, body composition and calcium intake. Not all athletes who present with menstrual disturbances will develop osteopenia. Nevertheless, the risk of stress fracture does seem to be increased in athletes with menstrual disturbances and with lower bone density. Whether athletes with menstrual disturbances are at a greater risk for osteoporosis in later life is not yet known. Bone loss can be at least partially reversed, especially with the spontaneous resumption of menses. This may serve to offset any previous increased risk of osteoporosis. Furthermore, other factors, apart from low bone mass, act to determine the likelihood of osteoporotic fractures. Therefore, the clinical significance of menstrual disturbances associated with exercise participation needs to be established for each individual athlete. Bone densitometry may guide the clinician in this respect and assist in the formulation of appropriate management strategies.

Bone Density↗

PubMed1996

Retired elite female ballet dancers and nonathletic controls have similar bone mineral density at weightbearing sites.

Elite female ballet dancers exhibit several risk factors for osteoporosis during their performing years. To study the long-term effect of this lifestyle, we compared the bone mineral density (BMD) of 101 retired elite female ballet dancers (mean age 51 years, SD = 14 years) and 101 normal controls, derived from a twin study, matched hierarchically for age, height, weight, and menopausal status. The dancers, who had been retired for a mean of 25.6 years (range 1-53 years) reported a greater prevalence of previous menstrual disturbance, greater lifetime alcohol intake and smoking, and a lower dietary milk intake in adolescence than controls (all p < 0.05). However, current exercise in the dancers was twice that of the controls (p < 0.01). The BMD of retired dancers did not differ from that of the controls at weightbearing sites. The mean +/- SE difference in BMD (dancers minus controls) was 0.009 +/- 0.013 at the total body, -0.009 +/- 0.018 at the total hip, 0.005 +/- 0.017 at the femoral neck, 0.014 +/- 0.018 at the femoral trochanter, 0.036 +/- 0.022 at the femoral intertrochanter and -0.017 +/- 0.021 at the lumbar spine. Retired dancers had lower mean (+/- SE) BMD at the nonweightbearing sites: ultradistal radius (-0.029 +/- 0.008) (p < 0.01) and at the midthird radius (-0.019 +/- 0.011) (p < 0.05). There was no difference in the proportion in each of the World Health Organization (WHO) categories of osteopenia (t score -1.0 to -2.5) and osteoporosis (t score < -2.5) at any of the measured sites. Regression analysis revealed that menstrual disturbance was negatively associated with BMD at the lumbar spine and the ultradistal radial sites, but not at the weightbearing femoral sites. This sample of retired elite ballet dancers who had multiple historical risk factors does not appear to have an increased risk for future hip or vertebral fracture based on WHO standards.

Absorptiometry, Photon↗

PubMed1996

Models for the pathogenesis of stress fractures in athletes.

It would seem that the development of a stress fracture results from unsuccessful adaptation of bone to a change in its mechanical environment caused by repetitive loading. It involves the physiological processes of microdamage production and remodelling. Whether the initiating factor is microdamage production or activation of remodelling through direct effects of strain is unclear. The remodelling process involves both the removal of bone which has become fatigue damaged or is extraneous to the requirements of the new loading environment, and the addition of new bone in an manner that is best suited to withstand the new mechanical strain. Normally this process is well modulated and does not cause symptoms. If the amount of bone removed is not sufficient to unduly weaken bone structure and the addition of new bone occurs sufficiently rapidly to correct any weakness before failure occurs or to repair microdamage, the process will successfully lead to a bone with appropriate material strength and geometry to withstand the new strain environment. However, if there is imbalance between bone removal and replacement, together with accumulation of microdamage, signs and symptoms of a stress fracture may result. Any factors which influence bone load, bone strength, or remodelling have the potential to result in a stress fracture. Attention should be paid to the identification of these factors in an attempt to prevent this overuse injury in athletes.

Adaptation, Physiological↗