Running Step Rate & Risk of Bone Stress Injury | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

Running Step Rate & Risk of Bone Stress Injury

Running Step Rate & Risk of Bone Stress Injury -

Running Step Rate & Risk of Bone Stress Injury

Bone stress injuries (BSIs) are very common among collegiate cross country runners. Average recovery time n this population is 13 weeks, approximately the duration of a cross country season. Identification of risk factors for BSI is vital for developing injury prevention programs, mitigating injury risk and maintaining athlete health. Kliethermes et al. (2021), determined if running biomechanics and Bone Mineral Density (BMD) were associated with BSI occurrence in NCAA Division I cross country runners.

54 healthy collegiate cross country runners were studied over 3 consecutive seasons.

Whole body kinematics, ground reaction forces (GRFs) and BMD measures were collected during the preseason over 3 years via motion capture on an instrumented treadmill and total body densitometer scans.

All medically diagnosed BSIs up to 12months following preseason data collection were recorded.

  • BSI incidence was associated with:
  • Step rate.
  • Centre of mass vertical excursion.
  • Peak vertical GRF.
  • Vertical GRF impulse

Higher step rate was independently associated with a decreased risk of BSI. A low bone mineral density (BMD) in combination with a low step rate were most influential in prediction of BSI risk. BSI risk decreased by 5% with each one step/min increase in step rate. No other biomechanical variables were found to be associated with BSI risk.

  • Low step rate was identified as an independent risk factor for BSI,
  • These risk factors are clinically meaningful as small increases in step rate are attainable and may significantly influence BSI risk.
  • Monitoring step rate & BMD may be worthwhile as part of a comprehensive program to treat and prevent BSIs in collegiate runners.


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Kliethermes SA, Stiffler-Joachim MR, Wille CM, et al. Br J Sports Med.

Dalton Urrutia, MSc PT

Dalton is a Physical Therapist from Oregon, currently living and running the performance physiotherapy clinic he founded in London for Grapplers and Strength & Conditioning athletes. Dalton runs the popular instagram account @physicaltherapyresearch, where he posts easy summaries of current and relevant research on health, fitness, and rehab topics. 
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