Article 1: Tenforde AS, Carlson JL, Chang A, Sainani KL, Shultz R, Kim JH, et al. Association of the Female Athlete Triad Risk Assessment Stratification to the Development of Bone Stress Injuries in Collegiate Athletes. American Journal of Sports Medicine. 2016;1–9.
29% collegiate athletes (NCAA) identified as moderate or high risk of having female athlete triad (higher in sports emphasizing leanness)
Higher risk categories had ↑ risk of sustaining a subsequent bone stress injury
Cumulative risk score may help identify athletes at increased risk for BSIs
Stress fracture treatment
Protection/Activity modifications depends on risk of non-union or fracture propagation
Low risk of complications: MT2-4 shafts, posteromedial tibial shaft
High risk: Anterior cortex tibia, patella, femoral head, superior side femoral neck, medial malleolus, talus, navicular, proximal MT4-5, base MT2, great toe sesamoids, pars
Address energy balance issues now
Vit D, calcium
Pulsed ultrasound bone stimulator
Evidence for bone stimulators in acute fractures may not be relevant in stress fractures because acute fractures heal with endochondral ossification vs stress fractures with intramembranous bone healing
Article # 2: Beck BR, Matheson GO, Bergman G, Norling T, Fredericson M, Hoffman AR, et al. Do Capacitively Coupled Electric Fields Accelerate Tibial Stress Fracture Healing?: A Randomized Controlled Trial. Am J Sports Med. 2008;36(3):545–53.
Electrical bone stimulator did not accelerate tibial stress fracture healing in primary between group comparisons
Some evidence in decreased time to healing for:
High compliance with stimulator
High rest compliance
Stimulator for more severe injuries (not statistically significant)
Author: Dr. Jacquelyn Corkum (Feb 7, 2017 PR ND)
Brukner, P. and Khan, K. (2012). Clinical Sports Medicine.
De Souza MJ, Nattiv A, Joy E, Misra M, Williams NI, Mallinson RJ, et al. 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad: 1st International Conference Held in San Francisco, CA, May 2012, and 2nd International Conference Held in Indianapolis, IN, May 2013. Clin J Sport Med. 2014;24(2):96–119
Mountjoy M, Sundgot-Borgen J, Burke L, Carter S, Constantini N, Lebrun C, et al. The IOC consensus statement: beyond the Female Athlete Triad–Relative Energy Deficiency in Sport (RED-S). Br J Sports Med. 2014;48(7):491–7.