Bone stress injuries in cross-country running on athletic training services

Epidemiology of bone stress injuries and health care utilization among PAC-12 athletes across the country

[ PMC gratis artikel ][ PubMed ]Wayner RA, Brown CN, Bovbjerg VE, Fredericson M, Soucy MT, Choe S, Simon JE. J Athl train. 2023;10.4085/1062-6050-0089.23 [published online ahead of print, 2023 Jul 18].

Full text freely available

Take home message

Bone stress injuries in cross-country athletes are most common in women, are excessively stressful, and require 10 to 11 shifts of athletic trainers.

Background

The injury rate in cross country running is approximately 4 per 1000 athletic exposures. Some authors have found that bone strain injuries account for ~20% of all injuries nationwide. Patients who sustain a bone strain injury may be at up to six times greater risk for subsequent bone strain injury. Unfortunately, we know little about how common bone stress injuries occur in male and female NCAA Division I cross country athletes and what health care services they receive.

Study objectives

The authors assessed health care utilization, injury rates, and injury characteristics of bone stress injuries in NCAA Division I cross country athletes.

Methods

The authors used deidentified data from the PAC-12 Health Analytics Program injury registry. The registry included data on injuries and health care services entered by athletic trainers from July 2018 to June 2022. The authors classified bone strain injuries as injuries in the lumbar spine, pelvis, or lower extremities. For this article, they excluded cases of medial tibial stress syndrome. The authors categorized injuries into acute or chronic onset and time-loss or non-time-loss injuries. They then calculated health care utilization by counting the number of encounters with a health care provider (athletic trainer or doctor), prescriptions, procedures, or tests. The authors also assessed the time of year the injury occurred: pre-season, during-season, post-season, and off-season.

Results

The number of bone stress injuries was 0.14 per athlete season. The rate of bone stress injury in women was 58% higher than in men. Overall, 92% of bone strain injuries occurred through an overuse mechanism. More specifically, 73% of all bone stress injuries had time loss and overuse classifications. On average, a patient received 10.5 athletic training services. Patients with an overuse and time-loss injury tended to receive slightly more athletic training services than patients with an overuse and non-time-loss injury (10.9 versus 12.2).

Viewpoints

Among Division I collegiate cross country runners, bone stress injuries are common and are usually caused by overuse mechanisms, leading to lost time. These injuries required significant athletic training services, but rarely other health care services (e.g., medications, tests, procedures, surgeries). It would be interesting to see if this pattern continues in other athletic conferences. The authors recognized that the use of athletic training services among these collegiate patients was more important than the use of athletic training services among high school cross country runners. Therefore, we need to carefully apply these results to different age groups.

Clinical implications

Clinicians should promote injury prevention programs for cross country athletes that target overuse injuries, including bone stress injuries. The high demand for athletic training services for this patient population highlights the need for adequate staffing to work with collegiate Division I cross-country skiers.

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Written by Mitchell Barnhart
Reviewed by Jeffrey Driban