{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:32:03Z","timestamp":1792024323421,"version":"4.4.0"},"reference-count":29,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T00:00:00Z","timestamp":1751241600000},"content-version":"unspecified","delay-in-days":90,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Joint Program Committee","award":["W811XWH-15-C-0024"],"award-info":[{"award-number":["W811XWH-15-C-0024"]}]},{"name":"Defense Health Program"},{"DOI":"10.13039\/100000005","name":"United States Department of Defense","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100000005","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100020506","name":"American Medical Society for Sports Medicine","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100020506","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["S10 RR023405"],"award-info":[{"award-number":["S10 RR023405"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Sport Exerc Med"],"accepted":{"date-parts":[[2025,6,2]]},"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Bone stress injury (BSI) is a common overuse injury in female athletes that can occur in a variety of bones, including both proximal (pelvis, sacrum, femoral neck) or distal (tibia, fibula, metatarsals) locations. Prior work has demonstrated differences in running biomechanics in those with BSI; however, this was not separated by anatomy. We hypothesised that both female athletes with distal BSI and female athletes with proximal BSI would have lower cadence, higher centre of mass (COM) and lower duty factor than those without prior BSI.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Cross-sectional study of 45 female athletes (15 with prior distal BSI, 15 with prior proximal BSI and 15 with no BSI history). Each ran on an instrumented treadmill at self-selected and 5-kilometre race speeds, with data collected in a fresh and exerted state. A series of analysis of variance tests (ANOVAs, group by condition) were used to analyse the results.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Participants with previous proximal BSI ran with greater vertical COM excursion compared with those with no previous BSI at race speed (10.2\u00b11.7\u2009cm vs 8.5\u00b10.8\u2009cm (p&lt;0.001)). The proximal BSI population had a lower cadence than the no prior BSI population at race speed (170\u00b113 steps per minute vs 180\u00b110 steps per minute (p=0.012)). Duty factor was lower in the proximal BSI group compared with the distal BSI group at the race speed (32\u00b13% vs 34\u00b13% (p=0.013)).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>COM and cadence should be further investigated for association with proximal BSI.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjsem-2025-002469","type":"journal-article","created":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T14:30:15Z","timestamp":1751293815000},"page":"e002469","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Biomechanics associated with bone stress injury in athletes differ by proximal and distal anatomical locations: a cross-sectional analysis"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7803-664X","authenticated-orcid":false,"given":"Logan W","family":"Gaudette","sequence":"first","affiliation":[{"name":"Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn E","family":"Ackerman","sequence":"additional","affiliation":[{"name":"Endocrine Unit, Mass General Hospital, Boston, Massachusetts, USA"},{"name":"Wu Tsai Female Athlete Program, Boston Children\u2019s Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary L","family":"Bouxsein","sequence":"additional","affiliation":[{"name":"Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle M","family":"Bruneau","sequence":"additional","affiliation":[{"name":"Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Roberto","family":"de Souza Junior","sequence":"additional","affiliation":[{"name":"University Centre of the Federal District, Bras\u00edlia, DF, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Garrahan","sequence":"additional","affiliation":[{"name":"Endocrine Unit, Mass General Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Gehman","sequence":"additional","affiliation":[{"name":"Endocrine Unit, Mass General Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie M","family":"Hughes","sequence":"additional","affiliation":[{"name":"United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jereme","family":"Outerleys","sequence":"additional","affiliation":[{"name":"Mechanical and Materials Engineering, Queen\u2019s University, Kingston, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard W","family":"Willy","sequence":"additional","affiliation":[{"name":"Physical Therapy and Movement Science, University of Montana, Missoula, Montana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene S","family":"Davis","sequence":"additional","affiliation":[{"name":"University of South Florida, Tampa, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8029-1466","authenticated-orcid":false,"given":"Kristin L","family":"Popp","sequence":"additional","affiliation":[{"name":"Endocrine Unit, Mass General Hospital, Boston, Massachusetts, USA"},{"name":"Physical Therapy, TRIA Orthopaedic Center, Bloomington, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam S","family":"Tenforde","sequence":"additional","affiliation":[{"name":"Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,6,30]]},"reference":[{"key":"2025083110300523000_11.2.e002469.1","doi-asserted-by":"publisher","DOI":"10.7205\/MILMED-D-10-00322"},{"key":"2025083110300523000_11.2.e002469.2","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1038\/s41572-022-00352-y","article-title":"Bone stress injuries","volume":"8","author":"Hoenig","year":"2022","journal-title":"Nat Rev Dis Primers"},{"key":"2025083110300523000_11.2.e002469.3","doi-asserted-by":"publisher","DOI":"10.4085\/1062-6050-52.8.01"},{"key":"2025083110300523000_11.2.e002469.4","doi-asserted-by":"publisher","DOI":"10.1177\/0363546514562739"},{"key":"2025083110300523000_11.2.e002469.5","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0b013e3181a984c4"},{"key":"2025083110300523000_11.2.e002469.6","doi-asserted-by":"publisher","DOI":"10.1249\/JES.0000000000000163"},{"key":"2025083110300523000_11.2.e002469.7","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2020-103833"},{"key":"2025083110300523000_11.2.e002469.8","doi-asserted-by":"crossref","first-page":"761","DOI":"10.2519\/jospt.2023.11860","article-title":"Preseason Vertical Center of Mass Displacement During Running and Bone Mineral Density Z-Score Are Risk Factors for Bone Stress Injury Risk in Collegiate Cross-country Runners","volume":"53","author":"Joachim","year":"2023","journal-title":"J Orthop Sports Phys Ther"},{"key":"2025083110300523000_11.2.e002469.9","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1177\/03635465211063909","article-title":"Spatiotemporal and Ground-Reaction Force Characteristics as Risk Factors for Running-Related Injury: A Secondary Analysis of a Randomized Trial Including 800+ Recreational Runners","volume":"50","author":"Malisoux","year":"2022","journal-title":"Am J Sports Med"},{"key":"2025083110300523000_11.2.e002469.10","doi-asserted-by":"crossref","first-page":"111136","DOI":"10.1016\/j.jbiomech.2022.111136","article-title":"A hierarchical clustering approach for examining potential risk factors for bone stress injury in runners","volume":"141","author":"Martin","year":"2022","journal-title":"J Biomech"},{"key":"2025083110300523000_11.2.e002469.11","doi-asserted-by":"crossref","DOI":"10.1177\/23259671241246227","article-title":"Factors Associated With High-Risk and Low-Risk Bone Stress Injury in Female Runners: Implications for Risk Factor Stratification and Management","volume":"12","author":"Tenforde","year":"2024","journal-title":"Orthop J Sports Med"},{"key":"2025083110300523000_11.2.e002469.12","doi-asserted-by":"publisher","DOI":"10.1249\/01.mss.0000183477.75808.92"},{"key":"2025083110300523000_11.2.e002469.13","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.1249\/MSS.0000000000002917","article-title":"Vertical Loading Rate Is Not Associated with Running Injury, Regardless of Calculation Method","volume":"54","author":"Schmida","year":"2022","journal-title":"Med Sci Sports Exerc"},{"key":"2025083110300523000_11.2.e002469.14","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1016\/j.jshs.2022.12.002","article-title":"Biomechanics associated with tibial stress fracture in runners: A systematic review and meta-analysis","volume":"12","author":"Milner","year":"2023","journal-title":"J Sport Health Sci"},{"key":"2025083110300523000_11.2.e002469.15","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2022-106328"},{"key":"2025083110300523000_11.2.e002469.16","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1007\/s00256-017-2632-7","article-title":"Stress fractures of the foot and ankle, part 2: site-specific etiology, imaging, and treatment, and differential diagnosis","volume":"46","author":"Mandell","year":"2017","journal-title":"Skeletal Radiol"},{"key":"2025083110300523000_11.2.e002469.17","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1002\/pmrj.12821","article-title":"Low energy availability surrogates associated with lower bone mineral density and bone stress injury site","volume":"14","author":"Holtzman","year":"2022","journal-title":"PM R"},{"key":"2025083110300523000_11.2.e002469.18","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1002\/pmrj.12510","article-title":"Lower Trabecular Bone Score and Spine Bone Mineral Density Are Associated With Bone Stress Injuries and Triad Risk Factors in Collegiate Athletes","volume":"13","author":"Tenforde","year":"2021","journal-title":"PM&R"},{"key":"2025083110300523000_11.2.e002469.19","doi-asserted-by":"publisher","DOI":"10.1097\/00042752-200104000-00002"},{"key":"2025083110300523000_11.2.e002469.20","doi-asserted-by":"crossref","DOI":"10.3389\/fphys.2022.899818","article-title":"Effects of running fatigue on lower extremity symmetry among amateur runners: From a biomechanical perspective","volume":"13","author":"Gao","year":"2022","journal-title":"Front Physiol"},{"key":"2025083110300523000_11.2.e002469.21","first-page":"1377","article-title":"Influence of Fatigue on the Modification of Biomechanical Parameters in Endurance Running: A Systematic Review","volume":"17","author":"Olaya-Cuartero","year":"2024","journal-title":"Int J Exerc Sci"},{"key":"2025083110300523000_11.2.e002469.22","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1016\/j.jshs.2022.02.004","article-title":"Impact loading in female runners with single and multiple bone stress injuries during fresh and exerted conditions","volume":"12","author":"Popp","year":"2023","journal-title":"J Sport Health Sci"},{"key":"2025083110300523000_11.2.e002469.23","unstructured":"Cohen J . Statistical power analysis for the behavioral sciences. Routledge Academic, 1988."},{"key":"2025083110300523000_11.2.e002469.24","doi-asserted-by":"crossref","first-page":"1837","DOI":"10.1249\/MSS.0000000000001629","article-title":"Relationships between Habitual Cadence, Footstrike, and Vertical Load Rates in Runners","volume":"50","author":"Futrell","year":"2018","journal-title":"Med Sci Sports Exerc"},{"key":"2025083110300523000_11.2.e002469.25","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1080\/02640414.2017.1321775","article-title":"Lower extremity joint loads in habitual rearfoot and mid\/forefoot strike runners with normal and shortened stride lengths","volume":"36","author":"Boyer","year":"2018","journal-title":"J Sports Sci"},{"key":"2025083110300523000_11.2.e002469.26","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.2014.5575"},{"key":"2025083110300523000_11.2.e002469.27","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.3529"},{"key":"2025083110300523000_11.2.e002469.28","doi-asserted-by":"crossref","first-page":"1842","DOI":"10.1249\/MSS.0000000000002974","article-title":"Peak Muscle and Joint Contact Forces of Running with Increased Duty Factors","volume":"54","author":"Bonnaerens","year":"2022","journal-title":"Med Sci Sports Exerc"},{"key":"2025083110300523000_11.2.e002469.29","doi-asserted-by":"crossref","DOI":"10.3390\/jcm11216497","article-title":"Clinical Application of Gait Retraining in the Injured Runner","volume":"11","author":"Gaudette","year":"2022","journal-title":"J Clin Med"}],"container-title":["BMJ Open Sport &amp; Exercise Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjsem-2025-002469","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T17:30:18Z","timestamp":1756661418000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopensem.bmj.com\/lookup\/doi\/10.1136\/bmjsem-2025-002469"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4]]},"references-count":29,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,6,30]]},"published-print":{"date-parts":[[2025,4]]}},"alternative-id":["10.1136\/bmjsem-2025-002469"],"URL":"https:\/\/doi.org\/10.1136\/bmjsem-2025-002469","relation":{},"ISSN":["2055-7647"],"issn-type":[{"value":"2055-7647","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4]]}}}