Joseph R Kardouni1,2,3, Craig J McKinnon2,3, Kathryn M Taylor2,3, Julie M Hughes2,3. 1. 1U.S. Army Forces Command, Fort Bragg, NC, 28310. 2. 2U.S. Army Research Institute of Environmental Medicine, Military Performance Division, Natick, MA 01760. 3. E-mail correspondence may be directed to the authors at the following addresses: Joseph R. Kardouni - joseph.r.kardouni.mil@mail.mil, Julie M. Hughes - julie.m.hughes17.civ@mail.mil, Craig J. McKinnon - craig.j.mckinnon.civ@mail.mil, Kathryn M. Taylor - Kathryn.m.taylor41.civ@mail.mil.
Abstract
CONTEXT: Stress fractures (SF) are injuries that can result from beginning new or higher volume physical training regimens. The pattern of clinical presentation of SF over time after individuals start a new or more demanding physical training regimen is not well defined in medical literature. OBJECTIVE: Report trends in the clinical presentation of stress fractures over the first six month of soldiers' time in the service. DESIGN: Retrospective Cohort study Setting: This study was conducted using medical encounter and personnel data from U.S. Army soldiers during the first 6 months of their career. PARTICIPANTS: U.S. Army soldiers beginning their careers from 2005-2014 (N=701,027). DATA COLLECTION AND ANALYSIS: Weekly SF numbers and incidence were calculated overall, as well as by sex, over the first 6 months of military service. RESULTS: SF diagnoses (N=14,155) increased steeply in weeks 3 and 4, with a peak in the overall incidence of SF diagnoses occurring during weeks 5-8. Although clinical incidence of stress fracture generally decreased beyond 8 weeks, incident lower extremity stress fractures continued to present for over 20 weeks. The hazard ratio (HR) for SF among women compared to men was 4.14 (95% CI = [4.01, 4.27]). CONCLUSIONS: Across the 6-month study period, women showed over 4 times greater hazard for stress fracture. The results also suggest that health care providers should be particularly vigilant for stress fractures within 3 weeks after the beginning of a new or higher intensity exercise regimen. The incidence of SF may continue to climb for several weeks. Even as stress fracture incidence declines, it should be noted that these injuries may also continue to appear clinically even several months after a change in activity or training.
CONTEXT: Stress fractures (SF) are injuries that can result from beginning new or higher volume physical training regimens. The pattern of clinical presentation of SF over time after individuals start a new or more demanding physical training regimen is not well defined in medical literature. OBJECTIVE: Report trends in the clinical presentation of stress fractures over the first six month of soldiers' time in the service. DESIGN: Retrospective Cohort study Setting: This study was conducted using medical encounter and personnel data from U.S. Army soldiers during the first 6 months of their career. PARTICIPANTS: U.S. Army soldiers beginning their careers from 2005-2014 (N=701,027). DATA COLLECTION AND ANALYSIS: Weekly SF numbers and incidence were calculated overall, as well as by sex, over the first 6 months of military service. RESULTS: SF diagnoses (N=14,155) increased steeply in weeks 3 and 4, with a peak in the overall incidence of SF diagnoses occurring during weeks 5-8. Although clinical incidence of stress fracture generally decreased beyond 8 weeks, incident lower extremity stress fractures continued to present for over 20 weeks. The hazard ratio (HR) for SF among women compared to men was 4.14 (95% CI = [4.01, 4.27]). CONCLUSIONS: Across the 6-month study period, women showed over 4 times greater hazard for stress fracture. The results also suggest that health care providers should be particularly vigilant for stress fractures within 3 weeks after the beginning of a new or higher intensity exercise regimen. The incidence of SF may continue to climb for several weeks. Even as stress fracture incidence declines, it should be noted that these injuries may also continue to appear clinically even several months after a change in activity or training.
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