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Returning Female Athletes to Running Following a Tibial Bone Stress Injury

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Thesis(4.51 MB)

Date

2023

Authors

George, Esther

Supervisor

Sheerin, Kelly
Reid, Duncan

Item type

Thesis

Degree name

Master of Philosophy

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Publisher

Auckland University of Technology

Abstract

Tibial bone stress injuries (BSIs) are common in female athletes, particularly among distance runners. They have a high recurrence rate in females, and complexity emerges in the wider management and successful return to running. Following a tibial BSI, a critical component to complete rehabilitation is the successful return to running, and there is a lack of consistency or strong evidence to guide this process in female athletes. Therefore, the primary aim of this thesis was to investigate what criteria should be used prior to allowing the introduction of running, and how the process of returning female athletes to running following a tibial BSI should be navigated. Firstly, a scoping review of the literature was conducted to outline the criteria used prior to resuming running and to establish evidence-based guidelines for the return to running process following a tibial BSI in females. Forty-eight studies met the inclusion criteria. The recommendations surmised from the scoping review are based largely on level IV evidence. Five components were identified as important to address prior to introducing running, these being: 1. The resolution of bony tenderness; 2. Pain-free walking; 3. Evidence of radiological healing in high-risk BSIs; 4. Strength, functional and loading tests; 5. The identification of contributing factors. An individualised graduated return to running programme should be instigated, often starting with walk-run intervals, progressing running distance, ahead of speed and intensity, with symptom provocation a key consideration. Contributing factors to the initial injury, in particular energy availability and menstrual health, should be addressed throughout the return to run process. Secondly, ten experienced sport medicine clinicians were interviewed to establish how females with tibial BSIs are returned to running clinically, and to determine the critical components of management. Reflective thematic analysis was conducted to establish the themes and subthemes. When returning female athletes to running following a tibial BSI in a New Zealand context, their health should first be optimised, with nutritional status, and psychological and hormonal health particularly important. Symptom resolution and functional movement testing should be utilised to assess readiness to return to running. Progression of running load should be gradual, and guided by pain and physical assessment findings, as opposed to the generic 10% rule for running distance progression. Running gait retraining and modification of running surface should be individualised, but may include increasing running cadence and avoiding hard surfaces initially. In order to improve bone health, plyometric training may be a beneficial addition in the advanced stages of progression. There is a need to individualise the return to running process and utilise a multi-disciplinary management approach. There are many facets involved in the return to running process following a tibial BSI in female athletes. All components are essential to address, but the size and influence of those components will be different for every individual. This thesis combines clinical reasoning with a comprehensive evidence synthesis to guide clinicians and researchers who seek to implement and evaluate return to running guidelines following a tibial BSI in female athletes.

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http://hdl.handle.net/10292/16692

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Masters Theses