Lower step rate is associated with a higher risk of bone stress injury: a prospective study of collegiate cross country runners

Review written by Tom Goom info

Key Points

  1. 54 collegiate cross country runners were included in this prospective study.
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Bone stress injuries (BSI) present a triple threat for clinicians – they’re challenging to diagnose, difficult to treat, and have a tendency to recur. Identifying modifiable risk factors for these injuries could be hugely beneficial in reducing their prevalence and impact.

Multiple factors are thought to be involved in BSI development including training load, diet and energy availability, previous BSI, body mass index, stress, and sleep (1). This study aimed to determine if running biomechanics and bone mineral density were associated with BSI in collegiate cross country runners.

Multiple factors are thought to be involved in bone stress injury development.
A lower step rate is often seen in combination with ‘over-striding’, which is thought to increase load on a number of tissues including the tibia, knee and hip.


This prospective study included 54 healthy cross country runners (33 female, 21 male) who were followed over 3 consecutive seasons. Data was collected in the annual pre-season period, and all medically diagnosed BSIs up to 12 months following data collection

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