Stress fractures are mechanically induced injuries resulting from fatigue damage to bone due to repetitive loading and are common injuries occurring in runners. In this study, we used computer simulations of marathon training programs to examine the effects of endurance running on femoral density, remodeling, and microdamage accumulation. Simulated remodeling activity increased in the femoral neck and proximal cortex and predicted microdamage increased in all regions examined after 16 weeks for each program. Daily running for three years produced more microdamage than the advanced training schedule over the same time period. Areas of high remodeling and damage corresponded to clinically observed locations of femoral stress fractures, indicating that the simulation may be useful in designing training programs to reduce fracture risk.
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