Biomechanical associations with bone stress injuries in running: A scoping review

The purpose of this scoping review is to evaluate biomechanical variables associated with bone stress injuries (BSI) in active individuals who participate in running. The goal of identifying differences in biomechanics by anatomical location of injury, gender, and/or primary physical activity is to help inform clinical management of BSI. A structured literature search initiated in September 2024 resulted in 21 studies (16 retrospective and 5 prospective) that were included in the analysis. Among retrospective studies, several biomechanical factors were found to be associated with BSI isolated to a specific anatomical site of injury (tibia: increased absolute free moment, greater peak hip adduction, and greater peak rearfoot eversion; metatarsals: lateral angle of peak horizontal braking force, reduced force under the middle forefoot, and faster time to peak rearfoot eversion; navicular: increased rearfoot eversion excursion, increased rearfoot eversion velocity, and decreased forefoot abduction excursion). In prospective studies across lower extremity anatomical locations of BSI, higher vertical ground reaction force, higher peak ankle plantarflexion moment, and spatiotemporal factors including higher vertical center of mass excursion and lower step rate were associated with developing BSI. Heterogenicity in the existing literature limits our understanding of the relationship of biomechanical variables and BSI. Inconsistent methodology, populations, and study designs limit generalizability and the ability to make definitive conclusions. This review identified candidate biomechanical factors to address in populations with BSI and highlights the need for more standardized, prospective studies with broader populations to strengthen evidence-based clinical strategies for the management and prevention of BSIs.