Electronic Theses and Dissertations

Date

2025

Document Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Health Studies

Committee Chair

Max Paquette

Committee Member

Kristin Popp

Committee Member

Shelby Peel

Committee Member

Stacey Meardon

Abstract

Bone stress injuries (BSIs) are a prevalent overuse injury in endurance runners, particularly at the distal tibia. These injuries develop when repetitive mechanical loading exceeds the bone’s ability to adapt and recover, leading to microdamage accumulation and, in severe cases, fracture. While both mechanical loading and physiological factors such as bone mineral density (BMD) and energy availability are thought to contribute to BSI risk, they are rarely assessed together, and most mechanical assessments remain confined to laboratory settings. The objective of this dissertation was to develop practical methods to measure tibial compressive force (TCF) outside of the lab, examine how external factors influence tibial loading in ecologically valid conditions, and explore how mechanical loading, training, and physiological factors relate to bone health in young runners. Study 1 evaluated the validity and day-to-day reliability of wearable sensor-based TCF estimation methods in 14 runners. Among five estimations, the VRF (foot IMU + force insoles), FOOT (foot IMU), and WRIST (wrist IMU) methods demonstrated moderate validity (ICC = 0.60–0.74) and excellent reliability (ICC = 0.93–0.98), supporting their utility for practical load monitoring. Study 2 examined how surface type, slope, and midsole foam thickness influence TCF during outdoor running. In 15 runners, TCF was 6.7 % greater in lower-cushion shoes compared to higher-cushion shoes, and 3.4 % greater during uphill compared to downhill running. Surface type had no effect. These findings suggest that footwear and slope influence tibial loading, whereas surface type may not. Study 3 explored relationships between mechanical loading, training behaviors, and energy availability markers with total body BMD in 14 adolescent and young adult runners. Training and physiological variables—but not TCF—were the strongest predictors of BMD. A combination of strength training history, easy run pace, and Triad Risk Assessment score explained 71.4 % of the variance in BMD. Collectively, these studies demonstrate the feasibility of wearable sensors for in-field monitoring of tibial loading and highlight that physiological and training factors may play a larger role in bone health than mechanical load magnitude alone. This framework can inform future longitudinal BSI risk monitoring and prevention strategies in runners.

Library Comment

Dissertation or thesis originally submitted to ProQuest.

Notes

Open Access

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