Study Design: Case-control nonexperimental design. Objectives: To compare flexural wave propagation velocity (FWPV) and tibial bone mineral density (BMD) in women with and without tibial bone stress injuries (BSls). Background: Physical therapists, particularly in military and sports medicine settings, routinely diagnose and manage stress fractures or bone stress injuries. Improved methods of preparticipation quantification of tibial strength may provide markers of BSI risk and thus potentially reduce morbidity. Methods and Measures: Bone mineral density, FWPV, bone geometry, and historical variables were collected from 14 subjects diagnosed with tibial BSls and 14 age-matched controls; all 28 were undergoing military training. Results: No difference was found between groups in FWPV and tibial BMD when analyzed with t tests (post hoc power = 0.89 and 0.81, respectively). Furthermore, no difference was found in tibial length, tibial width, femoral neck BMD, and lumbar spine BMD among the groups. There were no differences between the 2 groups in smoking history, birth control pill use, and onset of menarche. Finally, sensitivity and positive likelihood ratios for FWPV (0.14 and 0.63), tibial BMD (0.0 and 0.0), and lumbar BMD (0.18 and 2.0) were low, while specificity was high (0.77, 0.93, and 0.91, respectively). Conclusion: Current bone analysis devices and methods may not be sensitive enough to detect differences in tibial material and structure; local stresses on bone may be more important in the development of BSls than the overall structural stiffness.

J Orthop Spots Phys Ther. 2001;31(2):54-69.

Key Words: bone stiffness, overuse injuries, risk factors, stress fractures

Study Design: Single-group repeated measures with 2 raters. Objectives: To determine the interrater and intrarater reliability of water volumetry and the figure of eight method on subjects with ankle joint swelling. Background: Measurements of ankle swelling are commonly performed to determine the nature and stage of injury and to monitor progress made during rehabilitation. Water volumetry and the figure of eight method are 2 techniques used to measure ankle swelling. Methods and Measures: Twenty-nine subjects with ankle swelling were measured by 2 raters with the hypothesis that both measurement techniques would be reliable. Each rater performed 3 measurements of the swollen ankle using both measurement techniques during a single test session. The order of the rater and of the measurement technique was randomized, and the raters were blinded to each other's measurements. Results: We found high interrater reliability for both the water volumetry (ICC [intraclass correlation coefficient] = 0.99) and figure of eight methods (ICC = 0.98). Additionally, intrarater reliability was high for both raters using both methods (ICCs = 0.98-0.99). Conclusions: Both methods are reliable measures of ankle swelling. The authors recommend the figure of eight method because of its ease of use, time efficiency, and cost effectiveness. However, water volumetry may be more appropriate when measuring diffuse lower-extremity swelling. Reliability of these 2 methods was established using subjects with foot or ankle pathology. Therefore, the results are applicable and generalizable to the clinical setting.

J Orthop Sports Phys Ther. 1999;29(10):609-615.

Key Words: ankle swelling, measurement, reliability