Kliethermes et al. 2021, Lower step rate and bone stress injury in collegiate runners

Prospective study of 54 NCAA Division I cross-country runners across three seasons (91 athlete-years), in British Journal of Sports Medicine. Each 1 step/min increase in step rate was associated with about 5% lower risk of a bone stress injury (HR 0.95, 95% CI 0.91–0.98; p = 0.008), adjusted for sex and prior bone-stress-injury history — lower step rate meant higher risk. A homogeneous group; observational, so association rather than proven cause.