Stress Fractures in Female Athletes

Stress fractures are very common to female athletes, especially runners.  They are essentially an overuse injury that worsens over time.  Bone structure, running mechanics, and the Female Athlete Triad all make women more susceptible to stress fractures than men.

What is a stress fracture?

According to the American Academy of Orthopaedic Surgeons, a stress fracture occurs “when muscles become fatigued and are unable to absorb added shock. Eventually, the fatigued muscle transfers the overload of stress to the bone causing a tiny crack called a stress fracture.”

Typically a stress fracture begins with pain that occurs toward the end of a physical activity or after the activity is through.  It can progress to a constant pain while walking or standing.  In most cases, pain can be pinpointed and there is also some local swelling or tenderness.

Return to play time is typically 12 weeks, depending on the risk classification.  If an athlete begins activity before the stress fracture is fully healed, they are at a higher risk of re-fracturing that bone.

Factors that can contribute to a stress fracture: previous stress fractures, the Female Athlete Triad and the FIIT (frequency, intensity, time, and type of physical activity).

The Female Athlete Triad

The Female Athlete Triad is made up of 3 health problems common to female athletes:

• Energy Deficiency/Eating Disorders
• Low Bone Mass/Osteoporosis
• Menstrual Irregularity/Amenorrhea

Energy deficiency is another term for “under-fueling.”  We get our energy though our diets and if your body is not getting enough nutrients, it will not be able to perform and you will feel tired and weak.  It can lead to injury, illness, menstrual changes, and changes in energy levels.

Low bone mass can be a result of many risk factors: not enough calcium and vitamin D, cigarette smoking and alcohol consumption, a sedentary lifestyle, gender, and genetic predisposition.  Osteopenia and osteoporosis are advanced cases of bone loss and can be diagnosed through dual energy x-ray absorptiometry (DXA).

Energy deficiency can also lead to menstrual irregularity.  A cessation of the menstrual cycle is termed amenorrhea.  Low body weight, hormonal imbalances, stress, eating disorders, or over-exercising can cause amenorrhea.  When periods are missed, the female body produces less estrogen, a hormone essential to building strong bones.

The Female Athlete Triad is not something to be taken lightly.  Stress fractures are just one of the potential side effects of the Female Athlete Triad.

How can stress fractures be prevented?

There is no way to completely prevent stress fractures but here are some tips to help keep those bones strong and decrease the probability of injury:

• Drink your milk!  Calcium and vitamin D are essential bone building nutrients.  They work together as vitamin D helps the body absorb calcium.  The latest guidelines recommend 1,000-1,200mg per day of calcium and 600IU per day (800IU for 70+ years old) of vitamin D.  Peak bone mass is reached in your 20s but consuming enough calcium and vitamin D can help slow down bone mass loss as you age.

• If you are just beginning an exercise program or just getting back into it, start slow.  Increase your mileage gradually to avoid injuries.  Impact and weight bearing activities help to preserve bone mass but if you get too ambitious too quickly, it can add extra stress to your body.

• It’s important to incorporate a good strength training program into your routine.  Functional training, the Burdenko Method (on land), free weights, and resistance tubing are all great ways to maintain your bone mass and gain muscle strength and endurance.  Fatigue and weakness can lead to a change in your running form, which can then lead to injuries.  Build strong bones and muscles to keep from losing your stride.

• Get screened!  The Functional Movement Screen (FMS) is a good tool to discover any physical limitations or asymmetries in different patterns of movement.  Finding these areas of weakness and working to correct them will help to help to keep you injury free. 

• Change your shoes often.  A good pair of running will typically last 300-400 miles.  Pay attention to the wear patterns on your shoes.  Over-pronators or over-supinators may go through shoes quicker than someone with a more neutral stride.  If you start to see the bottoms of your soles wear off, its time for new shoes!  Running shoes will cost you around $90-110 but new shoes are cheaper than Physical Therapy and your feet, knees, and hips will thank you in the long run!

Blog post by Jen Skiba.