Stress Fractures in the Female Athlete
UW Health's Sports Medicine doctors in Madison, Wisconsin, treat a wide range of common athletic injuries, including stress fractures in female athletes.
About Stress Fractures
Stress fractures in female athletes can be caused by several different factors, which may be present individually or in combinations, and include training or exercise, nutrition, biomechanics and hormonal (endocrine). It is important to have a complete evaluation to determine what factors may be involved so that appropriate treatment(s) can be implemented to reduce the risk of developing stress fractures.
Sudden changes in training volume or intensity can trigger the development of stress fractures. Inadequate rest and recovery between training sessions also makes athletes more susceptible to stress fractures. The first several weeks of a sport season are a common time when athletes develop stress fractures, especially if the athlete is not well conditioned for the increased activity at the start of each season.
Proper equipment and training are important factors to reduce the risk of developing a stress fracture. It is recommended that running shoes be replaced after approximately 300 to 500 miles or if they have been used for longer than six months. Utilizing shoes that fit appropriately and support the feet is also important. Running or training on hard surfaces increases the impact forces, resulting in greater risk for developing a stress fracture. Softer surfaces like a treadmill, gravel trail or grass are recommended over cement sidewalks for running activities.
Proper nutrition is vital for athletes and allows for better training and recovery. Eating and drinking the right kinds and amounts of food and drinks reduce the risk of developing stress fractures. Many eating disorders do the opposite, leading to an increased risk of developing a stress fracture. Nutritional needs change as the frequency and intensity of activity changes during training and competition. As a result, athletes should adjust how they eat and drink over time to optimize health, performance and recovery.
Poor nutritional habits hinder the ability of bone to repair and adapt to the physical demands of exercise. Macro-nutrient needs (protein, carbohydrates and fat) and micro-nutrient needs (vitamins and minerals) should be assessed based on each athlete’s specific situation. Referral to a sports nutritionist may be appropriate and beneficial to ensure proper dietary intake.
Many biomechanical variables increase an athlete’s risk for stress fracture development, including strength, flexibility and structural alignment of the feet and legs. Specific running mechanics and overall movement patterns can be predisposing factors related to stress fractures. All of these variables are modifiable with proper identification and treatment.
Estrogen is an important hormone in the development and maintenance of bone density. Female athletes with infrequent or absent menstrual cycles are at risk to have low estrogen levels, which has a negative effect on bone health. When female athletes do not consume enough calories to fuel their physical effort (exercise and activities of daily living), energy imbalances may develop that reduce estrogen levels and ultimately cause bone injury. Female athletes with stress fractures should talk to their doctors about their menstrual cycles and their overall nutrition.
The initial treatments for stress fractures include rest and modification in activity level.
- Crutches and/or walking boots may be used to reduce weight-bearing stress during walking.
- Refraining from repetitive stress (exercise) allows the bone time to heal. A comprehensive approach to address any other factors that may have contributed to the stress fracture is beneficial and pertinent, with referral to other medical professionals as needed.
- Once the stress fractures are healed, a physical therapist or licensed athletic trainer can offer a formal plan to assist athletes with returning safely to sports/activity.