Understanding Stress Fractures:
Stress fractures are tiny cracks or breaks in bones caused by repetitive stress and overuse. They commonly occur in weight-bearing bones such as the tibia (shinbone), metatarsals (foot), or femur (thighbone). Young athletes, especially those participating in sports that involve repetitive impact, jumping or running are particularly susceptible to stress fractures due to their developing bones.
Factors Contributing to Stress Fractures:
Several factors increase the likelihood of stress fractures in young athletes:
- Overtraining: Excessive training without adequate rest and recovery is a primary risk factor for stress fractures. Encourage athletes to follow structured training programs that include rest days and gradually increase intensity.
- Poor nutrition: Inadequate intake of essential nutrients like calcium, vitamin D and protein or an energy-deficient diet can weaken bones, making them more prone to fractures. Promote a balanced diet that includes macro- and micronutrients and contains adequate calories to allow normal menstrual cycles in females.
- Low energy availability (LEA): LEA occurs when the energy intake is insufficient to meet the energy expenditure requirements. This may be particularly prevalent among sports that focus on leanness such as gymnastics, dancing and figure skating. If ongoing this can have significant negative effects on various body systems including endocrine, metabolic and skeletal systems. It can lead to menstrual disturbances in females, which in turn has a direct impact on bone health.
- Biomechanical issues: Poor running technique, improper footwear, and muscle imbalances can contribute to increased stress on bones. Regular gait analysis and appropriate footwear selection can help mitigate these risks.
Prevention Strategies:
Here are some effective strategies to prevent stress fractures in young athletes:
- Gradual progression: Encourage a gradual increase in training intensity, duration, and frequency. Implement periodisation techniques to allow for adequate rest and recovery periods.
- Cross-training: Encourage athletes to engage in a variety of sports and activities to reduce repetitive stress on specific bones. Cross-training promotes overall fitness, strength, and coordination while minimising the risk of overuse injuries. Studies have shown that playing ball sports in childhood has a six-fold protective effect against stress fractures later in life.
- Proper footwear and equipment: Ensure athletes wear appropriate footwear designed for their specific sport and foot type. Poorly fitting or worn-out shoes can contribute to abnormal stress distribution and increase the risk of stress fractures.
- Nutritional support: Emphasise the importance of a well-balanced diet to support optimal bone health. Encourage athletes to consume foods rich in calcium, vitamin D, and protein. If necessary, consult a registered dietitian to address individual nutritional needs.
- Strength and conditioning: Incorporate a comprehensive strength and conditioning program focusing on core stability, lower limb strength, and balance. Strong muscles can better absorb impact forces, reducing stress on the bones.
- Rest and recovery: Encourage athletes to prioritise rest and recovery as integral parts of their training regimen. Sufficient sleep, regular rest days, and active recovery exercises help prevent overuse injuries.
- Open communication: Foster an open dialogue between athletes, parents, coaches, and healthcare professionals. Encourage athletes to report any pain or discomfort promptly to prevent the progression of potential stress fractures. Focus on promoting a culture around strength rather than leanness.
Conclusion
Stress fracture prevention requires a multifaceted approach. Consulting with a healthcare professional such as physiotherapist will ensure young athletes are monitored appropriately and referred to a sports medicine or endocrine specialist for further investigation where necessary.
Author – 
Lisa Studach (North Curl Curl & Manly)
Lisa likes a mix of hands-on treatment and exercise prescription. She believes clients need to be able to be given and learn the tools to self-manage their conditions. She has a particular interest (and skill) in Clinical Pilates including pre- and postnatal rehabilitation as well as treating sporting injuries in both children and adults.
Click here to learn more about Lisa.