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Adolescent Stress Fracture Risk Factors

In our practice, we are often asked how to best prevent stress fractures – or to avoid getting another one in the future. While each person is different, and each case unique, there are some commonalities between these injuries. In fact, a recent study looked at risk factors for stress fracture or stress reaction (precursor to fracture) in adolescent athletes.(1) While we cannot extrapolate these results exactly to older adults, we can and should take the information under consideration!

Here’s what the study found:

  • Athletes with a lower body mass index (measure of weight) were more likely to have a stress injury

  • Those who slept less (approximately 45min/night) were more likely to get a stress injury

  • 58% of those with a stress reaction did not engage in weight training

  • Those athletes with higher stress levels were more likely to get injured

  • Athletes with a history of “shin splints” were more likely to get stress injury

  • Lastly, dairy intake was less with injured athletes than healthy

But what do these mean?

Lower body mass index

  • Contrary to popular belief, lighter athletes were more likely to get a stress injury. Body mass index is not the best measure for analyzing obesity or muscle mass, so we must take this with a grain of salt. However, this indicates perhaps more muscle mass or body weight may be protective against stress fracture.

Less sleep = increased risk

  • This one may seem like an obvious correlation, but perhaps not one we enact. Less sleep means less time for recovery, which can mean weaker bones. And a small amount makes a big difference! The participants in this study only differed by 45 minutes.

Weight training may be protective

  • Not a strong correlation, but one that we should listen to, regardless. With many positive benefits from strength training noted in other areas of running, every runner should be engaging in strength training.

Higher stress = stress fracture?

  • We know that having higher levels of emotional stress can impact all aspects of health, but now it appears to be counting against bone health, too.

Shin splint history?

  • “Shin splints” is a catchall term that can mean many different things, but it often indicates an inability to control ground reaction force. This may be landing more on your bones than muscles!

Got milk?

  • This study also found that athletes who drank more dairy had less incidence of stress fracture. A case for the cow?

These certainly are some interesting results! One thing to keep in mind is adolescent athletes are the more plasticthan adults, meaning they can take much more overload and stress before it turns into injury. So, if these common factors are affecting adolescents, then we can assume they would likely impact adults as well – perhaps to a greater degree!

Thanks for reading!


1. Nussbaum, E. D., Bjornaraa, J., & Gatt Jr, C. J. (2019). Identifying Factors That Contribute to Adolescent Bony Stress Injury in Secondary School Athletes: A Comparative Analysis With a Healthy Athletic Control Group. Sports health, 1941738118824293.


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