An Athlete's Guide to Stress Fractures

These tips can help you guard your bones and reduce stress fractures when training.

Many competitive athletes suffer from stress fractures over the course of their careers and that goes double for female athletes. But what's the deal with this all-too common injury? Why are stress fractures so common, and how can you prevent them? These tips can help you guard your bones and reduce stress fractures when training.

The Recovery Gap

When you train hard, you set off a chain reaction of bodily transformation. You tear muscle fibers, and they reknit, building size and strength. You stimulate bone growth through weight bearing and impact exercises. You alter your metabolism. And while these changes are triggered by exercise, they're ultimately completed during the recovery period.

The problem is that there just isn't sufficient recovery time between intense training sessions. Pair that with such factors as low bone density or hormonal changes in female athletes, and you've got a recipe for disaster. This is why proper nutrition, appropriate shoes and allowing for rest and recovery periods are all so important for athletes.

Trouble Spots

Stress Fracture

Not all stress fractures are created equal. In addition to having varied causes, different exercises cause different types of fractures. The most common ones occur in the legs and feet, which makes sense when you consider the type of repeat impacts these extremities are subject to in runners. Those that happen in the lower leg bones, and similar cumulative stress injuries, are so common that we even have a colloquial term for them—shin splints.

Other stress fractures fall into the category of injuries we don't think about much. That persistent back pain some athletes struggle with despite excellent core strength and posture? For some, the source is lumbar disc degeneration, but in gymnasts, divers and weightlifters, the source may actually be a stress fracture in the spine, known as spondylolysis, and can require significant rehab and even surgery.

Similarly, in long-distance runners, doctors occasionally see pelvic stress fractures. These are quite uncommon but have increased with the popularity of marathon running. They can occur at several different points along the bone and can also manifest as back pain. Additionally, teens may suffer this injury if they undertake a strenuous training practice and their pelvic growth plates have not yet closed.


Though there's no foolproof way to prevent stress fractures in serious athletes, there are several things you can do to reduce the likelihood and severity of such injuries.

First, be mindful of how your diet interacts with bone strength. In general, impact and weight bearing are good for long-term bone strength because they generate increased bone growth. For this to work, however, your body needs to have access to all the necessary vitamins and minerals. Calcium alone isn't enough. Our bodies also need vitamin D and a mineral mix including iron, zinc, potassium and others. Athletes should also avoid smoking and consuming too much caffeine, both of which can deplete mineral stores and impact bone strength.

As mentioned above, women need to be especially careful. That's because women are more prone to osteoporosis, a loss of bone density. Additionally, serious female athletes often experience variation in their menstrual cycles, which can result in hormonal imbalances and lead to a higher rate of bone loss and difficulty forming new bone. If your periods become irregular, see a doctor, increase your caloric intake, and consider slowing down your training.


Stress fractures can be especially difficult to diagnose. They're rarely visible on x-rays because of the low level of radiation, so many doctors will recommend a more expensive MRI. It's important to properly diagnose a stress fracture because they can take quite a while to heal, and confirmation of the injury can help affected athletes properly address such fractures.

After sustaining a stress fracture, most athletes need to stop training and rest the injured body part for at least 4 to 6 weeks. During this time, you can attend physical therapy and perform stretches or do yoga to maintain core strength and flexibility.

Non-athletes may view it as an overreaction, but many athletes experience grief, depression or anger while recovering from a stress fracture. This is normal; your usual outlet for stress management has been taken away, you're in pain, and you're worried about losing training momentum. Just remember: this is a bump in the road. Rest now, take care of your body, and focus on factors like flexibility, nutrition and recovery planning. You'll be back to your usual routine before you know it.