Risk Factors For Adolescent Stress Fractures

By Dev Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • A recent scientific found several characteristics associated with stress fracture risk: lower than normal body mass index, four weeks or more history of shin splints, minimal involvement in weight training, decreased amount of sleep, daily stress, and low dairy intake.
  • Further study is needed to prove cause and effect, but it’s reasonable to recommend strategies such as inclusion of resistance training, reducing monthly training load, and optimizing nutrition to reduce stress fracture risk

A stress fracture is an overuse injury that occurs when muscles become fatigued and eventually are unable to absorb the shock from a sport or fitness activity. Rather than being absorbed by the muscle, the stresses are instead transferred to the bone causing an injury to the bone itself. The bone injury is called a stress fracture.

Stress fractures in adolescent athletes are unfortunately fairly common. Here’s an interesting recently published scientific study that aims to identify risk factors for stress fractures in adolescent athletes. The authors found several characteristics associated with stress fracture risk: lower than normal body mass index, four weeks or more history of shin splints, minimal involvement in weight training, decreased amount of sleep, daily stress, and low dairy intake.

Data was collected from the National High School Stress Fracture Registry (NHSSFR), an internet-based adolescent stress fracture database. These findings were compared with a survey of 100 healthy athletic controls to identify significant differences between healthy adolescents and those with bone stress injury. Due to the design of the study, it did not identify cause and effect but instead sought to find an association between certain characteristics and stress fractures.

Taken as a whole these are interesting findings and there are a few messages that we can take away from the data.

First, a lower than normal body mass index may be a sign of reduced energy availability, similar to what takes place in the female athlete triad. While there are plenty of athletes with lower than normal body mass index who will never develop a stress fracture it is still reasonable and plausible to make an association between low body max index and less than optimal nutritional health.

Inclusion of resistance training exercises in any athlete’s training regimen should be beneficial. Resistance training improves muscle strength, power, and tendon resiliency, all of which will help to reduce stress on the bone.

Lower than normal dairy intake may have an effect on calcium intake, vitamin D metabolism, and also have a negative effect on bone health. This would also contribute to stress fracture risk.

I’m not sure what to make of the association with increased daily stress and reduced amounts of sleep. Connecting the dots between those aspects of health and development of a bone stress injury would be speculative.

This study aims to find factors associated with bone stress injury in adolescents and is commendable for being one of the first studies to do so. Further research is needed to prove cause and effect.

We come back to many of the principles that I’ve written about previously: young athletes should participate in multiple sports and cross train to the extent possible. Try to limit single sport participation to eight months or less out of the year. Do resistance training exercises, and optimize nutritional intake.

Related Content:

Categories: NutritionOveruseRunningSports Science
Concepts: 

Share this:

About Knee Cartilage

Your knee is under a lot of pressure, so it’s no wonder that just one false move can result in injury to the ligaments and cartilage in the joint. Cartilage is the surface on the ends of the bones in your knee that allow the joint’s surfaces to glide friction-free.

Symptoms of knee cartilage injuries include pain, swelling, popping in the joint and locking of the joint. Daily activities such as sitting down, standing up, or walking up stairs may become difficult. Fortunately, there are a variety of treatment options available to help alleviate your symptoms.

Causes of Cartilage Injuries

Knee cartilage may be injured through activity, trauma, or a disease such as osteochondritis dessicans that affects the bone beneath the cartilage and causes the overlaying cartilage to “blister.” These types of injuries are called focal defects because they usually affect a portion of the cartilage in that joint.

Types of Knee Cartilage Injuries

These injuries are caused by short, intensive, non-physiological strain on the joint and as a result, pieces of cartilage become detached from the joint surface. The depth of these lesions can vary, and not everyone affected complains of pain, although the cartilage is already damaged. This condition often affects young, active people who can subject their joints to non-physiological strain either during sport or in normal daily activity.

Osteochondritis Dessicans is the name of a bone disease that occurs most frequently in youths and young adults. When individual areas of the bone are affected, the cartilage covering these areas can also become diseased. This results in the affected section of cartilage becoming detached and forming a free body within the joint, leaving a lesion that reaches down into the bone. Left untreated, this may lead to longer term degenerative cartilage defects. These defects differ from focal defects in that they usually affect all of the cartilage in the joint.

Osteoarthritis is a degenerative cartilage defect that develops from wear and tear of the cartilage surface as part of the aging process. The cartilage surface gradually becomes rough and is then slowly worn away over a long period of time, until finally bone is rubbing against bone. At this point, the treatment usually involves replacing the joint with an artificial knee. Discover more information about knee replacement.

Why Cartilage Doesn’t Heal Itself

If you cut your finger, the wound heals within a few days or weeks as the skin can regenerate itself. It is different in the case of cartilage. The hyaline cartilage in a healthy knee joint is the most common type of cartilage in the body and is specially designed for absorbing shock and providing a friction-free surface. It is a tissue which contains a small number of cartilage cells (chondrocytes) by volume. These are responsible for the formation of cartilage tissue.

As in contrast to many other tissues in the body, cartilage is not supplied by blood vessels or nerves, which means that following an injury or disease-related changes, it only has a small capacity to heal itself. In the long term, the resulting repair tissue cannot withstand the stress placed on it as it does not possess the low-friction surface, and impact and pressure absorption of healthy joint cartilage. Even though cartilage may be unable to heal quickly and may have long lasting damage, there are many forms of treatment available for cartilage regeneration and symptom relief.

Find a Clinical Trial Site Near You >

Share this:

Understanding Allograft Cartilage Transplants

Play Video

Articular cartilage is a firm rubbery tissue that covers the ends of bones. It provides a smooth gliding surface for joints and acts as a cushion between bones.Cartilage can break down due to overuse or injury. This can lead to pain and swelling and problems with your joint.

Your treatment will depend on the size of the defect and the judgment of your surgeon. This procedure is performed on people who have a specific cartilage defect typically due to an injury. It is not done when cartilage loss is much more extensive.

A plug of allograft tissue containing bone and cartilage is shaped to fit into the area that is damaged. The damaged area is prepared and the new plug is inserted into the site.

Download Brochure

JRF Ortho specializes in providing orthopedic surgeons with the highest viability, most widely available cartilage solutions in the industry. Our goal is to provide innovative solutions for allograft joint repair to orthopedic surgeons who specialize in helping patients regain movement and improve their quality of life; thus, JRF Ortho is redefining the standard for allograft joint repair and maximizing the gift of donation.

Share this:

Strengthen Your Immune System with MCTs

There’s no way around it—germs surround us all the time.  Singular medium-chain triglyceride (MCT) oil contains medium-chain fatty acids (MCFAs) that act as natural antibiotics, which means they boost your immune system and fight off harmful bacteria, viruses, fungi, and protozoa. While completely harmless to our bodies, MCFAs are lethal to some of the most notorious disease-inducing microorganisms in existence. 

They Don’t Stand a Chance

MCFAs may help protect you against:
  • Viruses: influenza, measles, mononucleosis
  • Bacteria: throat infections, pneumonia, earaches, rheumatic fever
  • Fungi, Yeast, and Parasites: ringworm, candida, thrush, giardiasis

Silent Assassins

Due to its chemical structure, MCFAs are drawn to and easily absorbed into most bacteria and viruses. MCFAs enter the lipid membrane and weaken it to the point that it eventually breaks open, expelling the microorganism’s insides and causing imminent death. White blood cells then quickly dispose of the terminated invader’s remains.

Super Fatty Acids

With 8 grams of caprylic acid and 6 grams of capric acid per serving, MCT Oil harbors antimicrobial capabilities, while also being free from any undesirable or unsafe side effects.

  • Capric Acid: one of the two most active antimicrobial fatty acids
  • Caprylic Acid: a potent natural yeast-fighting substance

Research continues to prove MCFAs as one of the best internal antimicrobial substances available without a doctor’s prescription.

MCT Lean MCT Oil 

Add MCT Lean MCT Oil to your daily health regimen to help fight off illness during any time of the year! One of my favorite sources of MCFAs is MCT Lean MCT Oil.  It is rapidly absorbed, easy to digest, and quickly converted to energy to maximize athletic performance. You can add MCT Lean MCT Oil to any drink, smoothie, or shake and use it in place of highly processed and easily oxidized conventional vegetable oils in salad dressings and sauces.
Share this: