Stress Fractures in Women and How to Treat Them

This is part three of Common Injuries in Female Athletes and How to Treat Them: Stress Fractures

Q. What are stress fractures?

During movement, muscles pull on your bones to move them. When exercising, those pulls become more frequent and contain more force. If the body cannot keep up with the exercise routine, an overuse injury like stress fractures may occur. Stress fractures are often seen in the lower leg and foot bones.

Q. What is the most frequent cause of stress fractures?

There are several factors that may predispose an athlete to develop overuse injuries, the most common factor being nutrition. An imbalance of nutrition, especially insufficient caloric intake, can weaken bones and increase the risk of stress fractures. Insufficient caloric intake can also affect hormone balance, which is also associated with compromised bone health. Running or activity on hard surfaces can increase the amount of force on the lower leg and foot. Changing to a softer surface, like grass, can make a big difference in the impact take to the leg.

Q. Are women more predisposed to stress fracture?

There are several factors that make women more susceptible to stress fractures. Women generally have lower bone density than men, which can make bones more susceptible to stress fractures. A lower bone density, combined with an imbalanced diet, increases the chances of having a stress fracture and increases healing time if a stress fracture occurs.

Q. What is the best treatment for stress fractures?

Proper nutrition counseling and a balanced healthy diet is essential for healing a stress fracture. This includes sufficient protein intake, as well as vitamins and minerals. Eating these nutrients directly from the original plant or animal source is always ideal.

As the stress fracture heals, a gradual return to activity under the guidance of a healthcare professional is allowed if and when pain resolves. Rest and avoidance of activities causing stress on the affected area is crucial for healing. In some cases, a brace, cast, or crutches may also be recommended.

Q: When should a female athlete seek care for her stress fracture?

Seeing a primary care physician with a specialty in sports medicine is a good idea if an injury does not improve within 1-2 weeks with standard treatment such as R.I.C.E. If the athlete has pain with weight bearing or if there is swelling in their joints that does not resolve in 5 days, they should see their doctor and have imaging ordered. Athletic trainers or physical therapists can be incredibly helpful in guiding athletes when to see an orthopedic surgeon. For non-operative care such as concussion monitoring or ankle sprain management, a primary care physician or an athletic trainer can provide guidance and monitor for safe return to sports.

Q: What are some exercises or preventative measures athletes should incorporate into their regimen to avoid injury?

Everyone, not just athletes, can benefit from a regimen of strengthening and stretching exercises to keep their muscles balanced, strong, and flexible to protect from injuries. Yoga, pilates, and physical therapy exercises are excellent to direct these preventative measures. Strengthening core muscle groups such as hip abductors, core/abdominal muscles, quadriceps (specifically the inner quad, VMO), and muscles supporting the ankle will improve the athlete’s overall stability and significantly protect against injuries. Flexibility in your hips and lower back is also important.

About the author:

Myra Trivellas, MD is an orthopedic sports medicine surgeon with Hoag Orthopedic Institute. She played Division 1 lacrosse during her undergraduate education and continued her involvement in sports throughout medical school and residency. Her education, experience and research on female athletes and injuries gives her an in-depth perspective on how to treat sports injuries that we are excited to share with you.