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Stress Fractures

Campbell Clinic has recently seen an increase in stress fractures in the female high school cross country runner which has raised concerns and propelled this public awareness notification to address some of the issues dealing with increased risk factors associated with stress fractures and ways to potentially prevent stress fractures from occurring.


Studies have shown that female athletes have a significantly higher overall prevalence of stress fractures than their male counterparts. This can be attributed to many factors which include:

  • Puberty: Puberty is an important time for bone mineralization. Stress fractures have been reported to occur in 49% of women runners with a history of irregular menses compared and in 29% of those with a history of regular menses.(Barrow). Peak bone mass in women is achieved by early 20’s and is a strong predictor for long-term risk of osteoporosis. (Kanis and Eastell)
  • Diet: Nutritional deficiencies contribute to decreased bone mass density (BMD). Poor caloric intake needed for the energy expended seems to be a primary factor that predisposes female athletes to menstrual dysfunctions resulting in detrimental effects to bone health.
  • Poor fitness: Training resumed after significant inactivity or injury. Sedentary lifestyle does not allow for a proper physical fit foundation to be layed in preparation for sporting activities.
  • Training errors: Increasing mileage to rapidly.
  • Biomechanical: Pronated (flat) feet, increased Q angle and fore foot varus, and leg length descrepencies can contribute to stress fractures.
  • Running gait: Running gait patterns can be affected by muscular fatigue, muscle tightness, or minor injury which could result to placing increased stress on bone structures.
  •  Training surface: Running on poor surfaces or too much hill running can lead to increase risk of str