There have been a number of high profile athletes in the press recently who have unfortunately had to withdraw from major competitions due to stress fractures. indeed the incidence of such an injury is high amongst the athletic population. In todays modern era of Sports medicine this seems surprising, given what we know and how athletes train with scrupulous attention to detail this type of injury should have almost been eradicated shouldn’t it?
Well unfortunately, this is not the case. We still hear if athletes so close to a major championship in the best possible shape of their lives only to be taken down by such an injury that will in reality take months to heal and will in most cases wipe out a whole season.
So whats happening and what can we do about it? A stress fracture is exactly what it says on the tin, a fracture to the lining of a bone caused by repeated mechanical stress. These are very common in weight bearing receptive loading sports (Running/ Jumping). This type of injury doesn’t just occur over night though, very often I will see Athletes in the clinic with clinical findings of soft tissue stress in certain areas of the body (inside of the shin being very common in runners), that if not attended to with load management and treatment, will develop into a full on stress fracture. Repeated assessment and management of these stress responses are key indicators that something is not quite right.
But athletes are super strong human specimens so they cant get these surely? Not quite. To understand why athletes are at risk of such issues it is important to understand the bodies adaptation processes. When we train hard our body and brain receives this as a signal to get stronger, this occurs in many ways; heart chamber size increase in endurance training, muscle mass gain in strength training, and bone/ tendon/ soft tissue resilience increases following repetitive weight bearing loading (ie Running). This process of adaptation needs some key components to be addressed in order to function properly, one is adequate rest periods (and I mean REST) and the other is energy.
We often use calories to quantify a foods energy amount, and funnily enough we can also quantify training load quite accurately in terms of calories via the latest wearable technology. Now for example, lets say your body requires 1500 calories every day to just survive, this takes care of all your bodies cellular process and your general every day movements. Add to this your 500 additional calories from your daily training (and lets face it, this will often be higher) you now need 2000 calories to just survive. The problem is, if this calorie demand is not met with food (and we mean good healthy food!) then you develop an energy deficit. If this occurs, your brain has to make some “difficult decisions”. All that stuff about heart chamber size, muscle growth and bone strength from earlier, well, as important as that stuff is, they are not top of the list when we are in energy deficit. In this situation the brain takes over and starts shutting down certain bodily functions in order to survive. Two processes we commonly see disrupted in athletes is the Menstrual function in females and Bone/ soft tissue development in both males and females. This will lead to a much higher risk of stress reactions or stress fractures. It is also important to note that we develop our bone stock in our teen years, if this is not allowed to develop fully because of energy deficiencies whilst younger athletes train and compete then we risk carrying poorer bone stock later in life, this can lead to Osteoporosis (thinning of the bones) and more problems.
For some time in sport it was thought this issue was more prevalent in the female athlete population. As mentioned above the physiological effects may become more apparent to female athletes though it is important to note that the male athlete is just as susceptible to tissue and bone injury due to relative energy deficiency.
So what can we do to prevent this? Well, in my opinion we need to banish myths and improve athlete education.
Though this is still a common issue amongst athletes and one I see very regularly in clinic, I believe with simple attention to our bodies energy requirements and a holistic training problem, this type of injury is very much avoidable.