What Are The Risks For Stress fracture?

A paper just published shines new light onto what exactly may increase the risk for stress fracture in women runners, especially amongst those who have suffered a previous stress fracture.

Perceptions of risk for stress fractures: A qualitative study of female runners with and without stress fracture histories, Johnston et al, 2020,

Physical Therapy in Sport Volume 43, May 2020, Pages 143-150

The key findings seem completely intuitive, but it is nice to have these underlined. It should be noted this is a cohort qualitative study and therefore level IV evidence.

“The results of this study have implications for both prevention and treatment as women with SF reported running more, overtraining, and poorer nutrition and were less likely respond to pain. Based on what women reported, they need guidance on how to progress running safely.”


Six themes emerged; 1) Previous/Recurrent Musculoskeletal Injuries, 2) Activity Patterns and Training Regimens, 3) Nutrition, 4) Prevention and Intervention, 5) Pain, and 6) Mindset. Within these themes, between group differences are characterized by differences in knowledge and/or application of knowledge for health and wellness. Compared to women without SF, women with SF histories increased training load more quickly, had poorer nutrition, performed less cross-training, and kept running despite pain.


    Increasing training too quickly and not altering training due to pain are issues.Women with SF have mixed experiences in the medical community.Women also need education on safe return to running.Physical therapists should know risks and signs of SF, and refer as warranted.Healthcare providers must be supportive and provide time for communication of needs.



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