Bone Stress Injury and Female Athlete Triad
John D. Goodner D.P.M. is a board-certified foot and ankle surgeon. He specializes in treating foot, ankle, and leg injuries in children, teenagers, and adults. He is trained to perform the latest minimally invasive and arthroscopic surgical techniques. Growing up locally in Broward County, he was a two-sport varsity letterman... more
The female athlete triad can occur in any sport or exercise , most commonly in sports that emphasize a lean body build. Low energy availability can be accompanied by an eating disorder, to which the resultant is amenorrhea and eventual osteoporosis leading to a higher incidence of bone stress injury. Bone stress injuries are most commonly reported in the tibia and metatarsals, likely due to the increased strain to these areas from rigorous and repetitive activities. Bone stress injury is diagnosed most accurately with MRI. The recovery for a bone stress injury can be 6 weeks to 4 months depending on severity of the injury. A prospective multisite study of exercising girls and women was conducted by Barrack et al to determine the significant risk factors for bone stress injury.
Risk factors:
- Low Bone mineral density (Z score < -1.0)
- Low Body mass index (< 21.0)
- Purposeful Exercise ( > 12h/week)
- Leanness of sport/activity
- Elevated dietary restraint
- Oligomenorrhea/amenorrhea
- Elevated exercise training
Findings:
- Female athletes that exercise more than 12 hours per week with a body mass index less than -1.0 accompanied by 3-4 of any other risk factors listed above, have a 46% chance of developing bone stress injury
- Elevated exercise training and a low body mass index are the two variables with the strongest association with bone stress injury.
- It is recommended that trainers and coaches provide their female athletes with nutritional counseling, minimum weight requirements for sport participation, psychological counseling, exercise limitations, and muscle strengthening exercise to supplement their sport specific training
Reference: M Barrack et al. Higher Incidence of Bone Stress Injuries With Increasing Female Athlete Triad Related Risk Factors. The American Journal of Sports Medicine, Vol. 42, No 4, 2014
