Is Lifestyle a Factor for Adolescents with Bony Stress Injuries?

Identifying Factors That Contribute to Adolescent Bony Stress Injuries in Secondary School Athletes: A Comparative Analysis with a Healthy Control Group.


Nussbaum ED, Bjornaraa J, Gatt CJ. Sports Health. 2019 Jan. DOI 10.1177/1941738118824293. [Epub ahead of print]
Text Freely Available


Take Home Message: Adolescent athletes with bony stress injuries are younger, smaller, compete more, sleep less, and are more stressed than their healthy peers.


Almost half of all bony stress injuries occur in individuals under 20 years of age. Clinicians could develop targeted prevention strategies for bony stress injuries in young athletes if they had a better understanding of factors that contribute to these injuries. Therefore, the authors sought to identify factors related to bony stress injuries among adolescents competing in high school sports. Over a 2-year period, 60 athletic trainers in 11 different states working at various demographical high school settings volunteered to report data about diagnosed bony stress injuries to the National High School Stress Fracture Registry (NHSSFR). The NHSSFR defined a bony stress injury as a sports-related injury diagnosed by a physician and confirmed by appropriate imaging. The athletes with an injury, along with their athletic trainer, completed a 53-question survey through the NHSSFR online database. The survey asked about possible risk factors that may be associated with bony stress injuries. Two high schools provided 100 athletes (50 females) as healthy controls. These healthy controls had no history of athletic-related bone pain but completed the 53-question survey. Overall, 314 athletes (206 females) had 346 bony stress injuries in a variety of sports. The tibia (51%) and foot (26%) were the most commonly reported sites of injury followed by the fibula, lumbar spine, hip/pelvis, and femur, respectively. Compared to healthy controls, athletes with bony stress injuries…

• were younger
• had a lower body mass index
• reported less sleep per night
• competed in more sport seasons per year
• participated in fewer sessions of weight training per week
• had higher levels of stress
• had a history of “shin splints” 
• consumed less dairy 

More specifically, injured females were younger, had a lower body mass index, and participated in less weight training sessions per week than healthy females. Furthermore, injured males participated in less weight training sessions and reported less sleep per night than healthy males.

The authors concluded that there are several factors associated with bony stress injuries in adolescent athletes compared to healthy athletes. While there were differences between groups and sexes for body mass index, it is important to note that the body mass indexes were all in normal ranges for the respective age group. Another noteworthy observation was a majority of both groups (injured and healthy) competed at a varsity level; however, the athletes with bony stress injury were younger than the control group. Hence, younger athletes competing at a higher level of competition may be at greater risk for sustaining a bony stress injury. Additionally, athletes with a bony stress injury more frequently reported shin pain and longer lasting (>4 weeks) shin pain compared to the control group. It is unclear if the survey prompted athletes to answer all questions based on their lifestyle prior to the onset of a bony stress injury or time since the injury. Therefore, it remains unclear if the contributing factors from this study are risk factors or possible consequences of the bony stress injury (e.g., less sleep). Despite this limitation, clinicians should consider these potential risk factors to monitor the health and wellness of their high school athletes to determine the risk of stress injury development. These risk factors may also help clinicians identify prevention strategies