Epidemiology of stress fractures in collegiate student-athletes, 2004-2005 through 2013-2014 academic years
Rizzone KH, Ackerman KE, Roos KG, Dompier TP, and Kerr ZY. J Athl Train. 2017. [Epub Ahead of Print].
Take Home Message: A collegiate athlete is at high risk for a stress fracture during preseason and if they are female.
Stress fractures are a common injury in activities that require repetitive stress on bone. While many NCAA athletes take part in these activities, little is known about how often stress fractures affect collegiate athletes. A better understanding of when stress fractures occur and which athletes have an increased risk of stress fracture would allow clinicians to improve stress fracture prevention, implement more appropriate screening methods, and develop training techniques and protective equipment to decrease the risk of injury. Therefore, Rizzone and colleagues analyzed data from the NCAA Injury Surveillance Program to assess the incidence of stress fractures among collegiate athletes. All injury data from the 2004-2005 through 2013-2014 academic years were analyzed. The authors defined an Athlete-exposure as 1 student athletes participating in 1 game or practice. Season was categorized by the research team as either preseason, regular season, or postseason. Overall, 671 stress fracture which resulted in a minimum of 24 hours of missed time were recorded out of 11,778,145 athlete-exposures. Stress fractures were most common in women’s cross country, women’s gymnastics, and women’s outdoor track. Among sex-comparable sports (for example, soccer, basketball), a woman’s risk of stress fracture was about twice that of a male athlete. Stress fractures was most common in the preseason than in either the regular or post-season. About 1 in 5 stress fractures was a recurrent injury and roughly 1 in 5 stress fractures was season ending injuries.
Overall, these results are significant because it highlights that females, particularly those competing in cross country, gymnastics, and outdoor track need to be closely monitored for stress fractures and need strategies to reduce their risk for these fractures. For example, clinicians and coaches should adapt preseason training to reduce the risk of stress fractures or consider off-season conditioning programs that slowly reintroduce the body to sport-specific repetitive stresses prior to preseason. While these programs still need to be developed, clinicians can immediately begin closely monitor high-risk athletes for stress fractures and discuss with other members of the sports medicine team low-risk options to reduce the risk of stress fractures in preseason.
Questions for Discussion: Do you feel that your clinical experience is in line with the findings of this study? If so, what and how have you used this to decrease the impact of stress fractures on your athletes?