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"To Stress or Not to Stress in Adolescent Athletes"

Bone stress injuries (BSI) or stress fractures appear to be becoming more prevalent in adolescent sports. The question is why? Is it related to the intensity of the sport? Sport specialization at an early age? The study below by Tenforde et al investigated the prevalence of bone stress injuries in adolescent, middle school kids involved in distance running.

We know that adolescence is an important age group for bone remodeling, for females and males. The incidence of bone stress injuries is approximately 4-7% in middle school runners according to the study by Tenforde et al in 2022. The study involved 2107 male and female middle school runners looking at age, grade, height, weight, eating and menstrual behaviors, and exercise training. Out of the 2107 runners, 132 obtained bone stress injuries related to distance running. The incidence was greater in girls than boys. The tibia was the most common site of bone stress injury in both genders, but girls were more likely to sustain a bone stress injury in the femoral neck and sacrum. Other factors in incidence of BSI in adolescent runners was poor nutrition or eating disorders and family history of osteoporosis in girls. Boys' BSI were related to family history of osteoporosis and total running mileage. On the other side of things, both genders were less likely to develop a BSI if they had participated in soccer or basketball within 2 years of the survey. From my clinical experience, girls are more likely to develop BSI due to their wider pelvis, higher incidence of eating disorders, and lower bone mineral content. I have seen more BSI in the femur, sacrum, and iliac crest or ischium in girls vs. boys in adolescence. Boys tend to develop BSI in the tibia and metatarsal bones. This typically correlates with high running mileage. I have only treated a handful of girl adolescent runners that had BSI with high running mileage. Boys tend to overdo it more and need to be monitored more frequently. You need to be asking more questions about nutrition with girls and focus on hip strength with their wider pelvis. Adolescent runners are running more these days and competing at higher levels at earlier ages. It is important to emphasize hip and core muscle strength in both genders and monitor running mileage for overtraining and girl adolescent runners for eating disorders that could contribute to BSI. "Running is more than just the miles." Race Day Performance Team.

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