Stress Fracture in Athletes: A Practical Approach

Area of Science:

• Sports Medicine
• Orthopedics
• Exercise Physiology

Background:

• Stress fractures (SFs) are a significant overuse injury in athletes, marking a severe stage of bone stress injuries (BSIs).
• These injuries stem from repetitive mechanical stress surpassing bone's adaptive capacity, leading to performance decline and extended athletic absence.
• Effective management is crucial to prevent recurrence, highlighting the need for evidence-based strategies.

Purpose of the Study:

• To provide a clinically focused review of current evidence on stress fractures in athletes.
• To emphasize modifiable risk factors, including training load errors, neuromuscular fatigue, and Relative Energy Deficiency in Sport (RED-S).
• To propose a practical framework for diagnosis, management, and prevention to optimize athlete care.

Main Methods:

• A narrative review synthesizing existing research on SF epidemiology, pathophysiology, risk factors, diagnosis, management, and prevention.
• Emphasis on modifiable contributors within the RED-S framework.
• Discussion of a stepwise diagnostic approach including clinical assessment, lab tests, and MRI for severity grading.

Main Results:

• Diagnostic evaluation integrates clinical findings, lab work, and MRI, with MRI serving as the gold standard for early detection and grading.
• A risk-based management framework combines MRI severity and anatomical site to guide treatment and return-to-sport decisions.
• Low-risk SFs often resolve with conservative care, while high-risk fractures may necessitate closer monitoring or surgical intervention.

Conclusions:

• A practical clinical framework is proposed to aid decision-making for suspected or confirmed SFs in athletes.
• The framework aims to enhance early diagnosis, optimize treatment strategies, and minimize the risk of SF recurrence.
• Integrating evidence on modifiable factors and advanced diagnostics can improve outcomes in sports medicine practice.