Bone Stress Injuries

Abstract

Bone stress injuries (BSIs) result from repetitive microtrauma to bone that exceeds its remodeling capacity; they are common among athletes. Risk factors include low energy availability (as described by the Female Athlete Triad and Relative Energy Deficiency in Sport) and those with unfavorable biomechanics and bone architecture. BSIs are progressive in nature and often present with focal pain on weight bearing or palpation. Magnetic resonance imaging (MRI) is the most sensitive diagnostic tool, however is often unnecessary in clinical management. Management generally involves rest and physical therapy with gradual return to activity, but addressing any underlying medical conditions is paramount in preventing future injury. Strategies to prevent recurrent BSI include optimizing nutrition and energy intake, physical therapy to address biomechanical factors leading to fracture, and ensuring adequate sleep.