The Stress Fracture - Nutrition Connection

Did you know that, according to a 2024 study, about 20% of adolescent athletes will deal with a bone stress injury? This includes anything on the spectrum of what’s called a stress reaction to a stress fracture.

To me, that is a big percentage, but it’s also not a big surprise when I think about the number of athletes I have seen with stress fractures in the past 9 years. In fact, stress fractures are one of the top 3 reasons I see young athletes in my practice.

So, today, I’m dedicating a blog specifically to this serious injury. Let’s dive in…

First of all, WHY are stress fractures such a big deal?

stress fractures are such a big deal because:

• They are painful.

• They can often be season - ending injuries, taking 6 weeks or more to heal, depending on the severity.

• They appear to “come out of nowhere”. In other words, athletes typically don’t know the injury is coming or they don’t know how to listen to potential warning signs until it’s too late.

• They can create very discouraged athletes because they take athletes out of their sport for a long time. Sometimes athletes also feel a weight of responsibility when they realize this injury might not have happened if they had known certain facts.

Now that you see the big deal, let’s get into the science…

What is a stress fracture?

A stress fracture is a type of bone stress injury in which the bone experiences inflammation and swelling followed by a full or partial break. Diagnosis typically takes an athlete out of their sport for at least 6 weeks to give the bone time to heal.

How / Why Do Stress Fractures Occur?

Stress fractures are known as overuse injuries. They occur when high frequency of load is placed repeatedly on the bone like with gymnasts, runners, dancers, figure skaters and rowers. And often there is also one of the following present:

(a) not enough time given for rest and recovery

(b) a nutrient imbalance or

(c) both an imbalance of rest and of nutrition

The typical progression of this injury looks like:

1. inflammation of the tissue around the bone progressing to

2. edema (swelling with fluid) of the bone itself (aka - a stress reaction) and finally progressing to

3. an actual break in the bone (aka - a stress fracture).

What is nutrition’s role in stress fractures?

A stress fracture is an injury to the bone. Certain nutrients in the diet contribute to bone strength, growth and development. So, when there is an imbalance in these certain nutrients, it can put the bones at risk of injury.

Since we said a stress fracture typically involves an imbalance of nutrition, let’s first look at 2 most common reasons for the nutrient imbalance. I call the reasons either (1) a Primary Imbalance, one that was present prior to any increases in training or (2) a Secondary Imbalance, one that was a result of such a high volume of training.  Let me share an example of each scenario…

Scenario 1: Primary Nutrient Imbalance

Jane loved running. She was a distance runner and had always been one of the top performers on her team. From reading various articles and tuning into social media she began to feel she needed to be leaner in order to further increase her times. So, her meals and snacks became much more rigid, her carbohydrate intake was restricted and she focused intently on eating clean each day, whether she was home, school or at a restaurant with friends. This change in eating combined with consistent training, and even increased training mileage as she got more serious, created a nutrient imbalance that could not support the constant pressure on her bones and body.

Scenario 2: Secondary Nutrient Imbalance

Mary had an excellent food intake at her level of figure skating. She had no prior injuries and performed well.  In a short period of time, Mary moved up a level and with that she added in morning practices 3 days a week + additional off-ice conditioning classes. Mary didn’t think much about changing her diet because it had always worked well for her. However, the added training put more strain on her body. And some days, due to before-school practices, her intake went down because she had less time for a quality breakfast. This change in routine left Mary with a higher repeated work load on her bones and an inadequate intake of nutrients to support her body’s needs.

What Nutrients Should You Focus On?

Regardless of the reason for the nutrient imbalance, it’s important to get it fixed as soon as possible. As the athlete works to fix the imbalance, they should focus on key nutrients for bone health… those nutrients that will help keep the bone strong and healthy under immense training load coupled with growth spurts and development (remember, the body builds about 90% of it’s bone in childhood and adolescence!). Some key nutrients to think about include:

• Calcium

• Vitamin D

• Total Calories (i.e…. no underfueling)

• Magnesium

• Iron

This blog will not go through the specifics of each nutrient, but it’s important that the young athlete is educated on these nutrients and coached on how they can get them in their meals and snacks each day.

If you have concerns about stress fractures in your young athlete

I am taking clients struggling with this specific injury. If you would like to discuss working together, you can reach out to me HERE to schedule a free 15 minute Discovery Call.

Also, if you feel your athlete needs to learn more about nutrition related to stress fractures, please stay tuned because I’m releasing a self-paced recorded course in just a few weeks that dives into this very topic! It will be excellent education for the young athlete and it gives them action items to start improving their meals and snacks to support bone health. To get more details and stay up on its release, you can follow me on Instagram (@taylormorrisonRD) or sign up for my brief weekly emails by sending me a DM on Instagram saying “Newsletter”!

Another option for first steps may also be my Ending Underfueling Course. Being underfueled is a HUGE risk factor for stress fractures. If you think your athlete isn’t eating enough to support all the training they are doing in their sport this is a great self-paced course to get them eating a variety of different foods that will help them feel fueled, help them start eating enough of those foods, and support good bone health. You can grab it today and have access to it for 6 months!

I hope that today’s article shines a light on the serious injury that is a stress fracture. I hope it helps you take first steps to thinking through what you and your athlete can do to build and keep strong bones as they train and compete in their sport.

Wishing you a well-fueled young athlete,

Taylor

Introducing the Ending Underfueling Course!

Hi everyone!

It’s been a while since we’ve had a new article on the blog, but that is because I’ve been working EXTREMELY hard on something that I think can be valuable to many of you. It’s the Ending Underfueling Course and it’s out now!

If you have been following me for a while, you know that I talk a lot about underfueling in sport. And I talk about it because I have SEEN it and seen what it does to so many promising young athletes. I have worked solely with young athlete for about the last 8 years and underfueling has been the underlying issue for so many of the athlete that have come to see me struggling with their performance, struggling with injuries or struggling with body composition goals. 

I worked in a Sports Medicine center for at least 7 of those past years and sometimes even I was surprised that underfueling was the underlying reason for their injury or performance complaints. I remember, in the beginning, knowing an athlete was coming in to see me with a certain injury or issue and I would think, “ok, I’m not going to assume this is from underfueling. It’s probably something else”. BUT, after having our initial session and sometimes another follow-up, I knew quickly that the issue did in fact stem from the athlete’s underfueling. Even I, the practitioner, was surprised (early in my practice) to see (1) how rampant underfueling is in young athletes and (2) how serious and detrimental underfueling can be to their performance as well as their mental and physical health. 

With that said, I have worked with hundreds of athletes over the years to help them get out of an underfueled state. To help them see how much food they really need to perform, keep growing and feel their best. And, when we start, I have found that keeping it simple is actually very effective and appreciated by most of the athletes and families I work with. Many athletes that come to me have zero to limited food and nutrition knowledge. I like to start my education and coaching on the more general (but important) side, teaching the fundamentals, and giving the athlete a chance to offer their input as we start improving their fueling. I do NOT just hand a family a meal plan and say “this is how many calories you need a day” (not effective in the long-term, and for many probably not the short-term either).

Over the last 8 years I have loved working with young athletes in the clinic one-to-one setting, getting to know them, their sport and their struggles and help them increase and improve their intake. I have loved seeing the smiles on their faces when they come back to see me, feeling better in practices, reaching new levels, having better performances or finally recovering from an injury. It has been one of my biggest joys. 

Most of you know, however, that last year I shifted gears, went fully into private practice and decreased the hours that I worked in order to be more present and able to take care of family members. I am so thankful for the chance to do this, but when I made the shift I kept thinking, “There are so many athletes out there that would benefit from this initial information and coaching. I hate that I can’t reach as many young athletes anymore”. Then I found that, out of the athletes that I did work with in private practice, finding times to meet consistently was challenging and sessions got rescheduled due to sports conflicts. Now, I found myself thinking, “I wish I could just hand you my teaching so you could learn when it is convenient for YOU. At least you would hear what I have to say and could start working on some of these things on your own. Then we can troubleshoot and discuss questions when we are able to meet again”.

These two situations are really what prompted me to create what I’m announcing today, the Ending Underfueling Course.

What I do in this course is walk through what I typically teach the athletes that come to see me specifically for underfueling in our first one or two sessions. It is not an all-inclusive program where you will get all of the information about sports nutrition and proper performance fueling - it is very focused on this one specific topic of underfueling (I do have a comprehensive program that I run, if that is something you are even looking for). I have created the Ending Underfueling Course to be a quick focused resource for those of you with athletes struggling or who might be struggling with underfueling. It provides education on this term, including what it is, why it’s a problem and how much better we can be as athletes if we are playing in a fueled state vs. underfueled state. Then I dive into my initial coaching process that includes some teaching but also challenges athletes to start looking at what they are eating now, giving them a framework to follow to start getting where they need to be to be better fueled. And I provide handouts and worksheets along the way to support them. 

I decided to put this specific content in the course because I have actually had many many athletes come to me after just focusing on these action steps and tell me they are starting to feel and perform better and that creating meals and snacks and deciding how many meals and snacks to eat in a day has become easier and less complicated. 

SO, if this sounds like something your athlete could benefit from, please take a look at the course. THIS week is the first time I’m launching the course and because it’s new, I’m offering it at a huge (50%) discount for the first week it’s open AND I’m offering a free 20-minute bonus call for anyone that would like it after they purchase the course. You have the option to take the course as is OR, if you would like more support from me,  you can purchase a 60-minute session with me for a discount when you purchase the course.

interested in the course?

You can get more details HERE!

If your athlete has been struggling with underfueling, I would love to have them in the course!

Wishing you a well-fueled young athlete,

Taylor