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

When You're Not Sure What Type of Hydration Drink Your Athlete Needs

Another common question I get from both parents and athletes and what I see a lot of confusion around is this topic of hydration beverages. Sports drink vs. electrolyte powder vs. water… what is the best choice? With all of the marketing and all the options and all of the different sports, it’s understandable why athletes are confused on what to drink and when.

In today’s blog, I’m going to break down some of the facts for you. These are questions I ask my private or group clients that I work with when helping them create a unique hydration plan and this is what you need to think about and when deciding the best hydration choice for your athlete.

5 MAIN POINTS TO CONSIDER WHEN CHOOSING A HYDRATION DRINK FOR THE YOUNG ATHLETE

1. HOW LONG WILL THE ATHLETE BE PLAYING / PRACTICING?

2. WHAT IS THE ENVIRONMENT / CLIMATE LIKE? (SUPER HOT, HUMID, COLD, MILD?)

3. WHAT TYPE OF ACTIVITY WILL THE ATHLETE BE DOING?

4. DID THE ATHLETE HAVE ANY PRE-EVENT FUEL?

5. HOW OLD IS THE ATHLETE? ARE THEY A HEAVY / SALTY SWEATER?

How you respond to each of these questions will determine which type of hydration drink is best for your athlete.

Three Categories of Hydration Drinks:

1. Water

2. Electrolyte Replacements

3. Sports Drinks

In my opinion, you can think of making your selection based on the general idea that the longer and more intense the practice / event becomes, the more you need in your drink. Let’s break it down by drink…

Water

• The gold standard

• Less than 60 minutes of activity in mild to moderate temperatures, with minimal sweating

• Examples:

  • 30 minute choreography class

  • 45 minute soccer practice

  • 40 minute figure skating freestyle session
    

electrolyte drink

• An event of varying duration with minimal to moderate exertion but still heavy sweating

• Basically, not enough energy is being exerted to require the carbs in a sports drink, but the athlete is sweating a lot and so benefits from replacing elextrolytes

• Examples:

  • One baseball game

  • Practice for a more skill-based sport or position in the heat
    

sports drink

• 60 minutes or more of moderate to high-intensity activity

• Extreme heat conditions

• The athlete is a heavy and salty sweater

• The athlete does not have a carb-rich snack on-hand during the event or the athlete has trouble tolerating solid forms of nutrition before and during events (ex: due to high nerves).

• Examples:

  • A figure skater has 2 back-to-back 40-minute freestyle sessions followed by a 20-minute on-ice power class

  • A soccer athlete has a soccer game in the intense Texas summer heat OR has a tournament weekend.

  • A baseball player has a tournament without time to grab meals or carb-rich snacks in-between games.

  • A runner has a 1.5 hour cross country practice in the intense heat

  • A gymnast has a 4 hour morning practice and very little time to snack during the practice.

In addition to these facts, I thought I would share some common questions I get around this topic and how I respond…

COMMON QUESTIONS ABOUT HYDRATION DRINKS for YOUNG ATHLETES

What about all the sugar in sports drinks?

I know many athletes who have struggled through sessions underfueled with low energy stores (read; “low carb stores”) because they are trying to cut out sugar. While I understand this can come from a place of good intention, we must remember that, for the athlete, Sugar = Carbohydrate = Energy = PERFORMANCE!! 

Right before an event or during an event is a place where the body actually benefits from sugar, from simple carbohydrate like that found in a regular sports drink! These can be especially helpful if you have trouble tolerating solids like fruit / bagels / bars around events.

I had an athlete come to me recently who was struggling with burnout not even half-way through soccer practices. They struggled with fatigue and some dizziness. As I worked through my material with them, a light went off. This athlete realized that they had cut out all sugar including any drinks with sugar completely. They added in some Gatorade before and during long practices and at our next session said they felt a huge difference in energy levels and the dizziness was gone.  Success!

what about those who don’t drink sports drinks due to the dyes?

That’s ok! Did you know you can make your own sports drink? If you prefer to go a more diy route you can make your own! I’ve stumbled across a variety of recipes and am linking a few for you below…

• Citrus Sports Drink & Watermelon Sports Drink

• DIY Sports Drink

What about this one that I’m seeing everywhere?

Do a comparison of the drinks you are considering. There are some trendy sports drinks out there, but when I look at the nutritionals, I find they are actually very low in key electrolytes like sodium. If your athlete truly needs a sports drink to (1) maintain energy levels and (2) replenish electrolytes lost in their sweat, remember that the main electrolyte they are wanting to replace is sodium!

what about energy drinks?

I can only say “No” to energy drinks. The caffeine amounts can be more than what is listed on the container and there is no recommended amount of caffeine for kids and teens in the US. I also think that many times an athlete will turn to an energy drink for energy when what they really need is MORE FOOD (ie, FUEL). To make matters worse there, energy drinks can blunt the appetite leaving a body already craving food and nutrients more underfueled. This is all I will say for now but I do plan to do a blog dedicated to energy drinks at a later date.

I hope you found this helpful today.

Hydration drinks can be confusing, but when the athlete gets it right, they really can feel an exciting difference!

If you think or know that your athlete is struggling with their hydration. If they need a more detailed plan and someone to guide them, I would love to chat with you about it. I work with my private clients and group program clients to create their unique fueling strategy all the time!

You can reach out to me at taylor@taylored-nutrition.com to schedule a quick call and see if working together would be a good next step!

Wishing you a well-fueled athlete,

Taylor

When Your Athlete Has a Super Packed Schedule

Do you feel like you hardly see your athlete?  Like, you get in a quick groggy hello before they are out the door for early morning practice and then you get an exhausted “hi again” or “what’s for dinner?” after school? Maybe you don’t see your athlete until even later - like 8 or 9:30 pm because they have evening practices or had an evening game. Or maybe your athlete is in a sport like gymnastics, dance or figure skating where they could be at the gym/studio/rink for hours at a time with small school breaks in-between and in the evening.

Regardless which sort of schedule your athlete follows, with this time-consuming commitment to sport it can be really really difficult to get a good fueling strategy in place and meet the high nutrition demands of sport. I see this as a roadblock with so many of the athletes that I work with and so today I wanted to take a little time and give you 5 nutrition principles along with actionable strategies that your athletes can start putting into practice now to help them optimize their intake when they have a super packed schedule that makes it hard to fuel well….

5 Nutrition Principles for the Young Athlete

with a Packed Schedule

1. Snacks are their best friend.

• Have your athlete go with you to the store to pick out different snack-type items that he or she can have on-hand in a lunch bag throughout the day for easy fueling. These should be from a variety of food groups so that the athlete is getting a variety of nutrients and energy sources throughout the day.

• Some examples include: granola bars, whole grain crackers, string cheese, chocolate milks, yogurt, goldfish, nuts/seeds, deli turkey, carrot sticks, hummus, cottage cheese cups, dried fruit, fresh fruit.

• Need help strategizing how to mix and match? Grab a copy of my Sports Snack Survival Guide! DM me on Instagram or email me at taylor@taylored-nutrition.com to grab a copy!

2. Because they are snacking, they need to eat more often (than if they sat down for a larger more balanced meal)

• A young athlete should not go 4 + hours between snacks.  

• If the athlete is mostly getting fuel from snacks, he/she likely should be getting a snack about every 2 to 3 hours, depending on the content of the snack and the specifics (age, height, weight, sport played, etc.) of the athlete.

3. Fueling meals and snacks don’t have to be beautiful or look Instagram perfect to fuel the body well. - put away those perfectionistic ideals!

• I help my athletes put together a lot of fueling meals and snacks that they end up doing really well with and feeling really good about.  Many of them are surprised at how simple and basic the meals and snacks are! 

4. Meals & snacks need carbs + a variety of these other foods.

• When it comes down to it, your athlete needs carbs from a variety of food groups to keep those energy stores up. These should be in each snack and meal.  Alongside it, depending on when the snack falls in relation to a practice or training session, there should also be some protein, some fiber and some fat. 

• Have your athlete pick different food sources of carbs, protein, fiber, and fat that they enjoy so that they get a variety of micronutrients (vitamins & minerals) throughout the day as well.

• And while the athlete may have to rely on lots of snacks some days, they should make sure one or two meals is still a part of their day. That could be a great breakfast to start the day or a great dinner with family or friends to end the day.

• Smoothies can be a great way to pack in food group variety and energy that is easy and quick.  I, personally, feel the same way about oatmeal & overnight oats!

5. Don’t forget the water bottle.

• Water is still super important to keep those energy levels up and optimize performance. We want the athlete to be drinking throughout the day.

• Remember, items like milk, sports drink, flavored water, teas, smoothies, fruits, veggies, and applesauce all contribute to an athlete’s hydration goal!
  

I hope today’s post has given you 5 strategies that your athletes can start working on today and take with them into the school year. As always, reach out to me if you have any questions or concerns regarding fueling your young athlete. I would love to chat!

Happy Fueling!

Taylor

Image credit - https://historyofsoccer.info/

Young Athletes: Not Just Little Adults

In today’s post I want to point out some of the differences between adult and child athletes. I’m pretty excited to write about this today because, if you know me or have worked with me, you know that I am super passionate about pediatric nutrition (nutrition for kids and teens) and love to educate on all things pediatric nutrition. I have loved it since the day I started my dietetic internship in Memphis to my first job at a children’s hospital to volunteering to write a kids’ nutrition and fitness curriculum for the Junior League to working with athletes today. I love navigating the extra level of complication that surrounds children and adolescents when it comes to nutrition. I love that you have to take more into consideration when treating and making recommendations for children and teens because the body and brain are still in such rapid phases of growth and development. I love understanding how the bodies of child and teen athletes are different from those of adults and, therefore, cannot be treated and guided as such.

Today I’m going to share with you four factors that I think are important to know that make the needs and recommendations of child and adolescent athletes different than those of adults. I hope you find this helpful as you continue to fuel your young athletes.

4 Ways Child & Adolescent athlete nutrition needs

Differ From Adult athlete needs:

1. Children are more efficient at using fat for energy. It is not until going through puberty that they become more efficient at using carbs like adults. 

• Putting into practice … Young athletes don’t need to do all of that carb-loading before big cross country meets or tournament days. Those pre-race carb-loading dinners are more for camaraderie than actual help with fueling. Keep enjoying the dinners if you love them (I loved these as a cross country runner in middle school & high school) but just know it’s more for fun than for optimizing fueling or giving a performance advantage. Of course, carbs are still a young athlete’s best friend, but the need for “loading” has not been proven to benefit this population of athletes. It does not mean you have to load up on fats either, but it does mean that foods with fat should certainly be present in their meals or snacks.

2. Children / teens do not cool their bodies like adults do. Children/teens predominantly cool their bodies via radiative and conductive cooling (dry heat dissipation) while adults rely on evaporative cooling (sweating). During training, young athletes’ bodies get more efficient at peripheral vasodilation while adults’ bodies alter their sweat rates. All of this means that kids and adolescents do not sweat as much as adults to cool themselves and, therefore, do not lose as many electrolytes as adults do with exercise.

   • Putting into practice … Keep this in mind before buying expensive electrolyte supplements or sports drinks for your athlete.

3. Children & adolescent athletes are going through growth spurts at different times and different seasons. It’s important not to alter food choices or restrict intake too much at the risk of stunting growth, delaying puberty or decreasing performance. What could seem like a harmless small reduction in calories or a shift in food choices to a young athlete could mean a period of unintentional underfueling that decreases performance, puts the athlete at risk of injury, or, if long-term, delays growth and development.

   • Putting into practice … It’s important to encourage all meals and snacks and all forms of carbs, proteins and fats with our young athletes. I like to encourage athletes to listen to their body (unless they are already chronically underfueled but that is a separate post for another day). They may be extremely hungry one week or one month and need a little or a lot more food. Then the following week or month their appetite is lower. That’s ok! They’ve got to allow themselves to fuel through those growth spurts, giving the body what it needs, not only for the growth & development, but also for their sport and class load.

4. Supplement benefits may not apply.  What I mean here is that most supplements related to performance (not talking about vitamins & minerals here) that have been found to be effective are tested on adults, not children and teens. Even if the supplement is third party tested, that does not mean it is proven to be effective or recommended for use in kids and teens.

   • Putting into practice … Always keep this in mind when thinking about protein or other supplements for the young athlete.

Working as a pediatric sports dietitian merges the specialty of pediatrics and the specialty of sports. I know it can be confusing to sort through all of the nutrition information and product recommendations out there, which are mostly geared towards adult athletes. If your athlete needs help with their fueling strategy and you’re not sure where to start or where to go next, reach out to me! I would love to schedule a call and chat to see if working together would be a good next step.  

That’s all for today. Happy Fueling!

Taylor

Ten Important Nutrients For Injury Recovery

I work with a lot of injured athletes. I see athletes with torn ACL’s, history of concussion and a handful of other issues, but I most often see athletes with some type of fracture, typically one or more stress fractures. While rest and physical therapy are essential to optimal recovery, so is the athlete’s nutrition. Unfortunately, nutrition can sometimes get forgotten during the recovery stage but but I’m here to say, “Don’t let it!” What you eat during this period can really speed up your recovery or it can hold you back. If used with purpose, what you eat can decrease inflammation, help rebuild the tissue you have injured, prevent loss of lean muscle and help maintain your strength. These all seem like good reasons to focus on nutrition to me! And, like I say with most of my other tips and ideas, you don’t have to make your nutrition recovery complicated! I’m here to give you the facts and then help you most easily incorporate those facts into something doable each day.

If you are an injured athlete or the parent, coach or caregiver of an injured athlete, I hope you can take some of these ideas below and put them to use for the best recovery possible.

Happy Fueling!

Taylor

Why Should Nutrition Be Part of Your Recovery Plan?

1. Support the continued creation of muscle proteins.

   • Muscle protein synthesis (creation of muscle protein in the body) decreases after injury when activity declines and especially when a limb has to be immobilized (like getting a cast on a leg, arm, etc.)

2. Preserve the lean muscle mass you already have.

   • Nutrition becomes even more important to maintain your muscle mass since you cannot use exercise & your typical workouts to help.

3. Maintain appropriate energy balance.

   • While, yes, your energy needs may decrease some during your recovery phase, it’s important to realize that they may not decrease THAT much. This is especially true if you are on crutches, which require 2 to 3 times more energy than walking! If you decrease calories too much, you can slow down recovery due to the decrease muscle protein synthesis, increased muscle loss and impaired wound healing that this will cause.

4. Decrease Inflammation (not necessarily right after injury and surgery but starting a few days after, as inflammation right after an injury is important to the healing process)

   • Just as anti-inflammatory foods and antioxidants were important for recovery after games and practices, they are also important now as the body is working even harder to heal. Continue to include those foods high in antioxidants and those anti-inflammatory foods.

Ten Nutrients to Include in Your Recovery Plan

1. PROTEIN

   • Focus on foods high in the amino acid leucine, which stimulates the creation of protein.

     • Sources: lean chicken, beef and pork, fish, nuts & seeds, cheese, tempeh, milk, yogurt

   • Include a quality source of protein (ideally with leucine) about every 3 hours, after therapy sessions and before bed.

   • Include a quality source of whey protein before bed. Whey protein is released and digested more slowly so your body can work on maintaining and rebuilding muscle during the fasting state of sleep.

     • Sources: yogurt, milk, and cottage cheese

2. CARBOHYDRATE

   • Your body still needs carbohydrates for energy so it can use the protein you give it for muscle repair and building. You may need less carbohydrate than when you were training and competing but don’t cut them way back or out completely!

   • Focus on complex carbohydrates that take longer to digest. This will keep you fuller longer and prevent spikes and dips in your blood sugar.

     • Sources: whole grain bread, pasta, cereal, & crackers, fruit, yogurt, starchy veggies

3. HEALTHY FAT

   • Make sure to include sources of omega-3’s and some monounsaturated fats to help fight the inflammation and support your immune system.

     • Sources: nuts, seeds, avocado, oily fish (salmon & tuna), flax oil, extra virgin olive oil, nut and seed butter.

4. VITAMIN C

   • An important antioxidant that aids in wound healing , tissue repair, and a healthy immune system.

     • Sources: citrus fruits, bell peppers, tomatoes, cantaloup, potatoes

5. VITAMIN A

   • An important antioxidant that aids in cell growth and development and immune function.

     • Sources: sweet potatoes, spinach, carrots, tomatoes, cantaloupe

6. VITAMIN D

   • Aids in calcium absorption and supports bone health.

   • Sources: sunlight, fatty fish, many dairy products (check the label), fortified foods, egg yolks

7. CALCIUM

   • Important for strong bones.

     • Sources: dairy products, broccoli, kale, chia seeds, almonds, fortified orange juice

8. MAGNESIUM

   • Important for making proteins in the body and aids in the absorption & metabolism of calcium and vitamin D.

     • Sources: almonds, sesame and sunflower seeds, cashews, peanuts, bananas, beans

9. ZINC

   • Aids in wound healing, creation of protein and immune function.

     • Sources: lean beef, crabmeat, chicken, cashews, fortified cereals, beans
       

10. COPPER

    • Helps form red blood cells, helps build a strong immune system and strong bones.

      • Sources: sesame, pumpkin and sunflower seeds, cashews and shiitake mushrooms

My Up & At ‘Em Egg Cups are packed with protein, vitamin D, as well as some vitamin C and calcium, all promoting recovery after injury!

PUTTING IT INTO PRACTICE:

Sample Injury Recovery Meals

• Grilled salmon with seasoned brown rice, roasted broccoli, a baked potato and glass of milk

• Peanut butter & banana sandwich on wheat bread + 8 oz milk + 1 cup diced cantaloupe

• Homemade lean ground beef cheeseburger + whole wheat bun + lettuce, tomato, mustard + homemade oven baked potato fries + kale salad

• Baked chicken + baked sweet potato + oven roasted broccoli + glass of milk

Salmon is an excellent source of omega 3’s. Try my Miso Ginger Glazed Salmon for a tasty twist on your average salmon dinner!

PUTTING IT INTO PRACTICE:

Sample Injury Recovery Snacks

• Greek yogurt + fresh or frozen mixed berries

• Quaker Oatmeal Squares cereal + dry roasted almonds

• Slice of whole grain toast spread with almond butter and sliced bananas

• Cottage cheese + diced cantaloupe

• Hardboiled egg + whole grain granola bar

• Protein bar (like 88 Acres protein, Larabar protein, etc.) + glass of milk

Basic rolled or steel cut oats from the bulk bin at your local grocery store provide great fiber, carbohydrates, some protein (because it’s a whole grain), magnesium, and more. Top with a healthy fat like SunButter or almond butter and some fruit for a balance recovery-enhancing breakfast or snack.