Abstract
Physical activity is known to be beneficial for bone; however, some athletes who train intensely are at risk of bone stress injury (BSI). Incidence in adolescent athlete populations is between 3.9 and 19% with recurrence rates as high as 21%. Participation in physical training can be highly skeletally demanding, particularly during periods of rapid growth in adolescence, and when competition and training demands are heaviest. Sports involving running and jumping are associated with a higher incidence of BSI and some athletes appear to be more susceptible than others. Maintaining a very lean physique in aesthetic sports (gymnastics, figure skating and ballet) or a prolonged negative energy balance in extreme endurance events (long distance running and triathlon) may compound the risk of BSI with repetitive mechanical loading of bone, due to the additional negative effects of hormonal disturbances. The following review presents a summary of the epidemiology of BSI in the adolescent athlete, risk factors for BSI (physical and behavioural characteristics, energy balance and hormone disruption, growth velocity, sport-specific risk, training load, etc.), prevention and management strategies.
Highlights
Bone stress injuries (BSI) are typically associated with athletic or occupational overuse loading of the skeleton
While numerous factors have been associated with the incidence of bone stress injury (BSI), the extent to which each factor contributes to the development of stress fractures in the young athlete is yet to be fully understood
While adolescent females who consumed ≥3 serves of calcium daily were not found to be at lower risk of stress fracture, for those participating in ≥1 h of daily exercise, vitamin-D intake was positively associated with lower fracture risk [70]
Summary
Bone stress injuries (BSI) are typically associated with athletic or occupational overuse loading of the skeleton. Bones remodel in response to changes in type or intensity of chronic mechanical loading in order to adapt their density and morphology to best withstand future loads of the same nature (a phenomenon reflecting Wolff’s Law) [6] It is this precise reason that exercise is beneficial for bone. Attempts to categorise BSI severity clinically and radiologically have been only moderately successful [5] This complexity, coupled with marked individual differences in pain perception and tolerance [9,10], accounts for the spectrum of bone tissue disturbances referred to as BSIs, the disparity in abilities to tolerate similar forms and intensities of training, and marked variation in times to recovery. Bone responds positively to unusual or novel forms of loading [13]
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