Stress Fractures In Athletes Research Articles

Individual Factors in Young Female Athletes' Bladder Health (the Y-FAB Study).

Bladder health in high school and collegiate females is not well understood. The objective of this study was to compare toileting behaviors, lower urinary tract symptoms (LUTSs), and fluid intake in female athletes and nonathletes. English-speaking nulliparous females aged 13-23 years were recruited. Participants completed the Toileting Behaviors: Women's Elimination Behaviors Scale, Bristol Female LUTS Questionnaire, and Beverage Questionnaire. Statistical analysis included univariable analyses and multivariable comparisons of athletes to nonathletes adjusting for age and fluid intake. One hundred athletes and 98 nonathletes participated (mean age 20 ± 2, mean body mass index 23 ± 4). Athletes' sports were predominantly high impact. Dysmenorrhea and anxiety were higher in nonathletes (P < 0.01) versus more stress fractures in athletes (P < 0.001). Problematic toileting behaviors were prevalent regardless of athletic status; nonathletes were more likely to hold urine until home and empty away from home without the urge (both P = 0.04). Lower urinary tract symptoms were prevalent regardless of athletic status, including frequency (34.2%), hesitancy (33.3%), urgency (32.8%), stress incontinence (15.3%), and urgency incontinence (11.8%). Athletes had significantly more stress incontinence and urgency and higher incontinence subscores on univariable analysis, although the difference was attenuated after multivariable adjustment. Athletes consumed lower total fluids (P = 0.03). Problematic toileting behaviors and LUTSs were prevalent in high school and collegiate females, regardless of athletic status. Athletes had higher stress urinary incontinence and urgency and lower fluid intake. These findings support future work toward enhancing early bladder health interventions (screening, education, and LUTS prevention) among high school and collegiate females.

Can hydrogen prevent stress fractures in athletes?

As a result of the ability of hydrogen rich water to delay muscle fatigue, and considering that tired striated muscles do not sufficiently protect the bone from mechanical stress, the hypothetical mechanism according to which the consumption of the respective drink by athletes could reduce the incidence of stress fractures is discussed. The application of patches with transdermal release of molecular hydrogen in the areas where stress fractures occur frequently could strengthen this preventive action, due to the local anti-inflammatory and regenerative action established experimentally on the senescent bone, to which could be added the stimulation of osteogenesis, the inhibition of bone resorption and the prevention of fractures due to the antioxidant action. The hypothesis can be tested experimentally using the rabbit tibia as a model, or statistical studies can be done on the incidence of stress fractures in athletes who consume hydrogen rich water. Even baths in water saturated with molecular hydrogen can prevent stress fractures, because they reduce the perception of muscle fever, and the plasters could also prevent the complications of this type of fractures.

Metacarpal Stress Fractures in Athletes: A Systematic Review.

Stress fractures in general are common injuries; however, there is limited literature on metacarpal stress fractures in athletes. Our objective is to contribute the first systematic review of metacarpal stress fractures in athletes, with a particular focus on epidemiology, presentation, and outcomes. A systematic review regarding metacarpal stress fractures in athletes was performed via PubMed, EMBASE, MedLine, Cochrane, and Web of Science. Inclusion criteria consisted of case reports and case series of metacarpal stress fractures in athletes. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. A total of 11 studies (29 cases) were included. The mean patient age was 17 years, with 12 men and 15 women. The most common sports were tennis and badminton. The most common presentation was pain in the dorsal aspect of the hand related to activity. All patients underwent successful nonoperative management, with mean return to play of 9 weeks. Metacarpal stress fractures can present with significant pain and impact performance in athletes who perform sports involving repetitive movements of the hand and wrist. Nonoperative treatment, consisting of abstinence from sport until the patient was pain free combined with gradual return to play, was successful for all patients. The addition of proper technique and training load can result in satisfactory return to play. For patients who present with hand pain related to exercise, particularly a young racquet sport player, metacarpal stress fractures are a "can't miss" diagnosis associated with significant functional impairment.

Return to Sports in Stress Reaction and Stress Fractures in Indian Athletes: A Case Series.

A stress fracture is a painful condition which occurs when the adaptive ability of the bone is unbalanced. This imbalance predominantly occurs due to increased intensity, frequency, or duration of training. Identifying the etiology of stress fracture and its proper treatment prevents recurrence. Besides, evidence-based and supervised rehabilitation is indispensable for permanent remission of pain and return to sports to preinjury functional levels. The case series discusses the continuum of stress reaction to stress fracture in athletes, causes of stress fractures, their management, and return to sport. The paper aims to give a clear discussion about the management with rehabilitation guidelines for metabolic causes of stress fractures. This study was a case series of five cases coming to Sports Medicine outpatient clinic of Sports Injury Centre, VMMC and Safdarjung Hospital, New Delhi, and physical medicine and rehabilitation outpatient clinic of Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow over a period of 1 year. The discussed cases are young Indian athletes, both male and females, who have presentation along the continuum of medial tibial stress syndrome (MTSS) to stress reactions and stress fracture. The findings of the paper highlight the significance of rehabilitation for individuals suffering from MTSS. Accurate diagnosis with targeted rehabilitation leads to quicker return to sports. The rehabilitation program comprises of identifying and treating the cause of stress fracture, removing any risk factors, biomechanical correction wherever indicated, structured exercise program, training in underwater treadmill, cyclical increase in loading, reducing activity every 3rd week.

Clinical Presentation and Outcomes of Sacral Stress Fractures in Athletes: A Case Series of 13 Patients.

Sacral stress fractures are a rare cause of low back pain in athletes. Given the low incidence of these fractures, there is a scarcity of data on symptomatology, risk factors, and clinical outcomes. Patients diagnosed with sacral stress fractures would be athletes presenting with low back pain. Case series of 13 patients with sacral stress fractures. Level 4. We conducted a retrospective review of medical records to identify patients diagnosed with sacral stress fractures at a single academic institution. Fractures were diagnosed on noncontrast T2-weighted magnetic resonance imaging scans and categorized using the Bakker classification system. Subjects were administered an electronic survey that asked about (1) the onset, time course, and location of pain and other symptoms; (2) time to treatment and treatment modalities pursued; (3) sports performance and time to return to sport; and (4) risk factors for stress fractures. Of 18 eligible patients, 13 (72.2%) completed the survey with mean follow-up of 49.6 months (range, 1-144 months). Mean age was 28.0 years (range, 18-52 years); 9 patients (69.2%) were female, of whom 7 (77.8%) were premenopausal. The most common fracture type was Bakker type B (8 patients; 61.5%). Most patients presented with acute lumbosacral back pain in the setting of running/jogging activities. All patients underwent nonoperative treatment for an average of 3.8 months (range, 0-8 months) and three-quarters reported pain resolution at last follow-up. Rate of return to sport was 83.3%, but most patients reported ongoing deficits in running performance. Sacral stress fractures commonly present as acute lumbosacral back pain provoked by running sports. While the pain associated with these fractures prevents most athletes from participating in sports, nonoperative management appears to be an effective treatment modality with a high rate of return to sport.

Ultrasound Identifies First Rib Stress Fractures: A Case Series in National Collegiate Athletic Association Division I Athletes.

Isolated first rib stress fractures in athletes are thought to be rare. In this case series, 3 National Collegiate Athletic Association Division I athletes developed isolated first rib stress fractures over the span of 1 year, indicating that these injuries may occur more often than previously understood. These fractures can be easily missed because of the low incidence, lack of clinical suspicion, and vague presentation. Further, radiographs can fail to reveal such fractures. To our knowledge, this is the largest case series of athletes with first rib stress fractures presenting with vague rhomboid interscapular pain. We also demonstrated that ultrasound successfully visualized these injuries; in the hands of an ultrasonographer or clinical provider trained in musculoskeletal ultrasound, this technique offers an advantageous point-of-care screening imaging modality.

Sacral Stress Fracture in Athletes With Overuse: A Clinical Series of 11 Patients and Literature Review.

This was a narrative review. The purpose of this study was to report the physical and radiologic characteristics of sacral stress fractures in 11 athletes and to review the current literature on sacral stress fractures. Sacral stress fractures are rarely reported as a cause of low back pain in athletes. We retrospectively analyzed 11 athlete patients with sacral stress fractures and low back pain. All patients received conservative treatments, such as rest from sporting activities and physical therapy. Clinical data, such as age, sex, athletic activity, region of tenderness, and duration of low back pain, and radiologic data, such as information from plain radiographs and fracture lines on magnetic resonance imaging (MRI), were evaluated. The study included 11 athlete patients (5 males and 6 females) with sacral stress fractures, and their mean age was 18.7 years (range, 15-38y). The sports that caused the stress fractures were baseball, badminton, and basketball in 2 patients each and football, judo, marathon, volleyball, and dance in 1 patient each. All patients had tenderness on the sacrum. The mean duration of low back pain was 1.8 weeks (range, 1-4wk). Fracture lines on MRI were observed only in the caudal-ventral part of the sacrum in 7 patients and extended from the inferolateral angle of the sacrum to the superior lateral sacral alar in 4 patients. The study findings demonstrated that MRI and tenderness were useful for detecting the presence of sacral stress fractures in athletes. Moreover, fracture lines in the sacrum may progress from the caudal-ventral part of the sacrum to the cranio-dorsal direction.

Correlation between Abnormal Gait Pattern With Femoral Neck Stress Fracture In Athletes: A Systematic Review

Backgrounds: Stress fractures are common overuse injuries in the lower extremities. Repetitive episodes of high-intensity or extended-duration axial load to the leg place the bone at risk of stress-related injury. The femoral neck is an uncommon location for stress fracture (less than 5% of all stress fractures). Fracture location, type, and grade permits generic dichotomized classification of “low-risk” and “high-risk” fractures. Tension-side femoral neck stress fractures are considered “high-risk” because of their potential for displacement, nonunion, and avascular necrosis if displaced. Fractures in locations prone to these 3 outcomes are categorized as “high risk.” These include anterior tibial cortex, medial malleolus, talar neck, dorsal tarsal navicular, proximal fifth metatarsal metaphysis, tension side patella, and tension side of the femoral neck. The risk of avascular necrosis following treatment of displaced femoral neck fractures in adults may be as high as 45%. In runners, pain typically begins with onset of weight bearing early in the run. Pain may progressively increase and does not remit until the run ends. In some athletes, the desire to train or perform may supersede the pain. This may lead to disastrous consequences if a femoral neck stress fracture completes itself and displaces. This paper describes side effects abnormal gait pattern to femoral neck stress fractures in athlete. Methods: Our trial was an international, expertise-based, randomized, controlled trial. Details of the trial objectives and design have been published previously. Additional information about the eligibility criteria, interventions, follow-up, outcome definitions, and statistical analysis. To identify studies pertaining to the clinical results about Correlation between Abnormal Running Gait Pattern and Femoral Neck Stress Fracture, we reviewed the Cochrane, Pubmed, Embase databases for relevant articles published up to July 2022. We also reviewed the references of all identified articles to identify additional studies. Search terms were as follows: femoral neck stress fracture, femoral fracture, running gait. Following the PICOS (Participants, Interventions, Comparisons, Outcomes and Study design) principle, the key search terms included (P) patients were runner with FNSFs; (I) patients were running as a recreational sport, and or professional athlete; (C/O) the outcomes including sign and symptoms, femoral neck stress fracture, length of rehabilitation, time to get back in early performance in sport; (S) RTC, cohort study, or case control study. Results: A total of 13 RCTs, meta- analysis and systematic review correlation abnormal running gait with femoral neck stress fractures. Discussions: There are correlations between abnormal running gait with femoral neck fractures, because abnormal running gait with high intense could make bone stress injury. However, bone stress injury at neck femoral is one of many factors that commonly happen become a femoral neck stress fractures. Conclusions: Abnormal running gait combining with high intense training are etiology of bone stress injuries in athletes. Bone stress injuries in femoral neck could possibly become femoral neck stress fractures.

Vitamin D Supplementation and Its Impact on Different Types of Bone Fractures

Vitamin D helps to balance the levels of calcium and phosphorus to maintain proper bone structure. It is also involved in essential biological roles and displays a wide spectrum of potential benefits in the human body. Since there are many types of fractures that occur at specific ages and due to different circumstances, the influence of vitamin D on the frequency of a particular fracture may differ. Thus, the authors investigated the possible preventive effect of vitamin D on the risks of vertebral fractures, hip fractures, stress fractures and pediatric fractures. Additional aspects of vitamin D, especially on recuperation after injures and its impact on the severity of particular fractures, were also discussed. It was suggested that vitamin D supplementation may contribute to a reduction in hip fracture risk due to reduced bone turnover, decreased frequency of falls and improved muscle function. Furthermore, vitamin D appears to lower the risk of stress fractures in athletes and military recruits. Due to a nonunified protocol design, presented investigations show inconsistencies between vitamin D supplementation and a decreased risk of vertebral fractures. However, a vitamin D preventive effect on pediatric fractures seems to be implausible.

Femoral Neck Stress Fractures in Athletes and the Military.

Femoral neck stress fractures (FNSFs) are an infrequent condition in athletic and military populations. A high index of suspicion with liberal use of magnetic resonance imaging (MRI) is vital for early recognition and treatment initiation. An associated hip effusion on MRI is a risk factor for an evolving stress injury and requires close assessment and consideration for repeat MRI. Stress reactions and stable, incomplete FNSFs (<50% of femoral neck width) can be treated nonsurgically. Surgical intervention is accepted for high-risk, incomplete (≥50% of femoral neck width), and complete FNSFs. Overall, there is a paucity of high-quality literature on the rates of return to activity following FNSF.

Sacral stress fractures in athletes.

Fatigue stress fractures are a common overuse injury, frequently associated with high load-bearing endurance activities such as running, military training and aerobic exercise. While these fractures can arise at any site, sacral stress fractures are poorly studied with evidence consisting mainly of case reports and limited case series. This review aims to analyze and summarize all reports published to date describing cases of sacral stress fracture in athletes. PubMed, Embase, Web of Science and the Cochrane Database were systematically searched for studies reporting on Stress Fractures of the Sacrum. Insufficiency fractures of the elderly were excluded. The literature review revealed 49 studies reporting on 124 cases of sacral stress fractures. Seventy-six patients (61%) were professional or collegiate level athletes, and 37 (30%) were military recruits or police officers in training. Seventeen female athletes were identified as suffering from low bone mineral density (25%), 9 of which reported menstrual irregularities. Thirteen female patients (19%) had a history of eating disorders. While most sacral stress fractures occur in normal bones exposed to abnormal repetitive loads, the high percentage of lower bone mineral density can blur the lines between fatigue fractures and insufficiency fractures. The causes of these fractures are multifactorial. High endurance sports and the features of the female athlete triad were found in high percentage of the cases. Conservative treatment is the mainstay of treatment, consisting of ceasing of training and a period of rehabilitation and gradual return to training and competition.

The Effectiveness of Intramedullary Screw Fixation Using the Herbert Screw for Fifth Metatarsal Stress Fractures in High-Level Athletes

Background: Intramedullary screw fixation is the most common operative procedure used for treatment of fifth metatarsal stress fractures in athletes. However, the optimal implant in intramedullary screw fixation is still being investigated. Purpose: To review experiences with intramedullary screw fixation using the Herbert screw for fifth metatarsal stress fractures in high-level athletes. Study Design: Case series; Level of evidence, 4. Methods: The authors retrospectively analyzed 37 high-level athletes (Tegner activity score ≥7) who underwent intramedullary screw fixation using the Herbert screw for fifth metatarsal stress fractures between August 2005 and August 2017. The minimum follow-up period of the patients was 2 years. In assessing the surgical results, time to obtain bone union, time to return to original level of sport participation, and treatment failures/complications were reviewed. Additionally, the effect of intraoperative plantar gap widening caused by the screw insertion was analyzed. The surgical results of the 2 groups, the no-gap group (intraoperative plantar gap widening, <1 mm) and the gap group (intraoperative plantar gap widening, ≥1 mm), were compared, while correlations between intraoperative plantar gap widening and the surgical results were statistically analyzed. Results: Bone union and return to the original sport were attained in all patients without treatment failures/complications such as delayed union, nonunion, or refracture. The mean time to obtain bone union was 10.1 weeks, and the mean time to return to sport was 10.9 weeks. In comparing the no-gap group (n = 16) and the gap group (n = 21), no significant differences in the time to obtain bone union (P = .392) or to return to sport (P = .399) were noted. Additionally, there was no correlation between intraoperative plantar gap widening and the time to obtain bone union (r = 0.131; P = .428) or to return to sport (r = 0.160; P = .331). Conclusion: The use of the Herbert screw for intramedullary screw fixation to treat fifth metatarsal stress fractures in high-level athletes provided satisfactory results enabling all the athletes to return to the original sport without treatment failures/complications. Additionally, intraoperative plantar gap widening does not affect the surgical results using this technique.

Last Word on Viewpoint: Fragile bones of elite cyclists: to treat or not to treat?

Last Word on Viewpoint: Fragile bones of elite cyclists: to treat or not to treat?

Pituitary Adenoma Presenting With Bilateral Calcaneal Stress Fracture: A Case Report

Background Stress fractures are common in athletes. Cushing's disease is a rare yet serious etiology of poor bone mineralization and stress fracture. Case Presentation A 20-year-old male long-distance runner presented with right-side ankle pain. Magnetic resonance imaging (MRI) found evidence of a stress fracture of the calcaneus. A bone mineral density measurement revealed a T score indicative of osteoporosis. Blood tests and MRI of the adenohypophysis were performed. Outcome and Follow-Up A diagnosis of an adrenocorticotropic hormone–producing tumor of the adenohypophysis was made. Discussion This is the first report of a case of Cushing's disease presenting with stress fractures in an athlete. In this article, we outline the clinical picture, differential diagnosis for poor bone quality, and diagnosis and treatment of Cushing's disease, a rare yet important cause of stress fractures in athletes. JOSPT Cases 2021;1(2):109–111. doi:10.2519/josptcases.2021.10292

Vitamin D and Stress Fractures in Sport: Preventive and Therapeutic Measures-A Narrative Review.

There are numerous risk factors for stress fractures that have been identified in literature. Among different risk factors, a prolonged lack of vitamin D (25(OH)D) can lead to stress fractures in athletes since 25(OH)D insufficiency is associated with an increased incidence of a fracture. A 25(OH)D value of <75.8 nmol/L is a risk factor for a stress fracture. 25(OH)D deficiency is, however, only one of several potential risk factors. Well-documented risk factors for a stress fracture include female sex, white ethnicity, older age, taller stature, lower aerobic fitness, prior physical inactivity, greater amounts of current physical training, thinner bones, 25(OH)D deficiency, iron deficiency, menstrual disturbances, and inadequate intake of 25(OH)D and/or calcium. Stress fractures are not uncommon in athletes and affect around 20% of all competitors. Most athletes with a stress fracture are under 25 years of age. Stress fractures can affect every sporty person, from weekend athletes to top athletes. Stress fractures are common in certain sports disciplines such as basketball, baseball, athletics, rowing, soccer, aerobics, and classical ballet. The lower extremity is increasingly affected for stress fractures with the locations of the tibia, metatarsalia and pelvis. Regarding prevention and therapy, 25(OH)D seems to play an important role. Athletes should have an evaluation of 25(OH)D -dependent calcium homeostasis based on laboratory tests of 25-OH-D3, calcium, creatinine, and parathyroid hormone. In case of a deficiency of 25(OH)D, normal blood levels of ≥30 ng/mL may be restored by optimizing the athlete’s lifestyle and, if appropriate, an oral substitution of 25(OH)D. Very recent studies suggested that the prevalence of stress fractures decreased when athletes are supplemented daily with 800 IU 25(OH)D and 2000 mg calcium. Recommendations of daily 25(OH)D intake may go up to 2000 IU of 25(OH)D per day.

An investigation into the association of bone characteristics and body composition with stress fracture in athletes.

The aim of the study was to establish the bone and body composition characteristics of high-level athletes with and without a history of stress fracture injury. Overall, 279 high-level athletes (212 men, 67 women) (age 28.0±9.2 years; body mass 75.0±17.4 kg; height 1.78±0.10 m) and 112 non-athletic controls (60 women, 52 men) 36.2±15.0 years; 70.9±12.9 kg; 1.71±0.10 m) were assessed by DXA to establish their bone mineral density and content, body fat and lean mass. Athletes completed a questionnaire detailing their stress fracture history. There were no differences in whole-body bone mineral density (men 1.41±0.12 g/cm2, women 1.19±0.09 g/cm2), bone mineral content (men 3709±626 g, women 2263±290 g), body fat (men 16.3±5.0%,women 23.0±4.6%) and lean mass (men 65.4±9.9 kg, women 38.7±3.6 kg) between athletes with a history of stress fracture (34 men, 16 women) and those without (176 men, 40 women). DXA derived bone and body composition characteristics were not independent risk factors for stress fracture injury in high-level athletes. This study in a large cohort of high-level athletes provides normative bone and body composition values that can be used as a benchmark for researchers and applied practitioners.

Traumatic bilateral scaphoid fractures.

Aim To illustrate the surgical treatment of bilateral post-traumatic scaphoid fracture. Methods We came across a young student, who sustained bilateral, undisplaced scaphoid waist fractures following a fall during a football match. Despite careful clinical and radiographic evaluation by four views at the Accident and Emergency (A&E) Department, we initially performed only the diagnosis of the left scaphoid fracture treating it with a percutaneous Acutrack headless screw. Eight months later this patient returned to the A&E department due to a new trauma to his right wrist with the onset of painful symptoms: cystic scaphoid non-union. No pain had been reported on the wrist in those months. Results We performed osteosynthesis with Herbert headless screw through an extended volar approach placing a non-vascularized cortico-spongious bone grafts taken from radius. Periodic follow up by clinical examination, X-ray and CT scan with evidence of bone healing was performed. Conclusion Bilateral scaphoid fractures are rarely encountered, mostly as stress fractures in athletes and manual workers. If left untreated, arthritis, deformity, and instability can lead to significant disability. Comprehensive imaging should be done in case of suspected scaphoid fractures, especially after a trauma, even in the presence of modest symptoms, as failure to do so may lead to missed fracture. Considering what was exposed, the radiographic check on the right wrist repeated about two weeks after the trauma would have avoided a missed diagnosis, even in the absence of reported clinical symptoms. We therefore recommend to repeat the radiographic examination in all situations like these.

Conservative treatment of refractures after modified tension band wiring of fifth metatarsal base stress fractures in athletes.

Recurrent fifth metatarsal base stress fractures (MT5-BSF) in athletes present a challenging problem. The aim of this study was to evaluate the result of conservative treatment for the refracture of MT5-BSF after modified tension band wiring (MTBW). The outcomes of 15 elite athletes undergoing conservative treatment for refracture of MT5-BSF after MTBW were retrospectively reviewed. They were instructed to avoid weight-bearing with short leg cast for 6 weeks. After that, they started partial weight with a postop shoe. Stepwise exercise followed bone union by radiographs. Thirteen cases (86.6%) had a complete bone union after a mean of 18.9 ± 8.6 weeks. Twelve cases (80%) returned to their previous activity level and maintained for at least two consecutive seasons. Eighty percent of all athletic patients with the conservative treatment for refractures with healed MT5-BSF after MTBW on the plantar-lateral side could maintain and return to their previous sports activity for at least 2 years.

Chronic anterior tibial stress fractures in athletes: No crack but intense remodeling.

Delayed healing of anterior tibial stress fractures in athletes is related to high tensional forces acting across a putative fracture gap. These forces lead to crack propagation and create strains that exceed tissue differentiation thresholds for new bone to form in the gap. The "dreaded black line" is a radiographic hallmark sign of stress fractures considered to represent a transverse fracture gap. However, whether a fracture gap truly exists at the microscopic level remains unclear. The aim of this study was to describe the area of the "dreaded black line" microscopically and to identify signs of delayed healing. Between 2011 and 2016, we included seven athletes with chronic anterior mid-shaft tibial stress fractures. The fracture site was excised as a cylindrical biopsy. The biopsy was evaluated with micro-CT and histology. The formation of new bone in the defect was evaluated radiographically. The "dreaded black line" seen on pre-operative radiographs in all patients could not be seen on the microscopic level. Instead, the area of the putative crack showed widened resorption cavities, lined with active osteoblasts, and surrounded by immature bone. This area of intense remodeling seemed to create a false impression of a fracture line on radiographs. Complete cortical continuity was restored at the biopsy site at median 8months (range 6-13months). Tibial stress fractures in athletes normally show no fracture defect, but a region of increased remodeling. The healing process is already ongoing but seems mechanically insufficient.

Nutrition for the Prevention and Treatment of Injuries in Track and Field Athletes.

Injuries are an inevitable consequence of athletic performance with most athletes sustaining one or more during their athletic careers. As many as one in 12 athletes incur an injury during international competitions, many of which result in time lost from training and competition. Injuries to skeletal muscle account for over 40% of all injuries, with the lower leg being the predominant site of injury. Other common injuries include fractures, especially stress fractures in athletes with low energy availability, and injuries to tendons and ligaments, especially those involved in high-impact sports, such as jumping. Given the high prevalence of injury, it is not surprising that there has been a great deal of interest in factors that may reduce the risk of injury, or decrease the recovery time if an injury should occur: One of the main variables explored is nutrition. This review investigates the evidence around various nutrition strategies, including macro- and micronutrients, as well as total energy intake, to reduce the risk of injury and improve recovery time, focusing upon injuries to skeletal muscle, bone, tendons, and ligaments.