Citation

Warden SJ, Hoenig T, Sventeckis AM, Ackerman KE, Tenforde AS. Br. J. Sports Med. 2022; ePub(ePub): ePub.

Copyright

(Copyright © 2022, BMJ Publishing Group)

DOI

10.1136/bjsports-2022-106112

PMID

36376061

Abstract

Mention 'stress fracture' to an athlete or coach and there is instant concern. Frequently occurring at the beginning of an athletic season or in the lead up to a major competition, there is awareness that diagnosis invariably disrupts participation. The term 'stress fracture' has deep roots in our vernacular. Its use in the literature has risen steadily since the 1970s/1980s and shows no sign of waning. But are we all talking about the same thing, and does it matter?

Most bone stress injuries are not stress fractures

Stress fractures are a type of 'bone stress injury' (BSI).1 A BSI represents the inability of a generally normal bone to withstand repetitive loading leading to localised bone weakness and pain. A history of repetitive loading distinguishes BSIs from insufficiency-type injuries occurring with ageing and disease, although some athletes share a similar phenotype of compromised general bone health.

Stress fractures are characterised by a discernible fracture line on imaging. Only one-in-five athletes presenting with a BSI have a stress fracture.2 The other 80% have stress …

Language: en

Keywords

Bone; Fractures, Stress