Epidemiology: A stress fracture can occur at any age.
Mechanism of Injury/Description: A stress fracture occurs from repetitively pounding and impacting on the tibia or fibula, which leads to stress (or microfractures) to the bone. Typically, this occurs when there are NOT periods of rest between pounding, rapid increases in training/pounding, and can also be associated with Female Athlete Triad/ RED-S.
Signs/Symptoms: Usually pin point pain on the tibia (shin bone) or fibula (bone on the side of your leg) with any pounding or impacting/jumping are signs/symptoms of a stress fracture.
Diagnosis: A stress fracture is diagnosed by physical exam with pain with palpation (touch) on the tibia or fibula, a positive stress test, and pain with a single leg hop. A lateral x-ray will show a “dreaded black line sign”, which indicates a tibia stress fracture. An MRI can also be used to show edema (swelling/inflammation) in the bone.
Treatment: To treat a stress fracture, a gymnast should rest from pounding/impacting, he/she may be placed in a tall walking boot and crutches, do physical therapy, increase their calcium and vitamin D, and in severe cases, rod placement surgery.
Prevention: Proper increase in training volume and proper landing mechanics will help prevent stress fractures.
Gymnastics Medical Provider PEARLS: An MRI should be obtained if there is a high suspicion of a stress fracture. If the “dreaded black line sign” is seen on x-ray rod placement/surgical intervention may be the treatment. If a gymnast presents with a tibial stress fracture or multiple stress fractures be sure to do a female athlete work up as well as check Calcium and Vitamin D levels.
Gymnast, Parent, and Coach PEARLS: If your gymnast is having shin pain do not ignore it. See a Medical Provider to evaluate and determine the cause of the pain. If your gymnast develops a stress fracture and you do not believe there was a change to training volume ask your Medical Provider about Female Athlete Triad/RED-S, check Vitamin D and Calcium levels, and optimize sleep (8-10 hours), water intake, and nutrition (well balanced meals and making sure your gymnast is eating enough calories).