Physical exercise is touted as being beneficial for enhancing the functional quality of the skeletal system, as well as the cardiovascular and muscular systems. Unwise training practices, however, combined with potential risk factors may dispose an individual to a bone stress reaction (bone responses to repetitive loads within the physiological range) or stress fracture (frank fracture of a bone from clinically significant stress reactions that produce structural failure). Here, we trace the terms that have been used to describe these injuries and recount the etiology of stress reactions and fractures. Epidemiological data have been reported for military and athletic populations, and in many instances recurring risk factors have been identified, both those that can be modified and those that cannot. In this paper, we review epidemiological data and potential risk factors for stress fractures and summarize current thought about the treatment and prevention of these exercise-related injuries.
The authors are with the Human Performance Laboratory and McCaig Centre for Joint Injury and Arthritis, University of Calgary, Calgary, AB, Canada. Request reprints from Susan K. Grimston, University of Calgary, Human Performance Laboratory, 2500 University Drive NW, Calgary, AB, Canada T2N 1N4.