Stress Fractures in Dancers

Stress fractures occur in up to 46% of dancers during their career (Delegete, A). Over 60% of these fractures occur during puberty. Decreased strength, proprioception, and balance control, as well as poor technique can lead to increased stress to the bones and thus increased risk for stress fracture. Females are twice as likely than males to have a stress fracture secondary to caloric restriction, reduced bone mineral density, and menstrual irregularities (Delegete, A).

RISK FACTORS

• Delayed period
• Decreased bone mineral density
• Reduced caloric intake
• Vitamin D deficiency
• Muscular weakness
• Dancing on dead pointe shoes
• Dancing on hard flooring
• Increased dance intensity (Weiss, D)

COMMON FRACTURE SITES IN DANCERS

• Lumbar spine (pars interarticularis)
• Anterior tibia
• Distal fibula
• Forefoot (2nd metatarsal and cuneiforms) (Weiss, D)

POSSIBLE SIGNS/SYMPTOMS:

• Persistent pain
• Aching at night
• Bony tenderness
• Warmth
• Redness
• Swelling  
• Positive on imaging (MRI and/or bone scan) (Weiss, D)

​An acute fracture is typically not detected on x-ray. MRI and/or bone scan are preferred for detecting acute stress fractures.

REDUCING RISK
Rehabbing a stress fracture can involve complete rest for 6 to 10 weeks. It is important to recognize possible signs and risk factors to avoid bone damage.

• Avoid rapid increase in dance intensity
• Regulate pointe work and jumping intensity
• Avoid dancing on hard flooring
• Wear protective shoes inside and outside of dance
• Refer suspected dancers for nutritional consult to address restricted eating and vitamin deficiencies
• Work in correct alignment
• Improve flexibility, endurance, balance control, and strength (Delegate, A; Weiss, D)

References:
1) Delegete, A. Health Considerations for the Adolescent Dancer. A webinar through the Harkness Center for Dance Injuries. Accessed September 23, 2018.    
2)Weiss, David S. Stress Fractures in Dancers: Evaluation and Treatment. A webinar through the Harkness Center for Dance Injuries. Accessed November 11, 2018.    

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