The Core Mechanism
Bone breakdown outpacing remodeling from mileage spikes, low energy availability, or low bone density.
The Real-World Triggers
Stress Fracture rarely has a single cause. In runners, these are the consistent contributors:
- Mileage spike beyond bone adaptation capacity
- Low energy availability / under-fueling (RED-S)
- Menstrual cycle disruption (in female athletes)
- Low vitamin D or calcium intake
- Switch to harder surfaces or stiffer shoes
- History of prior stress injury
Why Runners in Particular
Running concentrates repeated impact and load through the same tissues thousands of times per session. Stress Fracture develops when that load exceeds the tissue's adaptation rate — usually because training spiked, recovery dropped, or strength didn't keep up.
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