Perceptions of risk for stress fractures: A qualitative study of female runners with and without stress fracture histories

Objectives: To gain insight into perceived factors related to bone health and stress fracture (SF) prevention for female runners and to understand their experiences within the medical community.

Design: Cohort qualitative study.

Setting: University health system.

Participants: Forty female runners, 20 who had SF histories and 20 age-and-running-distance matched women without SF.

Main outcome measures: Women participated in audiotaped qualitative semi-structured interviews. For women with a SF history, questions sought their perspectives on factors that they felt contributed to SF, experiences with the medical community, and changes made post SF. For women without a SF history, questions sought perspectives on factors felt important to perceived running-related bone health.

Results: Six themes emerged; 1) Previous/Recurrent Musculoskeletal Injuries, 2) Activity Patterns and Training Regimens, 3) Nutrition, 4) Prevention and Intervention, 5) Pain, and 6) Mindset. Within these themes, between group differences are characterized by differences in knowledge and/or application of knowledge for health and wellness. Compared to women without SF, women with SF histories increased training load more quickly, had poorer nutrition, performed less cross-training, and kept running despite pain.

Conclusions: More education is needed for female runners to decrease risks for SF.