IADMS New York 2002   [back to the Category]

Treating Stress Fractures in Dancers – Art or Science   [read the french version]

Author :   Peter E. Lavine, MD

Treating Stress Fractures in Dancers – Art or Science

Peter E. Lavine, MD
Orthopaedic Private Practice
Washington, DC, USA

Jennifer M. Gamboa, MPT, OCS; Leigh Anne Roberts, MPT
Body Dynamics
Arlington, VA, USA

Stress fractures are associated with repetitive demands on the skeleton that cause sub threshold insults that eventually lead to failure once the micro damage and fatigue exceed the bone’s reparative abilities. The etiology of stress fractures in dancers is diverse. Abnormal mechanical loading may occur due to structural issues, muscle fatigue, changes in force distribution or concentration, technical errors, over-training, and injury. Structural concerns would include hyperpronation, hypermobile first metatarsal, long second metatarsal, and a cavus foot. Hormonal abnormalities, especially amenorrhea, as well as dietary/nutritional disorders, contribute to increase the incidence of stress fractures in dancers.


The hallmark of clinical diagnosis is a high index of suspicion based on the dancer’s history and symptoms. Radiographic confirmation – standard radiographs, Technetium 99 scan, computed tomography, and magnetic resonance imaging – may also contribute to differential diagnosis.

Treatment may vary and depends upon the location and severity of the stress fracture. The use of immobilization, electric bone stimulation, and surgery, may be controversial in this elite population. This is especially true when special accommodations are made to prevent atrophy or a deterioration of conditioning and flexibility (use of relative rest). Often the focus of the treatment is toward early resumption of dancing. Issues surrounding hormonal imbalance, menstrual regularity, anorexia, and dietary and nutritional concerns must be explored.

A general review of the etiology, diagnosis, treatment and return to dancing schedule will be presented. Two cases of femoral neck stress fractures will illustrate some of the controversy in the treatment and resumption of athletic activity following stress fractures. The goal will be to stimulate robust discussion about treatment of stress fractures, assessment of when a stress fracture is healed, and how soon the patient can return to elite performance activities. What is best for the patient and where does the art of medicine collide with the science?