COVID-19 Project: Stress Fracture Prevention
by Kristin Koskinen, RDN
While you’ve been in quarantine, you may not have had many occasions to think about bone health. More dancers have been thinking about maintaining their weight during this unexpected off-season. Others are anxious about the weight they may have gained while at home and may engage in crash diets to drop the weight before they get back to the studio.
I get it, I really do. That’s why I want to talk to you about the long-term consequences of short term decisions like fad diets. When we know better, we do better, so I’ll share a bit with you about what I know so you can make better decisions to support your health and your career.
It’s a fact that the longer you dance, the more likely you are to suffer an injury. Dancers are particularly susceptible to injuries of the foot and lower leg, including stress fractures. It’s part of why you wear proper footwear to dance, even at home, and have heard you should avoid dancing on certain surfaces like ceramic tile and concrete.
Stress fractures are tiny cracks in a bone caused by repetitive stress. If left untreated, they can put you at risk of suffering a full fracture of the affected bone. They're commonly called overuse injuries.
Stress fractures can also be caused by normal stress to bones that don’t have sufficient density. Bone density is what we commonly think of as “strong bones.” Nutrient deficiencies can lead to what is called insufficiency fractures.
We tend to ignore our bones until there’s a problem, in part because we’re accustomed to them doing their jobs without complaint or much attention from us. Despite initial impressions, bones aren’t just rigid sticks that make up your skeleton. Instead, they are living, active tissues that are continually being remodeled. They support the body structurally and allow us to move. Blood cells are created in the marrow, and they act as a storage area for minerals, particularly calcium.
You’ve probably heard a lot about calcium and bone strength. What you may not know is that calcium is also necessary for muscle contraction, blood clotting, and several metabolic processes. Remember, bone acts as a storage area for calcium. If the body needs calcium for other vital functions, such as allowing your heart muscle to contract, it will borrow calcium from your bones. This can lead to weekend bones.
To be clear, popping calcium supplements isn’t the answer. For starters, the matrix of minerals that gives bone its strength includes other minerals like magnesium and phosphorus. Beyond minerals, you need adequate protein, fat, vitamins, and calories to support your bones.
If you regularly restrict your food intake or if you’re thinking about dieting before getting back to dance, keep these things in mind:
Low-calorie intakes are associated with a higher risk of stress fractures. In part, this is because you aren’t providing your body with the nutrients your body needs to function and rebuild.
- Low-calorie intakes can lead to weight loss. Weight loss writing three months has been associated with stress fractures in dancers.
- Low body weight can interrupt normal hormonal patterns necessary for bone health.
In short, you need to eat enough to support healthy body weight as well as a diet that provides all the nutrients your bones need.
Beyond eating adequately, dancers should pay attention to other nutrients of focus including vitamin D and vitamin K2.
Vitamin D assists in the absorption of calcium and phosphorus from the intestines. It’s not just a vitamin but a hormone produced by the skin when exposed to sunshine. Food sources include cold-water fatty fish, egg yolks, mushrooms, fortified orange juice, and dairy products. It’s not surprising that dancers are often deficient in vitamin D. Dancers spend much of their time indoors and don't get adequate sun exposure. Too often, they under eat food sources that provide vitamin D. You may want to consult with your healthcare provider about supplementing with vitamin D.
Vitamin K2 is a fat-soluble vitamin found in fermented foods, grass-fed meats, and dairy products, pastured eggs, and natto. The bacteria in your large intestine can produce K2, which is yet another reason to pay attention to what you feed your gut, but we'll cover than another time.
This fat-soluble vitamin is responsible for directing calcium to the bone and preventing it from settling in soft tissues such as blood vessels. It’s a double win since it aids in strengthening bones and supporting heart health. If you don’t consistently eat foods rich in vitamin K2, ask your health care provider if a supplement is appropriate for you.
As you keep your eyes on getting back to dance, prepare your body for a safe return. Lifestyle choices that include a healthy diet and getting responsible sun exposure now and after quarantine are measures that are largely within your control, even under quarantine. Eat a balanced diet and remember, the care you give yourself now will prevent injuries in the short term and in the long run.
Interested in learning more? Go to my website (www.eatwellpros.com) and follow me on Instagram (@kristin_koskinen_rdn) where I regularly post about food, nutrition, and dancer health.
Kristin Koskinen, RDN, LDN, LD, CD
Bone stress lesions in ballet dancers: scintigraphic assessment
AR Nussbaum, ST Treves, and L Micheli
American Journal of Roentgenology 1988 150:4, 851-855
Low body weight is directly linked to low bone density.
Stress fractures of the base of the metatarsal bones in young trainee ballet dancers
Walter Albisetti,1 Dario Perugia,2,4 Omar De Bartolomeo,1 Lorenzo Tagliabue,3 Emanuela Camerucci,2 and Giorgio Maria Calori3