A DANCE|PREHAB guide

“Stress fracture” is a scary phrase in the studio or doctor’s waiting room. Here’s the reassuring truth: bone stress injuries are common, well understood, and largely preventable, especially when parents know what to watch for and what questions to ask.

What is it, really?

Bone is living tissue that constantly rebuilds itself in response to training. A bone stress injury happens when training load increases faster than a bone can keep up. It’s not a random accident, but a signal that demand has outpaced capacity (Gabbett et al., 2021). It usually shows up in the feet or shins, given how much impact dance involves (Mandell et al., 2017).

Why growth makes this trickier

During the adolescent growth spurt, bones lengthen before muscles and tendons catch up, creating a temporary window of tightness and imbalance (Quinn et al., 2021). This is normal, but it’s also why the same training load that felt fine six months ago might not fit today.

Here’s the flip side: this same window is when most lifelong bone strength is built. About 90% of a young woman’s bone mass is in place by age 18-19 (Baxter-Jones et al., 2011; Quinn et al., 2021). Managed well, the growth years build a strong skeletal foundation for life.

The piece we don’t talk about enough: girls, energy, and bone

Dancers, especially girls, are at higher risk for Relative Energy Deficiency in Sport (RED-S): when the body isn’t getting enough fuel to cover training and normal growth (Mountjoy et al., 2023; Allen et al., 2024). This is rarely about willpower. It’s usually just a busy schedule outpacing appetite and time to eat (Quinn et al., 2021).

When the body senses low fuel, it deprioritizes reproductive and bone health first (Mountjoy et al., 2023).


That’s why:

• A missed, delayed, or irregular period isn’t “just part of being a dancer.” It’s useful health information (Quinn et al., 2021).
• Recurrent or slow-healing bone stress injuries can be a clue that fueling needs attention (Dauvergne et al., 2024).
• This is very fixable, especially caught early – usually the answer is more consistent fueling, not restriction (Mountjoy et al., 2023).

Awareness matters here, too: in one dancer survey, more than half of female dancers showed signs consistent with low energy availability, yet fewer than a third had ever heard of RED-S (Keay et al., 2020).

What actually helps

• Strength training builds bone, it doesn’t bulk dancers up. Resistance training is well established as safe for young athletes when supervised, and supports bone health alongside strength and coordination (Stricker et al., 2020).
• Progressive, not sudden, increases in training load give bones time to adapt. This matters most during intensives, show season, or a jump to a more competitive schedule (Gabbett et al., 2021).
• Sleep and nutrition are part of training, not extras. Bone rebuilds during rest, and short sleep has been linked to higher injury risk in young athletes (Quinn et al., 2021).

Questions to ask (to build your dancer’s autonomy, too)

You don’t need to have the answers – just ask good questions, and where age-appropriate, let your dancer ask some of these herself.

To your dancer:

• “Has anything felt different in your body lately, tight, sore, or off?”
• “Do you feel like you’re eating enough to keep up with how much you’re training?”
• “Has your period started, or has anything changed with it?”

To teachers or coaches:

• “Has training volume changed recently, especially around a growth spurt or intensive?”
• “Is there a strength and conditioning component built into training?”

To a doctor, PT, or dietitian:

• “Is my dancer’s training load appropriate for her current growth stage?”
• “Should we be tracking her menstrual cycle as part of her health picture?”
• “Would a bone density or energy availability screen make sense here?”

The bottom line

Bone stress injuries aren’t bad luck. They’re a signal. The growth years are the riskiest window and the best opportunity to build lifelong bone strength. Dancers do best when the adults around them are paying attention, asking questions, and treating fuel, rest, and strength as seriously as technique.

This is general education, not individualized medical advice. For concerns about your dancer’s bone or menstrual health, please consult a sports medicine physician, physical therapist, or registered dietitian who works with dancers.

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Sources:

• Allen, N., Kelly, S., Lanfear, M., et al. (2024). Relative energy deficiency in dance (RED-D): A consensus method approach to REDs in dance. BMJ Open Sport & Exercise Medicine, 10, e001858.
• Baxter-Jones, A. D., Faulkner, R. A., Forwood, M. R., et al. (2011). Bone mineral accrual from 8 to 30 years of age: An estimation of peak bone mass. Journal of Bone and Mineral Research, 26(8), 1729–1739.
• Dauvergne, M., Grant, M.-E., & Mountjoy, M. (2024). Relative energy deficiency in sport (REDs): The role of the physiotherapist. British Journal of Sports Medicine.
• Gabbett, T., Sancho, I., Dingenen, B., & Willy, R. W. (2021). When progressing training loads, what are the considerations for healthy and injured athletes? British Journal of Sports Medicine, 55, 944–953.
• Keay, N., AusDancers Overseas, & Francis, G. (2020). Indicators and correlates of low energy availability in male and female dancers. BMJ Open Sport & Exercise Medicine, 6, e000906.
• Mandell, J. C., Khurana, B., & Smith, S. E. (2017). Stress fractures of the foot and ankle, part 1 & 2. Skeletal Radiology, 46(8–9).
• Mountjoy, M., Ackerman, K. E., Bailey, D. M., et al. (2023). 2023 International Olympic Committee’s consensus statement on Relative Energy Deficiency in Sport (REDs). British Journal of Sports Medicine, 57, 1073–1097.
• Quinn, B. J., Scott, C., & Stracciolini, A. (2021). Special considerations for growing dancers. Physical Medicine and Rehabilitation Clinics of North America, 32(1), 75–86.
• Stricker, P. R., Faigenbaum, A. D., & McCambridge, T. M. (2020). Resistance training for children and adolescents. Pediatrics, 145(6), e20201011.