Aug 28, 2020
Reducing Stress Fractures in Female College Distance Runners
Dr. Terence Favero and Allegra VanderWilde

First-year student-athletes show the greatest number of injuries and therefore are at the most at risk. Because of this, it is important to examine the transition period they undergo from high school to college. Not all high school runners start from the same training base. 

A typical female high school runner averages about 25 miles per week with a range reported as low as 16 but as high as 45 miles per week. Most college coaches write summer transitional training programs to ramp those weekly mileage totals up to about 45-50 miles per week. That is not a big jump for a higher mileage athlete but can be as much as a three-fold increase in workload for a lower mileage runner. If a runner can survive this transition without an injury, then they also must adjust to training with more physiologically mature and faster athletes. So, team training runs, and interval sessions will be faster, harder, and longer, adding additional stress to their already increased weekly mileage. 

Team Transitions

Photo: Phil Roeder / Creative Commons

Many college programs invite its entering first-year students to a short four-day “training camp” to help the new athletes get acclimated to the team prior to the start of school. For many first-year athletes, this is a huge psycho/social stress, as they try to integrate into a new team’s social structure while assessing their place on the team. While a short training camp is unlikely to invite a BSI, many first-year athletes leave the training camp not only physically tired but emotionally drained, only to then jump right into traditional college orientations, which are exhausting in and of themselves.  

Extended Season

Most high school cross-country and track and field seasons are about 10 weeks long. Following high school state championships, there is usually a natural break. During this break athletes reduce their mileage, take some recovery time or opt to cross-train. But, in preparation for college, first-year students are asked to ramp up their mileage during the summer, continue with demanding college-level workouts, and don’t get a break until the end of their first collegiate competitive season. Thus, a normal 3-month season followed by a break is now extended to five months in total, eight weeks longer than they have continuously trained without a recovery break.  

Supplemental Training

Many college teams now have introduced various forms of supplemental training to support athlete development, yet very few high school endurance athletes engage in supplemental training. The most common supplemental training activities include strength training and plyometrics which may include single-leg hops, power skips, and other high intensity, bounding activities. Even bodyweight plyometrics can increase the force and stress on a bone by two-three-fold more than the typical foot strike of running. Another challenge is that these training sessions are likely conducted outside of the typical team training runs and interval sessions resulting in additional weekly “workouts.” Even if those workouts are low physical stress they do add to the psychological stress of additional work. 

College Transitions 

Fall athletes, not just in cross-country, must simultaneously manage training and competition while transitioning to the college environment. While high school is scripted, ordered, and highly supportive for students, college is relatively unstructured and allows for a greater degree of independence than students are accustomed to. First-year students have to figure out when and where and how best to allocate their time. Several studies on college student behaviors note that first-year students have to learn or re-learn time management skills. For a collegiate athlete, this means fitting in 15-20 hours per week of training time, on top of 15+ hours per week of challenging class and laboratory work. 

Social and Environmental Stressors

We often think of, and expect, college athletes, to be accomplished in all aspects of their life. Yet, like all first-year students, they experience bouts of homesickness, roommate troubles, and anxiety about their athletic and their academic performances. As reported in the National College Health Assessment, about 50% of college students feel completely overwhelmed by their academic responsibilities and, because of the stressors of training and competition, young college athletes are as likely if not more to experience the same stressors. 


Another, and often underappreciated, the stress factor is nutrition and food. After living and eating in a controlled home environment for 18 years, with meals prepared expressly to their needs and tastes, athletes become confronted with campus dietary options and choices that may not fully be in sync with their established eating patterns. Dietary restrictions, limited access to foods, and having to make healthy and appropriate food choices can be a challenge. Often overlooked in scheduling is the relationship between training, nutritional recovery, and class schedule. If class time is soon after a hard training or interval workout, an athlete may not have time to adequately rehydrate and refuel. 


Seventy percent of college students experience sleep deprivation. This can be compounded during times when students stay up even later to study for exams or to write papers. In addition, having a roommate on a different sleeping schedule or just typical dorm noise contributes to sleep issues. The coaching community is well aware that a lack of adequate sleep compromises the crucial recovery element of the classic training-response cycle. But, adequate sleep is also essential for mental and psychological wellness. For female athletes, sleep provides an additional protective measure from injury as studies have shown that disrupting the normal circadian sleep rhythms uncouples the bone remodeling process resulting in inhibition of bone formation. 

What Can Coaches and Athletic Training Staff Do To Help Reduce Overall Stress Loads To Reduce Injuries? 

Recognizing that transitions are disruptive means that some intentionality forethought and planning in several key areas should help reduce the incidence of BSI’s.

Balancing Training and Non-Training Stress 

Coaching is both an art and science. Learning to balance and compensate for extraneous stress factors will help keep an athlete on the road to health and wellness. For example, a coach could adjust training plans during times of heavy academic work when athletes are more stressed and sleep less. Since most college teachers often plan for a test or a paper about every three weeks, a coach or assistant could examine all the course syllabi of the athletes and identify the most challenging weeks of the semester. With this in mind, a coach could intentionally adjust the training and periodization plans to include a reduction in either total weekly distance, less intense interval workouts, or both in order to help better balance the training stress with the non-physiological stressors. 

Psycho/Socio Support 

Cross country is both an individual and a team sport and supporting the psychological needs of the athletes is essential. To help new athletes acclimate, coaches and teams could utilize a buddy system where regular communication begins shortly after high school graduation. A coach could identify a current, mature, and experienced athlete who is also a strong communicator and pair them with an incoming athlete. Encourage them to talk about their own struggles and transitions to college in order to help them build trust and help them alleviate some of the social stressors upon entering the team. The buddy system could also help throughout the year with connecting athletes to on-campus resources for academic, athletic, mental health, and community support. 

At the same time, it is important for coaches to build trust with their athletes. Many distance runners are conscientious, focused, driven, and goal-oriented — sometimes to the point of neuroticism. Those traits should surprise no one. Knowing all the potential challenges of transitioning from a strong competitive high school student-athlete to a far more highly competitive college environment can unsettle even the most accomplished runner. Often, new athletes are less likely to want to disappoint coaches and other support staff. This can prevent them from being honest about how they are feeling with regards to workouts, the team, or any academic struggles. Building and having a trusting relationship between an athlete and their coach is more likely to result in honest communication, especially when an athlete is experiencing a difficult moment, day or week. 

Meaningful but Manageable Goals

While so much of athletes’ success revolve around performance targets, coaches can also help and support an athlete by setting meaningful but manageable goals that are both qualitative and quantitative. While personal bests are hoped for, other important goals in the student experience might be staying injury-free, achieving good grades, and staying mentally strong and emotionally grounded even when faced with athletic and academic challenges. These qualitative goals give the coach-athlete relationship an opportunity to talk about staying healthy. When an athlete is struggling with training, substitute a non-training goal such as getting to sleep by 11 PM or finding a study partner for a hard class instead of meeting a weekly mileage goal. Substituting a more attainable goal will help the athlete feel like they are still on the road to success. 

Respecting Training Age

Unlike skill-based sports where a talented athlete can compete immediately as a first-year athlete and fatigue can be managed by limiting playing time, endurance sports are different. The most successful cross-country athletes are typically juniors, seniors or redshirt seniors. Building endurance capacity builds slowly over countless hours of uninterrupted training time. Trying to rush the development of first-year athletes, who are not as likely to contribute to team scoring or success invites injury. A lost season due to a BSI, not only sets an athlete back physically but also mentally as their teammates continue to advance. Most first-year athletes are not ready for supplemental training as they are making so many other adjustments in their life. The higher weekly mileage and harder interval workouts are a sufficient training stimulus. That doesn’t mean they would not benefit from supplemental exercises such as core strengthening, lateral hip and groin strength, and betting movement/motor control. Note, all of these can be accomplished without exercises that put high-stress rates on their lower extremities. 

Unfortunately, there is no physical assessment or physiological calculator that can tell a coach or practitioner that a significant stress injury is about to occur. Recognizing that young college athletes are more susceptible to injuries and adjusting their training program accordingly to balance the non-physiological stressors seems prudent. While coaches cannot control those stressors, they can account for them in training loads and training cycles. In some cases, training less may add up to improved physical and mental health and better, injury-free, performances. 

Terence Favero, Ph.D., is a Professor of Biology and Sport Scientist. He has previously served as a conditioning coach for the men’s and women’s soccer teams at the University of Portland and the men’s soccer team in preparation for the 2000 Olympics. He is currently the Chair of the World Commission for Science and Football. He can be reached at [email protected]. Allegra VanderWilde is a first-year medical student and a former cross-country runner.

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