Track & Field injury prevention for girls.
A bone-health and load-management sport before it is anything else.
Bone
Stress injuries are the defining risk in adolescent female distance runners.1
≥3 mo
No period for three months or more is a clinical finding requiring evaluation, not a normal training response.4,3
~10%
Practical ceiling for weekly mileage increase during build phases.6
Track and field, and distance running in particular, is the sport where energy availability and bone health matter most directly. Prospective work in adolescent runners identified sex-specific risk factors for stress fracture — low BMI, late menarche, menstrual irregularity, and high mileage — and fracture risk in young athletes tracks with menstrual status and bone parameters rather than with training alone.
The other half of the sport is speed. Hamstring strain is the classic sprint injury, produced in the late swing phase at top speed, and it recurs at high rates when athletes return before eccentric strength is restored. Both problems are managed with the same discipline: count the load, fuel the load, and progress it gradually.
What actually injures track & field players
Bone stress injury / stress fracture
The signature injury of the sportMechanism: Repetitive impact loading outpacing bone remodeling — tibia, metatarsals, femoral neck, and pelvis are the common sites.
Female-specific: Low energy availability, menstrual irregularity, and low BMI are established sex-specific risk factors in adolescent female runners; femoral neck and pelvic sites are medical urgencies.1,2,4
Hamstring strain
Most common sprint injuryMechanism: Late swing phase at maximal velocity, when the hamstring is lengthening under high force.
Female-specific: Eccentric hamstring training reduces strain incidence substantially; it is the single highest-yield exercise for sprinters and jumpers.5
Medial tibial stress syndrome (shin splints)
Very common early seasonMechanism: Rapid mileage or surface change, often the transition from indoor to outdoor or from off-season to full training.
Female-specific: Frequently the precursor to a tibial stress fracture in an under-fuelled athlete — persistent, focal shin pain deserves imaging, not tolerance.1
Patellofemoral pain
Common across eventsMechanism: High running volume with limited hip abductor and extensor strength.
Female-specific: Hip-focused strengthening outperforms knee-only rehab in female runners with patellofemoral pain.5
Why the risk is different for girls
These factors change what prevention has to address — they are not reasons to train girls less.
Bone is built in adolescence, and only in adolescence
Roughly 90% of peak bone mass is accrued by the end of the teenage years. An athlete who trains through amenorrhea in high school does not simply have a bad season — she reaches adulthood with lower peak bone mass and a higher lifetime fracture risk. This is the single most consequential female-specific issue in the sport.2,3,4
Weight is not a performance variable in a growing athlete
Comments about body composition from coaches are a documented trigger for restrictive eating in adolescent runners. Programs should have an explicit no-weight-talk policy, replace scales with performance markers, and make fueling before and after training a normal, coached part of the session.4,3
Energy availability comes before every other adaptation
When an athlete does not eat enough to cover the energy her training burns, the body downregulates the systems it treats as optional first — menstrual function, bone remodeling, immune response, and tissue repair. The IOC calls this Relative Energy Deficiency in Sport (REDs), and it raises bone stress injury and soft-tissue injury risk independent of how good her mechanics are. Amenorrhea (no period for three or more months) in an athlete is a clinical finding, not a convenience.4,3,2
Puberty changes the machine mid-season
The adolescent growth spurt lengthens the levers (femur, tibia) faster than the neuromuscular system recalibrates, and in girls the strength gain that accompanies growth is smaller than in boys. The result is a two- to three-year window of reduced dynamic knee control, wider dynamic valgus on landing, and higher relative injury risk. Programming should get more — not less — landing and single-leg work through this window.7
Menstrual-cycle phase is a variable, not a taboo
Hormonal fluctuation across the cycle affects laxity, neuromuscular control, thermoregulation, and perceived exertion, and prospective data in international footballers found injury incidence differed by cycle phase. The practical action is not to restrict training but to track: a simple cycle log next to load data lets athletes and staff see patterns and adjust intensity, hydration, and fueling.8
The protocol, block by block
Same base for sprinters and distance athletes; sprinters add the acceleration block, distance athletes add the drills block.
Block 1 of 5
Easy running and mobility
Easy jog, leg swings, walking lunges with rotation, ankle mobility work.
- Relaxed shoulders
- Full range, no bouncing
- Build gradually
What to check, and when to escalate
Menstrual and energy history
Confidential preseason questions on cycle regularity, age at first period, prior stress fracture, and fueling around training.
Red flag: Amenorrhea, oligomenorrhea, prior bone stress injury, or restrictive eating — refer to a physician before increasing load.
Hop test for bone pain
10 single-leg hops on the symptomatic side.
Red flag: Focal, reproducible bone pain — stop running and obtain imaging; this is not a soft-tissue presentation.
Eccentric hamstring capacity
Nordic hamstring hold or field test at preseason; record the angle of break.
Red flag: Marked side-to-side asymmetry or a prior strain within 12 months.
Load rules that prevent overuse
- Increase weekly mileage by roughly 10% or less, and hold a down week every third or fourth week.
- Fuel within 30-60 minutes after every hard session; morning training requires something eaten beforehand.
- Alternate surfaces — do not run every session on track or concrete — and rotate shoes.
- Any athlete returning from a bone stress injury restarts at a fraction of previous mileage under a clinician's graded plan, regardless of fitness.
Gear & equipment
- Spikes reintroduced gradually — they shift load to the forefoot and calf and are a common trigger for metatarsal and Achilles symptoms.
- Training shoes tracked by mileage, not appearance.
- Sports bra fitted properly; breast pain is a documented barrier to running participation in adolescent girls and is fixable.
Stages, not dates
Progression is criteria-based and clinician-led. A calendar date is not a clearance.
Stage 1 of 5
1. Medical clearance and cause addressed
For bone stress injury: energy availability, menstrual status, and vitamin D/calcium reviewed and being treated.
Questions coaches and parents ask
No. It is common, but it is not normal or benign. Absent or irregular periods in an athlete signal low energy availability and predict reduced bone density and higher fracture risk. It warrants medical evaluation, not a heavier training block.
Every claim, sourced
10 peer-reviewed sources. Each links to its PubMed record so you can read the original.
- 1
Tenforde AS, Sayres LC, McCurdy ML, Sainani KL, Fredericson M. Identifying sex-specific risk factors for stress fractures in adolescent runners. Med Sci Sports Exerc. 2013;45(10):1843-1851.
PubMed 23584402 - 2
Ackerman KE, Cano Sokoloff N, De Nardo Maffazioli G, Clarke HM, Lee H, Misra M. Fractures in relation to menstrual status and bone parameters in young athletes. Med Sci Sports Exerc. 2015;47(8):1577-1586.
PubMed 25397605 - 3
De Souza MJ, Nattiv A, Joy E, et al. 2014 Female Athlete Triad Coalition consensus statement on treatment and return to play of the female athlete triad. Br J Sports Med. 2014;48(4):289.
PubMed 24463911 - 4
Mountjoy M, Ackerman KE, Bailey DM, et al. 2023 International Olympic Committee's (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). Br J Sports Med. 2023;57(17):1073-1097.
PubMed 37752011 - 5
Lauersen JB, Bertelsen DM, Andersen LB. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med. 2014;48(11):871-877.
PubMed 24100287 - 6
Gabbett TJ. The training—injury prevention paradox: should athletes be training smarter and harder? Br J Sports Med. 2016;50(5):273-280.
PubMed 26758673 - 7
Hewett TE, Myer GD, Ford KR, et al. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med. 2005;33(4):492-501.
PubMed 15722287 - 8
Martin D, Timmins K, Cowie C, et al. Injury incidence across the menstrual cycle in international footballers. Front Sports Act Living. 2021;3:616999.
PubMed 33733235 - 9
Sugimoto D, Myer GD, Foss KDB, Hewett TE. Dosage effects of neuromuscular training intervention to reduce anterior cruciate ligament injuries in female athletes: meta- and sub-group analyses. Sports Med. 2014;44(4):551-562.
PubMed 24370992 - 10
Jayanthi N, Pinkham C, Dugas L, Patrick B, LaBella C. Sports specialization in young athletes: evidence-based recommendations. Sports Health. 2013;5(3):251-257.
PubMed 24427397
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