Stress Fractures in Figure Skating

[sisinka]

4) MINDSET

- REST OF THE TEAM'S MINDSET part 3

COACHES MINDSET:
1) Nutrition. Enough sleep. Vacations...
2) Lack of datas
3) Which things form coaches' soul and determine training approach?
A) Negative approach and negative behavioral patterns
4) Which things form soul of coach and determine training approach?
B) Positive approach and positive behavioral patterns


5) Coaches approach towards athletes

More or less strict approach, more familiar or distant... Approaches may vary a lot looking at text below.

- Frank Carroll - "...you gotta realize it’s all about them [the skater]; it’s not about you. This is their life, their career. You know, people will say to me, ‘You made Michelle Kwan the most beautiful skater, the world champion!” or ‘You made Evan Lysacek the Olympic champion!” That is not true. I was there to guide them and to help them. They made themselves the world champion and Olympic champion. They had the guts; they had the passion; they had the ability. I was just there to direct and give them emotional support and encourage them." (https://figureskatersonline.com/new...oll-talks-skating-with-figure-skaters-online/ )

- Mie Hamada - "On the Japanese Internet, she is sometimes called “crusher”, emphasizing her toughness and exactingness. She herself once, as if defending this style, described herself with the phrase “I’m a coach, not a neighbor’s aunt.” (https://fs-gossips.com/9546/ )

- Sofia Samodelkina on Sergey Davydov - "...Well, there just wasn’t any particular danger. It’s just that Sergei Dmitrievich loves to panic with any injury (laughs). Immediately begins: “Oh, what to do, what to do?” He is very worried about us...Relatively speaking, he did not tell me have a strong pain-relieving injection and go skating at the competitions at any cost. No. Sergei Dmitrievich, on the contrary, is strictly for health." (https://fs-gossips.com/7638/ )

- Carol Heiss - "...But I also tell them, you’re very special... I tell the kids, don’t let it go to your head, but I think you’re very special, and that’s why I’m willing to spend a lot of time with you and why I want you to stay in the sport. Because you don’t realize that until you’re out of it and you look back on it. And it doesn’t matter if you’re Olympic champion or if you’ve passed your senior free test, or you’ve passed your dance test — any level you achieve is special. You’ve learned the lesson because you’ve gone as far as you can go. The ice is very unforgiving, and these kids take the worst falls trying to do triple jumps. And it takes a special person to get up and get back out on the ice." (https://manleywoman.com/episode-62-carol-heiss-jenkins-part-2/ )

- Peter Grutter (about Stephane Lambiel) - "...His team has to be calm. A person who doesn't know Stéphane (Lambiel) well enough could make a misstep. A badly placed comment could really throw him off. You have to know what to say and when... Stéphane doesn't like the same comments to be repeated over and over again. ..." (https://www.goldenskate.com/forum/threads/interview-about-stéphane-lambiel-with-his-coach.18566/#post-286844 )

..."...We have sort of telepathy together. Sometimes I feel things and he says them out loud. He is like my son..." (https://absoluteskating.com/index.php?cat=interviews&id=2009grutter )

- Alexei Urmanov - "...Reporter - So, must the athlete find motivation in himself? Alexei: "He must not find motivation. If you don’t have motivation, take a rope, hang a noose where you had a chandelier, and hang yourself. Motivation should always be there, so it’s a little incomprehensible to me when one of the athletes says that he has lost motivation. If you lose motivation, finsh your career." (https://fs-gossips.com/7802/ )

- Tamara Moskvina - "...On mental training for her skaters, and helping them perform consistently: First you should analyze, what is their psychological status. Then you watch them during events, during competition or during situation when they are in a stress mood, and you try to find the proper approach in order to avoid such situations, or to teach them how to manage those feelings or those stresses. It depends on each person separately." (https://manleywoman.com/episode-81-tamara-moskvina/ )

... “I read books about psychology and mental preparation. I developed a method to deal with the nerves,” she said. Now she employs similar methods to help her students prepare for competitions." (https://www.goldenskate.com/tamara-moskvina-coach-of-olympic-pairs-champions/ )

I personally believe that coach needs to be psychologist as well to be able to help skaters to develop as much as possible. I do believe that better understanding of skater's mind may help in skater & coach cooperation, which may lead to better planned training program. Also if skater feels that coach shows understanding, the openness from skater's side can be bigger. This may help to reveal sooner the possibility of serious injury.


6) Coaches' power

I am used to system where coaches decide about planned content, competition and other skating things. I was very surprised that things can be different in America.

I offer you two stories...

First story: Rafael Arutyunyan - "...The problem in Pyeongchang was that before each program they had decided to do two elements that we did not train. He said that they decided it. I mean, he with his close circle, parents. When he said this, it was obvious that he would fail the short program. ...Reporter: But you, as a mentor, could not convince and explain that this is a risk, and the Olympic Games are not a place for experiments? Rafael Arutyunyan: I could not convince. I explained, but I could not convince." (https://fs-gossips.com/6883/ )

Nathan planned quad lutz in combination, quad toeloop and triple axel in Olympic Short Program 2018. He executed all three jumps with negative GOE, fell in lutz, no combination = 17th place after the Short Program. Before the event he was medal contender.

Second story: Tom Zakrajsek - "...On the criticisms that he pushes injured skaters too far: Sandy Rucker at one point, that was Sandy’s choice [to compete while injured] because she was doing the TV special for Lifetime and she was getting paid money to do that. That was certainly not my choice... Regarding Josh Farris, that was his choice to compete, and it was his parents’ choice for him to compete. I highly recommended that he withdraw, and certainly for him, he felt that if he didn’t compete, a spot at the world junior championships was on the line. ... A coach never has the right to withdraw a skater from a competition. It’s the athlete’s right to try. Did I support him in his decision? Yes. So I feel that’s my role as a coach, to advise him, but he and his family made their own decision and I supported that decision... With Rachael Flatt that year, and I think everybody knows this, she was injured the whole season. So it wasn’t like she went into Nationals or Four Continents that year uninjured. So, you know, the whole year she had been injured with that leg injury, so there wasn’t anything new when she went to the world championships. Now whether something about the diagnosis of the injury changed — that’s different. But she was injured that whole season on that leg, and been skating quite well and doing quite well. So I don’t know what people would want to say about that, except that I do know there was a huge expectation for three ladies [at next year’s worlds], and they were in a position again to have three ladies, and that didn’t happen. And that’s part of sport... And certainly by no means did I encourage Rachael to compete, and tell her she had to compete with an injury. Not at all, that wasn’t even the case. So if people think that, it is the furthest thing from the truth." (https://manleywoman.com/episode-78-tom-zakrajsek/ )

In January, 2011, Josh Farris made his senior-level debut at the U.S. Championships, ....he suffered a torn abductor muscle following a devastating fall during the second day of practice sessions at the event. This was followed by a broken fibula, an injury he sustained during the free skate. (https://www.starsonice.com/skaters/josh-farris )

Rachel Flatt was sent to the 2011 World Championships. A week before the event, Flatt was diagnosed with a stress fracture in her right tibia (her landing leg). Nevertheless, her coach Tom Zakrajsek stated that he felt that Flatt could complete her elements despite the stress fracture and did not request that the alternate, Mirai Nagasu, compete in her place. In June 2011, U.S. Figure Skating reprimanded and fined Flatt for not informing them of her injury in advance. (Wikipedia)

Planned content. I am very surprised that some coaches (probably mainly in America) doesn't have the main voice in planning program's content. Oficially it is coach who is responsible for skater's performance. Oficially criticism for poor performance goes towards skater AND coach. Criticism after poor performance about skater not being well prepared goes DIRECTLY towards coach. Is it common in America that parents behave like this? Is it paying off?

If coach says one thing, skater after discussion with family does another thing...then family and skater are partially adapting coach's role. Usually only coach is specialist in coaching. Who is responsible for overloading and injury then?

Withdraw decision. I am once again surprised. I am supporter of ideology that family should be the main supporter and protector for skater, even if some "strict" coaches may think that it is too much. Family love and protection can be one of counterbalancing things for skater dealing with mental overload, stress and self-esteem.

In case of Rachel there was not a clear information who decided (coach, parents) that stress fracture is not that serious problem. It was not good decision.

One medical point - skating with stress fracture prolongs treatment. Fracture becomes bigger - Ye Lim Kim - "When she initially injured herself in early January, it was a small scratch, but by the end of March, after continuing to skate on it, the fracture had worsened, with a fissure forming around almost the entire circumference of the bone." (https://fs-gossips.com/11137/ )

The longer treatment and immobilization = the bigger muscle hypotonia and atrophy in that segment of body. The longer it takes to get onto previous shape.

There is a question if Rachel and Joshua's stress fracture happened really in time when they found out. It could be sooner, but fracture line became bigger and pain aggravated, so they went for check-up. Even if fracture would really happen in time when they found out - Rachel was training whole week before competition and whole week during competitions - at least 200 jumps? After second triple axel Joshua had another 8 jumps (some of them in combination.) She finished 12th, he 21st. Based on Wikipedia - "on October 30, 2012, Flatt said she would miss the rest of the season due to the recurrence of an injury in her right lower leg and ankle." Rachel announced retirement at the age of 21. Joshua had multiple injuries. Based on Wikipedia - "however, he had to withdraw from the Cup of China (2014) due to a recurring right ankle injury, which had been a problem since 2011." Joshua retired at the age of 21.

Once again exchanging roles...family making medical decisions...whole team believing that stress fracture is not necessary to treat immediately, because Rachel skated with foot pain for whole season. I do not believe that exchanging roles is a good idea in any team. I think that suggestions are OK from anyone, especially if they are supported with good arguments. But I believe that coach's decisions should be done by coaches. Doctor's decisions by doctors. Skater's decisions by skater.

As to overloading injury - "Are you able to skate the program at competition today?" - it shouldn't be the right question taken into account coming to stress fractures. No coach or parent want skater to skate 4 minutes and never more. They want skater to skate and train for many years, for many hours a day, compete at many competitions and attend at least one or two Olympic cycles. "Are those 4 minutes of program going to crush these plans with high probability?" "Are those 4 minutes of program going to damage full training process for (all) next seasons?" Those are much better questions which should be spoken about.

--------

- Brian Orser - "At the end of their competitive careers, I want to have handed them tools of some kind to live their post-competitive lives... Although winning medals is important, more than anything I want to enrich their lives." (https://www.tumblr.com/nanoka12/136682167711/brian-orser-the-success-that-i-feel-is-for-my )

- Evan Lysacek about Frank Carroll - “He made me believe that I could skate perfectly in the Olympics,” Lysacek said after the 2010 Games."
(https://abcnews.go.com/Sports/wireS...ure-skating-coach-led-michelle-kwan-111009676 )

I wish all skaters to find the right coach for themselves. Somebody who will not only help them to reach their skating potencial, but who will also raise their personality and other qualities into the best. It will not only help to reduce number of overloading injuries in my opinion, but it will also help skaters to grow into best version of themselves for their whole life.

 

[sisinka]

AVULSION FRACTURE


Avulsion fracture is a failure of bone in which a bone fragment is pulled away from its main body by soft tissue that is attached to it. (https://www.ncbi.nlm.nih.gov/books/NBK559168/ )

Avulsion fractures are more common with young athletes. Teenage age is very typical because of growing body and still softer parts of bone.
More informations for example here - https://www.childrenshospital.org/conditions/avulsion-fracture

Avulsion fracture IS OVERUSE INJURY. Repetitive stress plays once again the biggest role.

- Jennifer Kirk

Preventing pain in figure skating

Earlier this week, The New York Times ran an article discussing injuries in figure skating and how science is helping to better understand and prevent them. (This article in its entirety can be found in my "Headline Grabs" section.) In addition to creating a new brand of skates and [...]

web.archive.org

- "...When I was 15 and regularly skating 2 1/2-3 hours per day, with the majority of that time spent performing triple jump after triple jump, I suffered a break in my pelvis. At the time I had just won a world junior title, and with the confidence that came from youth and the win, I was motivated to add some additional triple-triple combinations to my repertoire.

The afternoon my injury took place, on a triple lutz triple loop combination, I heard a pop. I had torn a piece of bone off from my pelvis and it was sticking into my hip flexor. Ouch. Unfortunately, at the time I didn’t know this was what had happened, and I continued skating through the pain for the rest of the session and for a few months following–before reluctantly visiting a doctor.

I often look back and wonder why I didn’t go to the doctor or even cease jumping for the day, and why I continued to train on a broken pelvis for the following season without taking the time off to fully heal the bone. Was it because I was that motivated to continue training? Was it because my coaches were pushing me to grit my teeth through the pain? I think it was probably a combination of both, along with a mindset some athletes hold, told best by the saying: “If it’s not bleeding, it’s not a big deal.”

I feel strongly that although injuries are unavoidable in skating, stressing the fact that it is okay for a skater to listen to their body and quit when it’s told them it’s had enough for the day is going to drastically reduce their occurances. I wish that I had been able to listen to my body more during my career, and I unfortunately still suffer pain in my hip today. Hopefully this trend of coaches scaling skaters’ training back and getting the message across that less, in a sport so focused on our athletes’ achieving more, can, at times, be best."


- Daria Usacheva

Daria Usacheva is diagnosed with a trochanteric fracture of the hip

According to Match TV, the preliminary diagnosis of the Russian figure skater Daria Usacheva is a trochanteric fracture of the hip.

fs-gossips.com

- "...A preliminary examination revealed a trochanteric fracture of the hip."


- Nathan Chen

Nathan Chen to miss worlds after injuring hip

Chen is expected to make a full recovery.

eu.usatoday.com

- "...Chen suffered an avulsion injury — when a piece of bone tears away from the main part of the bone...Chen underwent left hip surgery Wednesday. He is expected to return to the ice with restrictions in eight to 10 weeks and make a full recovery..."

Nathan's injury happened at gala at U.S. Nationals.

I really don't like when skaters go for difficult jumps, especially quad jumps at gala after big competitions. Body is exhausted after the competition from multiple reasons, which makes it more prone to injuries.

In case of Nathan, he describes his time following an injury in his book.
- about 5 months off the ice
- 4.5 months after the surgery he tried the first jump
- after the first jump it took another couple of months until he could train on the level like before the surgery.

Nathan didn't spoke about pain, swelling, uncomfortable walking on crutches (btw try to take a cup of hot coffee from kitchen to living room when you need to use both crutches because you cannot put any pressure on injured leg). Those and many other things are always a part of recovery process after surgery. The journey is long and difficult especially in case of elite athletes. That's why it is much better to prevent from those situations. Or at least try to prevent.

The situation with avulsion fractures is the same like in case of typical stress fractures. Skaters were overtraining for longer, first soft tissues reacted (pain and hypertonia, muscle imbalances, tendinitis, swelling...). Nobody took time for physiotherapy or rehab to correct all those issues, there was no correction of overloading at practise. So one day bone fractured - avulsion or stress fracture.

1) Not to overload or decrease load if needed and 2) start early with rehabilitation helps to reduce number of injuries and even prevents from injuries. And I am not only speaking about overuse injuries. When body is in good shape, muscles in right tone and balance, joints well centered - skaters are capable of higher level performance. But their body is also able to handle falls better - tired body with muscle imbalances is more prone to injury, while well strengthened body with well stabilized and well centered joints may sometimes help to avoid acute injury or at least reduce the seriousness of an acute injury.

The load on human's body is enormous in today's figure skating, the level of difficulty raised in last decades. It is really important to try to find out the ideal load on teenage and child's body.

 

[sisinka]

List of skaters with STRESS FRACTURES was updated:

SINGLE LADIES

SINGLE MEN

Another skaters with stress fractures in past:

MEN

- Tomoki Hiwatashi - "..."I had a major injury in my back during nationals(season 2022-23). It was a stress reaction," Hiwatashi recalled." (https://featured.japan-forward.com/...an-to-train-with-mie-hamada-paying-dividends/ )

- Michael Weiss - two stress fractures (ankle and toe of foot in 1999 and season 2000-01 were already mentioned)
- here is another one:
...He missed sectionals in the fall of 1995 due to a stress fracture in his heel, (https://www.goldenskate.com/forum/threads/tim-goebel-leaving-frank-carroll.7212/#post-91402 )

- Alexander Majorov - ...Last fall (2007) Sasha went to Golden Spin. His back was still bothering him … But something happened in practice and he couldn't move at all ...he went to Stockholm to have an MRI scan. There they found an old stress fracture in his back and a new one starting a bit further down..." (https://absoluteskating.com/index.php?cat=articles&id=2008sashamajorov )
...He withdrew from the Swedish Championships to recover after an operation to extract bone marrow for his father (season 2015-16)...His withdrawal from the 2016 World Championships in Boston followed the detection of a precursor to a stress fracture of the pelvis. (it could be due to extract bone marrow - bone bruise can be one of rare complications) (Wikipedia)

- Vladimir Litvintsev - "...I skated for eight months with an injury. Question: Injury – fibula stress fracture? Vladimir: Yes, exactly... In China (Olympics 2022), it was almost not painful anymore. I had a very moderate load, so I was able to perform well. I was taking a lot of painkillers." (season 2021-22)(https://fs-gossips.com/8738/ )

- Maxim Naumov - ...My first serious injury was five or six years ago (2017 or 2018). I’ve always had issues with my ankle. I have never had such a fracture. My bone broke, and part of it began to rub against the tendon. The first surgery was to remove part of the bone. The second was to remove other pieces, then the third was in the same place to close the hole they made to find the pieces of this bone, and the fourth was to heal the scars on the muscle tissue. All this was on the ankle. (https://fs-gossips.com/9891/ )

LADIES

- Caryn Kadavy - ...She withdrew from the 1989 U.S. Championships due to a stress fracture in one ankle... (Wikipedia)

- Tiffany Chin - ...After a stress fracture of the ankle kept her out of the 1981 nationals... (https://www.nytimes.com/1984/02/13/sports/outlook-is-shiny-and-goals-are-set-for-tiffany-chin.html )

- Diana Guseva - "...At the same time as Anya (Shcherbakova - season 2017-18), I had an injury - a stress fracture..."
(https://www.championat.com/figuresk...nie-s-zagitovoj-vostorg-ot-tuktamyshevoj.html )

- Emilia Murdock - Emilia has her eye on the 2022 Olympics — and not even a recent back fracture can derail her. (February 2017)
“She was doing a split jump, and it just snapped,” said Emilia’s mother, Yalin.
(https://www.bostonherald.com/2018/02/02/kalter-broken-back-didnt-deter-newton-teen/ )
...While at practice, Emilia fell and fractured her back (autumn 2019). In an email with The Darien Times, she wrote that her fall isn’t as bad as what happened to her in 2017, when she broke her back as a result of a stress fracture.
(https://www.darientimes.com/news/article/Darien-figure-skater-injured-will-not-compete-14988168.php )

- Courtney Hicks - ...X-ray, and it showed a triangular piece of bone about one inch on all sides had come away (from the tibia) below the knee,” Nicks said. “The doctor told me he had never really seen one like that before.”
Nicks said the injury occurred on the jump, a triple flip, that opens her free skate. But the coach wondered if her two falls on jumps in the short program might have owed something to the incipient leg problem. (autumn 2011)
(https://www.chicagotribune.com/2011/10/12/injury-knocks-top-young-us-skater-out-for-season/ )

- Darya Panenkova - "Stress fracture of the foot, not bad as a real fracture but it need some time to recover." (October 2017)
(https://www.goldenskate.com/forum/threads/daria-panenkova.59799/page-8#post-1802594 )

- Yukina Ota - ...let us know about your right ankle injury which seemed to concern you from 2003-04 season (later ir was told that Yukina was in pain for 4 season because of this). Yukina: "It was bone bruise..." (https://pigeon-post.net/interviews/JS_Yukina_Interview_en.html )

- Kiri Baga - "...Baga back in top form. After being sidelined with a stress fracture this summer (2010),..." (http://eric-minnesotaice.blogspot.com/2010/ )

 

[sisinka]

Rika Kihira's injury update.

- "...Rika withdrew from the 2021–22 Japan Championships due to a talus stress fracture in her right foot, first discovered in July 2021..." (Wikipedia)

“The fracture line has become much thinner. But honestly, it’s scary that this line is still there…” Rika Kihira about her injury

Rika Kihira about her injury and plans for the future.

fs-gossips.com

- "...In the 2021-2022 season, she missed all competitions due to injuries, including a right ankle injury. Her long-standing goal of qualifying for the Beijing Olympics ended up as a disappointment.

...In the 2022-2023 season, she participated in the Grand Prix series and the Japanese Nationals, but her injury was not fully healed, leading to unsatisfactory results.

...Amidst all this, on the June 29th 2023, she updated her Instagram and shared an X-ray image of her right ankle. She wrote, “It still looks intense in the photo… The fracture line has become much thinner. But honestly, it’s scary that this line is still there…” She further revealed, “Actually, it worsened again at last year’s Nationals…”

“There may be some tough moments ahead this year, but I’ll try my best to stay positive.” Rika Kihira will miss the entire 2023/24 season

Rika Kihira will miss the entire 2023/2024 season.

fs-gossips.com

- "...On the 28th (September 2023), through the Japan Skating Federation, she announced her withdrawal from the second event of this season’s Grand Prix (GP) Series, Skate Canada (Vancouver) in October. Her right ankle stress fracture, which has been troubling her for some time, has not completely healed. She had previously announced her withdrawal from the Chubu Championships earlier this month..."

She missed whole 2023-24 season.

------------

News from Rika's Instagram post (September 18th 2024).

“The fatigue fracture is almost healed, and I have been able to resume daily ice training. However, the doctor has advised that I’m still not in a condition to perform fully without worry.” Rika Kihira taking a break for the season

Rika Kihira announced she will take a break for the entire season.

fs-gossips.com

- "...I was entered in the Chubu Championship starting on September 21 (2024), but I have decided to withdraw.

The fatigue fracture in my right talus is almost completely healed, and I have been able to resume daily ice training. However, based on the latest MRI results and my own feelings, the doctor has advised that I am still not in a condition to perform fully without worry.

After much consideration on whether I should rush my recovery, and consulting with my coach Brian, I have come to this decision.

I will continue to train, work out, and undergo treatment within a range that does not strain my injury. I am committed to improving my skills and fully recovering from my injury, and I look forward to the day I can skate freely and confidently in front of everyone without any worries. I will continue to work hard every day.

Although I will not be competing this season, I am truly grateful for the support and encouragement I have received, both past and present. I appreciate your continued warm support.”

------

I find it very wise to concentrate on full recovery. I also think that Rika's example may help other skaters to rethink their training approach and strategy for dealing with injuries. Overall it would be positive if more skaters would be open about their injuries like Rika was, it could help to show the real danger of overused injuries. And such example could lead to better understanding and better prevention.

I wish Rika full recovery and safe return on competive ice!

 

[cailuj365]

This is a very fascinating list, and what I've taken away from this is that nearly every competitive skater has suffered a stress fracture at least once in their career. While I agree that rest, nutrition, and tailoring training regimen are all crucial as part of prevention, I am curious as to whether anyone knows whether figure skaters have ever used bone-strengthening medications, such as teriparatide (Forteo) or abaloparatide (Tymlos) to increase rate of bone healing from stress fractures once a fracture has taken place. These are medications approved for osteoporosis, usually as 2nd line when the other 1st line medications fail. However, the 1st line medications for osteoporosis usually work by a different mechanism, stopping bone loss, whereas Forteo and Tymlos stimulate bone formation.

Why do I even bring this up? In my day job, I'm an endocrinologist, so I diagnose and treat osteoporosis on a fairly regular basis. More and more, we are seeing younger adults, not postmenopausal in age, and now even professional athletes, get prescribed these drugs on an off-label basis to accelerate bone healing. These are particularly used when there has been delayed healing or persistent non-union of the fracture. There have been more and more published, peer-reviewed case series of these medications suggesting favorable results when used for this purpose. You'll find media articles of MLB and NFL players using these medications to heal from stress fractures. Our colleagues in orthopedic surgery also tend to favor these medications, because it seems to help around healing of fractures pre- and post-surgery. While the typical treatment duration is 1-2 years for osteoporosis, for the purposes of fracture healing, I've seen it used more like 2-6 months.

One major, major caveat -- these medications are not approved and have not been studied in children (<18 years old) and should not be given to anyone who is still potentially growing, and most figure skaters are very young. Most of the case reports and studies (and what I have observed in real life) are adults who are in their 30s-40s, perhaps mid-late 20s at their youngest. I would be EXTREMELY cautious in using it for anyone under 22 (and absolutely not for anyone under 18). However, could someone like Rika Kihira benefit from something like Tymlos at this point? Possibly...

The last thing I want to do is suggest that figure skating be as brutal and continue on as usual, because hoorah, there are medications that can potentially help you get better faster, but I don't see how stress fractures will be completely avoidable in skating. It is the nature of the sport to repetitively land hard on the ice and put tremendous weight loading forces on the feet, tibia, hip, vertebra, etc.

 

[sisinka]

Thank you for great medical post @cailuj365 ! It was interesting to read and very educational.

I didn't hear about those preparations before as my patients with osteoporosis use calcium supplements, vitamin D, less often bisphosphonates, or very rarely denosumab.

In Czech Republic teriparatide (Teriparatide, Forsteo, Movymia and other names in my country) is on prescription as well. While in 2020 it could be prescribed by doctor - specialist in Clinic Osteology only, now it looks it can be prescribed by any doctor. The same for abaloparatide (Eladynos in my country).

Like you mentioned one of contraindications is growing. And I think you hit the nail on the head with it. Most of stress fractures are happening in teen age for the first time (Vincent Zhou was even 9 years old). And typically many figure skaters have postponed puberty, so they have no way finished growth at the age of 18.

From articles of men with stress fractures I remember Todd Eldredge being 21 years old and Michael Weiss being 23 years old and older having their stress fractures. Filip Taschler was 24 years old. So they could be done with growing in that time, probably. But it was in 90s in case of first two men, where such medication was not taken into account.

I found one mention about young adults in medical database for these medications: in meaning that in case of young adults - "...the experience with these preparations are limited and the treatment should be used only when benefits clearly outshine possible risks..."

I looked for science studies, but there are not many. This is quite new method of treatment:

1) https://dugi-doc.udg.edu/bitstream/handle/10256/11152/Oliveras Font Mercè.pdf?sequence=1&isAllowed=y
- University of Girona with study from 2015, but it looked like planned study for future without results and outcomes (at least I didn't find any results)

2) https://www.sciencedirect.com/science/article/pii/S2214623716300114
- from 2016
- "...women, aged 21 to 45 years old,...
- ...teriparatide may help hasten fracture healing in premenopausal women with lower-extremity stress fractures..."

3) https://academic.oup.com/jcem/article/102/2/525/2972072
- from 2017
- "...Bisphosphonates or teriparatide may accelerate fracture healing in special circumstances.
- No study has been conducted evaluating the effect of teriparatide on stress fractures..."

4) https://journals.sagepub.com/doi/10.1177/2473011418790078?icid=int.sj-abstract.citing-articles.25
- from 2018
- "...teriparatide (Forteo) has shown some promise in the treatment of osteoporosis, but its use in stress fractures in the athlete is controversial and deemed off-label."

5) https://pubmed.ncbi.nlm.nih.gov/30908326/
- from 2020
- "...a case of a female National Collegiate Athletic Association Division I gymnast successfully returned to play after a 12-week course of teriparatide injections for an ischioacetabular stress fracture..."

6) https://scholar.google.cz/scholar?q=teriparatide+in+young+athletes&hl=cs&as_sdt=0&as_vis=1&oi=scholart#d=gs_qabs&t=1727590297935&u=#p=rc5ls6il700J
- from 2021, another planned study for the future without results
- "...Men and women, aged 18–40 years,...
- it mentions contraindications as @cailuj365 mentioned - "...Potential participants will be excluded if: ....present with open epiphyses in their diagnostic MRI scan;

This science article is the newest:

7) https://medcraveonline.com/EMIJ/EMIJ-12-00345.pdf
- from 2024
- "...Teriparatide is primarily used to treat osteoporosis but is also being investigated for its potential to accelerate fracture healing in athletes. The first reported use of Teriparatide in this context was documented in a 2015 case series (five athletes examined)
...In conclusion, Teriparatide shows potential as a treatment to accelerate fracture healing in athletes, but further research is necessary to establish its efficacy and safety fully. Athletes considering this treatment should consult with their healthcare providers to understand the risks and benefits."

---------------

Unfortunately I didn't find any materials about MLB and NFL players using this medication for stress fracture, could you sent the links here, please? I would like to read it.

And I would like to ask you about SIDE EFFECTS of these preparations? I didn't find any science articles about it. Do you have some links? Or do you have any personal experience with side effects?

Famous Mayo Clinic mentions side effects:

Teriparatide (subcutaneous route) - Side effects & dosage

www.mayoclinic.org

- "...more common (to pick few only):
confusion
constipation
depression
headache
increased urination
muscle weakness
nausea
unusual tiredness..."

Some of those side effects described above like more common could be very problematic for figure skaters. Especially confusion and muscle weakness in case of jumps...and mediacation should be take up to 6 months as you mentioned, which covers the time when skater is back on the ice already...

As to Rika, I do agree with you. The heeling is so much prolonged that in her case the benefits could overcome potential risks. She is 22 years old. Question is whether she doesn't have another contraindications growing including. And of course, maybe she already took this medication in past or now.

From articles I read, I don't remember any skater mentioning Forteo or Tymlos.

Btw do we have some orthopedist or traumatologist on the Forum?

 

[cailuj365]

Zach Wheeler (MLB):

Zack Wheeler has been injecting bone growth drug into stomach

In an attempt to stay healthy, Mets starter Zack Wheeler has been injecting himself in the stomach daily with a bone growth drug.

www.nbcsports.com

Can't find the article on the NFL player now, but I'm pretty sure I had seen it earlier.

The most common side effects that I have seen are dizziness/lightheadedness with positional changes after injection. It is usually transient, and for that reason, we usually recommend that the injection (yes, these are daily injections) be taken at night before bedtime so that any dizziness could potentially wear off by the morning. I have also seen people experience some heart palpitations. However, these side effects are not very common, and most people can take these injections without issues. The side effects of confusion, muscle weakness, depression, and increased urination are symptoms if Forteo/Tymlos increase blood calcium levels, but this is also uncommon.

I'm willing to bet that sports medicine doctors are recommending these to high-performance athletes in a widespread fashion for stress fractures, and this probably includes figure skaters above a certain age. If I know about this as an endocrinologist, it means that it's happening a lot in the sports world. These medications are quite expensive without insurance, and even with insurance, co-pay is high. However, cost and insurance is probably a US-specific issue, and I doubt that athletes are trying to use insurance for these medications. Fortunately, both Tymlos and Forteo (now generic) are approved for men now by the US FDA.

FYI, in the bone world, we refer to medications like Forteo and Tymlos as "anabolics," but they are NOT anabolic steroids. They're called anabolics, because they build bone rather than just stop bone loss.

I'm actually not the bone expert in my group, so I'll ask my bone endocrinology colleagues if they have any specific cases of using these in young athletes for stress fractures in their own practice. What I actually see and treat more is bone loss from hypogonadism (loss of estrogen/menses or low testosterone due to excessive exercise or low body weight), and some who I treat are young student athletes. In these cases, we focus on proper fueling/nutrition and changing exercise regimen to try to restore menses or testosterone. However, it is often very difficult because athletes are so active, and they have to follow the team training schedule. I end up having to prescribe hormone replacement for awhile to try to preserve their bones from future fragility fractures (which are separate from stress fractures), at least for the young women. Obviously, you can't take testosterone as an elite athlete...

 

[cailuj365]

And thank you @sisinka for compiling articles where teriparatide has been used in young people/athletes. There is also another study where it looks like they are studying it for stress fractures in young adults in the UK Army, but the results have not been published. Very interesting to see that it's been used in the NCAA for gymnasts. That means it's definitely talked about on the NCAA/collegiate-age level.

 

[sisinka]

Once again, great post! Thank you!

The most common side effects that I have seen are dizziness/lightheadedness with positional changes after injection. It is usually transient, and for that reason, we usually recommend that the injection (yes, these are daily injections) be taken at night before bedtime so that any dizziness could potentially wear off by the morning. I have also seen people experience some heart palpitations. However, these side effects are not very common, and most people can take these injections without issues. The side effects of confusion, muscle weakness, depression, and increased urination are symptoms if Forteo/Tymlos increase blood calcium levels, but this is also uncommon.

That is important information to hear that it is not common.

I'm willing to bet that sports medicine doctors are recommending these to high-performance athletes in a widespread fashion for stress fractures, and this probably includes figure skaters above a certain age. If I know about this as an endocrinologist, it means that it's happening a lot in the sports world. These medications are quite expensive without insurance, and even with insurance, co-pay is high. However, cost and insurance is probably a US-specific issue, and I doubt that athletes are trying to use insurance for these medications. Fortunately, both Tymlos and Forteo (now generic) are approved for men now by the US FDA.

I was curious how is situation looking like in my region.
I had a short conversation with our traumatologist, who confirmed that stress fractures are a diagnosis for orthopedists, so they are sending patient with suspicious stress fracture to orthopedic Outpatient Clinic. Nevertheless he heard about teriparatide.

Then I spoke with two orthopedists - they are working at both Inpatient and Outpatient Clinic. One is head doctor, other one is also the member of medical team of Athletic Representation in our country.

They are not specialized on Sports Medicine only, their sample of patients with stress fractures is not big.

They both heard about medication, but both immediately mentioned contraindications, growing period like the most important.

The first orthopedist had one patient when this medication was a possibility, but thanks to all contraindication it was not chosen for treatment. For his patients he recommends calcium and vitamin D.

The other one never used that medication, but he is used to patients - athletes who never visited him immediately (rather second or third week after the stress fracture). Which means he already saw healing process on the bone on X-ray or magnetic resonance, which was a sign for him not to look for additional medication.

The most crucial in their talk (in both cases) were two things:
1) Young person is healing well and fast. If healing is not going well, there must be some additional factor. Which leads to second point...(if there is no other disease or trouble which would prolong healing).
2) Rest. They both recommended resting time up to 6 weeks to allow bone to heal. Both repeated that resting time MUST be followed if an athlete wants to heal well and fast. With negative consequences (prolonged healing, bigger pain, lower level of performance) if not followed.

Both wanted training load to be step by step after the resting time.

I'm actually not the bone expert in my group, so I'll ask my bone endocrinology colleagues if they have any specific cases of using these in young athletes for stress fractures in their own practice. What I actually see and treat more is bone loss from hypogonadism (loss of estrogen/menses or low testosterone due to excessive exercise or low body weight), and some who I treat are young student athletes. In these cases, we focus on proper fueling/nutrition and changing exercise regimen to try to restore menses or testosterone. However, it is often very difficult because athletes are so active, and they have to follow the team training schedule. I end up having to prescribe hormone replacement for awhile to try to preserve their bones from future fragility fractures (which are separate from stress fractures), at least for the young women. Obviously, you can't take testosterone as an elite athlete...

That interests me a lot. I have another Thread - Eating Disorders on this Forum. I would like to prepare some questions for you (if you wouldn't mind), as this topic - loss of estrogen and menses is present in figure skating sport.

 

[sisinka]

...The last thing I want to do is suggest that figure skating be as brutal and continue on as usual, because hoorah, there are medications that can potentially help you get better faster, but I don't see how stress fractures will be completely avoidable in skating. It is the nature of the sport to repetitively land hard on the ice and put tremendous weight loading forces on the feet, tibia, hip, vertebra, etc.

Stress fractures are overuse injuries caused by repetitive motions where load on part of the body is bigger than a skater can deal with.
EXCESSIVE load is the biggest trouble in my opinion, not repetive motions itself.

On one side we do have a skater having certain level of ability to withstand certain amount of load.

On the other side we have training load. Which can be lower, equal or higger than skater's ability to withstand such load.

We do know that skater's body can be naturally weaker and more prone to injury during for example:
1) growing period
2) coming back after longer break.
Also
3) injury in any part of the body is more prone to re-injure, any injury may cause troubles to other parts of the body.
What is also influencing load or ability to withstand load is:
4) jumping technique
5) current tiredness

Skaters would probably come with more than 5 points. All these things are influencing skater's ability to withstand load. Skater cannot influence 1) and 2), while other points can be influenced.

As to technique - the book FIGURE SKATING LIKE A COSMIC FLIGHT by Alexei Mishin - landings in triple jumps are around 5 to 10G forces. Angle in ankle, knee and hip's joint of landing leg are important in increasing / decreasing landing load on body. Another essential thing is landing on toe-pick before moving on the other part of the blade. He mentions that landing on the blade (without toe-pick moment) increases landing loads almost twice.

As to tiredness - nutrition, rest time (day off), sleep, mental health...helps.

Every skater should be examined by Rehab doctor or Physiotherapist to evaluate and correct not only wrong posture and deep stabilizing muscle system activation. But also to find out where are "weak places" on skater's body, which will be more prone to injury.

In my understanding figure skating worlds concentrates on enormous number of repetitions (while I was skating myself it was common approach). Which is understood to be the only way how to master figure skating elements. The more you do, the better an element will be.

This is not working for elements where load on body is extremely big - triple and quad jumps. In these elements there is a certain number of repetitions which you cannot overstep, if you want to avoid stress fractures.

Skaters experiencing stress fractures or overuse injuries describe their training regime before the injury:

Stress Fractures in Figure Skating

And not only training on and off the ice. I believe that whole approach is not complex and skater's life and career are not planned and controlled in a fully functional way. While physical and mental demands had grown enormously - things which should COUNTERBALANCE both physical and mental...

www.goldenskate.com

(you need to open the link to see the right post number 73)
- Increased training load, too big number of jumps per practise...
- 35 triple flips per practise (Christopher Bowman)...20 quad jumps (Michael Weiss)...more than 30 quad attempts per practise (Daisuke Takahashi)... 200 jumps per training (Diana Guseva)...50 triple axels and 10 quad attempts per practise (Alexandra Trusova)...

The key is to balance skater's ability VERSUS training load.

 

[sisinka]

...
I dont agree with that either, I've made that same point a few times. I think Usacheva's injury for example is a result of too strict dieting. I think dehydration is a big risk with especially that training group. Dehydration is known to lead to muscle tears and bone breaks. No minerals/electrolytes and tendons are stiff. This was a coaching failure. Usacheva was clearly meant to be bigger and if she was I think her tech would have been fine. ...

Not sure if there are in-vivo studies concerning increased tendon sport injury risk accounting for natural hydration methods but here are two articles demonstrating biomechanical correlations with tendon fiber hydration. They demonstrate loss of flexibility and lubrication (among other things) which I believe are scientifically supported as correlated with tendon injury risk (but I could be wrong! I am lazy to check...)

Rehydration of the Tendon Fascicle Bundles Using Simulated Body Fluid Ensures Stable Mechanical Properties of the Samples - PMC

In this work, we investigate the influence of dehydration and subsequent rehydration of tendon fascicle bundles on their structural and mechanical properties by using distilled water, 0.9% NaCl, 10% NaCl, SBF, and double concentrated SBF (SBFx2). ...

pmc.ncbi.nlm.nih.gov

Water-content related alterations in macro and micro scale tendon biomechanics - PMC

Though it is known that the water content of biological soft tissues alters mechanical properties, little attempt has been made to adjust the tissue water content prior to biomechanical testing as part of standardization procedures. The objective of ...

pmc.ncbi.nlm.nih.gov

...

...
But I also find it anecdotally supported from my personal experience, that athletes suffer tendon related muscle detachments under dehydrated states such as resulting from martial art weight cuts for example. Actually powerlifting/bodybuilding/strongman probably provide the best anecdotal evidence in regards to pectoral tendon detachment, quadricep/hamstring detachment, plus bicep/tricep detachment under dehydrated weight-cut conditions. Its a very common occurrence and hydration is a well accepted factor by coaches and athletes in those sports. I think there is a lot of truth outside peer-review and a lot of falsity and monetarily-inspired deception in peer-review as well. Especially true for subjective and popular subjects like sports science. Though I understand the interest in peer-review sources and will generally fold to those requests. ...

DEHYDRATION AND INJURIES

@Mathematician wrote interesting notes in Eating Disorders Thread, which belong to topic about injuries avulsion fractures including.

I am taking his notes here.

More studies mentioned insufficient knowledge and the need to further research as to effects of water on muscle. It was mentioned in your suggested studies as well. I do hope that in future we will get to know more datas useful for medicine.

----------------------

Water-content related alterations in macro and micro scale tendon biomechanics - PMC

Though it is known that the water content of biological soft tissues alters mechanical properties, little attempt has been made to adjust the tissue water content prior to biomechanical testing as part of standardization procedures. The objective of ...

pmc.ncbi.nlm.nih.gov

- "...In tendons, it has been shown that a decrease in water content will shorten collagen fibrils within the tendon, which will increase the tensile stresses as a consequence..."

I asked other Rehabilitation doctors and Physiotherapists, I don't have feedback from all of them yet. But at the moment nobody from those who answered - they didn't hear or read in any materials about dehydration leading to tendon stiffness.
We know that dehydration leads to muscle weakness and muscle cramps, but dehydration and muscles stiffness is new information. But the idea of dry muscle leading to bigger stiffness gives us sense. One head doctor mentioned that: "Dried muscles will be less stretchable, which is more prone to injury." Also physiotherapists from Faculty of medicine didn't hear about dehydration + stiffness, but they say that it looks to be very likely.

I talked to a person who was choosen for athletic class at Sport School many years back. He mentioned muscle weakness and cramps in case of dehydration. But he also points out the fact that muscle weakness means that muscle loses its function in protecting body. It means bigger pressure on joints and bones. Muscles tonus is lowering. The perseverance is worse.

I also looked at some Bachelor's thesis about Dehydration from students from Faculty of Sport or Faculty of Physical culture. Students are using all possible written materials to write the thesis, but once again no mention about dehydration and muscle stiffness.

So at the moment I can say that this is not common knowledge in Rehabilitation community in my country. It is not written in any books, we didn't hear about it in seminars as well.

So thank you for the note about dehydration and muscle stiffness, I will remember it and very likely use it in future.

...
I am a little surprised you "never" heard of a correlation between hydration and tendon ruptures if you are involved with sports and athletes, but if you are not involved with them but only study the literature then I understand. ...

I treat athletes at Outpatient Clinic, but we have much more patients - non-athletes. Our clinic and hospital are not specialised on sport medicine. (Most of Rehabilitation doctors and Physiotherapists are working in hospital and Clinics as well, they work with both athletes and non- athletes.)

----------------

My ideas:
1) In case of fibres losing their flexibility, yes, it is more prone to injury.
There are studies in older people.
As to athletes I found this study to support my opinion:

https://scholarsarchive.jwu.edu/cgi/viewcontent.cgi?article=1078&context=health_fac

- from 2017
- Dehydration Reduces Posterior Leg and Trunk Flexibility and Increases Stiffness in Male Collegiate Age Runners
- 19 runners
- "... dehydrated subjects became stiffer and has less flexibility as compared to when they are euhydrated. These changes may impede performance and increase the risk of injury in dehydrated individuals."

2) More stiff or shortened muscles (from overloading or injury) are also creating bigger pressure on its origin and insertion, which leads to pain and if not solved than to another injury.
Too big pressure of shortened muscle may lead to avulsion fracture also. (Not to forget that in growing period bones and muscles are growing on different speed, which may also lead to relatively shortened muscle comparing to bone.)

3) "THIXOTROPY". Definition: Thixotropy is the property of some gels to turn into liquids under certain conditions. In human tixotropy of fluids and connective tissue (I hope English terms are correct) depends on hydration of hyaluronic acid. The hydration of hyaluronic acid is influenced by more factors - hydration of organism is among them. With lower hydration joints may block (block in meaning of reduced joint functional movement = joint play, NOT flexion / extension). With joint block - joints are overloaded, muscles are overloaded. That is why we mobilize joints as a part of the treatment in Rehab.

4) Also FASCIAS around muscles or organs have a lot of hyaluronic acid. Sticked fascias are another thing we treat at Rehab. Sticked fascias are also leading to joint dysfunction, muscle imbalance and overloading.

5) And another thing which comes in mind are INTERVERTEBRAL DISCS. They also contain water. We were taught that there is a difference - in the morning discs are taller, while it shortens in the evening after whole day of physical activity (the discs are losing water). Water percentage in discs goes down with age.
Shortened discs with less water contain are more rigid, protective function gets worse. Which may lead to all different types of spine injuries stress fractures including.

Overall all these things are increasing a possibility if an injury and increasing the seriousness of an injury.

Yes, dehydration influences many things in human body and increases risk of injury. Thanks @Mathematician .

 

[sisinka]

Preventing figure skating injuries - Boston Children's

Figure skating is a stunning combination of athleticism and grace. But as the sport becomes more demanding, the number of injuries has risen.

answers.childrenshospital.org

- article published at Boston hospital's page in 2022
- Dr. Ellen Geminiani of Boston Children’s Sports Medicine Division (long-time physician for Team USA) and strength and conditioning specialist Ariel Gagnon-Carr share their opinions and results of the research about injuries in figure skating

“I hope young skaters will think about how much preparation it takes for an athlete to make it to the Olympics. Every single one of those skaters has worked incredibly hard for years.”... “almost anyone who makes it to that level also loves to skate. That’s key. If you’re going to dedicate your life to something, you’ve got to love what you’re doing.”...

- ...Dr. Geminiani and a team of researchers at Boston Children’s and The Micheli Center reviewed 864 figure skating-related injuries...

Almost 70 percent of the injuries were overuse injuries caused by repeated stress. The rest were acute injuries caused by a single event, such as a fall or collision...

- ...“Many of the skating injuries we see at The Micheli Center for Sports Injury Prevention could have been prevented with proper strength training"...

..."We need to get over the idea that figure skaters have to spend countless hours on the ice at the expense of everything else. Training off the ice helps athletes develop strength and mobility that’s critical to preventing injury. Unfortunately, it’s going to take a culture shift within sports as a whole for many coaches and athletes to embrace this more balanced approach."...

Both specialist had great notes about overusing injuries caused by joints A) having normal range of motion and B) being hypermobile, so I will repost some parts:

- ..."A lot more skaters are trying to do challenging movements that their bodies can’t do. For instance, raising the free leg to parallel during the landing of a jump. If a skater doesn’t have enough hip mobility, they’ll arch their lower back to create the illusion that their leg is higher. Meanwhile, the landing puts eight to 10 times their body weight on their lumbar spine. Landing with an arched back puts extra stress on the lower back."...

- ..."On the other end of the injury spectrum are athletes with hypermobile joints. Figure skating involves some pretty extreme positions that athletes with loose joints tend to do very well. A coach may be thrilled when a young athlete can lift their leg over their head. But that position is not a controlled movement, it’s coming from forcing the joint into a position that’s not stable. Over time, this causes the joint to break down, particularly the hip joint. By the time a skater reaches a senior level, they have chronic hip pain. Most skaters and coaches don’t spend enough time on the fundamentals — strength training, mobility, and flexibility. That’s contributing to the rate of injury."...

- ..."Everybody thinks figure skaters have strong ankles. But how are you going to develop ankle strength when your ankle’s locked inside a stiff boot? Unless they’re doing targeted strength training for their ankles, skaters are relying on the boot to support them. Unfortunately, this leads to stress fractures, tendon injuries, tendinopathy, and chronic pain — to name a few of the foot and ankle injuries we see."...

@Diana Delafield was sharing her experience with hypermobility - Ehlers-Danlos Syndrome in another Thread:

ISU releases official agenda with proposals for 2024: age limits, jump limits and more

I remember that! I thought it was magnificent, back in the days when I was uncultured. What was magnificent about that performance was how the jumps augmented, embellished and supported the program as a whole. And in fact she got mostly 5.7s for tech and all 5.8s and 5.9s for presentation...

www.goldenskate.com

How should ISU address potentially dangerous elements?

Patrick Chan also included, at a very venerable age, the quad Salchow. He had done it in practice earlier in 2011... but never included them later on because he didn't need them or at least, he didn't think he did. When he returned to competition, he realized he had to and brought it back...

www.goldenskate.com

Besides joints A) having normal range of motion and B) being hypermobile, I would add the C) possibility - joint which is anatomically restricted in some direction. It will lead to the same overuse troubles like in case a), if the joint movement into restricted direction will be used more often.

 

[Skating91]

I wonder if a prolonged lack of sunshine leading to a lack of vitamin D during the parts of the season where training intensity is at its peak is an issue for some skaters, such as those from Russia or the Baltics. I'm sure many take supplements for this, but maybe some have a predisposition towards this

 

[sisinka]

I wonder if a prolonged lack of sunshine leading to a lack of vitamin D during the parts of the season where training intensity is at its peak is an issue for some skaters, such as those from Russia or the Baltics. I'm sure many take supplements for this, but maybe some have a predisposition towards this

Study about figure skaters and amount of vitamin D in their body through whole year with geographic differences being one of studied parameters could be interesting.

I do agree with you that skaters are taking supplements, but: "...80% of vitamin D is produced in the skin in response to ultraviolet B exposure and 20% of vitamin D is ingested by food or supplementation..." (https://www.researchgate.net/figure...n-in-response-to-ultraviolet-B_fig1_342180695 )

The ability to produce vitamin D thanks to sunlight differs: "...based on skin pigmentation, general age, latitude, the time of day when people go out in the sun and the season of the year.

Sunscreen can decrease the formation of vitamin D3 by the skin.

Our fat cells can store vitamin D for months..."
(There can another problem as figure skaters have usually low fat percentage.)
(https://www.uclahealth.org/news/art...nd-sun-exposure-vital-to-vitamin-d-production )

"...Except during the summer months, the skin makes little vitamin D from the sun at latitudes above 37 degrees north (above red line; the shaded region in the map) or below 37 degrees south of the equator. People who live in these areas are at relatively greater risk for vitamin D deficiency..."
First picture shows Northern America.
(https://www.researchgate.net/figure...e-summer-months-the-skin-makes_fig1_304219637 )

As to Europe: "...In the northern hemisphere at latitudes greater than around 40°N (north of Madrid, see Table 1), sunlight is not strong enough to trigger synthesis of vitamin D in the skin from October to March..."
(https://pmc.ncbi.nlm.nih.gov/articles/PMC4288313/ )

More than half of China and Japan are below 37 latitude. But based on Internet air pollution is higher in Asia, this also blocks sunlight, which will lead to lowers skin production of vitamin D.

There are also diseases where people must protect against sun.

 

[sisinka]

I wonder if a prolonged lack of sunshine leading to a lack of vitamin D during the parts of the season where training intensity is at its peak is an issue for some skaters, such as those from Russia or the Baltics. I'm sure many take supplements for this, but maybe some have a predisposition towards this

I looked at list of men with stress fractures and organized the fractures based on months of the year.

It could not be precise as stress fractures may be diagnosed later then happened.

I think that for top skaters the peak of their training intensity is during summer. When competitions start, training loads are decreasing in comparison with summer, in my opinion. Loads may increase before big competitions again, but probably not in such length as during summer.

SINGLE MEN

- 29 skaters, 41 fractures
(Alexander Majorov and Daichi Miyata with 2 fractures, Ilia Malinin, Sota Yamamoto, Alexey Erokhov, Michael Weiss and Evan Lysacek with 3 fractures)

- 9 fractures with unknown date
- during summer - 8 fractures
- during fall - 9 fractures
- during winter - 7 fractures
- in March - 6 fractures
- in April - 1 fracture
- in May - 1 fracture

Summer with high intensity training as a preparation for next season. (Season starts with competitions in summer, but many top skaters concentrate on Challengers / Grand Prix since September / October.)

Stress fractures in winter - all 7 happened in December / January, all men were from US or Canada. Timing is BEFORE their National Championships when the skaters could supposedly increase the training load. Evan Lysacek's stress fracture was mentioned in the middle of December during Grand Prix Final.

March is the time of final preparation for Junior and Senior World Championships.

It is just a small sample of skaters with this injury, all of them being top skaters. Peaks of training loads may be different for skaters not participating at Grand Prix and European / 4 Continents / World Championships.

 

[sisinka]

List of skaters with STRESS FRACTURES was updated:

SINGLE LADIES

SINGLE MEN

- Gabrielle Daleman - was already mentioned with stress fracture from 2014, but she had another one.

"...It’s with an extremely heavy heart that I announce I have to withdraw from Nationals due to a stress reaction in my back (written on December 2022), It’s on top of a previous fracture.
...I thought nothing of it when I competed at my 2 Grand Prix this year with it, I just thought it was simple back pain until I found out what the real problem was. I was told by my doctor it was dangerous for me to continue skating after Sheffield. It’s has been 5 weeks and I’m just starting to skate again..." (https://fs-gossips.com/9572/ )

- Ryan Dunk - "...In December 2019 while preparing for his first senior national competition, Dunk’s ankles had swollen due to bursitis from over-training. Since he was training so much, Dunk explained that his boot would wear down, not providing enough support during jumps and tricks...Once the season ended for him in January, Dunk underwent two procedures and the doctor found bone bruises. (https://thesuffolkjournal.com/38022...olk-senior-reflects-on-figure-skating-career/ )

Both Gabrielle and Ryan suffered from Eating Disorders which are risk factors for stress fractures.

- Maria Zakharova - "...She had a stress fracture of the scaphoid bone of her right leg (summer 2022), she even underwent surgery, she already has arthrosis. In fact, we ourselves did not expect that it would take so long. She didn’t go on the ice for 10 months at all, that summer she came out... (https://tass.ru/sport/21687173 )

- Antonina Dubinina - "...It was very difficult for me because an injury happened at the most inopportune moment. Just at the height of the season - in November (2022). ...And what was the injury? In the beginning it was stress fracture of an ankle. And then the same injury happened again... No, the injury was on the left leg, and in August (2023) it happened on the right. On the left it completely went away, everything is fine. I trained fully almost all summer, but then the same problems began with my right ankle..." (https://sport.rambler.ru/figureskat...erelom-uhod-ot-sokolovskoy-nravitsya-valieva/ )

 

[DancingCactus]

What I find absolutely fascinating and shocking is the lack of stenght training and the apparent lack of knowledge coaches have about developing muscles and flexibility slowly described in a lot of these citations.

Want to know how I came to be interested in figure skating at the beginning? A fricking manga about Ice dance from the mid 2000s. Everybody did a lot of strenght training and stretching there so I kind of a assumed if a mangaka knows how important this is, professional coaches surely also must know???

 

[Karoltyna]

What I find absolutely fascinating and shocking is the lack of stenght training and the apparent lack of knowledge coaches have about developing muscles and flexibility slowly described in a lot of these citations.

Want to know how I came to be interested in figure skating at the beginning? A fricking manga about Ice dance from the mid 2000s. Everybody did a lot of strenght training and stretching there so I kind of a assumed if a mangaka knows how important this is, professional coaches surely also must know???

I sometimes think that at least some of fs coaches are from the outer worls, where physics works differently I've got experience in different sport and have to say that things you mentioned aren't some sort of forbidden knowledge and coaches are generally knowledgable. (the title of this manga please?)

 

[DancingCactus]

The manga was Kiss and Never Cry. Great art style.

I've been doing martial arts for 10+ years recreationally and my coaches have all stressed the importance of stretching, training so you are able to reach more extreme positions without brute forcing etc....so yeah, I don't understand how figure skating coaches seem to have missed the memo?

 

[rabidline]

What I find absolutely fascinating and shocking is the lack of stenght training and the apparent lack of knowledge coaches have about developing muscles and flexibility slowly described in a lot of these citations.

Want to know how I came to be interested in figure skating at the beginning? A fricking manga about Ice dance from the mid 2000s. Everybody did a lot of strenght training and stretching there so I kind of a assumed if a mangaka knows how important this is, professional coaches surely also must know???

It could also be that the manga about ice dance did know the importance of strength and flexibility training, because obviously ice dancers need that strength to do their lifts safely (coincidentally one of their biggest point-getters).

It's a bit different with singles skaters, especially as the age of skaters starting skating and jumping gets younger. It's possible that coaches OR skaters tried to "keep" their physiques as close to how the skaters were when they're landing their jumps easily, and avoid strength training so that they don't build any muscles that can interfere with the jumps. And then when they finally did it, they're already carrying injuries which might also get impacted by the muscle training.