Stress Fractures

Posted on by Daniel Thompson, MD

Dr. Thompson practices in our Alexandria and Springfield offices.

What is a stress fracture?
One of the most common injuries in sports is a stress fracture. Categorized as an overuse injury, stress fractures occur with bone overloading and muscle fatigue such that they are unable to absorb added shock. Eventually, the overloaded bone develops a tiny crack called a stress fracture.

What causes a stress fracture?
Stress fractures often are the result of increasing the amount or intensity of an activity too rapidly. They also can be caused by the impact of an unfamiliar surface (a tennis player who has switched surfaces from a soft clay court to a hard court); improper equipment (a runner using worn or less flexible shoes); and increased physical stress (a basketball player who has had a substantial increase in playing time).

What are the symptoms of a stress fracture?
At first, stress fractures may be barely noticeable. Some symptoms can be:
• Swelling
• Pain
• Tenderness in a specific spot
• Increased swelling and pain with activity
• Decreased swelling and pain with rest
• Earlier onset of pain with each successive workout
• Continued pain at rest as the damage progresses


Where do stress fractures occur?
Most stress fractures occur in the weight bearing bones of the lower leg and the foot. More than 50 percent of all stress fractures occur in the lower leg.


Risk factors
Factors that may increase your risk of stress fractures include:
• Certain sports. Stress fractures are more common in people who participate in sports such as track and field, basketball, tennis or gymnastics.
• Increased activity. Stress fractures often occur in people who suddenly shift from a sedentary lifestyle to an active training regimen — such as a military recruit subjected to intense marching exercises or an athlete who rapidly increases the intensity, duration or frequency of training sessions.
• Sex. Women who have abnormal or absent menstrual periods are at higher risk of developing stress fractures.
• Foot problems. People who have flat feet or high, rigid arches are more likely to develop stress fractures.
• Weakened bones. Conditions such as osteoporosis can weaken your bones and make it easier for stress fractures to occur.


How are stress fractures diagnosed?
It is very important that during the medical examination the doctor evaluates the patient’s risk factors for stress fracture.
X-rays are commonly used to determine stress fracture. Sometimes, the stress fracture cannot be seen on regular x-rays or will not show up for several weeks after the pain starts. Occasionally, a bone scan or magnetic resonance imaging (MRI) will be necessary.
How are stress fractures treated?
Treatment varies depending on the location of the stress fracture. The most important treatment is rest. The amount of recovery time varies greatly depending upon the location, severity, the strength of the body’s healing response and an individual’s nutritional intake.


Therapy
To reduce the bone’s weight-bearing load until healing occurs, you may need to wear a walking boot or brace, or use crutches. In severe cases, the doctor may need to immobilize the affected bone with a splint or cast.


Surgery
Although it’s unusual, surgery is sometimes necessary to ensure complete healing of some types of stress fractures, especially those that occur in areas with a poor blood supply.


Prevention
Here are some tips developed by the American Academy of Orthopaedic Surgeons to help prevent stress fractures:
• When participating in any new sports activity, set incremental goals. For example, do not immediately set out to run five miles a day; instead, gradually build up your mileage on a weekly basis.
• Cross-training — alternating activities that accomplish the same fitness goals — can help to prevent injuries like stress fractures. Instead of running every day to meet cardiovascular goals, run on even days and bike on odd days. Add some strength training and flexibility exercises to the mix for the most benefit.
• Maintain a healthy diet. Make sure you incorporate calcium- and vitamin D-rich foods in your meals.
• Use the proper equipment. Do not wear old or worn running shoes.
• If pain or swelling occurs, immediately stop the activity and rest for a few days. If continued pain persists, see an orthopaedic surgeon.
• It is important to remember that if you recognize the symptoms early and treat them appropriately, you can return to sports at your normal playing level.

For more information about Dr. Thompson, read his bio on our website.

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