Fractures, Sprains and Strains

Stress Fracture

Description

Stress fractures are common sports injuries that occur due to overuse. As muscles become increasingly fatigued and less able to absorb the added shock of a sports activity, the overload of stress is eventually transferred to the bone, resulting in a tiny crack called a stress fracture. More than half of all stress fractures occur in the lower leg, usually in the weight bearing bones and foot. Overcoming a stress fracture can be difficult, but it can be done.

Causes

Stress fractures are often the result of abrupt or extreme changes in participation levels, but they can also occur due to problems with equipment and clothing. Common causes include:

• Sudden or overly rapid increase in frequency or intensity of participation
• Substantial increase in session length, or time spent participating
• Increase in impact level, such as experienced by a tennis player when switching from a soft clay court to a hard or unfamiliar surface
• Equipment, gear or clothing that is in poor condition or improper for the activity; for instance, running shoes that are excessively worn or lack flexibility

Risk Factors

Stress fractures can affect anyone who is active in repetitive sports, at any age. Studies indicate that athletes participating in sports such as tennis, track and field, gymnastics and basketball are especially susceptible to this injury. During these activities, the repetitive stress of the foot striking the ground can cause trauma. It is important to include sufficient rest between workouts or competitions to lessen the risk of developing a stress fracture.

According to studies, female athletes seem to experience stress fractures more often than their male counterparts. Many orthopaedic surgeons attribute this increased risk to "female athlete triad," a condition that consists of: bulimia or anorexia (eating disorders), amenorrhea or oligomenorrhoea (absence or infrequency of menstruation), and osteoporosis (loss of bone mass or density).

Symptoms

Pain that occurs during activity and then subsides with rest is the most commonly experienced symptom of a stress fracture.

Diagnosis

During the medical examination, your physician will evaluate your risk factors for this injury. Although X-rays are commonly used to diagnose stress fractures, in some cases they cannot be seen on regular X-rays, or they may not be visible on them until several weeks after symptoms appear. In some instances, additional imaging such as a CT scan (computed topography) or MRI (magnetic resonance imaging) is necessary to confirm the diagnosis.

Nonsurgical Treatment

Rest is the most important treatment for a stress fracture, however, your physician may also recommend the use of special shoe inserts or braces during recovery. Typically, it takes 6 to 8 weeks for a stress fracture to heal. During that time, it is crucial to completely discontinue participation in the sport that caused the injury, as well as any other activities that place stress on the injury or cause it to become more painful. If activity is resumed too quickly, larger, harder-to-heal stress fractures may develop. Reinjury can lead to chronic problems that prevent the injury from ever healing properly.

A relatively recent treatment option, PRP therapy, is currently being studied by researchers and is considered by some to hold promise for certain injuries. Contact your orthopaedic surgeon to find out if PRP would be appropriate for you.

Prevention

The American Academy of Orthopaedic Surgeons has developed some tips to help you prevent stress fractures.

• Set realistic, incremental exercise goals—Increase your pace or intensity gradually. This is especially important when beginning a new sport or activity. (Example: Don't start out by trying to run five miles a day; instead, build up to the goal by increasing your mileage slowly, on a weekly basis.)
• Cross-train—Alternate between several activities that accomplish the same fitness goals. (Example: Instead of running every day to meet cardiovascular goals, run on even days and bike on odd days. Increase fitness benefits by adding strength training and flexibility exercises to the routine.)
• Maintain a healthy diet—Be sure to incorporate foods that are rich in calcium and vitamin D into your meals.
• Use proper equipment—Use the correct equipment for your sport or activity; replace gear and clothing as it becomes old or worn, do not use it.
• Rest if you experience pain or swelling—Immediately stop participation in the activity and rest for a few days. See an orthopaedic surgeon if the pain persists.
• Receive treatment promptly—It is important to recognize the symptoms of a stress early. Prompt treatment by an orthopaedic surgeon can help you return to your normal playing level more quickly.