What Is a Hairline Fracture?

We often hear the term hairline fracture, but do you know what the term means?

Orthopedic physicians describe hairline or stress fractures as tiny cracks that develop on bones in the foot or lower leg. A common injury in runners, gymnasts, and dancers, anyone can develop a hairline fracture through repetitive jumping or running. Individuals with osteoporosis also are at risk for hairline fractures.

The bones of the foot and leg absorb a lot of stress during running and jumping. Common sites for hairline fracture include the metatarsal bones – the five long and narrow bones connecting the mid-foot to the toes – as well as the heel, ankle bones, and the navicular, the bone on the top of the mid-foot.

What are the symptoms of a hairline fracture?

The most common symptom is pain that gradually worsens over time, especially if you don’t stop weight-bearing activity. Other symptoms include swelling, tenderness, and bruising.

What causes a hairline fracture?

An overuse or repetitive activity, or an increase in either the duration or frequency of activity, can result in a hairline fracture. Even regular runners who suddenly increase either their distance, such as someone training for a marathon, or the number of times per week they run, can cause a hairline fracture.

Another cause of a hairline fracture is changing the type of exercise normally performed.

Bones adapt to increased forces through various activities, where new bones form to replace old bone. This process is called remodeling. When the breakdown of bone happens more rapidly than new bone can form, the likelihood of developing a hairline fracture increases.

Who’s most at risk for developing a hairline fracture?

There are several risk factors that increase the chances of developing a hairline fracture:

  • Certain sports: Participants in high-impact sports such as track and field, basketball, tennis, dance, ballet, long-distance runners, and gymnastics, increase their chances of getting a hairline fracture.
  • Gender: Post-menopausal women have an increased risk of hairline fractures. Female athletes may be at a greater risk because of a condition called the “female athlete triad.” This is where extreme dieting and exercise may result in eating disorders, menstrual dysfunction, and premature osteoporosis.
  • Foot problems: Poor footwear can cause injuries, so can high arches, rigid arches, or flat feet.
  • Weakened bones: People with osteoporosis, or anyone taking medications that affect bone density and strength, can develop hairline fractures even when performing normal activities.
  • Previous hairline fractures: Having one hairline fracture increases your chances of having another.
  • Lack of nutrients:Lack of vitamin D or calcium can make bones more susceptible to fracture. People with eating disorders are at risk for this reason. There can be a greater risk of hairline fractures during the winter months when diminished sunlight decreases the body’s absorption of vitamin D, compounded by an increased risk of slips and trips on icy surfaces.
  • Improper technique: Blisters, bunions, and tendonitis can affect how you run, altering which bones are impacted by certain activities.
  • Changes in surface: Changes in playing surfaces can cause undue stress to the bones of the feet and legs. For example, tennis player who move from a grass court to a hard court may develop injuries.

How is a hairline fracture diagnosed?

If you believe you have a hairline fracture, it’s important to seek treatment from an orthopedic physician as soon as possible.

Your doctor will perform a physical exam and review your medical history and general health, including diet, medications, and other risk factors. Diagnostic tools may include an MRI, X-ray, or bone scan.

How are hairline fractures treated?

If you suspect you have a hairline fracture, follow the RICE method: rest, ice, compression and elevation. An over-the-counter, non-steroidal drug can help with pain and swelling.

It’s important to seek further treatment if the pain becomes severe or doesn’t get better with rest. The treatment your orthopedic physician recommends will depend on both the severity and location of your injury.

Can other conditions develop if hairline fractures aren’t treated?

Ignoring the pain caused by a hairline fracture can result in the bone breaking completely. Complete breaks will take longer to heal and involve more complicated treatments. It’s important to seek advice from an orthopedic physician and treat a hairline fracture as soon as possible.

Medical treatments

Your doctor may recommend that you use crutches to keep weight off an injured foot or leg. You can also wear protective footwear or a cast.

Because it usually takes up to six to eight weeks to completely heal from a hairline fracture, it’s important to modify your activities during that time. Cycling and swimming are great alternatives to more high-impact exercises.

In some cases, a hairline fracture may require surgery. The addition of pins or screws can help hold bones together during the healing process.

What’s the outlook for someone with a hairline fracture?

It’s important to avoid high-impact activities during the healing process. Returning to high-impact activities — especially the activity that caused the injury in the first place — will delay healing and increase the risk of a complete fracture in the bone.

Even after the hairline fracture is healed, it’s important to gradually return to exercise.

In rare instances, hairline fractures don’t heal properly. This result is chronic, long-term pain. Talk with a board-certified orthopedic physician soon after the injury occurs to prevent pain and worsening damage to the bone.

High Speed, High Impact: A Risky Combo for Young Football Players

Injuries are an inevitable risk in athletics and football is no exception. Young football players have almost twice as many injuries as athletes in other sports, with more than 500,000 high school and college football injuries treated each year. One of the reasons for this elevated risk is that football is a high-speed, high-impact sport.

Tackling, blocking and other physical interactions between players can result in a number of common orthopedic injuries.

Another reason orthopedic injuries are so frequent in football is because the nature of the game requires players to pivot and change direction, increasing the likelihood of injuries to the joints and other tissues. Sudden bursts of speed can cause muscle damage if the player is not warmed up and in condition. Overuse injuries are also common, especially for quarterbacks.

These factors combine to make football a relatively high-risk sport. The most common musculoskeletal injuries in football include:

ACL injuries – The anterior cruciate ligament in the knee can become damaged or torn when a player is impacted from the front or rear. A torn ACL can often occur as a result of non-contact injuries.

MCL injuries – Injuries to the medial cruciate ligament in the knee is also very common because it occurs when the knee is impacted from the side.

Torn meniscus – When a player rotates their body while a foot stays planted, the knee can twist, causing the meniscus to tear.

Ankle sprains and strains – Ankles are susceptible to soft tissue damage when pivoting, changing direction, or when too much pressure is put on the ankle joint.

Muscle contusions – A strong impact to a large muscle, usually in the thigh, can cause a contusion. This is basically a large, deep bruise that can impair muscle function.

Torn hamstring – Bursts of speed can cause the hamstrings to tear if the player is not conditioned or properly warmed up.

Shoulder tendinitis – Frequent throwing can cause overuse injuries like shoulder tendinitis from repetitive motions.

Shoulder separation or dislocation – A direct blow below the shoulder can cause a separation of the acromioclavicular joint while a dislocation occurs when the head of the humerus detaches from the scapula.

Getting Back into The Game

Treatment for these football injuries can range from basic RICE (rest, ice, compression, elevation) to surgery, with several options in between.

Athletic trainers are a key component to keeping players healthy. Parents should help to maintain optimal performance condition by ensuring their young athlete is well rested, receives the proper nourishment, and maintains good condition all year long.

Still, injuries do happen. Be sure to see a board-certified orthopedic physician at the first signs of an overuse injury -soreness, swelling, tingling or discomfort – or when an accident occurs on the field. A thorough diagnosis and fast treatment will accelerate recovery and return to play for your young athlete.

Know Your Knee Pain

The knee is a complicated joint. It enables us to bend and straighten our legs so we can sit, squat, jump and run.

Our knees carry us through life and are exposed to injury as well as normal “wear and tear” throughout our lifetimes, from the scrapes and bruises of childhood to arthritis pain and other degenerative conditions common in older age.

The knee joint has three parts. The thighbone (femur) meets the large shin bone (tibia) to form the main knee joint. This joint has an inner (medial) and an outer (lateral) compartment. The kneecap (patella) joins the femur to form a third joint, called the patellofemoral joint. The ends of the femur and tibia, and the back of the patella, are cushioned with cartilage, helping ligaments slide easily over the bones and protecting the bones from impact.

Knee pain is one of the most common complaints heard by orthopedic physicians. When one or more parts of the knee are injured, you may feel different types of knee pain.

Self-Care for Knee Pain

Knee pain that occurs from a relatively minor injury can often be safely observed for a day or two to see if self-care measures will be helpful. Self-care options include:

  • Rest Avoid more strenuous or painful activities, but keep active. Try alternate activities that cause less discomfort – swimming instead of jogging, bicycling instead of tennis
  • Ice Put ice on your knee for 15 to 20 minutes a few times each day. Use ice cubes or a bag of frozen vegetable wrapped with a towel
  • Compression Wrap an elastic bandage around your knee to help control swelling. Make the bandage fit snugly around your knee, but not tight enough to cause pain or leg swelling
  • Elevation Lying down with your knee propped up on pillows may help control pain and swelling
  • NSAIDS Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDS) may help relieve pain, swelling and inflammation

When to Schedule an Orthopedic Visit

Knee injuries commonly send people to the orthopedic physician. Make an appointment with an orthopedic physician if your knee pain was caused by a particularly forceful impact or if it is accompanied by:

  • Significant swelling
  • Significant pain
  • Redness
  • Tenderness and warmth around the joint
  • Fever

When to Seek Immediate Medical Attention

Call 911 or ask someone to drive you to the Emergency Department if your knee pain is caused by an injury and is accompanied by:

  • A joint that appears deformed
  • A popping noise at the time your knee was injured
  • Inability to bear weight
  • Intense pain
  • Sudden swelling

Top Ten Common Knee Injuries

Treatment will vary based on the cause of your knee pain and the specifics of the injury. Treatment may involve managing pain and inflammation, and rest. Trauma-induced injuries, such as fractures, dislocations and tears, may require bracing, popping the knee back into place, or surgery, which in many cases today, is minimally invasive so patients heal quickly and return to normal activities. Physical therapy may be needed to help regain movement and strength in the knee and leg.

Below are ten of the most common injuries of the knee:

  • Fractures
  • Anterior cruciate ligament (ACL) injuries
  • Dislocations
  • Meniscal tears
  • Bursitis
  • Tendonitis
  • Tendon tears
  • Collateral ligament injuries
  • Iliotibial band syndrome
  • Posterior cruciate ligament injuries

Arthritis of the Knee

Osteoarthritis of the knee is the most common form of arthritis in the knee. It is a degenerative “wear and tear” type of arthritis that occurs most often in people age 50 and older, but may occur in younger people, too. In osteoarthritis, the cartilage of the knee joint gradually wears away.

Long-term knee pain from arthritis can often be helped by weight loss and exercises to strengthen the muscles around the joint.

Seek medical attention immediately for serious knee injuries. Early diagnosis and treatment for chronic, or long term, knee pain or arthritis can make a world of difference in your quality of life.  Know your knees and recognize when it’s time to schedule an appointment with an orthopedic physician.

Huddle Up About Back-To-School Sports Safety

For many kids, back to school means back to sports. Youth sports are a valuable experience, filled with challenges, competition and fun.  Being part of a team fosters feelings of belonging, inspires collaborative play and strategy, and can be an excellent form of exercise.

Still, parents often worry about the risk of injury their children face on playing fields. Even if your child returns to school in optimal condition after a summer spent building up body, flexibility and speed, too many kids still get stuck on the sidelines with injuries, some of which are preventable.

The Centers for Disease Control and Prevention says more than 2.6 million children are treated in the emergency department each year for sports- and recreation-related injuries.

Common injuries young athletes face are often related to the skeletal and muscular systems of the body. The American Academy of Orthopaedic Surgeons stresses that children’s bones, muscles, tendons, and ligaments are still growing, making them more susceptible to injury. Fortunately, many youth-sport injuries can be prevented. Continue reading “Huddle Up About Back-To-School Sports Safety”

Sports Medicine Specialists See Tommy John Surgery On The Rise Among Youth Baseball Players

So-called Tommy John surgery, a surgical repair for injured elbows, has saved the careers of many a major-league pitcher. While this may seem like an extreme treatment for a high school athlete, a recent study in the American Journal of Sports Medicine has found teenage pitchers now undergo more of the procedures than any other group. These results highlight the risk of overuse injuries in this age group, according to orthopedic specialists.

The study found that athletes ages 15 to 19 account for 56.8 percent of the ulnar collateral ligament (UCL) reconstruction procedures, commonly known as Tommy John surgery after the pitcher who won more than half the victories in his 26 years in the major leagues after becoming the first person to undergo the procedure.

Damage to the UCL, a band of tissue in the elbow that binds the upper and lower arm bones together, is typically an overuse injury caused by throwing at extreme intensity and frequency.

Sports have become so competitive that young athletes are often playing for nine or more months every year on school teams, travel teams and in multiple leagues, tournaments, showcases, camps, indoor ball and other programs. Playing when fatigued, and when a player’s physical condition and technique may not be the best increase the risk of developing an overuse injury.

A Growing Concern

The study shows both the incidence and regional demographic of Tommy John surgery in the United States. Interestingly, Tommy John surgery is most often performed in the second quarter of the year – during the traditional high school baseball season – and performed most often in the South than in any other region in the United States, echoing earlier research that showed that Major League players who grew up in the South are more likely to have Tommy John surgery as well. However, indoor baseball and travel teams is now extending the baseball season here on the East Coast, as well.

Prevention Beats Repair

The American Sports Medicine Institute has issued recommendations in its “Position Statement for Youth Baseball Pitchers” that include, limiting pitching to no more than 100 innings per year, taking a break from overhead throwing for an optimal four months per year, and plenty of vigilance about rest and proper technique.

Major League Baseball has launched its own “Pitch Smart” initiative, which includes guidelines for coaches, young players and parents, to avoid overuse injuries.

Players experiencing a UCL injury may experience:

  • Pain when using the arm in an overhead position
  • Soreness on the inside edge of the elbow
  • Minor swelling along the inside of the arm
  • Possibly numbness or tingling in the arm
  • Instability at the elbow joint, feeling like the arm may “give out” when moved through the motion related to your sport

Diagnosing & Treating a UCL Injury

Consult a sports medicine specialist or orthopedic physician at the early signs of these symptoms. Your doctor will conduct a thorough physical examination and order an MRI to assess the degree of the UCL injury.

There are three classifications of a UCL injury of the elbow:

  • A first-degree sprain occurs when the ligament is strained without it becoming stretched
  • A second-degree sprain occurs when the ligament is partially torn
  • A third-degree sprain occurs when the ligament is torn or ruptured

An ulnar collateral ligament tear results in an elbow that loses function altogether. Consulting an experienced sports medicine or orthopedic consultant at the earliest stage of injury can help alleviate further damage.

Ice, rest, anti-inflammatory medication and physical therapy, as well as the use of a cast or splint, will often help to resolve a mild UCL injury.

Surgery may be required for more acute tears and ruptures, using a minimally invasive, arthroscopic surgical approach where the ulnar collateral ligament is reconstructed using a soft tissue graft.

Avoiding Springtime Injuries

With days lasting longer, temperatures rising, and grass, flowers and trees becoming green, everyone agrees that spring has sprung. It’s natural to feel that those of us along the beautiful Jersey Shore can’t wait to get back on the playing field, the golf course, tennis court, track…or whatever sports venue calls out to you.

But, before you leap into action, remember that is has been a long, long winter and many of us are not in tip-top shape. Before you incur an injury that benches you for the rest of the season, review the list of common springtime sports injuries and what you can do to prevent them.

Rotator cuff (Tennis)

Hitting a tennis ball often puts stress on the joints, tendons and muscles of the shoulder. Because tennis players continually use the same joint, there’s a chance that in time they will develop problems associated with shoulder overuse. The most common orthopedic problems stemming from tennis are the rotator cuff injuries.

To prevent rotator cuff as well as other shoulder injuries, take steps to strengthen the muscles in the shoulder junction. Now is the time to start doing strengthening and weightlifting exercises three times per week.

Tendonitis (Power Walking)

This is the time of the year when you are motivated to shed a few pounds. Walking is one of the easiest exercises to improve your overall health. Anyone can walk anywhere, and it doesn’t cost anything! While Achilles tendonitis is commonly associated with running, the condition can also occur when you skip the warm up routine or when you begin a workout program after a long period of inactivity.

To ensure the success of your workout regimen, remember to always warm up before jogging or power walking. Lunges are one of the best exercises to loosen the Achilles tendon and the calf muscles.

Lower back pain (Golf)

The repetitive bending and twisting involved in golfing can place tremendous stress on the lower back. To make sure your back won’t interfere with your golf game, begin performing exercises to strengthen your core now. Here’s a good tip: stretch your lower back – bend over until you can touch your toes with your fingers a few times – before stepping out onto the golf course.

Tennis elbow (Baseball)

Despite its misleading name, tennis elbow is actually an inflammatory condition which affects the tendon that runs up to the side of the arm next to the elbow. The condition is specific to sports that require athletes to swing their arms repeatedly, such as pitching a baseball pitching. Start a regimen of stretching and strengthening exercises to prevent this debilitating condition from placing you on the bench this season.

Plantar fasciitis (Running)

Overtraining, overuse, over-striding and improper footwear are the prevalent reasons why runners end up with plantar fasciitis. Given its causes, the only way to prevent the painful heel condition implies performing exercises that render the overall foot area flexible. If your running shows are worn out, get a proper fitting on a new pair at a good local running store.


Teen sports are great: They promote teamwork, jump-start a lifelong exercise habit, and provide an antidote to obesity. But teen athletes can also get hurt, which means they—and their parents and coaches—should be vigilant about prevention.

Sports injuries fall into two categories. Acute injuries, like a sprained ankle or torn ACL, occur suddenly, after a missed step or a midfield collision. Overuse injuries are caused over time by repetitive motion. Overuse injuries used to be fairly rare among teens and kids but increasingly, orthopedic specialists see teens with overuse injuries that used to plague mostly collegiate or pro athletes.

These injuries include damaged ulnar collateral ligament in the elbow (common in baseball pitchers, it can be fixed with so-called Tommy John reconstruction surgery), or osteochondritis dissecans, an overuse problem most commonly found in the knee that can result in loose bone or cartilage fragments in the joint.

One culprit: America’s youth sports culture. Immersion in high school teams, private club teams, traveling teams and sports summer camps mean more injuries. Many kids now specialize early and pursue a single sport through adolescence, rather than switching sports with the season. When young athletes do that, they lose the benefit of cross-training. Focusing on all-around athleticism keeps the body balanced and less vulnerable to injury.


There are ways to protect against both overuse and acute injuries. Proper conditioning is crucial. Young athletes new to sports should start by getting in good overall shape—including working on aerobic fitness, strength, and flexibility.

Start by being active for 30 to 60 minutes most days of the week, for at least six to eight weeks, before they get into sports. If not, it’s an absolute setup for injury. On the other hand, serious teen athletes may need to build more recovery time into their schedule, training hard on some days, but going easier and working on recovery and technique on alternate days.

Technique is important. Many young pitchers, for example, improperly rely on their arms for power rather than their trunk and legs. Done correctly, both strength training and working on the core muscles of the back and abdomen may prevent injury and boost performance. Sports-specific warm-up programs can also help.

When an injury does occur, its severity can be lessened by rest, prompt treatment and physical therapy. The incorrect reaction is to discourage teens from participating in sports. The risk of injury is far outweighed by the benefits of physical activity.


Sports participation promotes the physical and emotional well-being of children, and also encourages a lifelong habit of exercise. Although the benefits of athletic activity are significant, too much activity can lead to injury.

In recent years, orthopedic physicians have begun to see young athletes with significant increase in overuse injuries. In most cases, these are sports related.

Overuse injuries occur gradually over time, when an athletic activity is repeated so often that some areas of the body do not have enough time to recover between playing. For example, overhand pitching in baseball can result in injuries to the elbow, and swimming is often associated with injuries of the shoulder.

Because young athletes are still growing, they are at greater risk of injury than adults. The consequences of overdoing a sport can include injuries that impair growth and may lead to long-term health problems.


When a young athlete repeatedly complains of pain, a period of rest from the sport is necessary. If pain persists, it is important to seek proper medical treatment. To ensure the best possible recovery, athletes, coaches and parents must follow safe guidelines to plan a return to the game.

Overuse injuries occur in a wide range of sports, from baseball and basketball to track, soccer and gymnastics. Some of these injuries are unique to a certain sport, such as throwing injuries of the elbow and shoulder that are prevalent in baseball players. The most common overuse injuries involve the knee and foot.

Overuse injuries can affect muscles, ligaments, tendons, bones and growth plates. In children, these structures are still growing, and the growth is generally uneven. Bones grow first, which pull at tight muscles and tendons. This uneven growth pattern makes young athletes more susceptible to muscle, tendon and growth plate injuries.

Growth plates are those areas of developing cartilage where bone growth occurs in children. The growth plates are weaker than the nearby ligaments and tendons. Repetitive stress can lead to injury of the growth plate and disrupt normal growth of the bone.

Concerned your young athlete may be developing an overuse injury? Make time to talk with a board certified orthopedic physician who specializes in the care of young athletes.

Orthopedic Injuries Rise with Hoverboard Popularity

Hoverboards, one of the hottest gifts for both kids and adults this past holiday season, are also becoming a popular reason for visits to the emergency room.
An item that is a mixture of a skateboard and a Segway, a hoverboard allows the rider to stand on a platform that will accelerate and move freely in the direction of the rider’s weight. While fun and perhaps exhilarating, hoverboards are also putting some riders at risk.
Orthopedic physicians are seeing an uptick in injuries to bones and joints, wrist and ankle injuries, and fractures. Other injuries associated with hoverboards include spinal fractures, facial lacerations, head trauma with concussion, and contusions. Some injuries are more serious because of the height and speed behind the fall.
Riders need to have good balance on the devices, which don’t have a handle. The faster riders go, the higher the injury risk. Hoverboards can speed up to 12 miles per hour.
To avoid and prevent serious injury from hoverboards, follow these safety tips:
* Wear a helmet
* Wear wrist guards, elbow pads and knee pads
* Practice and become familiar with the hoverboard in an open, soft flat field
* Be mindful of vehicles and other forms of traffic and impediments (stay off the roads)
Supervise children using hoverboards and take the same precautions as you would for using a scooter, bicycle or roller blades, especially wearing a certified safety helmet.
When it comes to hoverboard safety for children and adults alike, start slow and make sure you have something stable to hold on to while you’re getting a feel for the hoverboard.

Don’t Delay Treatment for Winter Ankle Injuries

Icy, snowy conditions can pose serious health and safety threats.

Over the winter months, we see a definite increase in fractures (breaks in the bones), sprains and other orthopedic injuries, resulting from slips and falls, and even from skidding accidents involving motor vehicles.

Broken ankles are one of the most common fracture types and can be caused by slipping and twisting the ankle while trying to navigate slippery surfaces.

If you fall on the ice and hurt your ankle this winter, don’t put off waiting to see a doctor. The ability to walk or hobble on your injured ankle doesn’t necessarily mean that your ankle isn’t broken or badly sprained. It’s best to have an injured ankle evaluated by an orthopedic surgeon as soon as possible. Only an x-ray and thorough examination by an orthopedic surgeon can determine the extent of your injury.

Putting weight on an injured ankle joint can worsen the problem and may lead to chronic instability, joint pain and even arthritis later in life. If you can’t see an orthopedic surgeon or visit an emergency room right away, follow the R.I.C.E. method – Rest, Ice, Compression and Elevation – until medical care is available.

The ankle joint is especially vulnerable to serious injury from hard falls on ice. Ice accelerates the fall and often causes more severe trauma, because the foot can go in any direction after it slips as well as bearing the weight of your body as you fall.

Falling on winter ice can cause simultaneous ankle sprains and fractures. It is possible to both fracture and sprain an ankle from a fall, and a bad sprain can mask the fracture.

Most ankle fractures and some sprains are treated by immobilizing the joint in a cast or splint.  Surgery may be needed to repair fractures with significant misalignments. New surgical plates and screws enable orthopedic surgeons to repair these injuries more quickly and with less surgical trauma.

Newer bone-fixation methods require smaller incisions, minimizing tissue damage and bleeding, reducing the risk of infection, and accelerating the healing process.