Dealing with Stress Fractures

A stress fracture is a small crack in a bone caused by overuse and high impact.

A stress fracture results from repetitive use injuries that exceed the ability of the bone to repair itself. Impact forces are transferred to the bones, causing microfractures that consolidate into stress fractures. Stress fractures occur in weight-bearing areas, commonly the lower leg, or tibia, and foot, or metatarsals.

Most stress fractures result from a rapid increase in the amount or intensity of exercise. Sports involving running or jumping place individuals at highest risk. Such sports include track and field, basketball, tennis, ballet, and gymnastics. Upper extremity stress fractures, though much less common than lower extremity stress fractures, can be caused by repetitive use of the arms in sports such as basketball or tennis.

Women are more likely than men to develop stress fractures. Women with irregular or absent periods – especially young female athletes – are at particularly high risk. About 60% of persons with a stress fracture have had a previous stress fracture.

Could It Be A Stress Fracture?

Dull, localized bone pain not associated with trauma that worsens with weight bearing or repetitive use. Localized swelling may occur at the pain site, which hurts to touch.

Orthopedic surgeons commonly utilize X-rays 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 computed topography (CT) scan or magnetic resonance imaging (MRI) will be necessary.

How Are Stress Fractures Treated?

Stress fractures heal with time and rest. Athletes are advised to rest from any activity that caused the stress fracture for the 6 to 14 weeks that the fractures take to heal, or until pain-free for 2 to 3 weeks. Your orthopedic surgeon can give you the best idea of how long it will take for your stress fracture to heal. If activity is resumed too quickly, a larger stress fracture may develop, the original stress fracture may never heal, and athletes are at risk for re-injury. Activities of daily living and limited walking are permitted.

Ice and nonsteroidal anti-inflammatory drugs can decrease pain and swelling. Calcium and vitamin D supplements may also be helpful. Substitution of a non-weight-bearing exercise, such as swimming, can prevent cardiovascular deconditioning.

Air splinting may help to speed recovery and reduce pain in severe or non-healing lower leg fractures. Other types of fractures occasionally require special shoes, casting or surgery. Ask your orthopedic surgeons which therapies are right for you.

If you have recurrent stress fractures, your orthopedic surgeon may advise an imaging test that assesses bone density.

How Can I Prevent Stress Fractures?

High-impact exercises should be increased gradually (not more than 10% per week). Athletes should stretch and warm-up appropriately before exercise. Using well-cushioned shoes in good condition can help prevent fractures. Ask your orthopedic surgeon if arch supports or orthotics are appropriate for your foot structure. Runners benefit from running on smooth, level surfaces.

Maintain adequate intake of calcium, a mineral found in bones, to have strong, healthy bones.

If you notice any pain or swelling during physical activity, refrain from that activity for a few days. Consult an orthopedic surgeon if the pain does not lessen.

Here Are Some Tips Developed By The American Academy Of Orthopaedic Surgeons To Help Prevent Stress Fractures:

  1. When participating in any new sports activity, set incremental goals. Do not immediately set out to run five miles a day; instead, gradually build up your mileage on a weekly basis.
  2. 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.
  3. Maintain a healthy diet. Make sure you incorporate calcium and Vitamin D-rich foods into your meals.
  4. Use the proper equipment. Do not wear old or worn running shoes.
  5. If pain or swelling occurs, immediately stop the activity and rest for a few days. If continued pain persists, see an orthopedic surgeon.
  6. 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.