Stress fractures
By Dr Suhel Kotwal, MS (Orth)
Definition
Stress fractures are tiny cracks in a bone which are caused by the repetitive application of force, often by overuse, such as repeated jumping or running long distances. They can also arise from normal use of a bone that’s been weakened by a condition called osteoporosis.
Stress fractures are most common in the weight-bearing bones of the lower leg and foot. Track and field athletes are particularly susceptible to them, but anyone can experience a stress fracture. If you’re starting a new exercise programme, for example, you may be at risk if you do too much too soon.
Symptoms
If you have a stress fracture, you may experience:
* Pain that increases with activity and decreases with rest
* Pain that occurs earlier in your workout in each successive workout
* Pain that increases over time
* Pain that persists even at rest
* Swelling
* A specific spot on the involved bone that feels tender or painful to the touch
At first, stress fractures may be barely noticeable. But pay attention to the pain. Proper self-care and treatment can keep the stress fracture from worsening.
As said above, most stress fractures occur in the weight-bearing bones of the lower leg and the foot. More than 50 per cent of all stress fractures occur in the lower leg.
When to see a specialist
Stress fractures aren’t always obvious. They develop over time, so it’s difficult to tell exactly when they require a bone specialist’s care. Go to your doctor if running or playing hurts your foot or leg even after you’ve stopped the provoking activity and given yourself time to rest.
Causes
If your bones are subjected to unaccustomed force without enough time for recovery, you’ll resorb bone cells faster than you can replace them. As a result, you develop ‘bone fatigue.’ Continued, repetitive force causes tiny cracks in fatigued bones. These cracks progress to become stress fractures. Some stress fractures don’t heal properly. This may lead to chronic pain.
Risk factors
You may be at increased risk of stress fractures if you:
* are an athlete who participates in high-impact sports such as track and field, basketball, football and cricket;
* are a female athlete with abnormal or absent periods;
* suddenly shift from a sedentary lifestyle to an active training regimen — such as a military recruit subjected to intense marching exercises — or rapidly increase your exercise length and intensity;
* have flat feet or high, rigid arches;
* have osteoporosis or other conditions that lead to weakened bones or decreased bone density.
In all of these sports, the repetitive stress of the foot striking the ground can cause trauma. Without sufficient rest between workouts or competitions, an athlete is at risk for developing a stress fracture.
Preparing for your appointment
You’re likely to start by first seeing your family doctor or a general practitioner, but if you’re a competitive athlete, you might go directly to an orthopaedic surgeon or other physician who is a specialist in musculoskeletal problems. The doctor will want to know:
* when your symptoms started;
* what pattern your symptoms occur in — at certain times, during or after certain activities or continuously;
* what sports and activities you normally do, and whether a change in your routine coincided with the start of your symptoms.
Tests and diagnosis
Stress fractures may not be apparent on regular X-rays until about three to four weeks after signs and symptoms begin. If your doctor suspects a stress fracture, the diagnosis may be confirmed with a magnetic resonance imaging (MRI) study or, in some cases, a bone scan, which tracks a radioactive tracer material through your bone after you have an injection of a tiny amount of the tracer.
Treatments and drugs
Treatment varies depending on the location of the stress fracture and on how quickly you need to resume activity.
Medication
If needed, take Acetaminophen or Paracetamol to relieve pain. Some research suggests that non-steroidal anti-inflammatory pain relievers — such as aspirin, ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others) — can interfere with bone healing.
Therapies
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. 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.
Lifestyle and home remedies
It’s important to give the bone time to heal. This may take four to 12 weeks or even longer. In the meantime:
* Rest: Stay off the affected limb as directed by your doctor until you are cleared to bear normal weight.
* Ice: To reduce swelling and relieve pain, your doctor may recommend applying ice packs to the injured area as needed — up to three or four times a day for 10 minutes at a time.
* Resume activity slowly: When your doctor gives the OK, slowly progress from non-weight-bearing activities — such as swimming — to your usual activities. Return to high impact activities, such as running, on a gradual basis, with careful progression of time and distance.
Prevention
Simple steps can help you prevent stress fractures.
* Start any new exercise programme slowly, and progress gradually. Don’t exercise too hard or too long. 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.
* Avoid sudden changes in intensity or type of exercise.
* Use proper equipment and footwear appropriate for your activity.
* Cross-train with low impact activities to avoid repetitively stressing a particular part of your body.
* If you have flat feet, ask your doctor about arch supports for your shoes.
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.
Nutrition counts, too. To keep your bones strong, make sure your diet includes plenty of calcium and other nutrients.
