What is a stress fracture?
Our bones are a dynamic tissue and are constantly changing and responding to the load that is placed upon them. When we walk or run, our bones need to absorb the forces generated. However, if repetitive loads overwhelm the ability of the bone to repair itself, a small hairline line crack in the bone can can appear, known as a stress fracture.
This overuse injury can occur across all ages and levels of sports men and women and is more common in runners and sports involving jumping.
Where can you get a stress fracture?
Stress fractures most commonly occur in the lower limb, as there is ongoing repetitive force through the long bones in the legs (tibia, fibula, neck of femur), bones of the foot (metatarsals and tarsals) and the pelvis. However, they are occasionally seen in bones of the upper arm, elbow and collar bone in sports that transfer high forces through the arms, such as tennis, swimming and gymnastics.
What causes a stress fracture?
Stress fractures can occur in a normal bone that has not adequately “adapted” to the increasing amount of load or training. This overuse could simply be caused by a change in activity, an increase in exercise volume or intensity, a manual job or a prolonged activity that you do not usually undertake.
However, stress fractures can also occur in a bone that is “weakened” by conditions such as osteopenia or osteoporosis.
Who is at risk of developing a stress fracture?
Stress fractures can occur in all ages and levels of sporting activity. However, there are a number of risk factors that can make certain people more susceptible. These include –
- A change in exercise habits, such as a sudden increase in the volume and intensity of training after a rest period or if a person changes the ground surface they are training on.
- Inadequate dietary intake for the level of sporting activity undertaken. This means that they are “underfuelling” which can cause problems with the body’s natural hormones and building blocks of bone. This condition is known as Relative Energy deficiency in Sport (RED-S)
- Low calcium and Vitamin D levels
- Females with irregular or absent menstrual periods
- Low percentage body fat
- Low bone density
- Muscle weakness and/or inflexibility, abnormal biomechanics with running.
- Prolonged use of some medications that can decrease bone density
What are the symptoms of a stress fracture?
Classically a stress fracture will cause pain in an area that can be pin pointed. The pain often builds up gradually over a period of time (known as bone stress), in a ‘crescendo’ type pattern and usually worsens when carrying out exercise. Once it becomes more severe, it can also start to cause pain during normal daily activities. The pain may be identified by pressing over the area of skin above the fracture. The pain usually improves with rest.
How is it diagnosed?
Our Sports Medicine Specialists can perform a detailed assessment and examination. In the majority of cases, imaging will be required. The fracture will not always be seen on an initial X-Ray and to confirm the diagnosis, you may need either a CT or MRI scan. This will show signs of bony swelling (oedema) and inflammation of the lining of the bone, which can indicate the bone, is being “overused”.
At your consultation with one of our sports medicine team, they will also discuss all of your risk factors and may suggest further investigations such as blood tests and a bone scan. This is to identify any underlying problems with your bones.
How can a stress fracture be treated?
The management of a stress fracture requires specialist input from a number of the Circle Rehabilitation team. This can include nutritional support, physiotherapy, biomechanical assessments and gait analysis.
The mainstay of treatment for a stress fracture is relative rest, and the time length can vary depending on the bone affected. In lower limb stress fractures, a special boot called an “Aircast “boot may be used to relieve some of the force from walking. You will be advised not to carry out the sport that causes pain. Painkillers may be needed at the initial stages of treatment, as the fracture is starting to heal. Paracetamol can be taken regularly. Non-steroidal painkillers like ibuprofen (neurofen) and diclofenac (Voltarol) should be avoided as they can slow bone healing.
If your stress fractures is due to” weakened” bones (known as insufficiency fractures), specific management is needed to treat the underlying cause. This may involve working with specialist sports nutritionists and psychologists depending on the severity of the problem. The team at the Active Women’s Clinic will be able to offer advice and support on next steps.
If your injury is in the leg or foot, non-impact sports such as swimming may still be acceptable in the early stages as this puts minimal weight through the leg and should not hinder healing of the fracture. The progress should be checked regularly by your rehabilitation team to ensure the fracture is healing well. Once you are pain free, our rehabilitation will start a gradual return to sport programme increasing the volume and intensity of your activities on a weekly basis. This can include using equipment such as the Anti-Gravity treadmill to ensure a safe return to running.
How can I prevent a stress fracture?
You can limit the risk of developing a stress fracture by following a few simple steps-
- Always follow appropriate training plans – increase running/walking distance and speed gradually, in increments no greater than 10 percent per week. Incorporate “rest days” into your training plan. Our rehabilitation team can offer expertise on specific training schedules.
- Select the proper footwear for the specific type of exercise.
- Focus on stretching and strengthening the muscles around the hip, thigh and calf
- Nutrition – remember your energy intake needs to balance your energy expenditure and “under fueling” for your sport can cause disruptions in your bodies hormones. Always ensure you have an adequate intake of calcium, Vitamin D, protein and carbohydrates. Our Sports Nutritionists at Circle can offer specialist advice.
- Periods- irregular and absent periods impact your hormones and if left untreated, this can negatively affect your bones. It is important to seek early medical advice as to the cause of your irregular or absent menstrual periods
- Listen to your symptoms and seek medical attention early