How to prevent, manage stress fractures
Matthew D. Gimre, M.D.
Matthew D. Gimre, M.D., a nonsurgical sports medicine and orthopaedic medicine specialist at OAD Orthopaedics, contributes the following article about stress fractures.
Stress fractures are common injuries in athletes. Stress fractures are injuries to normal bone that occur with repetitive loading and are not due to an acute traumatic injury. Over time, these episodes of repetitive micro-injury cause breakdown of bone in a particular location, and a fracture can develop.
Stress fractures occur most frequently in the weight-bearing bones of the legs and feet. Stress fractures can occur in any sport with running and jumping, including football, basketball, soccer and volleyball. Stress fractures in the upper extremities are rare, but can occur, especially with activities such as gymnastics, rowing and throwing sports.
Risk factors for developing stress fractures include intense, vigorous training with few or no days of rest; starting a new activity such as running; or increasing the duration or intensity of a given activity too quickly. Young women with eating disorders or irregular menstrual cycles are also more prone to stress fractures. Up to 60 percent of stress fractures occur in athletes who have had a previous stress fracture.
Symptoms of a stress fracture include localized bony pain and possibly mild swelling. The injured area is almost always tender to the touch. A telltale sign is the inability to continue with athletic activity. Stress fractures can also cause pain and limping with regular daily activities.
Your doctor will diagnose the stress fracture based on the history of your symptoms, an examination of the painful area and further tests such as X-rays. However, some stress fractures (especially in the early stages) do not show up on initial X-rays. Other tests, such as an MRI or bone scan, may be needed to diagnose the stress fracture — your doctor will determine if these tests are appropriate.
The treatment of stress fractures always requires rest from the sport or activity that caused the injury. The treatment might also require the use of a splint, cast or walking boot. Frequently, crutches are used until the pain with walking goes away. The duration of treatment depends on the particular bone that is injured and how well the bone heals over time. The length of treatment is typically between four and 12 weeks, but possibly longer.
Prior to return to activity, the injured area needs to be pain-free and non-tender to the touch. Once the athlete is cleared to resume training, return to activity should be gradual and pain-free. Your doctor will help you determine the correct timetable for your recovery and return to sports.
Some stress fractures, unfortunately, do not heal well. These include fractures of certain bones (such as the navicular bone in the foot), and fractures in certain locations of the femur (thigh bone) or tibia (shin bone). These stress fractures require close observation and can require a prolonged period of non-weightbearing. In some circumstances, surgery is required. However, the vast majority of stress fractures do not require surgical intervention.
To prevent stress fractures, an athlete should use appropriate footwear with good support. Athletes should increase the intensity of their training gradually, and they should pay close attention to any painful symptoms. Despite these recommendations, stress fractures cannot be fully prevented and should be considered as a diagnosis in athletes with persistent pain with training.
Stress fractures are common athletic injuries but are frequently overlooked initially because there is no acute injury and the symptoms worsen gradually. Increased awareness among athletes will help with earlier diagnosis, earlier treatment and return to play and hopefully prevention of serious injury. Any athlete with persistent pain during activity, especially with local bony tenderness, should seek evaluation by an orthopaedic physician or sports medicine specialist who will guide the athlete through the appropriate evaluation and treatment.
Matthew D. Gimre, M.D., is OAD’s nonsurgical sports medicine and orthopaedic medicine specialist. Fellowship-trained in sports medicine, Dr. Gimre’s expertise encompasses athletic, musculoskeletal and chronic conditions and acute injuries. OAD is a 23-physician orthopaedic group with locations in Warrenville, Naperville, Wheaton, Carol Stream, Bartlett and Glen Ellyn. For appointments and information, call (630) 225-BONE (2663), and visit OAD online at www.OADortho.com.
— Provided by OAD