Stress fractures

By Joseph M. Harris, PT, ATC, CEAS - President/Clinical Director - Physical Therapy Solutions, PSC

Stress fractures are small cracks in bone that are caused by overuse of a weight bearing body part. This repetitive application of force causes the bone to breakdown. Stress fractures are common in running sports where there is repetitive pounding of the legs. Also some people get stress fractures when they start a new exercise program and begin to pound their legs more than they are accustomed to. Repetitive force causes the bone to be overstressed and break down faster than bone growth can occur. This causes tiny cracks in the bone that eventually become stress fractures. Most stress fractures occur in the leg and foot with over 50 percent of stress fractures occurring in the lower leg.

Signs and symptoms of a stress fracture include pain that increases with activity and decreases with rest. Pain and tenderness that is very point specific over a bone. Swelling may occur. Pain may persist at rest and may increase over time. The injury usually starts with a slight pain and progressively worsens. Athletes who participate in high impact sports are more susceptible to stress fractures. Stress fractures occur more in females than in males and females with abnormal or absent periods are also at higher risk. People with osteoporosis or with flat feet or high arches are also at higher risk of having stress fractures. Also one is at higher risk when activity levels are suddenly and rapidly increased.

Because stress fractures do not typically show on x-ray until three or four weeks after pain begins, MRI or bone scan is used to image the painful area and view the stress fracture. Acetomenophen (Tylenol) may be used for pain. Ice can also be used to relieve pain and swelling. Relative rest is indicated and casting, a walking boot, and/or crutches may be needed to enforce rest to the body part. If the bone heals slowly, a bone stimulator may be used to promote bone growth. In rare cases, surgery may be indicated.

After the bone has healed, return to sports should be slow and progressive. In order to prevent stress fractures, correct flat feet with arch supports; wear proper footwear; avoid sudden increases in work out schedules and begin new workouts gradually and progressively. It is best to set incremental goals when beginning a workout program. The running surface is also important. Running on dense surfaces, such as concrete, significantly increases the risk of stress fracture. Nutrition is also important. Be sure to take in plenty of calcium and other nutrients like vitamin D to promote strong and healthy bones.

By Joseph M. Harris, PT, ATC, CEAS

President/Clinical Director

Physical Therapy Solutions, PSC

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