Stress Fractures

A common injury in sports is a stress fracture. A stress fracture is an overuse injury. It occurs when muscles become fatigued and are unable to absorb added shock. Eventually, the fatigued muscle transfers the overload of stress to the bone causing a tiny crack called a stress fracture.

Stress fractures often are the result of increasing the amount or intensity of an activity too rapidly. They also can be caused by the impact of an unfamiliar surface, improper equipment and increased physical stress.  Most stress fractures occur in the weight bearing bones of the lower leg and the foot and are most commonly seen in the following sports – tennis, track and field, gymnastics, and basketball.  This is because in 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.

Symptoms

Pain with activity is the most common complaint.  The pain subsides with rest.

Diagnosis

X-rays are used to diagnose stress fractures however sometimes they cannot be seen on regular xrays or there will be a delay between symptom onset and radiographic findings.  Computed topography (CT) scan or magnetic resonance imaging (MRI) will then be necessary.

Treatment

The most important treatment is rest from the activity that caused the stress fracture.  Participating in another pain-free activity during the six to eight weeks it takes most stress fractures to heal is recommended. If the activity that caused the stress fracture is resumed too quickly, larger, harder-to-heal stress fractures can develop. Re-injury also could lead to chronic problems where the stress fracture might never heal properly.   In addition to rest, shoe inserts or braces may be used to help these injuries heal.

Prevention

The American Academy of Orthopaedic Surgeons has developed a number of recommendations to help prevent stress fractures:

  • When participating in any new sports activity, set incremental goals. For example, do not immediately set out to run ten kilometres a day; instead, gradually build up your distance on a weekly basis.
  • 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.
  • Maintain a healthy diet. Make sure you incorporate calcium- and vitamin D-rich foods in your meals.
  • Use the proper equipment. Do not wear old or worn running shoes.
  • If pain or swelling occurs, immediately stop the activity and rest for a few days. If continued pain persists, see an orthopaedic surgeon.
  • 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.