Stress Fractures

What is a stress fracture?

Bone is made by living tissue which is constantly being removed and created. It is normal for force through a bone to cause microscopic damage that the body quickly repairs. If the damage is too much or too repetitive or the body’s repair systems are compromised (fatigue, illness, lack of recovery), then a particular bone can become progressively weakened in one spot.

Stress injuries can be anything from a slight weakening/bruising of the bone to a displaced fracture (and everything in between)

How do stress fractures occur?

Sometimes the causes for a stress fracture is obvious – such as endurance athletes training at very high volumes. But often stress fractures can occur without an obvious escalation in training or clear cause. This is because there can be multiple contributing factors at play. Some possible warning signs can include missed or late periods in female athletes, high volumes of endurance training or weight-loss.

A very common mistake athletes make in self-diagnosing is made in the following statement: “I couldn’t possibly have a stress fracture, I have only been training at low volumes/intensity”. Training volume is just one of the many potential contributing factors and many athletes and non-athletes develop stress fractures seemingly innocuously with very low activity levels at times.

What are the symptoms of a stress fracture?

The most reliable feature to find when examined is direct tenderness over a bone – such as a metatarsal (foot) or tibia (shin).

However, that finding is not foolproof.  Hip and Spine stress fractures can produce vaguely located pain and no localised tenderness.

Not all stress fractures behave in the typical matter but pain that is always in the same, well localised spot and increases with increased weight-bearing activity is common. If you also have localised tenderness to touch over a bony area, the suspicion is higher still.

Plenty of stress fractures still won’t be so obvious.  Often, the pattern of the pain is the most reliable feature: ie pain that gets worse the longer that you run that is present on impact.

How is a stress fracture diagnosed?

Sometimes an expert physician can diagnose a stress fracture just on examination but more often the assessment leads to a high suspicion that needs to be confirmed with a scan. Scans can also be helpful in determining the severity of a stress injury which will influence how it is treated. Sport and Exercise Physicians are the only specialist medical doctors that have the training and experience to deal with all types of athletic stress injuries.

How do you treat a stress fracture?

All athletic stress injuries should be seen by a Medical Specialist. Often we need to investigate to see if there is an underlying hormonal or nutrient problem that has led to the injury – and if a problem is identified that will also require treatment.

Not all stress fractures are the same. Some bones have a fantastic capacity to repair themselves and need less attention than others. Some can be extremely difficult to manage and repair and early expert care can prevent lifelong repercussions.

Where do stress fractures commonly occur?

The most common sports for stress fractures occur in the bones of the feet (metatarsals, navicular, heel bone) and the shin (tibia and fibula). These are also the most common sites in people who do running sports but almost any bone can get a stress fracture depending on the activity. Fast bowlers commonly get stress fractures of their spine, rowers can get them in the ribs and tennis players can get them in the arm.

How long do stress fractures take to heal?

There is no set amount of rest for all stress fractures. Some heel very quickly and are very forgiving, others can take much longer. It is absolutely essential to see a Sports and Exercise Physician to work out the appropriate treatment for your specific type of stress injury.

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