Stressed about a Stress Fracture?

Have you been diagnosed with a stress fracture? Is it keeping you from doing your normal activities? Read what Sheltering Arms physician Berkeley Blanchard Martin, M.D. has to say about the condition and its recovery process.

What is a Stress Fracture?
A stress fracture is a small fracture usually due to an overuse injury. It may be due to repetitive forces such as running or jumping, or normal forces on a weakened bone from a condition such as osteoporosis.

When a bone is stressed, it begins the normal process of remodeling, initially with cells called osteoclasts breaking down bone, followed by cells called osteoblasts rebuilding bone. If there is enough time for recovery, the bone will rebuild. However, with continued repetitive forces, microfractures accumulate, eventually resulting in a stress fracture.

Symptoms/Diagnosis
Usually pain develops gradually with activity, often as a mild ache that goes away after stopping the activity. With continued exercise, the pain becomes more severe, occurring earlier in the work-out, and persisting afterward.

Common locations for stress fractures are the tibias (shins), followed by metatarsals (bones in the foot). Other locations include the fibula (in the calf), calcaneus (heel), navicular (in the foot), femur (thigh), and pelvis.

The diagnosis can be made by your doctor, who may order imaging. A plain x-ray may not be able to reveal the stress fracture. In that case, your doctor may order a bone scan or MRI, which are more sensitive in detecting a stress fracture.

Risk Factors
Stress fractures are most common in runners and military recruits. The most common risk factors are training errors, such as increasing the intensity, frequency, or distance of workouts, or changing footwear too abruptly. Other risk factors include a history of prior stress fracture, low bone density, genetic factors, low vitamin D and calcium intake, physical fitness levels, and biomechanical factors such as foot type (excessive supination or pronation), leg length discrepancy, and loading rate.

Treatment/Healing
Stress fractures are classified as low or high risk depending on their likelihood of healing completely. Treatment is individualized. In general, most stress fractures are low risk and are treated with relative rest, typically for 6-8 weeks, and possibly a brace or walking boot. Low or non-impact activities such as swimming, water running, cycling, or elliptical use are usually allowed. High risk fractures may require non-weight-bearing for a period of time, or even surgery. While your fracture is healing, make sure your diet has adequate calcium and vitamin D.

Returning to activity
Once the fracture has begun to heal and daily activities are no longer painful, your doctor may assist you with a slowly progressive return-to-activity program. The healing process continues for up to 6-12 months, and too much activity too soon may delay healing. So, don’t go too fast!

Over a course of several weeks you will likely begin with a combination of walking and jogging, then slowly progress to running, sprinting, and sport-specific activities. Some discomfort may occur, but this is generally allowed, as long as the pain is mild and you are not limping or changing your gait. Physical therapy may be useful at this point to help correct any biomechanical risk factors and prevent future stress fractures.

Your doctor or therapist will be your guide as you return to enjoying your normal activities. Take it slow, and get back out there!