Stress Fractures
fracture index
A stress fracture is fracture caused by non-traumatic, cumulative overload on a bone;
caused by a number of factors including overtraining, incorrect biomechanics, fatigue,
hormonal imbalance, poor nutrition, and osteoporosis.
Most often 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.
Causes of stress fractures
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 (a
tennis player who has switched surfaces from a soft clay court to a hard court); improper
equipment (a runner using worn or less flexible shoes); and increased physical stress (a
basketball player who has had a substantial increase in playing time).
What are the symptoms of a stress fracture?
A stress fracture may not cause swelling. However, each individual may experience
symptoms differently. Symptoms may include:
- Pain that increases with activity and decreases
with rest
- Pain that occurs earlier in your workout in each
successive workout
- Pain that increases over time
- Pain that persists even at rest
- Swelling
- A spot that feels tender or painful to the touch
At first, stress fractures may be barely noticeable. But pay attention to
the pain. Proper self-care and treatment can keep the stress fracture from
worsening.
The symptoms of stress fractures may resemble other conditions and medical problems.
Always consult your physician for a diagnosis.
How is a stress fracture diagnosed?
Diagnosis of a stress fracture usually is confirmed with a complete medical history and
a physical examination. X-rays often cannot detect stress fractures at first because they
are so fine. Once calluses form around the fracture, an x-ray can confirm a stress
fracture. Sometimes, a bone scan is performed to detect a stress fracture.
How are stress fractures treated
The most important treatment is rest. Individuals need to rest from the activity that
caused the stress fracture, and engage in a pain-free activity during the six to eight
weeks it takes most stress fractures to heal.
If the activity that caused the stress fracture is resumed too quickly, larger,
harder-to-heal stress fractures can develop. Reinjury also could lead to chronic problems
where the stress fracture might never heal properly.
Here are some tips developed by the American Academy of Orthopaedic Surgeons to help
prevent stress fractures:
Slowly increase any new sports activity. For example, do not immediately start running
five miles a day; instead gradually build up your mileage on a weekly basis. Running also
can be done on alternate days. Try alternating the days you run on a weekly basis.
Maintain a healthy diet. Make sure you incorporate calcium-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.
| Site of Stress Fracture |
Percentage Healed at 2-4 wk, % |
Percentage Healed at 1-2 mo, % |
Percentage Healed at >2 mo, % |
| Tibia, proximal third |
0 |
43 |
57 |
| Tibia, middle third |
0 |
48 |
52 |
| Tibia, distal third |
0 |
53 |
47 |
| Fibula |
7 |
75 |
18 |
| Metatarsals |
20 |
57 |
23 |
| Sesamoids |
0 |
0 |
100 |
| Femur, shaft |
7 |
7 |
86 |
| Femur, neck |
0 |
0 |
100 |
| Pelvis |
0 |
29 |
75 |
| Olecranon |
0 |
0 |
100 |
*Source
Brukner, 1997, adapted from Hulkko (Findings were from a case series of 368
stress fractures in athletes in which healing times of stress fractures in
different locations were assessed.)
Stress fracture healing
Stress fracture symptoms
Stress fracture treatment
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