What is a stress fracture?
A stress fracture is a common sports and overuse injury which results in multiple thin break or crack formation in a bone. Stress fractures make up 2% of all injuries in athletes. Gymnasts, runners and basket-ballers are common victims of stress fractures.
Stress fractures or micro-breaks are caused by repetitive sub-maximal force being placed on a bone. This means that the force alone is not enough to cause boney damage but continual application of stress results in progressive damage and fatigue of the bone.
If you don’t feel like reading right now have a look at this short informative video by Dr Abbey Davidson (Osteopath):
What causes a stress fracture:
Commonly seen causes of stress fractures include:
- Overuse or overtraining (especially running or jumping)
- Rapid change in exercise/sporting habits
- Inappropriate equipment (especially footwear)
- Poor training technique
- Change in training surface (indoor track to concrete)
Prevention is always better than cure. It is wise to avoid these common causes of stress fractures to avoid any disruption to training.
Common Sites of stress fractures:
It is important to recognise the common sites of stress fractures as location plays a key role in diagnosis. Common stress fracture locations include:
- Tibia (shin bone) *commonly confused with shin splints*
- Metatarsal (foot bones)
- Calcaneus (heel bone)
- Navicular (foot bone)
- Femoral neck (hip)
Stress fractures are most frequent in the lower limb (leg, ankle, foot) but can occur far less commonly in other areas of the body (including: ribs, arm bones, hand bones, etc).
Symptoms of a stress fracture:
Common signs and symptoms of a possible stress fracture include:
- Bone pain (“pin-point” and specific)
- Pain aggravated during/after exercise and with touching
- Pain relieved with rest
- Local weakness, swelling and/or redness
- Recent change in exercise intensity or frequency
If you are concerned you are suffering from a stress fracture consult your GP, Osteopath or Physiotherapist for appropriate investigation.
Risk factors for stress fractures:
Those who are more prone to developing stress fractures include:
- Running or jumping sports participation
- Sudden change in exercise habits (increase intensity or number of training sessions)
- Inappropriate equipment (e.g. footwear)
- Female gender
- Menstrual/hormonal disturbances
- Bone weakening disorders
- Vitamin D deficiency
Where applicable avoid or manage risks fractures to decrease your chances of developing this injury.
How is a stress fracture diagnosed?
Stress fractures are often diagnosed using clinical presentation meaning information gained from your consultation in regards to your signs, symptoms, medical history and exercise participation. X-Ray, MRI and Nuclear medicine bone scans can be used if further confirmation is required.
What you can do right now for a stress fracture?
When recovering from a stress fracture it is important to rest, gradually return to activity, utuilise appropriate equipment (including footwear),
Rest. Athlete’s absolutely dread this advice but it is crucially important in recovery from a stress fracture. This allows the weakened bones time to repair and re-strengthen. 4-6 weeks of avoiding running, jumping and aggravating physical activity. In some cases a crutches with a splint or brace will be recommended so weight-bearing is avoided. Continuing to exercise and aggravate on this type of fracture can result in further injury and longer recovery times.
Progressive and gradual return to sport. After a 4-6 week period of rest, progressive return to exercise and loading on the injured bone is essential. This will allow for the strength in the bone to increase over time to cope with the repetitive stress and force exercise places upon it.
Utilise appropriate equipment for your sporting activity. This can mean purchasing new more supportive footwear or whatever sports specific equipment that is appropriate for your injury. This will help not only in your recovery but prevention of future injuries of a similar variety.
Change your exercise surface. If the cause of your initial injury was running on harder type surfaces like concrete change things up and spend some time exercising on softer surfaces. Alternatives include indoor tracks or grass. This will lessen the force while you are recovering and again decrease the chance of future injury.
Physio and Osteo treatment for a stress fracture:
Your physiotherapist or osteopath will firstly spend time assessing you and making sure you are in fact suffering from a stress fracture. They will then spend time educating you about the injury and the treatment plan going forward. In some cases they may prescribe you a splint/brace and crutches.
Your physio or osteo will oversee and monitor your graduated return to sport. There would be nothing worse than resting from sport for 4-6 weeks, returning too quickly and re-injuring yourself. So your trained health professional will advise you through a progressive return and get you back to your full intensity as soon a safely possible.
In addition the hands on work you osteo or physio will prescribe you some exercises strengthen the surrounding joints. The stronger and more stable you are will mean less force placed on your bones. Strengthened muscles will act as shock absorbers and help you avoid re-injury.
As a general rule the earlier the diagnosis of a stress fracture the faster the recovery. We encourage you to get assessed by a health professional if you think you may be suffering from a stress fracture.
How long until a stress fracture gets better?
Just like a regular fracture (or break) the bone healing process can take 4-6 weeks. After 4-6 weeks progressive and monitored return to activity is encouraged.
If not adequately rested and treated stress fractures can develop into complete breaks and cause continual problems. Untreated stress fractures can cause deformity (which can limit range of motion and function) and arthritis (which can cause pain and weakness). This is why resting and following the advice of your health professional.
Some higher risk stress fractures may require surgery.
By Sydney CBD Osteopath Dr Abbey Davidson