are pretty common with sports. There are lots of different things that
may contribute to the development of this injury. And treatment can be
tricky at best if you don't know what to look for.
on to find out
more about this injury, how it occurs, symptoms, and prevention.
is a Stress Fracture?
It is different from a normal fracture
in that there isn't
actually break in the continuity of the bone. In order to
understand what a stress fracture is, we have to look at how normal
Bone, unlike soft tissue, is in a
constant state of renewal. Everyday you have bone cells that are broken
down by the body, and replaced with new bone cells. This is the normal
process. The amount of stress that is placed on the bones everyday
helps to determine how much bone is broken down, and how much is
This is why weight bearing exercise is
recommended for good bone health. The more you exercise, the stronger
your bones get as they adapt to the stress.
problem with this is that sometimes, when the stress is too great, the
bone breaks down more than it rebuilds. This causes an area
of weakening. Which is really what this injury is. An area of weakening
within the bone, due to excessive stress.
Causes a Stress Fracture?
The most common cause of this
injury is running. I have seen lots of patients with stress reactions
due to running. The repetitive pounding causes a lot of stress on the
bones, and sometimes it is just too much to handle. Over several weeks,
an area of the bone begins to weaken, because it cannot rebuild as fast
as it is being broken down.
You don't have to be a
runner to have a stress reaction in the bone. Any sport that requires a
lot of running, like soccer or basketball, and that involves running on
hard surfaces can cause this injury.
that can contribute include low bone density, poor diet and nutrition -
not enough vitamins and minerals to rebuild the bones, and the
biomechanics of the foot and low leg.
By far, the most common area for this injury is
in the lower extremity. The foot, ankle, low leg, and sometimes the
femur can all be involved. The most common of these are the metatarsals of the foot
, and the tibia of the low leg
is most likely because these bones all support the body's weight during
activity, and can bear the brunt of excessive activity stress.
is the most common symptom of a stress fracture. It usually starts off
gradually, and then progresses to pain after activity, and then all the
time. It usually feels like it is deep in the bone, and may be
described as a burning type of pain.
Pain with the
landing part of running, or when you strike the ground is very common.
The pain may lessen a little if you rest for a few days, but
unfortunately returns immediately when you begin activity again.
Do You Know For Sure?
How do you know if you have a stress
fracture, versus some other type of injury, like shin splints
You have to examine
your activity levels, nutrition, and other factors. If you are putting
in a lot of miles, or are participating in a lot of practice and game
hours, and if your pain does not lessen with rest, you may have a
stress reaction in your bone.
X-rays will usually
not show a stress fracture. The best test is a bone scan, which looks
at how much bone is being broken down and rebuilt. An area of stress
will show up as an area with lots of activity.
physician may recommend a bone scan if they think you may have a stress
the best and most effective treatment for this injury is rest. It is
the only way to allow the bone to rebuild itself. If you continue your
activity, then you will continue to weaken the bone, and it will not be
able to heal. In fact, it will continue to get worse, until it gets so
weak that the bone actually breaks.
fractures are treated with some type of protected rest, perhaps in a
walking boot. This lasts for several weeks, and then a very gradual
return to activity. A hard cast is not necessary, as there isn't a true
break to protect, but a walking boot allows for good protection of the injured area.
best way to prevent this injury is to monitor your activity. Make sure
you gradually accomodate to your sport. Don't jump in and start running
5 miles a day, 7 days a week. Work up slowly and give your bones time
to get stronger.
Rest is also important. Your body
cannot sustain levels of activity without rest for long periods of
time. So, if you are a runner, take at least 2 days a week off. Give
the bones time to recover, and they will thank you.
Make sure you have
good athetic shoes
that support your
feet. And that you are running or participating on good surfaces. Try
to avoid running on hard concrete every day.
is the final key to prevention. Make sure you eat
diet, and get lots of calcium - milk, cheese, yogurt. It is very
important for good bone health.
fractures are common injuries, but they can be prevented. A gradual
increase in activity, with planned days of rest, good shoes and proper
diet are also important.
Treatment focuses on
resting the injured area, and allowing the bones to rebuild themselves.
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