A stress fracture is a common overuse injury most often seen in athletes. Usually, a fracture, or broken bone, is caused by an acute event, such as a car crash or a fall. When this is the case, the bone experiences a very high force that causes the stress fracture.
A stress fracture occurs when the forces are much lower, but happen repetitively for a long period of time; these injuries are also known as "fatigue fractures." Stress fractures are commonly seen in athletes who run and jump on hard surfaces, such as distance runners, basketball players, and ballet dancers.
A stress fracture can occur in any bone, but is commonly seen in the foot and shin bones. They rarely occur in the upper extremity because the weight of your body is not supported by your arms as it is in your legs.
How is a stress fracture diagnosed?
Physical examination and history are important in diagnosing stress fractures. Because these overuse injuries have a typical course and common physical findings, the history and examination can be critical in the diagnostic evaluation. X-Rays usually do not show a stress fracture, but they may show evidence of bone attempting to heal around the stress fracture. Further studies, including an MRI or bone scan may be necessary if the diagnosis is unclear or if the problem does not resolve with treatment.
Why did I get a stress fracture?
Bone is constantly undergoing changes to adapt to its environment. When astronauts go into space, they are known to develop a thinning of the bone similar to osteoporosis. The reason is that their skeleton is not under the constant demands of gravity, and the bone adapts to that environment. Stress fractures are usually seen in athletes who increase their level of activity over a short period of time. The increased demand placed on the bone causes the bone to remodel and become stronger in the areas of higher stress. However, if the response of the bone cannot maintain the pace of the repetitive demands, a stress fracture may result.
Another factor that can contribute to the development of a stress fracture are dietary abnormalities and menstrual irregularities. Because both factors contribute to bone health, any problems with diet (e.g. poor nutrition, anorexia, bulimia) or menstruation (amenorrhea) may place an individual at higher risk for these injuries. This is one reason that adolescent female athletes are at particularly high risk for development of a stress fracture.
What is the treatment for a stress fracture?
The best treatment is almost always resting the injured leg. If there is no evidence that the stress fracture may displace, then avoiding the overuse activity may be sufficient treatment. However, if there is a concern of displacement of the stress fracture, then weight-bearing should be avoided (i.e. use crutches), and a cast may be placed. One rule of thumb (but not an absolute rule) is: if there is pain, don't do it. This means if jogging causes pain where you have a stress fracture, don't jog. If walking causes pain in that location, use crutches.
Other general stress fracture treatment principles include:
- Ice the injured area
- Wear proper equipment, specifically footwear
- Increase activities gradually
- If pain develops and persists, seek medical advice