15 Things You Should Know About Stress Fractures
Domlur, Bengaluru Feb 9, 2017
A crack in the bone caused by repeated stresses is called a stress fracture or hairline fracture. These generally show up poorly on X-ray which are not full thickness breaks, although poor management leads to full thickness breaks.
Here are 15 things which you didn’t know about stress fractures:
1. Hairline fractures are injuries caused by overuse
Bone when stressed by sports constantly repair and remodel. Capacity of the osteoblasts to remodel will be lost under repeated stress. An extended period of repeated cyclic loading might also cause stress fracture. Change in the athletic activity and a history of exercise-related pain are the typical presentation of stress fracture.
2. Stress reaction differs from stress fracture
A precursor which causes stress fracture is stress reaction. The structure of the bone breaks down and becomes weak at the stress reaction stage without any fracture. Stress fracture results when the bone structure has compromised to a crack or a fracture.
3. 7 to 20% of all sports injuries are caused by stress fractures
Sports related to running or jumping at field and track events, tennis, basketball, gymnastics, even ballet often carry the highest risks for stress fractures. The most commonly affected areas are tibia, fibula and metatarsals. Repeated use of arms in a game like tennis causes upper and lower rib and limb stress less commonly.
4. Stress fractures generally occur in people who are under training
It is difficult to know who will get a hairline fracture as it is seen even in people with general fitness, normal muscles, biomechanics and training. Increase in distance or change of the running shoes commonly leads to stress fractures. Stress fractures are also observed in people when they suddenly start their exercise or athletes who regularly perform heavy tasks.
5. 3 extrinsic risk factors for stress fractures:
- Increased load
- Increase in the number of the load repeats
- Application of load in a decreased surface area
6. Intrinsic factors contributing to stress fractures
- Decreased bone density and turnover rate
- Hormonal variations
- Lower muscular strength
- Length differences of the legs
- History of fractures
7. Stress fracture sites depend on the sport
Though stress fractures occur at the sites of tibia, metatarsals and fibula most commonly, they vary from sport to sport.
- Tibia and fibula among distance runners
- Ribs among rowers
- Metatarsals typical among dancers
- Calcaneus and metatarsals in military persons
- Navicular, tibia and metatarsals among track runners
8. Presentation of stress fractures are not always clear
Because of the occurrence of the subtle symptoms, stress fractures are generally easy to miss. It would be difficult to immediately diagnose because of the delayed localization of the pain which initially occurs in a diffused area. The pain is generally localized in later stages.
9. Stress fractures are not easily detected
Stress fractures which are commonly seen in athletes, results when abnormal force is applied on the normal bone and abnormal force on the osteopenic bone. Stress fracture injuries are rarely seen on X-rays and hence the diagnosis is generally confirmed with the MRI scan. If osteopenia exists, it can be confirmed by a bone density scan.
10. The first phase of treatment generally involves taking rest from the activity which is causing symptoms of stress fractures
Some of the initial steps which have to be considered to treat stress fractures include:
- Avoid abnormal stress
- Fitness has to be maintained by exercise
- Usual activity should be retained by safe painless activity
- Maturity of healed bone to match increased remodeling of the bone
11. Stress fractures if left untreated lead to severe complications
- More serious and complete fractures occur if stress fractures are not treated properly, especially at the higher risk sites of fractures
- Union and non-union delay are the other possible complications of the stress fractures
- An internal fixation may be needed if the complications are disabling
12. Risks for stress fractures may be reduced by the following proper exercise techniques
- A lower risk of stress fractures occurs by running on smooth and leveled surfaces
- Running with an injury must be avoided
- Usually full activity is recommended after the third week of initiation of the stress, to alter the intensity of training because of the weakness of the bone.
13. Measures which prevent osteopenia and osteoporosis are generally beneficial to prevent stress fracture
- Avoid smoking
- Avoid excessive alcohol
- Have good intake of calcium and vitamin D
14. With proper treatment, stress fracture may be cured within 3-12 months
Treatment with internal fixation generally recovers in 3-12 months while 1-2 years are required in severe cases. Patients who exhibit symptoms and complications even after treatment may require further management.
15. 5 phases of stress fracture recovery are:
- Phase 1- Generally begins at the time of diagnosis which is called the injury period. It usually lasts about 4 to 6 weeks
- Phase 2- Generally called the recovery phase lasts for 3 to 4 weeks which usually contains less pain. Cause for the stress fracture is determined in this phase. Strengthening, therapy and flexibility must be followed from the phase 1.
- Phase 3- This build phase generally lasts 3 to 4 weeks when the body’s strength is developed. Yoga and other core exercises can be followed in this phase
- Phase 4- Preparation for race will be established depending on the fitness, distance of race and expectations
- Phase 5- This is the race phase where the intensity of the activity in all the other phases can be increased. Skipping even a single phase might require to restart all the other phases from the beginning.