By Dev Mishra, M.D.
President, Sideline Sports Doc
Clinical Assistant Professor of Orthopedic Surgery, Stanford University
- A stress fracture is a type of overuse injury
- Stress fractures often start with mild activity related pain that never disappears
- Stress fractures will usually heal with proper treatment, allowing return to sports but the healing process can take a long time
Last week we wrote about an overuse/growth related injury called Osgood-Schlatter syndrome and this week I’d like to focus on another overuse injury: stress fractures.
Here’s a common scenario:
A high school distance runner started developing a slight ache in her inner leg towards the middle of spring track season. She thought very little of it and continued to train and compete. She iced down religiously after training, used a compression sleeve, and used a foam roller. The pain gradually intensified to the point where she needed to pop 3 or 4 ibuprofen pills before every race just to be able to finish. High school season ended, she took two weeks off from running and then went straight into summer training, now using hill runs in preparation for a marathon she wanted to run this July. But the pain worsened immediately on her first training run and bothered her with any amount of walking or even just weight bearing.
When this young woman came to see me the concern was for a stress fracture in her tibia, and we confirmed this with imaging. My suspicion is that she started with a shin splint syndrome but continued to power through the pain. The muscles and soft tissues were unable to support the running stress, the stress transferred to the bone instead, and a stress fracture in the bone was the result.
What is a stress fracture?
A stress fracture is a crack in a bone that results from overuse. It occurs when muscles become fatigued and are unable to absorb added shock. In the scenario above the suspected shin splints ultimately caused bone overload. Eventually, the bone gave out as well and developed a crack.
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).
Most stress fractures occur in the weightbearing bones of the lower leg and the foot. More than 50 percent of all stress fractures occur in the lower leg. The tibia, fibula, and metatarsal bones are common stress fracture sites.
In my experience runners are most susceptible to stress fracture. Other sports placing the young athlete at risk for stress fracture are tennis, gymnastics, and basketball. In all of these sports, the repetitive stress of the foot striking the ground can cause trauma. Without sufficient rest between workouts or competitions, an athlete is at risk for developing a stress fracture.
Symptoms of a Stress Fracture
Pain with activity is the most common complaint with a stress fracture. This pain typically subsides with rest. If your pain progresses to the point where simple walking is painful, you should see a sports physician. You should also see a sports physician if your pain returns immediately after a period of a few weeks rest. As you can see from the scenario at the top of this post there’s sometimes a progression from shin splints to stress fracture, so if you’re just not sure what you are dealing with then get professional evaluation from a sports physician early on.
How are stress fractures treated?
The most important treatment is rest. Athletes 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. Re-injury also could lead to chronic problems where the stress fracture might never heal properly. In addition to rest, shoe inserts or braces may be used to help these injuries heal.