Therapy & Treatment for Stress Fractures
What is a Stress Fracture?
A stress fracture (also known as a bone stress injury), results from the inability of a bone to withstand the repetitive forces and stressors being applied to it. Overuse without adequate recovery is the most common mechanism. For example, when a runner goes out for their daily 5-mile run, the foot must absorb the weight of the entire body as it strikes the ground. This then happens hundreds of times per mile. Even with well-designed running shoes, these abnormal forces can lead to injury.
Some of the most common regions in which stress fractures occur include the second metatarsal, tibia, and femoral head. Stress fractures are commonly seen in runners and dancers. Athletes which commonly experience stress fractures of the upper limbs include gymnasts, tennis, baseball and basketball players. Golfers and rowers are the most likely athletes to experience stress fractures in the ribs. Individuals who have suddenly and greatly increased their activity levels recently are susceptible to them as well.
Symptoms
During the early stages, a person might not notice a stress fracture developing. As it advances, discomfort will often be felt local to the site of the fracture, which will grow into a nagging pain. The initial stage of a stress fracture is known as a stress reaction. This reaction will eventually transition to a moderate and then severe pain. Mild swelling can occur around the site. This is most commonly seen with stress fractures that occur in the feet. Pain from a stress fracture will be felt throughout the entirety of the activity being performed, normally increasing in intensity as time goes on.
Causes
When an individual engages in repetitive activity, the body becomes accustomed to the amount of weight that the bones and muscles associated with that activity must bear. In order to accommodate the activity, the bones must tear down and rebuild themselves in a manner similar to muscles. This remodeling process of bone involves osteoclasts breaking bone down and is known as resorption**, **followed by osteoblasts forming new bone cells.
If an individual increases the level of activity, say, by increasing the amount of weight lifted, the torque, or number of times the movement is performed, then the bone might be caught in a temporary period in which it is being resorbed faster than it can be replaced. In such a state, it is more brittle than otherwise, and thus vulnerable to stress fractures.
Risk Factors
There are a number of factors that can increase the risk of an individual developing a stress fracture. Here are a few important ones:
High-Impact Activity
Certain sports include certain actions (e.g. running) that can increase the risk of developing a stress fracture. The more impact, the greater the risk. Good nutrition, rest, and recovery are essential for reducing that risk.
Sex
Women are six times more likely to develop a stress fracture if they are currently experiencing menstrual cycle irregularities or no cycle at all. Female Athlete Triad, now known as Relative Energy Deficiency in Sport (RED-S) plays a huge role in stress fracture susceptibility. Post-menopausal women can also be at an increased risk for stress fracture due to the prevalence of osteopenia and osteoporosis in that population.
Nutritional Deficiency
People who are not getting enough calcium or Vitamin D (or who fail to absorb it) can put themselves at greater risk of developing a stress fracture. People who have unhealthy diets, who abuse certain drugs (e.g. methamphetamine), or have an eating disorder can end up with low levels of key nutrients, and thus be at greater risk of developing a stress fracture.
Complications
The most common complication that can arise as a consequence of not treating a stress fracture is *worsening *of the fracture. When this happens, the individual can no longer ignore the pain.
Another complication is avascular necrosis; this occurs when the blood supply to the bone is no longer adequate. This leads to additional complications and poor healing of the injured bone.
Finally, people with nutritional deficiencies or osteoporosis who have a stress fracture may not see their bone heal completely. This is called a nonunion. Such individuals may require extended time for a complete healing, and may need additional assistance.
How to Prevent Stress Fractures
There are several things a person can do to reduce their risk of developing a stress fracture. Here are a few suggestions:
Proper Nutrition
When your body has all of the right vitamins and minerals, there is much less chance of developing a stress fracture. Your recovery will happen much faster with proper nutrition, and with stronger bones and muscle. Properly nurturing your body with what you consume is essential for all individuals however especially important in athletic populations as well as populations which are more susceptible to stress fractures (i.e. those with osteoporosis, a very low or very high BMI, thyroid disorders, rheumatoid arthritis, or amenorrhea).
Gradual Increases in Activity
As stated above, if you are beginning a new workout regimen or job, there is some wisdom in starting small and gradually increasing your workload.
Cross Training
If you vary your workouts, you can cut down on the amount of stress put upon any one part of your body. This gives the muscle and bone time to recover, and build back stronger through varied movements.
Treatment For Stress Fractures
A complete recipe for healing from a stress fracture will require diagnosis from a physician with knowledge of the issue. Your doctor will understand the elements unique to your case and be able to craft a treatment plan specifically for you. Here are a few guidelines:
Stop Related Activity
Stop any activities that may have contributed to the stress fracture forming and seek out care from a medical professional. Do not ignore the pain; let it be your guide.
Unload the Region
The more you use the region affected by the stress fracture, the longer it will take to heal. Plan for 6+ weeks of healing time. This does not mean you cannot stay active. You can still perform various strength building exercises that will be beneficial in prevention of additional stress fractures. Your sports chiropractor or physical therapist can devise a plan for you.
Crutches and Protective Footwear
Crutches and protective footwear may be needed in certain cases. Not all stress fractures will need to utilize these, but if it has become severe enough or an individual is having trouble unloading the region, then it may be necessary.
Choosing Radius Physical + Sports Rehab for Stress Fracture Treatment
If you think you might be suffering from a stress fracture, or if you have been diagnosed with one, the professionals at Radius Physical + Sports Rehab are experienced at getting you back to what you want to be doing. Over the years, we have treated all kinds of stress fractures, and have been able to help people navigate through to a successful recovery, while also advising our patients on healthy lifestyle choices to avoid similar issues in the future. Give our office a call and we will be happy to help you through your situation. Stress fractures can be a significant setback, but they don’t have to be. With the right team on your side, you have nothing to worry about.
