Stressed about Stress Fractures?

Most bone fractures occur as a result of traumatic or violent injury, but this is not true of all fractures. In fact, most of us have heard about stress fractures, but they remain a mystery to many. Like the majority of running injuries (tendonosis, fasciitis, and, shin splints) stress fractures are overuse injuries. Similar to muscle, bone breaks down and builds up in response to the stresses of exercise. Stress fractures occur when the bone breakdown happens more quickly than the body's ability to rebuild. Due to several factors, the body may not produce sufficient bone and as a result, micro cracks, called "stress fractures," can occur in the bone.

Stress fractures most frequently occur in athletes, especially runners. Although stress fractures have been described in almost every bone of the human body, they are most common in the lower extremity weight-bearing bones.

Contributing factors to the development of a stress fracture

There are several factors that may contribute to the development of a fracture. These can be assessed and corrected with direction from a physical therapist. Some of these factors include:

• inappropriate or excessive training (particularly on hard or uneven surfaces)
• high arches or flat feet
• muscle fatigue
• poor flexibility (particularly of the calf muscles)
• ankle joint stiffness
• poor biomechanics
• muscle weakness
• inappropriate footwear
• poor diet
• leg length discrepancies
• being overweight
• menstrual disturbance

Symptoms/Diagnosis

Stress fractures produce pain and point tenderness over the area where the fracture has occurred. The pain is increased with activity and is relieved with rest. X-rays may not be helpful in diagnosing an early stress fracture because the bone often appears normal and the fractures are not visible. Point tenderness, or localized pain, is typically the most obvious finding in physical examination. After several weeks of rest, the bone begins to repair itself and often demonstrates a callus on X-ray. The diagnosis of an early stress fracture can usually be confirmed by a bone scan or magnetic resonance imaging (MRI).

Treatment for a stress fracture typically involves an initial period of rest. This may involve a period of non-weight bearing on crutches to protect the fracture and allow healing to occur. The period of rest typically is between 2 - 6 weeks depending on the severity and location of the stress fracture. Following the rest period, a supervised progression of activity by a physical therapist is initiated.

Physical Therapy for a Stress Fracture

Physical therapy treatment for patients with this condition is vital to speed up the healing process, ensure an optimal outcome and prevent injury recurrence. Treatment typically includes:

• IASTM (instrumented assisted soft tissue mobilization)
• joint mobilization (particularly to the ankle)
• activity modification advice
• arch support taping
• biomechanical correction
• exercises to improve strength, balance and flexibility
• a gradual return to activity plan
• correct footwear advice
• the use of crutches if necessary
• on the use of an appropriate brace if necessary
• individualized return to run program

As mentioned above there are many factors that can cause a stress fracture but the combination usually differs for each individual. The physical therapists at 3DPT specialize in biomechanical evaluations and video running analysis which will help them identify factors contributing to your injury. They will use their experience and expertise to create an individualized program to help safely return you to activity and prevent the recurrence of injury. If you are feeling pain or discomfort while running or exercising, don't hesitate to schedule an appointment today!