None — Stress Fracture
A stress fracture is a tiny break in a bone caused by excessive force. It is considered to be a type of overuse injury. When the muscles become too tired, they are no longer able to endure repeated or excessive shock, placing extra stress on the bone. With enough force (or repeated force), a crack develops in the bone.
Stress fractures are one of the most common kinds of sports injuries. They generally occur when a person increases the amount of activity or training too rapidly. Most cases involve the lower leg bones, especially the tibia (shinbone, accounting for about half of stress fractures) and the metatarsals (the long bones in the forefront of the foot, accounting for about 25 percent of stress fractures). Sports that involve running and jumping have the highest rates of stress fractures. Sports that require repetitive use of the arms, like tennis or baseball, can cause stress fractures in the arm bones.
Stress fractures are more common in women than in men. Researchers estimate that 60 percent of those with the condition have a previous history of stress fracture.
Signs of stress fracture include a dull pain not associated with a known injury. Nicholas Sgaglione, M.D., Orthopaedic Surgeon with Long Island Jewish Medical Center in New Hyde Park, NY, says the pain usually doesn't go away with stretching or after resting. The pain becomes worse during exercise and the tissue in the affected area may be tender to the touch. In some cases, patients may have localized swelling or a bump over the site, an indication the body has tried to heal the injury.
Diagnosis and Treatment Sgaglione says a stress fracture may be tricky to diagnose. Patients often believe the symptoms to be caused by minor injury and may try to work through the pain. When a patient comes for an evaluation, he takes a thorough history of the types and intensity of activities (including any recent changes in activity levels) and performs a physical exam of the site. Usually, the activity history, accompanied by tenderness at a specific point along the affected bone is a good indication of a potential stress fracture. X-rays may be taken. However, Sgaglione says stress fractures often don't show up on X-ray scans, especially soon after the onset of symptoms. If there is any uncertainty about the cause of the symptoms, an MRI or other type of more sophisticated imaging scan may be recommended.
Initial treatment for stress fractures involves rest from activity, ice, and non-steroidal anti-inflammatory medications. Sgaglione says some people are reluctant to give up their activity, especially if they are in the middle of a training program. However, continued stress on the injured bone could lead to a serious fracture that requires more involved treatment and a substantial loss of training time. He recommends cross training, both to keep the body in good physical shape, and to reduce the degree of stress on the bones. It can take up to 12 months for an injury to heal sufficiently.
Once activity is permitted, patients need to build intensity and duration slowly. Stretching and warm ups are recommended. Sgaglione also recommends using proper footwear to reduce impact on the foot and leg bones.
AUDIENCE INQUIRY For general information on stress fractures: American Academy of Orthopaedic Surgeons American College of Foot and Ankle Orthopedics and Medicine American Orthopaedic Society for Sports Medicine