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Stress Fractures- Causes, Symptoms, Prevention, and Management

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Stress fractures are one of the most common injuries seen during sports. Read the article to know more.

Medically reviewed by

Dr. Anuj Nigam

Published At December 8, 2022
Reviewed AtJune 10, 2024

Introduction

Stress fractures are one of the most common sports injuries. Overcoming a stress fracture can be difficult as they occur by causing tiny cracks in the affected bones. A repetitive force, often from overuse, is repeated jumps and running longer distances. Stress fractures can also result from the frequent use of a bone that has already been weakened by a condition such as osteoporosis.

Stress fractures are typically found in weight-bearing bones of the lower limbs. Athletes involved in contact sports and military recruits who carry heavy packs over long distances are at the highest risk. However, any individual can sustain a stress fracture due to simply implementing a new exercise program by over-exertion.

What Is a Stress Fracture?

A stress fracture is a repetitive stress injury that occurs when muscles become fatigued and cannot absorb added shock. The fatigued muscle thus transfers the overload of stress to the underlying bones causing tiny cracks called stress fractures.

Activities that Make Individuals More Prone to Develop Stress Fractures:

Studies indicate that tennis, track and field, gymnastics, and basketball athletes are highly susceptible to stress fractures. The repetitive stress injury caused due to the foot striking the ground can cause trauma, resulting in tiny cracks developing within the bone. Sufficient rest between workouts or competitions is an absolute necessity, and an athlete who neglects proper resting periods can develop stress fractures.

What Are the Causes Behind Stress Fractures?

Stress fractures result from increased intensity or duration of activity at a faster pace than the body can handle. An impact of an unfamiliar surface, improper equipment, and increased physical stress may result in this condition.

Where Are the Common Sites of Occurrence of Stress Fractures?

Mainly stress fractures occur in the weight-bearing bones of the lower limbs. Stress fractures in the lower extremities account for nearly fifty- percent of the reported cases.

Are Women More Predisposed to Stress Fractures?

Stress fractures affect people of all ages and genders. Those who participate in activities like running or other repetitively strenuous tasks are more predisposed. Studies conducted, however, have indicated that female athletes experience more incidences of stress fractures when compared to their male counterparts.

This condition is referred to as "the female athlete triad," which consists of the following three disorders;

  1. Bulimia or Anorexia: These are eating disorders primarily seen in women in their late teens to early thirties.

  2. Amenorrhea: Infrequent menstrual cycles.

  3. Osteoporosis: Calcium metabolism in females occurs at a higher rate than in males, leading to the early onset of this condition.

What Are the Symptoms Seen In the Case of Stress Fractures?

Pain while performing activities are the most common symptom associated with a stress fracture which eventually subsides with rest. However, more extreme cases may report increased pain even on rest and medication.

Risk for Developing Stress Fractures:

Factors that can increase the risks of a stress fracture include the following;

  • Certain Sports: Stress fractures are more typically seen in people involved in sports such as running, basketball, tennis, dancing, or gymnastics.

  • Increased Activity: Stress fractures often occur in individuals who suddenly switch from a sedentary lifestyle to an active lifestyle. It may also be seen in cases where there is a rapid increase in intensity, duration, frequency, or a combination of the three during training sessions.

  • Sexual Predilection: Women, especially those who exhibit the female triad, as mentioned earlier, are at increased risk of developing stress fractures.

  • Foot Anatomy: People who are flat-footed or have rigid arches are more likely to have stress fractures. Wearing worn-out footwear may also contribute to the condition.

  • Weakened Bones: Pathological conditions such as osteoporosis can weaken the bones and make it easier for the cracks to develop, resulting in stress fractures.

  • History of Stress Fractures: If an individual has a previous history of stress fractures, they are at an elevated risk of developing more in the future.

  • Malnutrition: Eating disorders such as anorexia or bulimia and the lack of vitamin D and calcium salts in the diet can make bones more brittle and likely to develop stress fractures in the foreseeable future.

Complications Arising From Stress Fractures:

Some stress fractures do not heal properly, and this may result in other chronic problems. If the underlying causes of the condition are not addressed, the patient may be at increased risk of stress fractures.

If the activity responsible for a stress fracture is resumed too quickly, it may result in more extensive and harder-to-heal fractures. Re-injury also could lead to chronic problems, and the stress fracture may never heal properly.

How Can Stress Fractures Be Diagnosed?

The physician must evaluate the patient's risk factors for developing stress fractures in the first place during the medical examination. X-rays are typically used to determine stress fractures. However, some stress fractures cannot be visualized by regular X-rays. These fractures may not appear for several weeks after the pain initially starts. Additional medical imaging such as computed tomography (CT) scan or magnetic resonance imaging (MRI) is necessary. This is to rule out other probable causes for the pain, such as ligament or tendon injuries.

What Are the Treatment and Management Protocols for Stress Fractures?

The importance of rest in treating stress fractures cannot be emphasized enough. Individuals need to refrain from the activities that caused the fracture in the first place, and engaging in a pain-free activity during the resting phase is advisable. Six to eight weeks is required for most stress fractures to heal completely. In addition to rest, shoe inserts, orthotics, or braces are used to heal the injuries.

How Can Stress Fractures Be Prevented?

As suggested by the American Academy of Orthopedic Surgeons, the following means to prevent stress fracture incidences can be helpful;

  • Setting Incremental Goals: For example, to run five miles a day, individuals should gradually build up their mileage weekly instead of overexerting themselves from day one.

  • Cross-training: This involves alternating activities that accomplish the same fitness goals. This can help prevent micro-injuries that ultimately lead to stress fractures. For instance, running and cycling on alternate days is advisable instead of running every day to meet cardiovascular goals. Strength training and flexibility exercises should also be incorporated to achieve maximum benefit.

  • Healthy Diet: The importance of a properly balanced diet, especially for athletes and exercise trainees, are instrumental in maintaining the body composition against repetitive wear and tear.

  • Using Proper Equipment: The individuals must refrain from using inappropriate or damaged equipment, such as old tennis rackets, worn-out running shoes, etc.

Recognizing the symptoms early and consequent prompt treatment can help individuals return to sports at their original playing level.

Conclusion

Overcoming a stress fracture can be difficult as they occur by causing tiny cracks in the affected bones. However, more extreme cases may report increased pain even on rest and medication. Individuals need to refrain from the activities that caused the fracture in the first place, and engaging in a pain-free activity during the resting phase is advisable.

Frequently Asked Questions

1.

How Do You Know You Have a Stress Fracture?

Stress fractures do not exhibit pain initially; however, the pain worsens over time. The pain will be felt in a specific spot and relieved during rest. In addition, swelling will also be noticed in the area with pain. Also, imaging studies like X-rays and MRI (magnetic resonance imaging) help confirm the diagnosis.

2.

Can You Walk with a Stress Fracture?

Walking with a stress fracture causes pain, but a few people have mild pain. So it is important to take rest and keep the fractured leg in an elevated position. With the help of a crutch, walking will be advised to prevent force on the fractured foot. So an individual with a stress fracture can walk with the crutch’s support.

3.

How Long Do Stress Fractures Take To Heal?

Stress fractures usually take around six to eight weeks to heal, and it is advisable to restrain from performing activities that have caused the stress fractures. However, a doctor’s advice is recommended before resuming physical activity to avoid complications.

4.

Will a Stress Fracture Heal on Its Own?

Stress fractures heal spontaneously with effortless measures like resting and avoiding the activity that caused the fracture. However, in a few cases, when healing is prolonged, surgery will be considered to promote healing.

5.

How Painful Is a Stress Fracture?

The stress fracture starts with a dull pain in the fracture site, gradually increasing in intensity while performing physical activities. And the pain decreases with rest. In addition, deep aching pain, in some cases, will be felt in the affected limb. However, they do not cause excruciating pain, unlike other fractures.

6.

What Happens if a Stress Fracture Is Left Untreated?

If stress fractures are left untreated, they can lead to,
 - Prolonged healing.
 - Increase in pain.
 - Additional fractures in the site.
 - Avascular necrosis (the lack of blood supply that causes the death of bone tissues).

7.

Do I Need to Go to the Hospital for a Stress Fracture?

Medical attention is mandatory for physical examination and evaluation. The diagnosis will also be based on the physical review, and imaging tests will be recommended for confirmation. And depending on the diagnosis, rest or medications will be advised or prescribed.

8.

How Should You Sleep With a Stress Fracture?

Since stress fractures are more common in the lower limbs, they should not be subjected to further damage by exerting pressure on them. So keeping the affected leg elevated will prevent complications and promote healing by preventing further harm.

9.

How Can a Stress Fracture Be Healed Quickly?

Stress fractures quickly heal following the RICE (rest, ice, compression, and elevation) protocol.
 - Rest: Rest is essential to keep the fractured limb from bearing weight.
 - Ice: Use packs or ice wrapped in a towel on the fractured site to reduce the swelling. Follow this for 20 minutes several times a day.
 - Compression: Compress the affected site by wrapping a towel or a bandage to prevent swelling.
 - Elevation: Keep the affected limb elevated at a level higher than the heart.

10.

Are Stress Fractures Visible on an X-Ray?

Stress fractures are not visible initially on an X-ray soon after the symptoms appear. However, they can be visibly seen after a few weeks to months. Since stress fractures appear as tiny crack lines on  X-ray, they are mostly healed when they begin to become visible on the X-ray. So, these healed bony lines called callus help figure out the fracture.

11.

Is Heat Good for Stress Fractures?

Applying heat promotes healing and reduces muscle stiffness by enhancing blood circulation in the injured site. This encourages the inflammatory properties that provide additional recovery support. In addition, it also reduces muscle stiffness and stimulates movement.

12.

Why Do Stress Fractures Hurt More at Night?

The stress hormone cortisol has an anti-inflammatory property that elevates blood glucose levels, enhances the brain’s activity in glucose regulation, and provides substances that heal tissues. So, the levels of these hormones are reduced at night, leading to less inflammation and healing. Also, there is bone damage which is associated with pain.

13.

How Do Doctors Treat a Stress Fracture?

The stress fractures are managed initially by recommending wearing walking boots and using crutches or braces to avoid weight bearing on the affected limb. Medications will be advised to relieve pain, and surgery will be considered in locations with reduced or no blood supply.

14.

Do Stress Fractures Exhibit a Throbbing Pain?

Stress fractures do not cause throbbing pain but produce dull pain in the affected limb. Generally, they do not cause pain initially but can worsen over time. But the pain reduces with rest and elevation.

15.

How to Differentiate Between Plantar Fasciitis and Stress Fracture?

The classical sign of plantar fasciitis is that the foot hurts with the first movement when one wakes up, but it gets better with time. In contrast, in stress fracture, there is a dull pain in the affected area, which increases with activity and decreases with rest.

16.

How to Treat a Foot Stress Fracture at Home?

Stress fracture generally needs rest and restraining the activity that caused the fracture. Also, the RICE protocol that involves rest, placing ice packs, compressing the fractured area with a towel or bandage to reduce swelling, and placing the leg in a higher position above the heart level helps heal stress fractures at home.
Dr. Anuj Nigam
Dr. Anuj Nigam

Orthopedician and Traumatology

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stress fracturebone fracture
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