A stress fracture is a fine crack that develops in bone, most commonly in the foot or lower leg. The injury can range from periostitis, which is inflammation of the periosteum (a thin membrane that covers the outside of the bone) through to a full cortical break in the bone. Cortical bone is a dense outer surface of bone.

What Causes Stress Fractures?

Stress fractures are caused by overuse, that is, repetitive and unaccustomed force without adequate recovery in between. Bone can remodel in order to adapt gradually to increased activity load, but when the intensity or volume of an exercise or activity is increased too quickly, bone will reabsorb cells faster than it can replace them, causing a fracture. The reason they most frequently occur in the foot and leg is because they are weight-bearing parts of the body and take a lot of stress when moving.

Some forces that can result in a stress fracture include jumping up and down repeatedly or running long distances, however they can also develop through normal use if the bone has been weakened by a condition like osteoporosis.

Risk Factors for Developing a Stress Fracture

Some people are more prone to stress fractures than others and it is worth considering the following.

  • Those with low Bone Mineral Density (BMD) are more likely to suffer from stress fractures.
  • Deficiencies in diet and nutrition can also have an impact, particularly deficiencies in calcium and vitamin D.
  • Irregular hormones or a sporadic or absent menstrual cycle can mean inadequate calories are being consumed to support healthy bone density levels.
  • Females are more at risk than males.
  • Previous stress fractures make the area susceptible to further injury.
  • High impact sports and activities put more pressure on the legs and feet, making the risk of stress fractures greater.
  • Increasing the volume or intensity of training too quickly.

Stress Fracture Symptoms

While symptoms can vary depending on the location of the stress fracture and the severity, usually there will be a slow onset of pain as running or other activity increases. If the injury continues to be aggravated, the pain frequency will increase and will begin to impact normal daily activities and even continue through the night. After several days or even weeks of rest to recover the injury, the pain may return which is an indicator or damage to the bone.

Common symptoms are:

  • Pain and swelling at the site of the stress fracture.
  • Tenderness when the bone is touched.
  • Not being able to put a lot, if any, weight on the affected leg.
  • Pain is likely to improve with rest and increase when moving.

Treatment Options for Stress Fractures

If the pain worsens or is persistent, it is important to visit a doctor or sports physiotherapist for an assessment and diagnosis. If a stress fracture is suspected, an x-ray or MRI will be conducted and in some cases a CT or bone scan will be required as stress fractures are not always visible on an x-ray.

The first part of treatment for a stress fracture is to have a period of non-weight bearing on the affected limb by using crutches and also possibly a CAM Boot. The team of physios at Melbourne Sports Physiotherapy have years of experience with stress fractures to be able to assess and treat your injury. They are specialised in physio after an ankle sprain, soft tissue therapy, post op physiotherapy, groin physiotherapy and much more. Often, they will need to refer you to a Sports Physician or Orthopaedic Surgeon for further advice and pain relief.

How to Prevent Stress Fractures

There are some things you can do to help prevent this type of injury, especially if you are an athlete or at higher risk due to the factors listed above.

  • The correct footwear is really important. Being properly fitted for footwear will ensure you have good support to help protect your feet and legs.
  • Always gradually increase your training so your body can adapt to the increased stress and load you are putting on it. Start any new activity slowly and don’t exceed a 10% increase per week.
  • Train well – in other words, be careful if you are changing running surfaces or equipment and make sure you are using good form.
  • Cross training will still help you obtain your fitness goals, while minimising stress on the body. For instance, if you are a runner, put some variety into your schedule like cycling or swimming on some days, or add weights training to benefit your body and limit the repetitive pressure on the same parts of the body.
  • Address any nutritional deficiencies so you have enough calcium and vitamin D.
  • Have any health issues or injuries assessed by a health professional. Early intervention can potentially prevent any further damage.

If you have any concerns or suspect you may have a possible stress fracture, call or make an appointment online with a specialist sports physio for a full assessment and diagnosis before things get any worse. Get back to moving well and pain free as soon as possible.

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