Stress Fracture

STRESS FRACTURE
Introduction:

A stress fracture is one type of incomplete fracture in bones. It is caused by “unusual or repeated stress” This is in contrast to other types of fractures, which are usually characterized by a solitary, severe impact.
It could be described as a very small sliver or crack in the bone this is why it is sometimes dubbed “hairline fracture”. It typically occurs in weight-bearing bones, such as the tibia (bone of the lower leg) and metatarsals (bones of the foot).

Causes
Bones are constantly attempting to remodel and repair themselves, especially during a sport where extraordinary stress is applied to the bone. Over time, if enough stress is placed on the bone that it exhausts the capacity of the bone to remodel, a weakened site — a stress fracture — on the bone may appear. The fracture does not appear suddenly. It occurs from repeated traumas, none of which is sufficient to cause a sudden break, but which, when added together, overwhelm the osteoblasts that remodel the bone.

Stress fractures commonly occur in sedentary people who suddenly undertake a burst of exercise (whose bones are not used to the task). They may also occur in Olympic-class athletes who do extraordinary quantities of high-impact exercise, in professional and amateur distance runners who run high weekly mileage, or in soldiers who march long distances.

Muscle fatigue can also play a role in the occurrence of stress fractures. For every mile a runner runs, more than 110 tons of force must be absorbed by the legs. Bones are not made to stand that much energy on their own and the muscles act as shock absorbers for the excess force. But, as muscles become tired and stop absorbing most of the shock, the bones experience greater amounts of stress. Finally, when muscles (usually in the lower leg) become so fatigued that they stop absorbing any shock, all forces are transferred to the bones.

Symptoms

Stress fractures usually have only a few symptoms. A stress fracture could present as a generalized area of pain and tenderness associated with weight bearing. Usually when running, a stress fracture in the leg or foot will cause severe pain at the beginning of the run, moderate pain in the middle of the run, and severe pain at the end and after the run.

Diagnosis

Physical examination and history are important in diagnosing stress fractures. Because these overuse injuries have a typical course and common physical findings, the history and examination can be critical in the diagnostic evaluation. X-Rays usually do not show a stress fracture, but they may show evidence of bone attempting to heal around the stress fracture. Further studies, including an MRI or bone scan may be necessary if the diagnosis is unclear or if the problem does not resolve with treatment

Treatment

If a stress fracture occurs in a weight-bearing bone, healing will be delayed or prevented by continuing to put weight on that limb.

Rest is the only option for complete healing of a stress fracture. The amount of recovery time varies greatly depending upon the location, severity, and the strength of the body’s healing response. Complete rest and a cast or walking boot are usually used for a period of four to eight weeks, although periods of rest of twelve to sixteen weeks is not uncommon for more severe stress fractures. After this period a very gradual resuming of activities may be resumed, as long as the activity does not cause pain. While the bone may feel healed and not hurt during daily activity, the process of bone remodeling may take place for many months after the injury feels healed, and incidences of re-fracturing the bone is still at significant risk. Activities such as running or sport that place additional stress on the bone should only gradually be resumed. One general rule is to not increase the volume of training by more than 10 percent from one week to the next.

Rehabilitation usually includes muscle strength training to help dissipate the forces transmitted to the bones.

Bracing or casting the limb with a hard plastic boot or air cast may also prove beneficial by taking some stress off the stress fracture. An air cast has pre-inflated cells that put light pressure on the bone, which promotes healing by increasing blood flow to the area. This also reduces pain because of the pressure applied to the bone. If the stress fracture of the leg or foot is severe enough, crutches can help by removing stress from the bone.

With severe stress fractures, surgery may be needed for proper healing. The procedure may involve pinning the fracture site, and rehabilitation can take up to a half year

Physioline’s Prevention Program

One method of avoiding stress fractures is to add more stress to the bones. Though this may seem counter-intuitive (because stress fractures are caused by too much stress on the bone), moderate stress applied to the bone in a controlled manner can strengthen the bone and make it less susceptible to a stress fracture. An easy way to do this is to follow the runner’s rule of increasing distance by no more than 10 percent per week. This allows the bones to adapt to the added stress so they are able to withstand greater stress in the future.

Strengthening exercises also help build muscle strength in the legs. Strengthening these muscles will prevent them from becoming fatigued quickly, allowing them to absorb the strain of running for longer periods of time. Key muscles that need strengthening with lower leg stress fractures are the calves and the shin muscles. Runners often suffer from overuse injuries or repetitive stress injuries. These include stress fractures, stress reactions, tendinitis, meniscal tears, ITB Friction syndrome, and exacerbation of pre-existing arthritis. Stress fractures, if not diagnosed and treated, can develop into complete fractures

Depending on a variety of factors (including weight, running surface and shoe durability), runners should replace their shoes every 300-700 miles to allow adequate mid-sole cushioning. A change in running surfaces can also help prevent stress fractures. However, it is also argued that cushioning in shoes actually causes more stress by reducing the body’s natural shock-absorbing action, increasing the frequency of running injuries

During exercise that applies more stress to the bones, it may help to increase calcium and vitamin D intake, depending on the individual. Also, it is important to monitor diet, because nutrition plays a vital role in bone development. Some individuals are at risk of osteoporosis, and depending on the country in which medical care is being supplied, there may be an osteoporosis screening program available.

PHYSIOLINE’S SPECIALIZED PHYSIOTHERAPY HAS VITAL ROLE TO PLAY

At Physioline, all the members of the rehabilitation team work together so as to provide proper care and the therapy in order to:

  • Pain relief
  • Reduce stiffness
  • Strengthening of muscle
  • Regain full range of motion
  • Gait training
  • Advice to wear spring steel shoe insert for stability

Visit Physioline for further Consultation and treatment.