Stress fractures: Symptoms, diagnosis and treatment
A stress fracture is a crack in a bone, and can be a common injury in high impact sports such as distance running or basketball.
Stress fractures can be quite painful, but usually heal themselves if rested for a few months.
Many different sports increase the risk of stress fractures. Activities that require running and jumping may cause fractures in the legs or feet. More than half of all adult and adolescent stress fractures occur in the lower leg bones. In adults 25% of fractures are in the metatarsal bones of the feet (the bones of the instep).
Other sports that require repetitive movements - such as bowling a ball in cricket or rowing - can result in stress fractures in other parts of the body.
Stress fractures are much more likely to develop in people who have just started a new exercise or abruptly stepped up the intensity of their workout. When the muscles aren't conditioned, they tire easily and can't support and cushion the bones as well. Increased pressure is exerted directly on the bones, which can lead to a fracture.
Stress fractures seem to be more common in women, especially in women who do not have regular menstrual cycles. A reduction in oestrogen can cause osteoporosis, or weakening of the bones. Teenagers may also be at greater risk, since their bones aren't fully hardened.
Any anatomical abnormalities - such as fallen arches - can distribute stress unequally through the feet and legs, increasing the risk of stress fractures. Poor-quality equipment such as worn-out running shoes has the same effect.
Unfortunately, stress fractures tend to recur. About 60% of people who have a stress fracture have also had one previously.
Symptoms of a stress fracture
Stress fractures usually cause dull pain around the site of the fracture. This pain worsens while exercising, walking or standing. Another symptom is swelling in the area.
Diagnosis of a stress fracture
To diagnose a stress fracture, your doctor will give you a thorough physical examination. Although sometimes helpful, X-rays are often unable to detect stress fractures. Your doctor may send you for an MRI, a nuclear bone scan or other imaging technique to diagnose a fracture.
Treatment for stress fractures
The initial treatment for a stress fracture is to elevate the extremity and rest while the bone heals itself. Ice the affected area for 24 to 48 hours and reduce activity. For pain, painkillers such as paracetamol or ibuprofen (an NSAID - nonsteroidal anti-inflammatory drug) may be recommended. Depending on which bone is involved, your doctor may recommend a splint or cast to immobilise the affected area.
When the swelling has decreased to the point you can see skin creases, you can begin partially putting weight on the area. In some cases, crutches or a walking stick is necessary. Usually you can begin full weight bearing two weeks after the symptoms started. Weight bearing stimulates healing.
For the next six to eight weeks, or until you're free of pain, avoid the activity that caused the stress fracture. If you exercise again too soon, you could delay the healing process. You could even cause damage that may never heal properly.
When you are ready to return to the activity, do it slowly. If you rush back in, you could injure yourself again.
Very severe stress fractures that won't heal on their own may require surgery. Full recovery may take months or years.