Hello, I'm Dr. Michael Jonesco, an Ohio State Sports Medicine physician, and in this brief
video I'd like to discuss stress fractures.
Running season is upon us and stress fractures are a leading reason that athletes miss training
or race time.
Stress fractures are injuries to the bone, and bone comprises the skeleton, which is
responsible for providing our body with mechanical support as well as locomotion.
Bones can undergo different types of injuries. And when people hear of broken bones, they
often think of macrotrauma, or one acute traumatic blow in which one force is too great and causes
an acute fracture, much like the snapping of a twig.
Stress fractures, on the other hand, are a result of microtrauma, or small repetitive
injuries that occur at the cellular level, usually without any specific event. In the
body's natural state, bone is constantly going through a process of remodeling in which there
is a balance of bone being broken down and replaced with new, healthy bone. Any time
you increase the load or force on bone, it breaks down faster, causing a negative bone
balance. But if the athlete is healthy and bone is given adequate recovery time, our
bodies can respond appropriately by rebuilding bone to quickly compensate for restoring balance.
A stress fracture occurs when the body has inadequate remodeling response, allowing for
more bone to be broken down than is replaced. Basically, you're breaking bone down faster
than you can build it back up. So how do stress fractures present themselves?
It's important to note that stress fractures can occur in any bone undergoing excessive
stress. Typically they are seen in lower extremities in running or jumping athletes. Most commonly,
I see them in the tibia, or the shins, or the metatarsals, which are bones of the feet.
However, as I mentioned, any bone can be affected, including the upper extremities of throwing
athletes or ribs of rowers, where large muscle groups pull repeatedly on their bony anchors.
Patients with the stress reaction or fracture also report a gradual but increasingly achy
or bruising pain over the bone affected. The pain increases with activity and is initially
relieved with rest. However, if one continues to train on the injury, pain starts earlier
and earlier in the workout with longer periods of recovery time needed for the pain to subside.
The injury can become tender, even to light touch, and eventually becomes a constant ache,
including nighttime pain. Continuing to run through the pain is not recommended, as it
can lead to longer recovery time, full on fracture, chronic pain, or even the need for
surgical intervention.
Be aware of several risk factors for stress fractures. These include being highly active,
and as mentioned, stress fractures are seen frequently in distance runners and dancers.
Anyone, however, who has a significant change in their training regimen, for example in
distance, intensity or frequency, is at risk. Previous to injury, anatomical differences,
or simply being young or female are risk factors, especially those with a history of eating
disorders or abnormal periods.
Diagnosis is best done with a detailed history and physical exam. Sometimes X-rays will show
changes that are helpful. But most stress fractures are not visible with simple X-ray,
especially within the first three weeks.
Oftentimes more advanced imaging, including MRI or bone scans, are needed for definitive
diagnosis. Typically I like to go beyond simple diagnosis, or what your injury is, and find
out why your injury occurred. Evaluation of shoewear, training history, diet and supplementation,
medication administration history are all part of the bigger picture.
Oftentimes I will use a gait analysis, in which our experienced staff watches and videos
your running form to pinpoint any abnormalities in your running that puts extra stress or
load in the injured area which would predispose you to injury.
How do you treat stress fractures? As we have discussed, stress fractures are really overuse
injuries. Logically then the best treatment is to underuse the affected limb, which means
taking some time off and allowing the bone to heal itself. If it's a lower extremity
injury, that means no impact activities, like running or jumping. Sometimes crutches, bracing,
or casting is helpful. Rarely, but occasionally, surgery is recommended for certain high-risk
stress fractures. After a period of rest and activity modification, the pain will improve
and we will start into the recovery phase.
I typically begin with a gradual progression of increasing intensity of exercise, including
swimming, biking, elliptical, and then returning to running or sport. Additionally, we are
working on correcting the risk factors. We do this by looking at possible training errors,
through strengthening and stretching program, a shoe change or orthotics may be warranted.
And a change in diet or supplementation may also be necessary.
As with any health issue, prevention is always the best plan. For stress fractures, remember
these three tenants.
The 10 percent rule. Do not increase intensity, frequency or duration of your workout or training
by more than 10 percent within a given week. Keep your diet nutritionally and calorically
balanced. If you are unsure if you are taking in enough calories or have irregular periods,
we often use our sports nutritionists to help put you back on the right track and ensure
your body has enough energy to maintain proper bone health.
Good shoes can help tremendously, and these are not necessarily the most expensive or
coolest looking. Knowing how your foot strikes will help you pick out shoes that reduce force
throughout your body. An OSU physical therapist, or even running shoe stores, can help you
make this decision and a recommendation for you.
In addition, I recommend changing shoes every 350 to 400 miles or so, especially if you
have a history of stress fractures.
Thanks for taking the time to learn a little bit more about this often frustrating, but
easily treatable sports injury. Should you or someone you know have concern for stress
fracture, seek consultation from a physician with experience treating sports related injuries,
and go Bucks.