Stress fractures: how and why they occur, duration of treatment

What is a stress fracture?

Stress fractures are chronic bone injuries. They are not classic fractures that occur due to trauma, but are caused by excessive stress over a longer period of time.

What is the mechanism of stress fracture?

Bone is not as immutable a structure as it might seem. Bones undergo remodeling , just like other tissues, and at the same time some bone is being formed and some bone is being broken down . Under normal circumstances, these processes are more or less in balance , so our bones remain healthy and strong.

With prolonged overload, the loss (resorption) of part of the bone is higher than its formation. Thus, the bone gradually loses strength and without adequate rest it can break . This large fracture is preceded by many microfractures , which can be detected, for example, on magnetic resonance imaging before the bone breaks completely (1).

Why do I have a stress fracture?

High load on the bones does not immediately mean that you will have a stress fracture, although regular running over 40 kilometers per week is a risk factor . The main problem is that the body is not prepared for this high load by gradual loading . A major risk factor is when an untrained person suddenly walks or runs significantly more kilometers than they are used to . Studies show that you are at risk if you add over 32 kilometers to your normal load in one week. We also know that women are more susceptible to these injuries. Inadequate nutrition can also accelerate the onset ^1,2 . Other high-risk sports where even top athletes encounter stress fractures due to long-term high load include football, hockey or gymnastics.

How will the fracture manifest itself?

Initially, fractures may not hurt at all and then it is not difficult to train with them for a longer period of time. Later, they will appear during training , usually at the end or after training . Gradually, the pain worsens , it starts to appear at the beginning of training and the pain occurs even during a normal day ¹ .

How does a stress fracture heal and how long does it take?

If you suspect this injury, it is absolutely essential to see a doctor , have the fracture X-rayed, and the doctor will recommend treatment.

Minor fractures are treated with partial rest , ice , and sometimes anti-inflammatory and analgesic medications. Activity and stress on the bone must be moderate (normal daily activities, not training) and must never be painful . After the bone image improves and the bone is pain-free for 2 weeks , you can return to training . Start with a maximum of half the performance and sufficient rest between training sessions for 2 weeks . Over the next 6 weeks, you will gradually return your performance to the original level . For severe, late-diagnosed fractures, this process takes longer ¹ .

How to prevent fractures?

Logically, it is essential not to suddenly increase the intensity of training or the distance covered. The right shoes also play an important role, as well as changing them; regular running shoes provide cushioning for about 400-550 kilometers of running. Sufficient nutrition is also important for bone strength. Proper nutrition is also essential for bone strength. You must ensure that you have enough protein, calcium, phosphorus and other minerals. You can get protein from meat and legumes, and minerals can be obtained from foods such as dairy products, cabbage, broccoli, nuts and others. Another option is to supplement minerals together with vitamin D ¹ .

Where do stress fractures most commonly occur?

Stress fractures are much more common in the lower extremities than in the upper extremities. They are seen in the pelvis, femoral neck and shaft, metatarsals and metatarsals , and most commonly in the tibia or fibula ^1,2,3 .

Source: https://www.hss.edu/orthopedic-trauma-case39-leg-stress-fractures.asp

Resources:

1. Fredericson, Michael et al. "Stress fractures in athletes." Topics in magnetic resonance imaging : TMRI vol. 17.5 (2006): 309-25. doi:10.1097/RMR.0b013e3180421c8c

2. Patel, Deepak S et al. "Stress fractures: diagnosis, treatment, and prevention." American family physician vol. 83.1 (2011): 39-46.

3. Gallo RA, Plakke M, Silvis ML. Common leg injuries of long-distance runners: anatomical and biomechanical approach. Sports Health. 2012 Nov;4(6):485-95. doi: 10.1177/1941738112445871. PMID: 24179587; PMCID: PMC3497945.