A stress fracture, or hairline fracture, can occur when too much stress or weight is put on a bone that is already weak. It could occur as a result of an imbalance in the health of the bone due to conditions that are not handled well when the body is rebuilding natural bone.

Bone fractures are a particular risk for adults, particularly those who are active and in generally good shape. With the right kind of training, stress fractures could be prevented from occurring in the future.

WHAT IS A STRESS FRACTURE?

A person removing the shoes to his/her foot

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When overly fatigued muscles can no longer buffer the shock of impact tiny cracks in your bones can appear called a stress fracture. The impact from repeated movement transfers to your bones and causes these fractures. They are commonly seen in weight-bearing bone in the ankle, shin, and foot.

How Are They Diagnosed?

Your doctor will examine the area and will probably have an MRI done to see what the damage is. If you have stress fractures, you will be advised to take a break from the activity that has caused it. Based on how bad the injury is, you may have to wear a boot or brace to help with healing. The best practice is to know how to avoid future injury.

RISK FACTORS

There are many reasons a person may be at risk, you don't have to be an athlete. Some risk factors include:

  • Long-term use of oral corticosteroids or drugs that can decrease bone density
  • High caffeine, low protein, or low calcium intake
  • Previous history of stress fractures
  • Inflexibility or weak muscles
  • Intense infrequent workouts
  • Changes in training terrain or a marked increase in activity
  • Under 18 or over 40 years of age
  • Flat feet or high arches
  • Uneven foot or leg alignment
  • Low bone density particularly in menopausal women or those with suppressed menstrual cycles due to low body fat
  • Asian or Caucasian races; lighter-skinned people have lower vitamin D absorption and production hence risk of lower bone density
  • Female gender
  • Military, particularly basic training
  • Certain sports such as basketball, soccer, dance, or field and track sports

WHAT CAN CAUSE FOR A STRESS FRACTURE? 

The major reason for a stress fracture is overuse. They are particularly common in athletes who are engaged in high-impact sports like long-distance running, tennis, gymnastics, and basketball. They can also occur if you are normally inactive and suddenly begin an exercise regime. An example is suddenly doing a lot of walking when you normally don't or beginning to jog. This happens because your muscles aren't prepared for the stress you are placing on them. They aren't ready to absorb the intense amount of shock you are placing on them. Teenagers are particularly at risk because their bones are still growing and are not completely hardened. People who have weak bones due to medical reasons such as osteoporosis are also at risk.

Other reasons are poor technique or training when exercising. Using bad equipment.  Worn out running shoes that no longer have the proper cushioning or good arch support can be bad for your feet and cause stress. These are a few reasons:

  • Training changes
  • Poor running technique
  • Jumping and running

Symptoms

Gradual pain that intensifies when doing weight-bearing exercise will let you know you may have suffered a stress fracture. The pain will lessen when you rest, it may even go away completely when you are inactive and not jumping, walking, or running. The top of the foot, the area around the shin, or the ankle may swell. The part of the body where the injury is may be tender to touch and bruised. You may even feel a dull pain that gets sharper as you walk or use the injured area.

Treatment

Typically your doctor will recommend that you cease the activity causing the pain, wear a walking boot, if needed, and apply cold therapy. Treatment can range from simply resting to wearing a cast, doing physical therapy or in the worst case needing surgery. This depends on how many fractures there are and the area affected. You also should:

Rest - take a break from your activities and rest. Regardless of the type of injury you have, such as a stress fracture of the shin, ankle, or metatarsal, you need to take a break. if you don't, you could further injure the area and cause a complete fracture or a broken bone. You should rest between 4 to 8 weeks and change to a lower-impact sport. Some patients may need to stop activity completely depending on the severity and type of stress fracture. Often times all that is needed is rest.

Apply cold therapy - Apply cold compresses or ice packs to the area to limit swelling and pain.

Take anti-inflammatory medication - Medications such as aspirin and ibuprofen can be taken for pain, but they can also affect bone healing. Consult your doctor for best practices.

Protective footwear - Patients may need to wear a special orthopedic shoe to reduce the stress if they are suffering from a foot or ankle injury. Examples are:

  • Removable fracture brace that protects the ankle and foot
  • A wooden-soled therapeutic sandal
  • Shoe insert or stiff-soled shoe to prevent flexing

Braces or Casts - Depending on the type of fracture you have, you may need to wear a cast. Ankle fractures or bone injuries affecting the outside of the foot may require a longer healing time. Braces, casts and other items immobilize the foot and ankle and help with healing. You may require a wheelchair or crutches. Common types of braces or casts include:

  • Slings or arm braces for stress fractures of the lower or upper arm
  • Fiberglass or short plaster casts for lower leg stress fractures
  • Air casts or pneumatic braces
  • Walking boots

Physical therapy - After the healing and rest periods are over, working with a physical therapist is often advised. This will help to:

  • Reduce the risk of re-injuring the area
  • Ease return to the activity that caused the stress fracture
  • Strengthen the injured bone

Some common types of physical therapy are:

  • Strengthening exercises
  • Weight training
  • Water exercises
  • Isometric exercise

Recovery Time

It can take 6-8 weeks to heal stress fractures. Switch to a non-weight bearing activity like biking or swimming if often recommended while you are healing. Follow your doctors advise for the best activities to do while healing.

TIPS FOR STRESS FRACTURE PREVENTION

Actions you can take to prevent a fracture in the future include:

GRADUALLY ADJUST YOUR TRAINING ROUTINE

TAKE HEED WHEN CHANGING TRAINING SURFACES

CHECK THE EQUIPMENT YOUR ARE USING

CHECK YOUR FORM IN THE MIRROR

GET ENOUGH VITAMIN D AND CALCIUM IN YOUR DIET

BE CAUTIOUS WHEN TRANSITIONING FROM OFF- TO PEAK-SEASON TRAINING

CROSS-TRAINING IS IMPORTANT

GIVE EXERCISE A BREAK WHILE ON VACATION

CAREFULLY SWITCH YOUR SHOES

CONCLUSION

Woman doing some cross training

Photo by Oleg Magni from Pexels

There are things you can do to prevent a stress fracture. Proper technique and training are important in avoiding an injury. By knowing how to exercise correctly you will prevent bone loss and muscle fatigue. Eating the right foods such as foods rich in vitamin D and calcium can build up your bone strength. Gradually work up to your exercise goal and slowly increase your distance and time. Wearing the right shoes and using the right equipment will also prevent injuries.

Featured Image: Photo by Buenosia Carol from Pexels

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