Stress Fracture

Stress fractures are tiny cracks in a bone caused by the overuse and the repetition of movements during exercise. When your muscles are fatigued, they become unable to absorb additional shock during exercise and transfer the overload of stress to the bone. This constant process causes tiny “microcracks” in the bone.

Stress fractures are most common in the weight-bearing bones of your lower legs. They result from increasing the amount and intensity of activity or from an impact on unfamiliar surfaces. For example, a tennis player who changes from a soft to hard court may experience a stress fracture. Athletes participating in tennis, basketball, track and field, and gymnastics are most susceptible to stress fractures, especially if they are not resting enough between training sessions.

Studies have shown that women are more at risk for stress fractures than are men. This appears to be related to nutritional deficiencies and a woman’s propensity for decreased bone mass density.

The most common signs and symptoms include swelling and pain that decrease with rest, and increase with activity. Also, there may be a spot that feels tender or painful when pressure is applied. A stress fracture is sometimes mistaken for a shinsplint (an inflammation of the tibia or shinbone that commonly affects runners). However, stress fractures are more serious.

The most important factor in managing your pain and healing the fracture is rest, which may be needed for 4 to 12 weeks. You may also have to modify other daily activities during these weeks. The next step, rehabilitation, includes a program of muscle strengthening and generalized conditioning. If pain persists, careful use of nonsteroidal anti-inflammatory medications (NSAIDs) may be helpful. However, these medications may limit bone repair and are therefore should be used cautiously. In most cases, stress fractures can be managed with these conservative measures. However, more severe fractures may require surgery to fix and prevent further injury to the bone, as well as to ensure proper healing. Recovery from this kind of surgery is approximately six months.

You may be at risk for a stress fracture if you:

• Participate in high-impact sports
• Have been told you have low bone density
• Suddenly begin an intense training schedule
• You are an adolescent (bones are not fully mature)

If you suspect that you have signs or symptoms of a stress fracture, if the pain is prolonged, or if there is no improvement with rest, please see your doctor for further evaluation and treatment.