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| The last column discussed what sports injuries are and how to assess their severity. This column will tell you what to do when you have an acute sports injury. The three main goals... read more |
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| Acute Sports Injuries are traumatic in nature. Some are very dramatic such as when Mike Foligno broke his leg at centre ice the season before last. Although his was a bone injury m... read more |
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Leor
Burshtein |
B.Sc(KIN), M.Sc.(PT) Leor received a Master of Science in Physical Therapy degree from the University of Toronto after completing a Specialized Honours degree in Kinsiology a... read more |
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Stress Fractures | Tuesday, April 11, 2006 |
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 The Toronto Marathon is fast approaching on May 7. Your training is going extremely well. As you increase your mileage perhaps too quickly you develop a pain in your foot. Ininially the pain is not too bad and only there when you are running. After a couple of weeks the pain intensifies not only in your running but after you finish and even aches in bed at night. You go to your physician who tells you that you have a stress fracture. You know join the ranks of many athletes that 'have fallen victem to this small bone fracture that can occur in virtually any bone in the body.
What is a stress fracture? When there is increased stress on a bone the body reacts to make the bone stronger. It does this by actually removing old bone at the point of maximal stress where it is breaking down. The body then makes new bone to make that part of the bone extra strong. Unfortunatly the building process goes more slowly then the breaking down process. If you do not give your body a chance to catch up by an appropriate rest period the bone eventually breaks down and cracks. This initially is only a surface crack. A good analogy is if you take a soft piece of metal and bend it back and forth. Initially the metal holds up but with repetetive stress it starts to fatigue and eventually crackas at the surface. If you continue to stress the metal it eventually will break right through which will happen in the body as well where if you continue to exercise with a stress fracture the bone will break right through. Fortunately most people will listen to their body and seek the right treatment before it gets that bad.
Stress fractures were first talked about in the United States army. New reqruits were asked to walk miles a day. Many developed stesss fractues in their feet. At that time they were appropiately called ""March Fractures""
Although most stress fractures occur in the lower leg in the foot and the leg, they can occur throughout the body where there is repetitive increased stress on a bone. I have seen them in ribs, the spine and even in a finger of a tennis player. Stess fractures are much more common in females. Some studies have shown women to be ten times more prone to developing a stress fracture. This is due to several factors. The most important factor is a females hormonal balance. Females who do not menstrate regularily or have the female athlete triad of eating disorders, irregular or loss of menstration and osteoporosis will have weaker bones that are more prone to developing stress fractures.
If you have what you think is a stress fracture you should see your physician. Because it is only a surface crack in the bone the fracture will usually not be visible on a regular x-ray. On examining you the doctor will be highly suspicious of a stress fracture if you have exquisite tenderness when he/she pushes on the site of the fracture. The best way to diagnose the fracture is with a bone scan. A nuclear tracer is injected into a vein. The tracer is picked up in areas of increased bone activity such as a stress fracture and gives a charachteristic appearance on the screen to confirm the diagnosis.
The main form of treatment for stress fractures is rest. You must give the bone a chance to heal the fracture and allow the body to build the new bone at this point of stress. Calcium supplements are given to ensure there is enough calcium to build the new bone. Although you can not continue your activity that caused the fracture, you can always do some other activity to maintian your fitness. A runner can swim, run in the water or cycle. You then must correct any of the predisposing factors so you do not get a recurrence. The most common causes are overuse or training errors(usually increasing your training too fast), improper shoes, muscle weakness or imbalance, inflexibility, biomechanical factors such as flat pronated feet and, hormonal and nutritional factors. All of these must be adressed and corrected if necessary.
Once the fracture is healed and the athlete is pain free for a minimum of two weeks there is a VERY slow return to activity. Usually the athlete is only off for 4-6 weeks but is suprised by how slowly they have to back to their training.
So, you saw your doctor and confirmed your stress fracture. You corrected the predisposing causes and the most important thing is that you maintained your fitness with cycling and swimming and you are now back into your marathon training and sure to be there on the start line on May the 7th.
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