Stress fractures accounts about 10 percent of all injuries in sports medicine clinics and on field also They’re most common running injuries.
Stress fracture are repetitive use injury.
Stress fracture is common injury in athletes and military recruits.
As we all are aware of this fact that bone is a living tissue and it responds to any kind of stress by making more bones.
When the bone fails to respond to the stress properly ,then it leads to fatigue fracture.
Now if we talk about running sports then on an average stress fracture account about 20-30% of all injuries that occur due to running .
Stress fracture occurs when the muscle become tired and cannot handle enough stress.
Stress fracture occurs when body has inadequate remodeling response allowing for more bones to be broken down than is replaced.
Poor nutrition and poor lifestyle habits can mainly elevate the chances of stress fracture in your body .
Stress fractures are of two types :
- Fatigue fracture – It occurs when normal bone undergoes abnormal intolerable stress.
- Insufficiency fracture – It occurs when mineral deficit bone undergoes abnormal intolerable stress. It occurs mainly due to mineral deficit.
Stress fracture not only occur in tibia but can occur in any bone which is unable to tolerate excessive stress .
Stress fracture also occurs in dancers and most common location of injury in dancers is metatarsal.
Golfers mainly suffer from stress fracture in ribs.
Players of racket and basketball sports are at high risk to suffer from stress fractures of the pars interarticularis .
Symptoms can vary widely :
Pain occurs with activity which subsides with rest.
Pain gradually worsens over time when you continue the aggravating activity beyond its limit.
Pain is localized , acute or sharp and subcutaneous at medial tibial surface.
Swelling present around affected area.
Tenderness present around affected area mainly tibia .
Pain occur during walking.
Other associated features:
Exaggerated by vibration, tuning fork and ultrasound.
Stress fracture incident increases by playing on hard ,more rigid and unforgivable surfaces either field or something else .
Fredericson Classification According to MRI Findings of Stress Fracture :
Lesion Stage. Findings of MRI
Stage 1 Presence of Periosteal oedema
Stage 2 Presence of Bone marrow oedema in T2 weighted
Stage 3 Presence of Bone marrow oedema in T1 and T2 weighted
Stage 4a Presence of Intracortical signal abnormality
Stage 4b Presence of fracture line present
- Frequent submaximal stress
- Low bone density
- Low energy availability and/or eating disorder
- Menstrual disturbances
Ways through which we can prevent .a Stress Fracture to occur:
- Boost the Training process Slowly – Don’t make sudden changes in distance or intensity or frequency when training.
- Work on flexibility of calf muscles – Do stretching of calf muscles to avoid stress fracture.
- Allow all of your bones to heal perfectly immediately after an injury – A premature initial and early return to complete activity can elevate the chances of obstacle when dealing with injuries.
- Utilize Dairy Products – High intake of milk, yogurt, cheese, curd and calcium-rich foods in diet
- Include intake of animal protein and mineral like potassium also in diet
- Increase intake of Calcium and Vitamin D for your bones
- Avoid Using Nonsteroidal medicine
- Prevent running on dense rigid vigrous Surfaces
- Start Wearing Correct Running Shoes to avoid injury
Physical Therapy Management:
- In most cases, the initial management include a period of rest to allow the healing of stress fracture,as this may involve the use of crutches or wearing a weight-bearing boot in moderate to severe cases, to reduce the bone’s weight-bearing loads.
- Early stage treatment protocol:- analgesia, modified weight-bearing, and activity modification including discontinuing the offending activities.
- We must advice temporary mobilization if patient is unable to ambulate .
- Advice of activity modification include water fitness, cycling, and elliptical exercise to maintain strength and fitness of body .
- Rehabilitation and strengthening, and gradual return to activity.
- Proper footwear for specific type of exercise
- Walk/warm up prior to running
- Stretch + strengthen muscles
- Cool down properly after exercise
- Most stress injuries will improve with rest, analgesia, activity modification, cross-training, and a slow return to sport.
- Manual Therapy: Consider forefoot mobilization.
- Non weight bearing of lower body with strengthening focusing on gluteal muscle – clams
- Strengthening of core muscles
- Ankle muscles strengthening
- Foot/ankle strengthening – progress balance activities
- Plyometrics: emphasis soft landing and hip strategy
By Dr. Prachi Tyagi ( P.T )