Stress fractures: Understanding this common overuse injury

Orthopedics Sports Medicine Healthy Aging
Injured girl on the tennis court

Stress fractures are one of the most common injuries among athletes and others who engage in activities with repeated impact especially to the lower extremities. 

“We often see these types of fractures in runners, tennis players, gymnasts, basketball players, as well as military recruits,” says Stephanie A. Giammittorio, D.O., a sports medicine physician with Riverside Orthopedic Specialists Williamsburg. “The injured area will have an insidious onset of pain with activity but usually gets better with rest.”

Stress fractures, also called hairline fractures, are overuse injuries. When muscles, which act as shock absorbers, get tired, their ability to cushion bones decreases. Without the buffer, the added force can cause stress fractures.

“The tibia, or shin, is the most common location for stress fractures,” Dr. Giammittorio says. “We also see them in different bones in the feet and the fibula – the bone next to the tibia.” 

What contributes to stress fractures?

Certain factors increase your risk of developing stress fractures. These include:

  • Excessive physical activity with not enough rest between workouts
  • Consuming more than 10 alcoholic drinks a week
  • Having osteoporosis or osteopenia, a condition that results in weaker bones
  • Running more than 25 miles per week
  • Smoking
  • Suddenly increasing physical activity
  • Biomechanical errors during activity that load the bone

Women also run a higher risk of developing stress fractures because of hormonal differences, lower bone density and nutritional factors. This can put them at risk for something called the Female Athlete Triad (check back for an upcoming blog on this topic).

Diagnosing stress fractures

One of the first clues toward diagnosing a stress fracture is feeling pain while exercising but relief with rest. However, if a stress fracture is not treated, the pain can progress to the point where it occurs at rest too. 

If your health care provider suspects a stress fracture, an X-ray will help with the diagnosis. If the film is negative, radiologists may recommend repeating the X-ray in two to three weeks to look again. 

In the meantime, the RICE method is often recommended: 

R – Rest. Avoid activities that cause pain. 
I – Ice. Apply cold packs for 20 minutes at a time, several times a day. Don’t put ice directly on the skin.
C – Compression. Lightly wrap the area in a soft bandage to prevent additional swelling. 
E – Elevate. If the suspected fracture is on your foot or leg, raise the area higher than your heart while resting. 

Treating and preventing stress fractures

“Resting from activity that causes pain is the best way to heal it,’” says Dr. Giammittorio. “Activity modification for approximately six to eight weeks will give it time to heal. In the meantime, over-the-counter pain medication can help with pain relief. Physical therapy during this time can help correct biomechanical issues that may have contributed to the injury, build muscular strength and maintain fitness.” 

Depending on where the stress fracture is located, your doctor may prescribe crutches to keep weight off the affected area. An air cast or walking boot may also help the area heal faster.

In most cases, stress fractures will heal by taking these nonsurgical steps. For some with stress fractures in feet or ankles, surgery may be necessary. An orthopedic surgeon will insert pins, screws or plates to stabilize small bones in the foot and ankle. 

Here are some tips from the American Academy of Orthopaedic Surgeons to reduce the risk of stress fractures: 

  • Cross-train – Alternate activities to prevent impact to the same area. 
  • Eat a healthy diet – Get enough calcium and vitamin D.
  • Wear proper footwear – Don’t use old or worn-out shoes. Get fitted at a specialty shoe store so the associate can check your gait and pick the right style for you. 
  • Look into orthotics – Some people will benefit from orthotics to correct their gait. 
  • Start slowly – When increasing activity or starting a new sport, set incremental goals to add to your mileage or duration. 

At Riverside Sports Medicine Specialists, our goal is to get you back to the field, court or track as quickly and safely as possible. We have several convenient locations near your work or home.  

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