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Stress Fractures

Answers to Your Health Questions by David B. Gealt, D.O.

Q. What is a stress fracture?

A. Most commonly stress fractures occur in the lower extremity, particularly in running athletes; however, stress fractures can occur in the upper extremity or chest with sports such as gymnastics, rowing, or in the overhead athlete. Repetitive stress forces cause microfractures and focal bending stress an area of bone beyond its threshold causing a stress reaction at that specific point.

Q. What are risk factors for stress fractures?

A. Running sports is number one with a rapid increase in training activity. Other risk factors include improper footwear, poor foot mechanics, shin splints, overuse, diet, prior stress fractures and steroid use. The female triad which include osteoporosis, loss of menstrual periods and anorexia/eating disorders, also pose a great risk.

Q. What are the symptoms of stress fractures?

A. Commonly an athlete begins with a localized pin point type pain along a specific area of bone which originally is caused only with activity and resolves with rest but over time becomes more constant if not treated. There is pain to palpation or compression at the
site of injury and on occasion is associated with swelling.

Q. What tests are performed to identify a stress fracture?

A. Begin with plain x-rays to rule out a fracture. Sometimes we test an area in the office with the use of a tuning fork which can increase the amount of pain from the vibration. If a stress fracture is still suspected, a bone scan or MRI can be ordered.

Q. How do we treat a stress fracture?

A. Initially we prescribe strict rest from the activity for at least 4-6 weeks. Often immobilization is recommended with a cast or cam walker boot along with partial or complete non-weight bearing status depending on the type of stress fracture.

Also treat any underlying biomechanical factors with orthotics and correct any improper training techniques to prevent recurrent problems. It also is important to check ones diet to make sure the athlete is getting proper nutrition. After the athlete has become asymptomatic, the athlete is progressed with a rehab program to return to play. On occasion surgery may be needed especially if conservative treatment fails.