STRESS FRACTURES

Miami Heat Magazine, Vol. IV, No. 5, End of March 1993

In sports there are two types of injuries. Some injuries occur from one sudden traumatic event such as a clipping injury in football or a fall while roller-blading. However, the more common type of sports injury is that which results from overuse. Overuse injuries are caused by chronic repetitive stresses to the area of the body that is injured. Common overuse injuries include tennis elbow, swimmer’s shoulder and jumper’s knee. These injuries are the result of chronic repetitive stress of a tendon that results in pain and "tendonitis." When an overuse injury results in trauma to a bone this frequently results in a "stress fracture."

A stress fracture is a microscopic fracture "break" of the bone that has been injured. Frequently, an athlete will complain of the gradual onset of pain while participating in a sporting activity. The onset of symptoms may be over a period of days or weeks. Usually, the athlete will have pain over the injured bone as well as occasional mild swelling. The athlete will usually give a history of having increased his/her sporting activity over a several week period prior to the onset of the symptoms. Stress fractures usually occur in the feet or lower leg. Occasionally, a stress fracture can occur in the arm in sports subject to high stresses in the upper extremities such as Jai-Alai and gymnastics.

The physician who examines an athlete who complains of pain that worsens during exercise should suspect a diagnosis of a stress fracture where appropriate. Since the stress fracture is a microfracture of bone, a regular x-ray may not show the stress fracture. Therefore, when a stress fracture is suspected and an x-ray is non-diagnostic, the physician should order a special x-ray test called a radionucleotide bone scan. Usually, if a stress fracture is present, a bone scan will show the fracture within 48 hours after symptoms began.

Treatment for different stress fractures vary depending on which bone is involved, length of time symptoms have been present and the activity level and the sport of the athlete. Most stress fractures are treated with a period of rest, walking only when necessary and a modified training regimen that does not put stress on the fractured bone. For example, a runner with a stress fracture of the foot may be able to substitute his/her training with a swimming program for maintaining aerobic conditioning while the fracture is healing. Occasionally, some athletes may require cast immobilization for the stress fracture to heal, such as John Salley’s this past month. He had a stress fracture of the ankle that required a cast. Rarely is surgery required to heal stress fractures in the foot, ankle, lower leg or hip.

Many stress fracture problems are preventable. An athlete should gradually advance over a period of weeks his or her activity level in terms of running or jumping sports in an effort to prevent injury. Aerobics on a soft cushioned floor can also help decrease the risk for stress fracture. Runners who run on soft surfaces, as on grass or a cushioned track, may have fewer stress fracture problems than those who run on concrete. Many athletes may benefit from soft cushioned orthotics that are properly molded to their feet in an effort to act as a shock absorber and further decrease the risk of stress related injuries. Proper shoe wear for the particular sport may also decrease the risk of injury.

Stress fractures are a common injury to athletes. These injuries usually occur due to repetitive stresses which cause a microfracture of the bone, usually in the foot, ankle or lower leg. Early diagnosis is crucial in an effort to have the injury heal as quickly as possible, in many circumstances without the need of using a cast or correcting through surgery. Many stress fracture injuries are preventable with proper conditioning, gradual increase in running or jumping activities and proper orthotic and shoe wear.