Stress Fractures

It's an injury that can strike both over-enthusiastic beginners and experienced jocks -- the dreaded stress fracture.

But while a regular bone break is so dramatic and immediate that there is no mistaking the injury, stress fractures can be difficult to diagnose on their own. Much like a tiny crack in a windshield, a stress fracture tends to worsen over time until you can no longer ignore it.

Getting a proper diagnosis and following your doctor’s recommendations are key to confirming and treating your stress fracture.  

3 Pictures of where the femoral bone meets the hip socket showing a fissure in the bone articulating with the hip joint. There are three different types of stress fractures3 Different Types

What are stress fractures?

Most often affecting the foot and lower leg, stress fractures are very small breaks in the bone that result in pain and swelling, especially when undertaking the injury that caused them. Stress fractures can also occur in non-load-bearing bones that are subjected to intense repetitive motion, such as the bones in your wrists and elbows after frequent tennis or basketball practice.   

Stress fractures often show themselves first as tenderness and soreness in the injured area. Most often you’ll feel this pain when putting weight on the bone or bones, or doing a specific motion involving that bone. The injured area may also tend to swell after a specific kind of workout.

In addition, the symptoms usually worsen over time when left untreated.

Skeleton picture of the shin and foot with a little crack in the shin with an arrow pointing at it. The cracked is labeled a stress fractureShin Stress Fracture

What causes them?

Repetitive weight-bearing stress on the bones most often cause stress fractures, especially when your body isn’t used to performing the action, or when it is performed at an exceptionally strenuous rate. The tiny cracks appear in the bone when an insufficient time is taken between sessions of this activity.

Sufficient rest time allows new bone cells to form between high-stress action on your weight-bearing bones, but insufficient time means that your bones aren’t producing enough cells to strengthen them for the repetitive motion of the stressful activity, and hairline cracks begin to appear.  

How do I know if I have a stress fracture?

Obviously, a doctor is in the best position to determine if a stress fracture is causing your pain. But she may have to send you to a specialized imaging lab to confirm the suspected diagnosis, because a basic exam and even an X-ray often won’t detect the tiny bone cracks. Bone scans or magnetic resonance imaging (MRI) are usually the diagnostic tools of choice for confirming and pinpointing stress fractures.

Of the two, an MRI is often preferred, because the image is more likely to show exactly where the injury is and whether it is in the bone or the surrounding tissues. When the injury is in the bone and the cracks are small, rather than larger breaks to the bone, they are known as stress fractures.

An MRI machine with a flat bed you lie on that pushes you into the machine while you lie and it scans you for injury.Big expensive MRI machine

How will my doctor treat my injury?

Other than making recommendations for modified activity, your doctor may also specify a device that keeps you from putting weight on the injured area, or from performing the motions that exacerbated the injury. These can be as simple as stiff-soled shoes, but braces and specialized walking boots are also common.

Crutches may be needed, depending on the location and severity of your stress fracture. In addition, casts are sometimes used to treat stress fractures, often when the injured bones are located at the outer sides of your feet, or along the tops of your feet.

More rarely, your doctor may recommend surgery. Surgeries for stress fractures involve putting in some kind of fastener, such as pins or screws, in order to hold the bones together.

What can I do to speed healing?

Making sure you don’t add more “stress” to the the stress fracture is key to the healing process. Once your doctor confirms the diagnosis, she will likely recommend that you avoid the kind of activity that led to the injury for at least six weeks.

That doesn’t mean you have to be on total bed rest. Instead, you might consider switching from running to a non-load-bearing workout, such as biking or swimming -- if your doctor confirms that the injured area can take even these modified activities.   

Aside from resting the injured area, applications of ice packs for about 10 minutes at a time, three times a day or as needed, can lower pain and reduce swelling.

If your doctor approves, over-the-counter or prescription medication that is anti-inflammatory and non-steroid may be helpful. Options include Ibuprofen and naproxen.

The word anti-inflammatory written with a label making machine across the picture with related words spread around anti-inflammatory.Ibuprofen and Naproxen Can Help

What happens once my bones heal?

According to the American Academy of Family Physicians, about 60 percent of the stress fractures doctors treat are found in patients with previous stress fractures. This sobering statistic underscores how important it is to resume your previous activities as carefully as possible in order to prevent further injury.

After you’ve had the recommended period of rest, your doctor may order an imaging test to determine whether the bone has healed adequately. If so, you can start working out again slowly, perhaps by starting with non-weight-bearing exercises like biking and swimming.

When you do move on to the activity that likely led to the injury, be sure to take “baby steps.” The 10 percent rule for starting a new activity is a good one for resuming it -- don’t increase duration or intensity by more than 10 percent each week. At the very least, make sure you go a day between types of workouts that focus on the same body area.

Who is most likely to get this injury?

Several types of people are at risk for developing stress fractures. Women with irregular periods, or who no longer menstruate, are vulnerable to stress injuries, as are people of both genders suffering from osteoporosis, which results in lower bone density.

Another pre-existing condition which can play into stress fracture risk is a foot shape, such as a high arch or a “flat” arch. People with these types of issues will find that their feet don’t absorb surface shock as efficiently as other foot shapes do.

Lifestyle certainly plays a part as well. “Weekend warriors” who go from almost no strenuous activity to a great deal of it put themselves at risk for stress fractures. On the other end of the spectrum, people who regularly work out, but engage in especially body-punishing sports, can put themselves at risk. These activities include gymnastics, tennis, jogging and basketball.

A basketball rim in black and white with a  black and white basketball going into the hoop.Especially at risk are basketball players, tennis players, joggers and those that practice gymanstics

How can I prevent new stress fractures?

It’s best to ease yourself into any new physical activities. So whether it’s hiking the Appalachian trail or working on your backhand, don’t plunge into it with lengthy, once-a-day training sessions, and avoid practices and moves that aren’t designed for beginners. In terms of specifics, that means that you shouldn’t increase the intensity level by more than 10 percent per week -- and never rush the pre-workout stretching.

Softening the shocks your body absorbs from running and other activity also makes a world of difference. Invest in footwear designed with your chosen activity in mind. Joggers with previous stress fractures can benefit from keeping to smooth running surfaces to reduce the impact.

How can diet help?

Women, especially, should examine their diets as they begin ramping up a strenuous new workout program -- or while they are recovering from a diagnosed stress fracture. Make sure you get plenty of calcium in your diet to encourage strong bone structure, and discuss with your doctor whether you need supplements.

Dairy foods are rich in calcium, whether you’re a whole milk kind of person or a strict 1-percenter. Look for dairy foods like milk, yogurt, ice cream and cheese for calcium boosts. Fortunately, calcium levels are not affected by whether you choose the full-fat or reduced fat portions, so select the type that best fits your dietary needs.

Some fish types are also great sources of calcium. Salmon and bone-in sardines are your best bets for high doses of the mineral.

Going vegan? Look to dark green vegetables, such as broccoli and the leafy vegetables known as cooking greens. This versatile group includes kale, collards, bok choy, mustard greens and turnip greens. Some of these greens are palatable when raw. If cooking them, use steaming, stir-fry and other low-water cooking methods in order to keep the calcium rate high.

A wooden small box full of raw broccoliBroccoli

Other plant-based calcium options for building up your bones are cooked dried beans, almonds, sunflower seeds, and the sesame spread known as tahini.

Even switching your sweetener of choice can add calcium. Blackstrap molasses is full of useful minerals, including calcium. Use it when baking, or add it to your morning oatmeal, smoothie or hot tea.

Finally, if most high-calcium foods just don’t appeal to you, look for foods to which calcium has been added. Orange juice, bread and cereal are among the foods often supplemented with calcium, so look for the “extra calcium” label on packages.

The label Ca on a square to represent the element calcium from the periodic chart.Make sure you get enough Calcium

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Prevent Stress Fractures
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