A stress fracture is an injury where there is repetitive load put on a bone which it is unable to handle, resulting in a tiny break. In short, the stress of these repetitive loads exceeds the ability of the bone to repair itself. A stress fracture is the progression of what is known as a stress reaction which is not yet a break but is painful. If these issues are not identified and the same loads are put onto these bones, a complete fracture may develop.
Stress Fracture Causes
It is thought that stress injuries occur when there is an imbalance in the normal microdamage of bones and bone remodelling. Bony stress fractures are often the result of increasing the amount or intensity of an activity too quickly. They can also come about due to biomechanical factors, hormonal imbalance, nutritional factors, medications (such as steroids) and other systemic health issues.
Where does a stress fracture occur?
Weight bearing bones are more often affected, including:
- Bones of the foot
- Tibia (shin bone)
- Femur (thigh bone)
- Lower back
- Symptoms vary from person to person, but a common complaint initially is pain with activity which subsides with rest.
- As the processes progresses, pain may be felt with rest or at night.
- Swelling and tenderness may also be present around the primary area of pain.
A stress fracture can be provisionally diagnosed through a thorough subjective and physical examination, but often imaging is required to confirm the diagnosis. In terms of imaging, and MRI is often best in identifying these injuries.
The management of stress fractures will differ depending on what bone of the body is injured as well as the degree of damage. Generally, the initial management will include a period of relative rest to allow the stress fracture to heal. This may include the use of crutches or a moonboot for example.
Once this initial healing period is complete, a graduated rehabilitation program that rectifies the causative factors of the injury needs to be established and performed to enable a safe return to pre-injury levels of activity. This may be multidisciplinary, involving not only physiotherapists but potentially other professionals such as nutritionists or dietitians, psychologists, exercise physiologists and sports scientists.