SmartHealthForLife.com

Stress fractures are a common occurrence particularly in sporting endeavours and in recruits in the armed services, with overuse of the lower limbs a common theme. The lower leg is the most frequently affected area but other parts, even the arms, can be affected. The tibia, fibula and metatarsals are the most obvious areas to suffer, with further up the lower limbs much less commonly occurring. Repetitive stresses to the bones of a level not sufficient to cause direct fracture are the underlying cause of this injury.

The affected area may be the source of increasing pain levels during exercise and activity, with the sufferer often reporting they have increased their training levels in intensity or frequency. Conservative treatment is usually straightforward with limitation of activity of the part and in some fractures immobilisation is required. Healing is often also straightforward although there is the danger of non-union in some fractures, with some needing internal fixation. Orthopaedic fixation and careful immobilisation will lead to healing in the vast majority of cases.

These types of fractures occur because bone has been loaded again and again and there is rarely any specific traumatic event responsible for the fracture. Bones remodel to reinforce themselves when they are subjected to loads involving tension or compression, with minor damage of the bone occurring due to the stresses. If the remodelling process gets behind as the microscopic bone damage occurs then a fracture can result. The most common occurrence is for the person to have significantly increased their activities recently.

Factors which increase the likelihood of a fracture occurring are reducing the bone area across which the stresses are acting, increasing the absolute levels of force and making the application of such stresses more frequent. The cross-sectional area of the bone is the factor determining the results of force applied, a smaller area meaning a higher order of force is suffered by the bone. Or the force could be increased in itself. Typical examples of risky activities are jumping or running, with other risks being changes in the exercise surface and techniques used.

Many of the mechanical factors are presumed to be the important issues in stress fracture but there may be many others including changes in diet with low calorie intake, reduced bone density or osteoporosis, muscle weakness, being female and perhaps a series of other factors. Female runners have a particularly high incidence of this kind of injury as they may have restricted calorie intake, changes in their menstrual cycle and reduction in density of bone, typical in sports people who have a low bodily weight like a ballet dancer.

A stress fracture typically comes on without much warning and often without severe symptoms, during an activity of repeated limb loading and without trauma. Resting will usually abolish the pain which will re-appear on performance of the weight bearing activity again. Tenderness and swelling may be apparent locally around the fracture site but it may be two to four weeks before a fracture can be discernible on x-ray. Bone scanning may detect fractures much earlier, within 72 hours of the incident, but are less clear as to the exact cause.

The usual management of stress fractures is conservative care, with the simplest and often the most effective method being a reduction in the responsible activity for 4 to 6 weeks. If there is a significant degree of pain on weight bearing then they can be placed in a brace, a rigid walking boot or a below knee cast, with crutch use as required. Orthoses in the shoes have been studied and found to allow a reduction in fracture incidence of a certain amount, with shock absorbing insoles having less clear benefits but potential.

Typical healing of stress fractures is uncomplicated but there is a risk of the fracture suffering from poor healing or non-union in particular bodily regions. The fifth and second metatarsals can suffer from delayed or lack of healing at their bases and as such should be reviewed in case more controlled immobilisation or surgical intervention is required.

Jonathan Blood Smyth is the Superintendent of Physiotherapy at an NHS hospital in the South-West of the UK. He writes articles about back pain, neck pain, and injury management. If you are looking for physiothrapists in Southampton visit his website.

Possibly Related Posts:

• Knowing Cervical Manipulation
• How To Identify And Find Useful Solutions For Upper Back Pain
• Inexpensive Tips To Reduce And Prevent Back Pains
• The Chiropractic Secrets To Why It Hurts So Much.
• Facts About Early Pregnancy Back Pains