Stress fractures: symptoms, causes and treatment

Stress fractures are small cracks that appear in the bone due to overload, i.e. intense and/or repeated exercise.

This injury can appear in any area of ​​the body, but fortunately there are different risk factors that we must keep in mind to prevent this condition, and we can follow some general tips so that this type of problem does not come to us. not affect.

In this article we will talk about stress fractures and we will see what symptoms they cause, what are their causes and risk factors, how they are diagnosed and treated, and how to prevent them from occurring.

    What are stress fractures?

    Stress fractures are small cracks that appear after repeated overload or trauma. That is, this type of injury, which can be more or less serious, occurs when you repeatedly perform a gesture or action, such as running long distances or constantly jumping.

    This type of fracture can occur anywhere on the body, but given the definition and type of wear and tear this injury requires, it is most commonly seen in the lower extremities, either the lower leg or foot.

      causes

      As we have seen, the stress fracture is caused by physical overload, and this tends to manifest itself when the intensity of the exercise increases without the body being prepared and without allowing time to adapt.

      The body adapts to the change in exercise or sports practice through a process called remodeling: it is the balance between the destruction of bone tissue and the formation of new tissue. When remodeling occurs inappropriately, resulting in greater destruction, a stress fracture is more likely to develop.

        Risk factors

        The characteristics of this type of fracture make it more common if certain conditions are met. Let’s see what factors increase the risk of this injury.

        1. The type of sport

        The occurrence of a repetitive motion fracture makes it more common in high impact sports.where one makes long runs, as in athletics, or where one makes continuous jumps, as may be the case in dance or gymnastics.

        2. Being a woman

        There has been an increased risk of stress fracture in women, especially those with an abnormal menstrual cycle or amenorrhea, that is, no menstruation.

        3. Changes in the shape of the feet

        As we have already seen, the feet are one of the areas most at risk of being affected, especially if the form is not the right one. For example, This occurs in people who have no arch (flat feet) or who have a very pronounced arch. Additionally, wearing inappropriate footwear that does not protect the foot well also increases the risk of injury.

          4. Overactivity

          It is common for this type of injury to appear in people who lead a sedentary lifestyle and suddenly begin to exercise, doing it in an accelerated manner and with a disproportionate increase in intensity. If the exercise level and time do not adapt to your physical condition, it means body overload..

          5. Bone damage

          A problem in the bones, such as osteoporosis, with weaker and worn bonesincreases the risk of developing a stress fracture.

          6. Inadequate diet

          A lack of nutrients (such as low levels of vitamin D or calcium, which are nutrients related to the condition of the bones) increases the risk of having this type of fracture.

          7. Weakened area

          If there are parts of the body where we have already suffered injury or damagethese are more likely to suffer sooner and we can suffer this type of fracture.

            Symptoms

            The most common symptom is pain in the area of ​​the body where the condition is located when we play sports or strain the area. Discomfort tends to lessen or disappear when we stop exercising. In this way, we notice a more sensitive part of the body, also being able to observe swelling and redness of the area.

            The pain usually decreases when we stop exercising, but if we do nothing about it and continue to load the area, the pain may linger and linger after exercise.

              Types of fractures

              The type of fracture is classified according to area and ease of improvement. Thus, we will have lower risk areas with faster recovery, requiring less rest time: femur, ulna, tibia and 1 to 4 metatarsals (long bones in the foot that connect the ankle to the toes).

              On the other hand, the areas most at risk of fracture are: the neck of the femur, the anterior diaphysis of the tibia (central part), the medial malleolus (part of the tibia and fibula protruding from the ankle), the lateral process of the talus (bone which has the function of transmitting the weight of the body to the foot), the navicular (located in the dorsal part of the foot above the arch of the foot), the fifth metatarsal and the sesamoids of the foot (bone embedded in a tendon) .

                Diagnostic

                Now that we know the symptoms and causes of stress fracture, it will be easier to understand the process followed by the professional to establish the diagnosis. To rule out other conditions and make sure it’s an overload fracture, it’s common to ask about the type of sport you play and the days of the week you play it; also questions about any previous injuries, and an inspection is usually done for any swelling or redness of the skin..

                Later, if a fracture is suspected, an X-ray is usually done or, if greater accuracy is needed, an MRI is chosen. In this way, pain and outward signs can be contrasted with the internal state of bones and muscles.

                Processing

                The type of treatment chosen will depend on the area where the disease is located and the intensity of the pain or the severity of the fracture. Usually the condition clears up after 6 or 8 weeks after immobilizing the area and/or keeping it at rest.. That is, the pain is usually relieved by stopping the exercise that caused the injury and decreasing the overload on the affected area. It is also possible to supplement the rest by applying ice to the area where it hurts, 2 to 3 times a day.

                Despite the improvement after 6 to 8 weeks, It is recommended not to play sports before 12 to 16 weeksand reactivation should be gradual, gradual, without overloading the area.

                If there are complications from the injury, adequate treatment has not been performed, the cause of the fracture has not been repaired and the pain remains chronic, surgery may be required to intervene on the injury and relieve the pain . For this reason, it is so important to go to the doctor when we notice that the pain persists and to follow the treatment prescribed by the professional, to avoid surgery that will require a longer rest time.

                Prevention

                Visit the complications that can lead to this type of fracture and the possibility of preventing them by practicing a good sports practice and not overloading, we will try to follow some guidelines to prevent the injury from appearing or becoming chronic.

                1. Do not overload the body

                As we know, this fracture occurs mainly by overloading a part of the body, and for this reason we will try to stop in time and not force. We know our body better than anyone and the different sensations we can have.. Thus, if we feel more tired than usual, it is better to rest for a short time, in a preventive way, than to continue to force and end up needing a longer recovery time.

                2. Gradually increase the intensity

                The body needs time to adapt; as we have seen destruction and formation of new bone tissue must be balanced. In this way we will increase the intensity of the exercise, either by increasing the time or by increasing the weight, gradually so that the body can get used to it gradually and there is no lag.

                3. Avoid hard or very uneven surfaces

                To decrease the impact is best to avoid hard surfaces. It has been scientifically proven (Newton’s third law) that hard surfaces, such as asphalt, they restore to us the same intensity of force that we exert on them.

                4. Wear proper footwear

                It is important that the shoes are comfortable, suitable for the exercise we are performing and in good condition (not worn or broken), in this way we better protect the foot and avoid overloads. If we need some sort of concealer (like templates), we should use it consistentlyto reduce the risk of damage.

                5. Work the whole body

                Avoiding overloading an area of ​​the body can help us carry out a balanced workout, in which we will work the different parts of the body without focusing on just one. So we will obtain a better general condition of the body and reduce the risk of injury through continuous exercise focused on one area.

                6. Follow a good diet

                It has been shown that a good diet, where the necessary nutrients are consumed (as we have seen, calcium and vitamin D are essential for good bone health) reduces the risk of stress fracture when the body is stronger.

                Bibliographic references

                • Patel, D., Roth, M. and Kapil, N. (2011) Stress fractures: diagnosis, treatment and prevention. American Academy of Family Physicians.
                • Rodríguez, JA, Parra, B., Gámez, F. and Puñet, E. (2016) Consecutive stress fractures. About a case. Foot and Ankle Magazine.
                • Robinson, P., Campbell, V., Murray, AJ & Nicol, A. (2019) Stress fractures: diagnosis and management in primary care. British Journal of General Medicine.

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