Common Health Issues

Stress Fractures: Causes, Types and Treatment

• By Rich Health Editorial Team
• March 18, 2021

A stress fracture is a small injury or a minor crack in bone arising as a result of overuse or repetitive trauma(1). Stress fractures are a common complaint in military recruits and athletes, especially those who do long-distance running (2).  It occurs because the exhausted muscle can no longer bear the shock from overexertion and the stress is directed to the bone. The fracture causes intense pain in the affected bone, which is aggravated by activity and relieved by rest.

A stress fracture can occur in any bone of the body that is overused and is under sheer stress (3)

Stress fractures, however, are commonly seen in the bones of the lower extremities, (4), particularly tibia. The stress fractures in the foot bones also occur frequently, as a result of weight-bearing activities and impact. 

Causes of Stress Fracture

Though stress is the major cause of the bone fracture, other factors contribute too. These are (5):

• The technique of sport is incorrect or practising of the technique is incorrect.
• The training program is vigorous, requiring rapid activity without any break.
• Running on the road or a track that has a sloping surface.
• Changing the surface you practice on, that is a transition from soft indoor track to hard ground.
• The types of equipment used for exercising and sports are poor and inappropriate. Similarly, wearing wrong and improper footwear can increase the risk of stress.
• The repetitive activity of certain bones, required in high impact sports like long-distance running, basketball, tennis etc. may result in stress fracture.
• Low levels of Vitamin D and calcium in the body.
• Having a poor diet that does not meet the daily calorie requirement.

Above mentioned are factors that are influenced by the external environment and can be modified, hence known as extrinsic factors. There are some non-modifiable or intrinsic factors too that can increase the risk of stress fractures (5). These include:

• The bone density decreases as the age of an individual increase. The older athletes are more likely to get stress develops easily in their bones compare to younger and are, thus, more vulnerable to the stress fractures.
• Increased weight or decreased, both are not good for bones. The underweight individual may have weaker bones, while the overweight person’s bone has to bear extra stress.
• Female athletes are at risk, if they have menstrual irregularities or no periods.
• The previous disease of a foot may modify its shape and produces little more stress resulting in fracture.
• Presence of bone disease like osteoporosis, in which your bones become porous, decreases the strength of the bone. The weak bone cannot handle the stress and fractures easily (3)

 

Types of Stress Fracture

Stress fractures frequently occur in the bones of the lower extremity, because they bear the weight of the whole body and are repetitively exposed to the stress. Depending on the bone involved stress fractures can be of following types(5)

Metatarsal Stress Fractures

This type of fracture usually occurs in ballet dancers, gymnasts and hikers where there is constant pressure on the metatarsal bones, which are long bones connecting ankle and toes. Resultantly, the foot becomes painful and swollen in the middle or front region.

 

Navicular Stress Fracture

The navicular bone is present just above the heel and is one of the tarsal bones. It fractures commonly in individual who play high impact sports such as jumping, hurdling, soccer and basketball. Navicular bone experiences dual stress, that is, above from the body's weight and below from the ground. 

 

Tibia Stress Fracture

The shin of the lower limb comprises of the two thin bones – the larger tibia and relatively smaller fibula. It bears the maximum stress and fracture when the foot is pounded repeatedly on a hard surface. The pain of tibial stress fracture is experienced in the shins. This type of fracture is common in runners, gymnast and volley ballplayers. 

 

Ribs Stress Fracture

Ribs are 12 horizontal bones located on each side of chest forming a cage-like structure with other bones. The first rib is comparatively delicate as many vessels traverse it; therefore, it is more prone to injury. People who play baseball, rowing, dance and windsurfing – all sports requiring vigorous movement of shoulder – are more likely to have a rib stress fracture.

 

Hip Stress Fracture

Hip stress fracture, commonly seen in a long-distance runner, mid-impact sports athletes and military recruits, results in an injury to the ball of the hip joint. This produces intense aching pain in the groin region, which worsens as the person lie down or run and hops. Sometimes hip fractures may not heal properly and the fractured bones misaligned. This situation is dangerous as the blood supply of the hip bone compromises – a condition called osteonecrosis. 

 

Stress Fracture Treatment

The treatment of stress fracture is essential to prevent future complications. A neglected stress fracture may give rise to arthritis, misaligned bone or more severe consequences requiring surgery. The general measures include taking appropriate rest and avoiding activities that further stresses the affected bones. It is necessary to consult the doctor for expert advice. 

The medical treatment depends on the site of the fracture, extent of the injury and the symptoms it is producing. The doctor may suggest one of the following treatment options (4,5)

• Take rest from the activities that result in the overuse of the bone. The rest period should be at least 2-8 weeks long depending on the extent of fracture for proper healing to occur. This can be combined with a pain killer, such as non-steroidal anti-inflammatory drugs.
• Rubbing an ice pack over the affected area for about 10 minutes reduces pain and swelling.
• Cross-training. It involves practising non-impact exercise with the advice of the doctor. The idea is to train the bones to handle stress by gradually increasing the stress.
• Physical therapy may be advised for prompt recovery and avoiding the risk of re-injury.
• Footwears, such as stiff-soled shoe and wooden-soled sandal, is recommended to reduce stress on lower limb bones.
• The casting may be applied to fix the fractured fragment of bone for proper healing.
• Sometimes surgery is needed to fix the fracture internally.

 

 

References:

1. May T, Marappa-Ganeshan R. Stress Fractures. [Updated 2020 Nov 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554538/
2. Peris P. (2003). Stress fractures. Best practice & research. Clinical rheumatology, 17(6), 1043–1061.
3. Matcuk, G. R., Jr, Mahanty, S. R., Skalski, M. R., Patel, D. B., White, E. A., & Gottsegen, C. J. (2016). Stress fractures: pathophysiology, clinical presentation, imaging features, and treatment options. Emergency radiology, 23(4), 365–375.
4. Kaeding, C. C., & Najarian, R. G. (2010). Stress fractures: classification and management. The Physician and sports medicine, 38(3), 45–54.
5. Astur, D. C., Zanatta, F., Arliani, G. G., Moraes, E. R., Pochini, A., & Ejnisman, B. (2015). Stress fractures: definition, diagnosis and treatment. Revista Brasileira de ortopedia, 51(1), 3–10.