A stress fracture is a small crack in the bone that is usually due to repeated loading and overuse. A stress fracture will often start as bony stress reaction and progress to a stress fracture if not properly managed, and rested. In some cases, stress fractures can also result in complete fractures if not offloaded properly. Most commonly, stress fractures occur in the tibia and in several bones in the foot.
How do they occur?
Generally they occur because of poor load management. This can be due to increasing mileage, frequency of exercise, altering training surface etc. They are also more common in athletes that are involved in running and jumping sports. Women appear to be more affected than men, particularly those who have had a history of eating disorders, amenorrhea (infrequent menstrual cycle) and osteoporosis.
Signs and Symptoms
Athletes generally will have an onset in pain localised to bone that gradually progresses. It is brought on with loading activities and reduces once the activity ceases. Generally there is a continuum in which stress fractures develop, pain may start as a niggle and progress to constant pain while exercising. Pain is very localised to one particular spot on the bone. Athletes may experience pain at night that causes them to wake.
Do you need scans?
Scans are recommended to rule in or out a stress fracture. X-rays can be used to determine whether there is a fracture, however they may not show for weeks after the pain commences. Bone Scans and CT scans are more accurate ways to diagnose a stress fracture.
What should you do if you suspect a stress fracture?
Firstly, any aggravating activities need to be ceased. Your local sports physiotherapist will be able to conduct a thorough assessment to see if the stress fracture is the cause of your symptoms. Depending on the severity of symptoms, you may be advised to go into a CAM boot to offload the injured site. Rehabilitation, following a period of rest, will usually include progressive return to sport, while addressing any strength and biomechanical deficits present. Careful loading will be key to successful return to sport.