There are lots of things in life that can cause stress — from little things like traffic jams to major career or personal life decisions. But there are only a few things that can result in stress fractures. The two most common causes are repetitive force, such as repeatedly jumping up and down or running long distances and osteoporosis, a disease that weakens bones.
For many people, the pain that goes along with a stress fracture is barely noticeable at first. But it tends to keep getting worse. “The term “stress fracture” typically refers to a fracture that develops over a longer period of time in which we can’t necessarily pinpoint when the trauma occurred. It often is associated with a repetitive use injury over time and slowly worsens if the activity is not stopped,” said Dr. Brandon Barnds, Orthopedic Surgery, AdventHealth.
Stress fractures are most common in the lower leg and foot — the weight-bearing bones — in part because we all use our feet constantly to walk, run and jump. Stress fractures are also very common in the tibia or lower leg bone and are related to shin splints.
However, they also commonly occur in the ribs, pelvis, hip, knee and the shoulder blade. Wherever they appear, the symptoms are similar:
- Gradual onset of pain that worsens with activity
- Tenderness and swelling at the affected area
- Bruising or discoloration, in some cases
“Some stress fractures cause an ache that is present only with a certain activity or with pressing on the part of the bone that is fractured; while other stress fractures can cause severe pain, sometimes even with rest, which typically occurs if the fracture is displaced or moved out of alignment,” said Dr. Barnds.
Because stress fractures are not as easy to recognize as a “regular” broken bone, they can be more difficult to diagnose. For example, it could appear, at first, that the injury is shin splints, plantar fasciitis or a soft tissue injury.
While x-rays and bone scans are often used to diagnose the problem, magnetic resonance imaging (MRI) is the most sensitive test to identify stress fractures.
Once someone is diagnosed with a stress fracture, treatment depends on how serious the injury is.
“Most stress fractures can be managed with a period of non weight-bearing (using crutches) or immobility for approximately six weeks. For foot and ankle stress fractures, we often place patients in a walking boot and for upper extremities, we often use a sling or brace,” said Dr. Barnds.
Although unusual, surgery is sometimes necessary to ensure complete healing of some types of stress fractures, especially those that occur in areas with a poor blood supply.
For less serious cases, self care may be an option. It’s important to give the bone time to heal. This may take several months or even longer. During this period, it is important to:
- Rest. Stay off the affected limb as directed by your doctor until you are cleared to bear normal weight.
- Use ice. To reduce swelling and relieve pain, your doctor might recommend applying ice packs to the injured area as needed — 15 minutes every three hours.
- Resume activity slowly. When your doctor gives the OK, slowly progress from non-weight-bearing activities — such as swimming — to your usual activities. Resume running or other high-impact activities gradually, increasing time and distance slowly.
The Best Approach to Stress Fractures Is to Avoid Them
You can protect your bones by making lifestyle changes and avoiding habits that may put you at risk for a fracture.
Our bodies are constantly absorbing and replacing bone tissue. When that process becomes disrupted so that either too much bone is removed or not enough bone is replaced, the result is the disease known as osteoporosis. As bone mass and density decrease, the natural gaps and holes within the bones become visibly larger, which leaves them more prone to injury.
“A well-balanced diet is the key to adequate bone health, along with ensuring proper levels of calcium and vitamin D. Exercise in moderation is also key. Regular exercise improves bone health, but excessive repetitive use or exercise can lead to a stress fracture,” said Dr. Barnds.
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