Stress Fractures

Stress fractures refer to tiny cracks in a bone caused by repetitive force and overuse, such as running or repeatedly jumping up and down. These stress injuries can occur from normal use of your bone that’s been weakened over time by underlying conditions, such as osteoporosis.  

Stress fractures most commonly affect the weight-bearing bones of the lower leg and foot. 

At Impact Sports & Spine, we seek to determine the contributing factors to the development of a stress fracture to ensure optimal healing and reduce the likelihood of recurrence. Our team monitors your progress to adjust treatment as necessary for your condition.

Stress fractures are part of a spectrum of disorders referred to as bone stress injuries. Bone stress injuries involve bruising of bone, the accumulation of tiny cracks, and the ultimate development of a fracture line if not addressed soon enough. Bone stress injuries are generally the result of an interplay between overuse and underlying susceptibility.  

When it comes to bone stress injuries and stress fractures, overuse is generally marked by a rapid increase in activity, such as running or jumping. When the increase in activity is too rapid, the forces that cause bone breakdown outpace those that influence bone regrowth. As a result, the bone becomes injured.

Bone stress injuries typically affect weight-bearing bones in the lower body, such as the lower leg, heel, and foot. Although less common, stress fractures can also affect the lower back, hip, hand, wrist, and ribs. 

A stress fracture is a common sports injury for athletes, military recruits, or people who suddenly increase their activity levels. It is different from acute traumatic fractures. 

While stress fractures tend to develop gradually, presenting as slowly worsening pain and tenderness, acute traumatic fractures are sudden breaks in the bone caused by a significant impact or trauma. It causes immediate and severe symptoms like intense pain, swelling, and deformity. You typically need to consult an orthopedic surgeon for acute traumatic fractures, whether they require surgical intervention or casting.

Common symptoms of a stress fracture include:

• Gradual onset of pain that worsens with physical activities
• Pain that does not get better after rest or stopping activities
• Mild to moderate swelling
• Tenderness at a specific point over the affected bone
• Bruising may be visible around the fracture site
• Difficulty in standing or walking

Stress fractures result from increasing the amount or intensity of your physical activity too quickly. Bone adapts gradually to increased loads through a normal process called remodeling, which accelerates when the load on the bone increases. During remodeling, old bone tissue is broken down (resorption), and new bone tissue is formed.

When bones are exposed to unfamiliar forces without sufficient recovery time, they resorb cells faster than they can be replaced, increasing the risk of stress fractures. 

There are numerous underlying features that can make a bone more susceptible to a bone stress reaction, and thus stress fracture. It is common to group these underlying features into two buckets: biomechanical and biochemical.  

Biomechanical features that can increase one’s risk of developing a stress reaction include anatomic abnormalities or dysfunction, such as having flat feet or a leg length discrepancy.  

Biochemical features refer to metabolic abnormalities that increase the likelihood that bone turnover will be impaired. Examples of biochemical features include calcium or vitamin D deficiency, thyroid dysfunction, significant dietary restrictions (including disordered eating), and poor absorption of nutrients. The term relative energy deficiency in sport (RED-S) refers to the imbalance between energy input and energy output which results in an increased risk of bone stress injury occurrence.

Our doctors discuss your medical history, including symptoms, activity levels, and potential risk factors. We then perform a detailed physical examination and advanced diagnostic ultrasound to pinpoint the root cause of your symptoms. In some cases, additional imaging tests, such as an MRI scan, may be needed.

Once we have identified the location of a stress fracture, an appropriate treatment plan can be developed. Activity restriction and protection of the bone stress injury are critical for the healing of bone stress injuries. In more chronic cases, additional treatment modalities can be considered. In severe, high-risk stress fractures, we may recommend an orthopedic surgery consultation.  

Consider following these prevention tips to reduce your risk of stress fractures and maintain healthy, resilient bones.

• Gradually increase activity when starting a new exercise routine 
• Replace worn-out shoes regularly
• Mix high-impact activities with low-impact ones
• Perform muscle-strengthening exercises
• Consume a balanced diet rich in calcium and vitamin D
• Use proper technique and form during physical activities
• Train with proper equipment
• Take adequate time to rest and recover between workouts

Our team performs a comprehensive evaluation to design a personalized plan tailored to your specific condition and needs. We use advanced imaging techniques and a range of conservative treatments to promote healing and prevent future injuries.

At Impact Sports & Spine, we focus on providing high-quality non-surgical care for acute and chronic musculoskeletal injuries. Our team focuses on uncovering the root cause of your condition rather than merely treating the symptoms. 

To schedule a consultation with our skilled practitioners, call us at 301-363-9693 or request an appointment online.