[dropcap]D[/dropcap]o you have pain during activity that just won’t go away? You could be suffering from a stress fracture. A stress fracture is a small crack or bruising in the bone, typically caused by overuse or a repetitive activity. The most common of all stress fractures are on the tibia bone (the shin) and then the foot, but they can occur anywhere in the body. They were initially known as “march fractures” as they were typically seen in soldiers after marching for too long or too far.
Stress fractures of the shin or foot, as well as being seen in soldiers, are common in runners but can occur in any sport, especially if there is a lot of jumping involved. Even sports such as tennis, with the repetitive action of hitting the ball, can cause a stress fracture of the upper limb.
But you don’t have to play sports to be affected; stress fractures can happen if you go hiking or spend a long day browsing around the shops. Going on sightseeing excursions can put you at risk. Other risk factors are:
• Diet – low calcium intake
• Gender – women are more prone to suffer from stress fractures than men
• Heavy, irregular menstruation
• Low body weight
• Low bone mineral density
• History of stress fractures
There are several causes of stress fractures: weak bones, poor biomechanics, overtraining and repetitive movements, wearing the wrong type of footwear with inadequate support, and working out or running on hard surfaces. Diet can also play a role.
It is thought that one aggravating factor is when the muscles pull on the bone, during movement; in the lower leg this can often be felt as shin splints, a pain radiating over the shin. If the initial warning signs are not acted on and adequate rest and treatment are not taken, shin splints can lead to a fracture where pain is then felt in a specific area of the shin. However, unlike shin splints, where pain is felt over a wide area after a workout, stress fractures can usually be felt during activity and the source of pain easily identified. Often people are fooled into thinking that their problem is resolving as the area of pain has reduced; but the warning sign is now there is pain during exercise, not after.
Stress fractures can be difficult to diagnose and, as they are so small, they are often not picked up on an X-ray. The most reliable diagnostic is an MRI, which can be expensive, but if you or your healthcare provider suspect a stress fracture, there are steps you can take to speed up your recovery. The most obvious signs of a stress fracture in the lower limb are pain on weight-bearing or exercise, and inflammation and extreme tenderness when the area is touched. The first step to recovery is rest and refraining from any activity
that exacerbates the problem. In the case of a stress fracture of the tibia or the foot, that usually means using crutches or a walking stick to reduce weight on the affected area. This means the muscles no longer pull on the bone, allowing better healing and a faster recovery. Your doctor may even suggest a cast, depending on the severity of the pain.
You may also be prescribed calcium or advised to change your diet to one rich in calcium. In extreme cases, where the area is not healing, surgery may be indicated. This usually involves grafting fragments of bone onto the affected area to speed up the healing process
Prevention is always better than cure and there are things you can do to minimise the risk of suffering from this painful injury. Always wear footwear that gives plenty of support where most needed; always build up slowly the intensity of your exercise programme and take plenty of time to rest; always warm up and stretch, and remember to cool down. Exercise is good for us but only if done properly. If you are not fit or are returning to activity after some time off, do not go full speed ahead. Slow and steady wins the race.
