1. Most stress fractures occur secondary to overuse. If the person has normal bone strength, a stress fracture will occur from too much use. If a person has weak bones or osteoporosis then a stress fracture can occur from normal use.
Normal Bone = Stress Fractures = Overuse
Osteoporotic Bone/ Osteopenia = Stress Fractures = Normal Use
2. Pain occurs with increasing amounts of activity. Pain is typically minimal when getting out of bed first thing in the morning but then worsens as the day progresses.
3. Stress fractures most commonly occur in the metatarsals of the feet.
4. Trace swelling is usually seen with stress fractures in the foot. Pain is usually localized to one small area with palpation.
5. Diagnosis: rarely are stress fractures seen on plain X-ray. Most are diagnosed with MRI or bone scans. Stress fractures involving the spine may need a SPECT scan and or a CT scan for diagnosis.
6. Treatment: most stress fractures can be treated with relative rest. Relative rest refers to activity that does not cause the stress fracture to hurt. For example, if a runner has a stress fracture in the foot they may run in a pool or ride a bike. “At risk” stress fractures are treated differently. Please see #7 below.
7. At risk stress fractures are located in the femoral neck / hip of the femur, intertrochanteric region of the femur / hip, lumbar spine, navicular bone of the foot and the anterior ( front ) tibia. At risk stress fractures may need to be treated with surgery or complete immobilization and rest.
8. Bone stimulators may speed up the healing process. A bone stimulator is an external device that the person places over the stress fracture. The bone stimulator sends in sound waves which help to speed up the healing process.
9. Prevention involves assessing why the person got the stress fracture in the first place. A review of the athletes training log or an assessment of prior exercise amount, type, and distance, needs to be completed so mistakes in training are not repeated.
10. The Female Athlete Triad: this is a serious medical condition that involves disordered eating such as anorexia and/or amenorrhea (loss of normal menstrual cycle) that result in early onset osteoporosis. This is most commonly seen in girls and women in sports such as gymnastics, ice skating, and running.