Stress Fractures – Don’t Let Them Stop You

Are you planning a Marathon this year? Perhaps a new sport, or an event you have entered? Great – but be careful with your training loads. If you don’t give your body time to adapt to new or increased loads, or you could end up with a stress fracture.

When a bone is gradually exposed to repeated load, it adapts by producing and laying down more bone to strengthen itself. An example of this would be the bones in your feet when you start doing more running. If the increase in repetitive load is too rapid to allow the bone to respond by strengthening itself, the bone can overload and develop a stress fracture. This is a tiny microfracture in the bone, that often won’t show up on xray.

Stress fractures can occur in many different bones in the body, via direct impact, or by a muscle repeatedly pulling on a bone. Pain is normally very localized and can generally be easily felt when you push on it.  If further confirmation is required, the investigation of choice is then a bone scan or an MRI.

For most stress fractures, the main treatment is complete rest from the type of activity that caused it, and this can be required for 6 to 8 weeks. This would be incredibly inconvenient if you were training for a Marathon! Soft tissue injuries can sometimes be managed with a reduction in training, but stress fractures need complete rest to heal. Perhaps a movie marathon instead?!

Here is a summary of more common stress fractures and their causes:

Metatarsal (ie the long bones in your feet that lead into your toes) – This is commonly called a ‘March fracture’, as it can be common in Army populations with large volumes of pack marching. Also very common in runners and ballet dancers! Sometimes crutches are required for 2 to 4 weeks.

Tibia (ie the main bone in your lower leg) – Another common running one, and again this can require crutches to heal.

Navicular (ie a bone in the middle of your foot on the inside) – Often this is more from sprinting and jumping sports. A baddie, as you would probably have to wear a cast for 6 weeks to heal it!

Ribs (ie bones you breathe with!) – I have seen this in rowers a few times, as the trunk muscles pull on the ribcage and cause overload. Very painful, but fortunately no plaster cast required, as that would make it rather hard to breathe…

Vertebra (ie bones in your spine) – This is a nasty one for fast bowlers and gymnasts.

EARLY INTERVENTION for stress fractures is the key. So if you have a tender spot on your bone that wont go away, consult your friendly Physiotherapist.

Happy training!