By Shannon Bright, ATC
One of the most common injuries sustained in athletics today is a stress fracture. Although the term stress fracture is easily recognized, many athletes may not understand exactly what they are. A stress fracture is essentially a small crack or fracture in the bone. Although stress fractures are relatively common, they are often misunderstood due to the various causes and complications related to diagnosis.
Some of the signs of a stress fracture are localized swelling, focal tenderness, and pain. One of the most common symptoms of a stress fracture is pain that is exacerbated by activity but diminishes with rest. The pain may also get progressively worse over time and occur earlier in successive workouts. Percussion (tapping) over the area may illicit pain at the fracture site.
The most common sites for stress fractures are the tibia, fibula, metatarsal shaft, calcaneus, femur, ribs, and the humerus. It is important that stress fractures be considered when an injury is sustained in a susceptible body area that does not get better with conventional treatment.
There are several factors that may contribute to sustaining stress fractures. One of the factors is returning to activity too quickly following injury. If the body is not given proper time to heal, further injury is much more likely. Another factor that can contribute to stress fractures is moving from one sport to another without proper training or conditioning. This is especially important to remember for multi-sport athletes that move from outdoor sports on grass (such as football) to indoor sports on hardwood (such as basketball). The change in running surface can predispose the body to injury due to the change in the ground reaction force. Starting initial training too quickly can contribute to stress fractures because the body is more vulnerable to injury due to muscle imbalance and fatigue. In addition to these contributing factors there are also some structural factors that may predispose an athlete to sustaining stress fractures. Flatfeet, a short first metatarsal bone, or a hypermobile metatarsal region may increase the chances of an athletic to have a stress fracture.
Stress fractures are often difficult to diagnose in the early stages of injury since there is not always an obvious reaction in the bone. X-ray examinations may not reveal a stress fracture for several weeks. Other types of imaging may be utilized such as bone scans, MRI, or CT scans.
The management of stress fractures depends on the athlete, injury site, and extent of injury. Arguably the most effective treatment of stress fractures is rest. It may take up to 12 weeks for the bone to heal and the pain to subside. Depending on the body area affected, crutches, a walking boot, or braces may be given to further protect the athlete.
Although stress fractures are not completely unavoidable, there are several steps that may be taken to help in the prevention of stress fractures. The first step is to progress exercise gradually. The athlete should initiate all new exercises gradually and give their body time to adjust to the increased demands. Proper equipment is important since structural abnormalities may contribute to the presence of stress fractures. Cross-training or alternating activities can help reduce the chances of stress fractures because it reduces repetitive stress on one certain part of the body. With the proper steps taken for prevention, the likelihood of sustaining a stress fracture is greatly reduced.
Shannon Bright, ATC is a first year graduate student and recipient of the Hughston Athletic Training Fellowship in Columbus, Georgia. She received her Bachelor of Science Degree in Athletic Training/Sports Medicine from Valdosta State University in May of 2008. While at VSU, she worked with baseball, football, volleyball, and Valdosta High School. Shannon also completed rotations with The Hughston Clinic in Valdosta, Family Medicine, Valdosta Physical Therapy, and Farber Student Health Center, as well as an internship at LaGrange College. She is an active member of the National Athletic Trainers Association (NATA), the Southeast Athletic Trainers Association (SEATA), and the Georgia Athletic Trainers Association (GATA) where she currently serves as the President of the GATA Student Advisory Committee. She is married to Adam Bright, a teacher and coach at Harris County High School and serves as the head athletic trainer at Kendrick High School, Columbus, Georgia.