Stress Fractures
The sporting world is rife with stress fractures. Simply put, they signify that our skeleton is failing to support the loads that are put on it. This results in structural exhaustion, pain, decreased performance, and in rare circumstances, a complete fracture. Because stress fractures can result in extended absences from sports and other activities, management and prevention are crucial.
Pathogenesis
As a result of the strain they are put under, our bones are continually being rebuilt and healed. This stress may cause microscopic fragments in the bone, which are eventually fixed by the cellular elements of the bone.
When the bone can’t heal the damage it is receiving quickly enough, a stress fracture will result. The following three scenarios can lead to stress fractures.
>Increase in the amount of applied stress or load (too much load);
>Loading too fast due to insufficient recuperation time between sessions;
>Applying typical stresses to bones with weakening (low bone density or osteoporosis).
>The volume, intensity, and surface of your workouts, the amount of calcium or calories in your diet, and hormonal considerations are just a few of the other elements that might cause a stress fracture.
Epidemiology
Younger persons are more frequently impacted by stress fractures, which are most common in the lower leg. Stress fractures are classified as severe injuries since it often takes 3 months to return to sports or other activities.
History
Normal insidious onset means that the patient was not aware of a specific incident or time when the damage happened. Often, there is no apparent beginning of trauma, with pain decreasing during rest and returning upon resuming activities.
There are both intrinsic and extrinsic risk factors, as with most injuries. Intrinsic includes topics such as;
Gender: Women are more prone than males to suffer a stress fracture.
Oestrogen levels, for example, which affect endocrine and hormonal function, increase the incidence of stress fractures in women.
Low bone density can cause stress fractures because the bones are less strong.
Reduced range of motion at a joint can result in changed loading and increased rates of stress on specific locations, which has been linked to the development of stress fractures.
Dietary behaviours, such as restrictive eating patterns or eating disorders, can result in inadequate bone reabsorption, making the bone weaker and more prone to fracture.
Examples of extrinsic risk variables are:
Increases in load, volume, intensity, and duration are training-related parameters. The greatest risk factor for training mistake is abrupt changes.
Mechanical variables, or things like hard surfaces like pavement or improperly supportive shoes, are examples of this.
Age – Your bone density may vary depending on your age. Children and teenagers have not yet attained their maximal bone densities, whereas older persons often have lower bone densities.
Examination
When checking for a stress fracture, an osteopath will look for a variety of things. Localized soreness at the injury site, followed by swelling, is the major symptom of a stress fracture. Some joints and bones are difficult to assess, so your osteopath may ask you to complete a series of tests, such as gradually increasing activity—from calf lifts to jogging—and seeing whether they cause pain.
Investigations
Depending on the injured bone and the circumstances surrounding it, there are a variety of solutions accessible in the case that more examinations are required. Options include an X-ray, CT scan, bone scan, MRI, and DEXA scan.
Treatment
A period of lighter loading in this case is the most crucial element. Not necessarily non-weight bearing, but simply a time when activity is changed. such as cycling rather than jogging
Rest, relatively in order for the fracture to heal properly, the patient or athlete must be able to maintain a particular degree of conditioning. A conditioning/rehabilitation strategy must meet a number of criteria, including:
>Proper diagnosis is crucial because it enables us to create a rehabilitation strategy that works.
>Finding potential contributing factors requires both intrinsic and extrinsic elements that the rehabilitation strategy can address.
Initial management: Although this phase is quite comprehensive, it can be summed up as involving some kind of activity modification at first, followed by an investigation of potential contributing factors. After that, focus on keeping yourself healthy before trying to speed up tissue recovery.
Return to sport/lifestyle – This is yet another in-depth topic that involves getting back into motion, adjusting the load via the injured limb, and retraining your stride before developing a loading strategy.
Specific conditioning — different forms of exercise can be performed here while strength, flexibility, proprioception, and neuromuscular weaknesses are tracked.
Sports- and lifestyle-specific retraining, where we include particular workouts and drills.
Returning to sport and lifestyle, there are a few things we need to consider raising. Examples include risk vs. reward, the patient’s personal goals, and the injury history profile.
Prevention
It’s crucial to be able to recognise any potential risk factors involving things like strength, footwear, floor surface, nutrition, and hormones in order to assist prevent stress fractures.
In order to allow for bone adaptation, exercise progression should be moderate.