What is a Stress Fracture?
One of the most common injuries in sport is a stress fracture. Stress fractures are tiny cracks in a bone. Stress fractures are caused by the repetitive application of force through the bone that isn’t strong enough. Essentially, the bone is weaker than is required for the activity demands or exercise intensity.
The most common stress fractures occur in runners, but stress fracture can occur due to the demands of your sport. eg lumbar spine stress fractures in gymnasts and cricket bowlers. Common running stress fractures include foot (navicular, metatarsal), tibia (shin splints).
Stress fractures also can arise from normal use of a bone that’s been weakened by a condition such as osteoporosis. Overcoming an injury like a stress fracture can be difficult because they normally occur in very active people, who hate not to exercise!
Stress Fractures occur in 2 scenarios:
- Excessive force through normal bone
- Excessive force through abnormal bone eg Osteoporosis
Stress fractures are most common in the weight-bearing bones of the lower leg and foot. Track and field athletes are particularly susceptible to stress fractures, but anyone can experience a stress fracture. If you’re starting a new exercise program, for example, you may be at risk if you do too much too soon.
What Causes a Stress Fracture?
A stress fracture is an overuse injury. It occurs when muscles become fatigued and are unable to absorb added shock. Eventually, the fatigued muscle transfers the overload of stress to the bone, causing a tiny crack called a stress fracture.
Stress fractures often are the result of increasing the amount or intensity of an activity too rapidly. They also can be caused by the impact of an unfamiliar surface (e.g. a runner who has switched surfaces from grass to concrete).
Other stress fracture causes include improper equipment (a runner using too rigid or too flexible shoes) and increased physical stress (a player who has had a substantial increase in playing time).
Where do Stress Fractures occur?
Most stress fractures occur in the weight-bearing bones of the lower leg and the foot. More than 50 per cent of all stress fractures occur in the lower leg. Common sites include:
- Metatarsal (Foot)
- Navicular (Mid-Foot)
- Tibia (Shin)
- Neck of Femur (Hip)
- Pars intraarticularis (Lower Back – Spondylolysis or Spondylolisthesis)
What Activities are susceptible to Stress Fracture?
Sports that involve the repeated impacts of running and landing are vulnerable to stress fractures.
Studies have shown that athletes participating in tennis, track and field, gymnastics, and basketball are very susceptible to stress fractures. In all of these sports, the repetitive stress of the foot striking the ground can cause trauma.
Without sufficient rest between workouts or competitions, an athlete is at risk of developing a stress fracture.
Are Women More Susceptible to Stress Fractures?
Stress fractures affect people of all ages who participate in repetitive sporting activities, like running. Studies have shown that female athletes seem to experience more stress fractures than their male counterparts.
This is attributed to a condition referred to as “the female athlete triad”:
- eating disorders (bulimia or anorexia),
- amenorrhea (infrequent menstrual cycle), and
- osteoporosis (reduced bone density).
As a female’s bone mass decreases, her chances of getting a stress fracture increase. The advice of a sports dietitian is highly recommended.
What are the Symptoms of a Stress Fracture?
- Pain with activity is the most common complaint with a stress fracture.
- This pain subsides with rest.
How are Stress Fractures Diagnosed?
It is imperative that during your examination that your health practitioner evaluates the patient’s risk factors for stress fracture. X-rays may determine stress fracture. Sometimes, the stress fracture cannot be seen on regular x-rays or will not show up for several weeks after the pain starts.
Occasionally, a computed tomography (CT) scan or magnetic resonance imaging (MRI) will be necessary. MRI is the most specific and sensitive test available. A bone scan will identify “hot spots”, which may indicate stress fractures or tumours etc.
How are Stress Fractures Treated?
The most important treatment is rest. Individuals need to rest from the activity that caused the stress fracture, and engage in a pain-free activity during the six to eight weeks; it takes most stress fractures to heal. If the activity that caused the stress fracture is resumed too quickly, larger, harder-to-heal stress fractures can develop. Re-injury also could lead to chronic problems where the stress fracture might never heal properly. While you are resting from your sport, it is wise to screen for predisposing factors. We recommend a team injury management approach.
- Sports Physician or Doctor to address bone density, hormonal issues, calcium, Vitamin D etc
- Physiotherapist for whole lower limb and core muscle and joint function
- Orthopaedic Surgeon for surgical intervention if required.
- Sports Dietitian to ensure adequate nutrition.
- Podiatrist for foot biomechanics assessment
- Psychologist to assist with return to sport issues
How to Prevent Stress Fractures
- When participating in any new sports activity, set incremental goals. For example, do not immediately set out to run five kilometres a day; instead, gradually build up your mileage every week. Use the 10% rule.
- Cross-training — alternating activities that accomplish the same fitness goals — can help to prevent injuries like stress fractures. Instead of running every day to meet cardiovascular goals, run on even days and bike on odd days. Add some strength training and flexibility exercises to the mix for the most benefit.
- Maintain a healthy diet. Make sure you incorporate calcium- and vitamin D-rich foods in your meals. Be guided by your Sports Dietitian.
- Use the proper equipment. Do not wear old or worn running shoes. Be guided by your podiatrist.
- Undertake a Musculoskeletal Screening performed by your Sports Physiotherapist.
- If pain or swelling occurs, immediately stop the activity and rest for a few days. If continued pain persists, see an orthopaedic surgeon.
- It is important to remember that if you recognise the symptoms early and treat them appropriately, you can return to sports at your normal playing level.
Please consult your physiotherapist or doctor regarding the appropriate management of your stress fracture.
Stress Fracture Related Conditions
Spinal Stress Fractures
- Spondylolysis (Back Stress Fracture)
- Lumbar Stress Fractures (Cricket Fast Bowlers)
- Rib Stress Fracture
Lower Limb Stress Injuries
- Shin Splints
- Anterior Tibial Stress Syndrome
- Medial Tibia Stress Syndrome
Common Treatments for Stress Fractures
- Early Injury Treatment
- Avoid the HARM Factors
- Active Foot Posture Correction Exercises
- Biomechanical Analysis
- Balance Enhancement Exercises
- Proprioception & Balance Exercises
- Agility & Sport-Specific Exercises
- Soft Tissue Massage
- Walking Boot
- Dry Needling
- Heat Packs
- Running Analysis
- Supportive Taping & Strapping
- TENS Machine
- Video Analysis
Sports Injury Management
You probably already know that a sports injury can not only affect your performance, but also your lifestyle. The latest research continues to change sports injury management considerably. Our challenge is to keep up to date with the latest research and put them to work for you.
How we treated you last year could vary greatly to how we treat you this year. The good news is that you can benefit significantly from our knowledge.
What Should You Do When You Suffer a Sports Injury?
Rest from painful exercise or a movement is essential in the early injury stage. "No pain. No gain." does not apply in most cases. The rule of thumb is - don't do anything that reproduces your pain for the initial two or three days. After that, you need to get it moving or other problems will develop.
Ice or Heat?
We normally recommend avoiding heat (and heat rubs) in the first 48 hours of injury. The heat encourages bleeding, which could be detrimental if used too early. In traumatic injuries, such as ligament sprains, muscle tears or bruising, ice should help reduce your pain and swelling.
Once the "heat" has come out of your injury, heat packs can be used. We recommend 20 minute applications a few times a day to increase the blood flow and hasten your healing rate. Heat will also help your muscles relax and ease your pain. If you're not sure what to do, please call us to specifically discuss your situation.
Should You Use a Compressive Bandage?
Yes. A compressive bandage will help to control swelling and bleeding in the first few days. In most cases, the bandage will also help to support the injury as the new scar tissue is laid down. This should help to reduce your pain. Some injuries will benefit from more rigid support such as a brace or strapping tape. Please ask us if you are uncertain what to do next.
Gravity will encourage swelling to settle at the lowest point. Elevation of an injury in the first few days is very helpful, especially for ankle or hand injuries. Think where your injury is and where your heart is. Try to rest your injury above your heart.
What Medication Should You Use?
Your Doctor or Pharmacist may recommend pain killers or an anti-inflammatory drug. It is best to seek their professional advice as certain drugs can interfere with other health conditions, especially asthmatics.
When Should You Commence Physio?
In most cases, "the early bird gets the worm". Researchers have found that intervention of physiotherapy treatment within a few days has many benefits. These include:
- Relieving your pain quicker via joint mobility techniques, massage and electrotherapy
- Improving your scar tissue using techniques to guide the direction it forms
- Getting you back to sport or work quicker through faster healing rates
- Loosening or strengthening of your injured region with individually prescribed exercises
- Improving your performance when you do return to sport - we'll detect and help you to correct any biomechanical faults that may be affecting your technique or predisposing you to injury
What If You Do Nothing?
Research tells us that injuries left untreated take longer to heal and have lingering pain. They are also more likely to recur and leave you with either joint stiffness or muscle weakness. It's important to remember that symptoms lasting longer than three months become habitual and are much harder to solve. The sooner you get on top of your symptoms the better your outcome.
What About Arthritis?
Previously injured joints can prematurely become arthritic through neglect. Generally there are four main reasons why you develop arthritis:
- Previous injury that was inappropriately treated (eg old joint or ligament sprains)
- Poor joint positioning (biomechanical faults)
- Stiff joints (lack of movement diminishes joint nutrition)
- Loose joints (excessive sloppiness causes joint damage through poor control)
What About Your Return to Sport?
Your physiotherapist will guide you safely back to the level of sport at which you wish to participate. If you need guidance, simply ask us.
What If You Need Surgery or X-rays?
Not only will your physio diagnose your sports injury and give you the "peace of mind" associated, they'll also refer you elsewhere if that's what's best for you. Think about it. you could be suffering needlessly from a sports injury. Please use our advice to guide you out of pain quicker . and for a lot longer.
If you have any questions regarding your sports injury (or any other condition), please contact your physiotherapist to discuss. You'll find our friendly staff happy to point you in the right direction.
Acute Sports Injury Clinic
The acute sports injury consultation fee is significantly lower than a routine assessment and treatment consultation. In most cases, your private health will cover the full cost of your full acute injury physio assessment fee.
How to Best Care for Your Sports Injury?
There is never an excellent time for an injury. But we do know that most sports injuries occur over the weekend! That's why at PhysioWorks, we have established an Acute Sports Injury Clinic at a selection of our clinics on a Monday and Tuesday.
Why Use an Acute Sports Injury Clinic?
Your Acute Sports Injury Assessment Consultation allows us to provide you with:
- A quick and accurate diagnosis. One of our Sports Physiotherapist's or an experienced sports injury-focused Physiotherapist will confidently guide your new injury management.
- Early acute sports injury care, professional advice and education. What to do this week?
- Fast referral for X-rays, ultrasound or MRI scans to confirm your diagnosis.
- Prompt referral to Sports Physicians, GPs or Surgeons with whom we work if required.
- Immediate supply of walking boots, braces and rental crutches if needed.
- Low-cost professional service.
Who is a Sports Physiotherapist?
Sports Physiotherapy is the specialised branch of physiotherapy which deals with injuries and issues related to spokespeople. Practitioners with additional formal training within Australia are Sports & Exercise Physiotherapists.
What is Sports Physiotherapy?
Sports injuries do differ from common everyday injuries. Athletes usually require high-level performance and demand placed upon their body, which stresses their muscles, joints and bones to the limit. Sports physiotherapists help athletes recover from sporting injuries, and provide education and resources to prevent problems.
Each sports physiotherapist usually has sport-specific knowledge that addresses acute, chronic and overuse injuries. Their services are generally available to sportsmen and women of all ages engaged in sports at any level of competition.
Members of Sports Physiotherapy Australia (SPA) have experience and knowledge of the latest evidence-based practice, skilled assessment and diagnosis of sports injuries, and use effective 'hands-on' management techniques and exercise protocols to assist recovery and prevent future damage. SPA members have access to the most recent advances in sports physiotherapy. You'll be pleased to know that most of PhysioWorks physiotherapists and massage therapists have a particular interest in sports injury management.
What is Physiotherapy Treatment?
Physiotherapists help people affected by illness, injury or disability through exercise, manual joint therapy, soft tissue techniques education and advice. Physiotherapists maintain physical health, help patients to manage pain and prevent disease for people of all ages. Physiotherapists help to encourage pain-relief, injury recovery, enabling people to stay playing a sport, working or performing activities of daily living while assisting them to remain functionally independent.
There is a multitude of different physiotherapy treatment approaches.
Acute & Sub-Acute Injury Management
Hands-On Physiotherapy Techniques
Your physiotherapist's training includes hands-on physiotherapy techniques such as:
- Joint Mobilisation (gentle joint gliding techniques)
- Joint Manipulation
- Physiotherapy Instrument Mobilisation (PIM)
- Minimal Energy Techniques (METs)
- Soft Tissue Techniques
Your physiotherapist has skilled training. Physiotherapy techniques have expanded over the past few decades. They have researched, upskilled and educated themselves in a spectrum of allied health skills. These skills include techniques shared with other healthcare practitioners. Professions include exercise physiologists, remedial massage therapists, osteopaths, acupuncturists, kinesiologists, chiropractors and occupational therapists, just to name a few.
Your physiotherapist is a highly skilled professional who utilises strapping and taping techniques to prevent and assist injuries or pain relief and function.
Alternatively, your physiotherapist may recommend a supportive brace.
Acupuncture and Dry Needling
Many physiotherapists have acquired additional training in the field of acupuncture and dry needling to assist pain relief and muscle function.
Physiotherapists have been trained in the use of exercise therapy to strengthen your muscles and improve your function. Physiotherapy exercises use evidence-based protocols where possible as an effective way that you can solve or prevent pain and injury. Your physiotherapist is highly-skilled in the prescription of the "best exercises" for you and the most appropriate "exercise dose" for you depending on your rehabilitation status. Your physiotherapist will incorporate essential components of pilates, yoga and exercise physiology to provide you with the best result. They may even use Real-Time Ultrasound Physiotherapy so that you can watch your muscles contract on a screen as you correctly retrain them.
- Muscle Stretching
- Core Exercises
- Strengthening Exercises
- Balance Exercises
- Proprioception Exercises
- Real-Time Ultrasound Physiotherapy
- Swiss Ball Exercises
Biomechanical assessment, observation and diagnostic skills are paramount to the best treatment. Your physiotherapist is a highly skilled health professional. They possess superb diagnostic skills to detect and ultimately avoid musculoskeletal and sports injuries. Poor technique or posture is one of the most common sources of a repeat injury.
Aquatic water exercises are an effective method to provide low bodyweight exercises.
Sports physio requires an extra level of knowledge and physiotherapy skill to assist injury recovery, prevent injury and improve performance. For the best advice, consult a Sports Physiotherapist.
Women's Health Physiotherapy is a particular interest group of therapies.
Not only can your physiotherapist assist you in sport, but they can also help you at work. Ergonomics looks at the best postures and workstation set up for your body at work or home. Whether it be lifting technique improvement, education programs or workstation setups, your physiotherapist can help you.
Plus Much More
Your physiotherapist is a highly skilled body mechanic. A physiotherapist has particular interests in certain injuries or specific conditions. For advice regarding your individual problem, please contact your PhysioWorks team.
Can You Change Knee Running Stress?It has been shown by simply changing the way we run can have a large bearing on how much stress goes through our knees... and who’s knees wouldn’t mind that?Heiderscheit et al (2011) found that simply by increasing the step frequency during running you can "offload" your knee joint stresses.
Simple things that you can change:
- Decreasing your step length to avoid overstriding.
- Less up and down movement of your centre of mass.
- Less "braking" force on your lower leg.
- Less knee bend at foot strike.