Focus On: Stress Fractures
What are stress fractures and why do they occur?
A stress fracture is a small crack within a bone that mostly occurs in the lower legs and feet with repetitive mechanical overload through activities such as running. This is commonly caused by over-training but a number of factors may be attributable such as changes in running surface or footwear. Other risk factors include bone density, skeletal alignment, body size and composition, flexibility, strength, hormonal and nutritional factors.
What are the symptoms?
Symptoms will include pain with activity which subsides with rest; swelling and tenderness at the pain site may also be present.
Diagnosis
Stress fractures may be diagnosed from symptoms alone but imaging tests are often needed to confirm the diagnosis. These imaging tests may include X-rays, bone scans or magnetic resonance imaging (MRI).
Treatment
The main principle of treatment is to manage the bones weight bearing load with activity modification until healing occurs. As a general rule this takes 4 – 6 weeks for most bones. Hydrotherapy and aquatic exercise are the ideal environment to be able to continue movement and exercise with reduced or non weight bearing available to help reduce or eliminate impact forces. Sometimes it may be necessary to completely offload the area by wearing a supportive boot or walking with crutches. By modifying training methods it is possible for runners to maintain fitness and prevent muscle wastage during this time, whilst still allowing the bone to heal. As time progresses the bone remodels and a pain free graded exposure to load continues to help in the healing process. Activities such as aquatic running and cycling are particularly helpful.
Prevention
Awareness of the causes of stress fractures outlined above can lead to the appropriate interventions to minimise risk. Bone is weakest during the 3rd week after initiation of a stressful activity such as increased running distance or intensity. Therefore it is suggested that a reduced training load in the 3rd week after an increase is a sensible method of reducing the incidence of stress fractures in runners.
What a customer says
I’m an ultra-runner and that is something where you spend a lot of time on your feet, you have repeated impact and given that I have got a long term bone disorder I suppose it was fairly inevitable that I would break something. I had a stress fracture last June and I started using Aqua Physio at that point to try and maintain my fitness whilst I recovered. The injury really just meant I couldn’t run but I could do a lot of other things, so I used a combination of cycling and Aqua Physio to try and keep my fitness levels up. So I’m using Aqua Physio really to replace a couple of my regular running training sessions. I saw the physio to work out a programme that would suit me and would work around my needs and I went twice a week. The combination of Aqua Physio and cycling at home actually worked really really well, it was surprisingly effective at keeping up my fitness levels. Not only did I maintain fitness I actually improved it slightly better so having not run from June for two months almost, in the September I did a marathon and had a personal best.
