Stress Fracture

The Pediatric Sports Medicine team at Johns Hopkins All Children's Hospital in St. Petersburg, Florida, discusses stress fractures.

Stress fractures are an overuse injury. Our muscles not only move our joints but also absorb shock and protect our bones. When we overdo it our muscles get tired and weak and can no longer absorb the shock to our bones. Our bones can handle some stress but if it's too much small micro cracks or fractures develop causing a stress fracture.

Stress fractures can happen for a number of reasons. The most common is increasing the amount or intensity of an activity too quickly, especially if the activity is new to you and you're not in shape. For example double sessions in football, starting track or basic training. Changing training conditions can cause stress fracture. Things like switching to a clay court in tennis, running on pavement instead of grass, increasing your training time or running with worn out shoes are examples. Basically, anything that increases physical stress too quickly can cause stress fractures.

Most stress fractures occur in the lower extremities, that is, from the pelvis down. Common places include the metatarsals of the foot, the tibia or shinbone, the knee either just below or above the joint, the shaft of the femur or thigh bone, the femoral neck or hip, and even the bones of the pelvis.

Symptoms are usually gradual in onset. Pain occurs with activity and is relieved by rest. It may gradually worsen over time so that the pain becomes more severe and lasts for a longer time with less activity.

The diagnosis of stress fracture is made by asking your history of training, performing a physical exam and taking x-rays. Stress fractures may not show up right away on x-ray and additional studies like a bone scan, CT or MRI may be needed.

Rest from the painful activity is the mainstay of treatment for stress fractures. It usually takes 6 to 8 weeks to heal. You can do other activities during this time of healing as long as it does not cause any pain.

Stress fractures are rarely an emergency but one type can be a big problem if not identified early. That is the femoral neck stress fracture. If you have pain in your groin area with activity stop, and get it checked out as soon as possible.

Things you can do to prevent stress fractures include setting incremental goals. Don't run 10 miles on your first day, gradually build up over time. Cross train -- do other activities that complement your training. For example add flexibility and strength training to your running program. Eat a healthy diet. Make sure you are getting enough calcium and vitamin D. Use good equipment. Don't run in worn out shoes or sneakers with no support.

Get checked out by your doctor if you're pain is severe or not getting better with rest.

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