Understanding Stress Fractures: Part 2

Risk Factors for Stress Fractures

Many factors can result in stress fractures including:

• Faulty or worn-out equipment such as:
• Using worn-out running shoes, worn-out point shoes for dance, or other defective supports.
• Using the wrong type of support in your shoes such as a supinator using a shoe that corrects excessive pronation. It is important to seek someone with expertise in your sport to fit you with the proper shoes.
• Training errors such as:
• Sudden increases in frequency or duration of training.
• Training while in a state of exhaustion.
• Poor training techniques.
• Amenorrhea or the absence of menstrual bleeding results in loss of bone mass at a similar rate to that experienced by post-menopausal women (up to 5% per year). This makes them very susceptible to stress fractures.
• Restrictive diets that results in an inadequate supply of essential nutrients or calories, and can have a negative effect on bone density.
• Muscular weakness or muscle imbalances.

Diagnosis

• History – Patients who develop stress fractures often have a history of pain that is brought on by physical activity, and reduced pain with rest. There is usually an accompanying history of recent increases in physical activity.
• Palpation – Touching the affected area (around the stress fracture) often elicits localized tenderness directly over the bone. Swelling over the area and redness is also commonly observed. Often there will be tenderness to percussion over the area.
• Pain – Unfortunately, the pain pattern of a stress fracture may not provide a direct indication about the actual presence of a stress fracture. The pain from a stress fracture is usually well localized, but in some cases, can be spread out over a larger area.
• Note: In the case of a femoral neck stress fracture (seen in runners/dancers or high impact athletes) the patient will feel groin pain that becomes worse with any activity (including walking) and that gets better with rest. This can become a very serious stress fracture if it transforms into a complete fracture. In such cases, the head of the femur can die due to lack of blood supply caused by the fracture.
• Tuning Fork – The vibrations of a tuning fork have been used as an indication of a stress fracture. Some practitioners dispute this test, but it may give the practitioner an indication that further diagnostic tests need to be performed.
• X-rays – Diagnostic X-rays are often not very good at finding a recent stress fracture. A stress fracture may not show up on the X-ray for 2-3 weeks. Despite this, an X-ray is one of the first diagnostic procedures that should be performed. If possible an MRI, or bone scan should also be performed, these procedures are much more definitive than an X-Ray.

In part three of Understanding Stress Fractures we will cover the treatment of stress fractures.

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