Tuesday, July 27, 2010

Understanding Stress Fractures: Part 3

Treatment Considerations: Keep the following points in mind when treating stress fractures.

What Not To Do for Stress Fractures
Certain treatments and behaviors will exacerbate, or inhibit the healing of your stress fractures, including:
  • DO NOT USE NASID’s – These medications inhibit bone healing and mask pain symptoms. Unfortunately many athletes, especially professional dancers, use large doses of NSAID’s.
  • Ignoring a stress fracture - A stress fracture that is ignored could turn into a complete fracture, which then requires surgery, resulting in a long healing time. Bottom line, you will never get over a stress fracture by just ignoring it, it will only get worse until even minor motion becomes extremely painful.
What To Do to Treat Stress Fractures
The following has been found to be effective in dealing effectively with stress fractures.
  • Prevention – The best way to treat this injury is to avoid it in the first place.
o Training No matter which sport or activity you are involved in (running, dance, etc.) be sure to increase your distance, frequency, or intensity gradually over a period of time.

§ Focus on the quality of your training, not just quantity. Adequate rest goes a long way in preventing a stress fracture. Rest is an essential training component for avoiding injury and stress fracture.

§ Do not train when you are exhausted, higher levels of injuries occur when in states of exhaustion.

Make Your Bones Strong (preferably before the injury occurs).

A key point here is that you can only make deposits of calcium (and other minerals) into your bone bank up until age 25. After age 25, you need to take daily calcium to prevent unnecessary withdrawals from your bones. Note of interest: Calcium deficiency is a prerequisite for a stress fracture. 98% of Adolecent dancers are calcium deficient (Harkness Centre for Dance Injuries 2010).

o First consider the composition of your bones:
§ 70% minerals (calcium phosphate, magnesium, sodium, potassium, fluoride, chloride). This bone matrix of mineral is called hydroxyapatite. You need all of these minerals. It pays to focus on good dietary habits including the right amount of supplementation.

o Maintain your calcium levels:
§ Children under 9 years of age require 800 mg. per day. If you are between 9 - 50 years old, you need 1300 mg of calcium per day. Those over age 50 require at least 1000 mg. of calcium per day.

§ 70% of your bones are made up of minerals (hydroxyapatite). The best way to ingest calcium is through a complete Bone Matrix supplements. We often recommend that our patients take MCHA to meet their nutritional requirements.

After the Stress Fracture has Occurred 

The time frame for recovering from most lower-extremity stress fractures is between 8 to 17 weeks. This time frame will be much longer if the area is not given adequate time to heal. The good news is that most stress fractures respond well to conservative therapy and do not require surgery (if the stress fracture is not ignored).

o Initially, weight bearing exercises must be eliminated with any lower-extremity stress fracture. This is essential to allow the bone to heal and complete the normal remodeling process.

o An air cast (pneumatic walker/walker boot) or crutches is often recommended during the initial stages of injury. The air cast will often be used for 4 to 6 weeks depending on the speed of healing.

o Cross-training is essential to speed the recovery. Swimming, cycling, and routines that do not involve weight bearing are often recommended. The patient should also continue with upper extremity exercises.

o A slow rate of return to activity should be implemented since introducing weight-bearing exercises too soon will increase the duration of the injury. As a general rule, once the area is completely pain-free, light walking can be resumed.

o Pulsed electromagnetic field or low-intensity pulsed ultrasound therapy could speed the healing.

o Rehabilitation programs need to focus on several key factors (flexibility, strength, endurance, balance, propiroception, and alignment). This also includes addressing any weaknesses in hip or proximal stabilizers.

o Custom made orthotics may also be useful in helping to reduce biomechanical stresses on the affected area (Available through Kinetic Health).

If you would like more information or to purchase our books please go to www.releaseyourbody.com . 

If you would like information about our clinic in Calgary Alberta please go to www.kinetichealth.ca.



1. Amenorrheic Bone Loss - Karen K. Miller and Anne Klibanski Neuroendocrine Unit, Department of Medicine, Clinical Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114
2. Brukner P, Bradshaw C, Khan KM, et al. Stress fractures: A review of 180 cases. Clin J Sport Med 1996;6:85-89.
3. Buckwalter JA. Articular cartilage: Injuries and potential for healing. The Journal of Orthopaedic and Sports Physical Therapy 1998;28:192-202.
4. Principle of Dance Medicine, Clinical Management of the Dance Patient – Harkness Centre of Dance Injuries 2010
5. Khan K.M., P.J. Fuller, P.D. Brukner, et al. (1992) Outcome of conservative and surgical management of navicular stress fracture in athletes. Eighty-six cases proven with computerized tomography. Am J Sports Med 20(6):657-666.
6. Lebrun, M. (2007). "The Female Athlete Triad: What's a Doctor to Do?" Current Sports Medicine Reports 6: 397–404.
7. Matheson GO, Clement DB, McKenzie DC, et al. Scintigraphic uptake of 99mTc at non-painful sites in athletes with stress fractures. The concept of bone strain. Sports Med 1987;4:65-75


  1. It is true...we need to take care of the calcium intake and preservation of it in the body.The bones get destroyed and there are fewer ways to replenish the lost calcium as we grow older.
    Energetic Healing

  2. Here is a good article from AOR that should answer your questions on Calcium. http://www.aor.ca/assets/Research/pdf/bone-health-basics.pdf