Stress Fractures in Runners
The 2012 Summer Olympics have ended but thrilled the world with some fantastic efforts and world records. The dedication and efforts of the Olympic athletes inspires all levels of athleticism even in our own community. I have been evaluating many high school and college runners who are ramping up their miles for cross country season. Also the fall marathoners and half marathoners are becoming more familiar.
The increase in mileage puts all athletes at risk for lower extremity stress fractures. Stress fractures are abundant in my practice over the next several months.
Stress fractures occur due to repetitive loads on bone with exercise that cause an imbalance between bone resorption and bone formation. A sudden increase in repetitive stresses like running or cross training without adequate rest will eventually lead to increased bone breakdown and fracture. Muscle weakness can also contribute to added bone stress and eventually stress fractures.
Stress fractures occur more frequently in females and individuals with poor aerobic fitness. Other risk factors that can contribute are hypothyroidism, excess alcohol consumption, anorexia, amenorrhea and advancing age. Naturally, individuals with poor bone density from any cause are at increased risk.
In runners the most common areas to be inflicted with a stress fracture are the forefoot, midfoot and tibia. In adolescence, the proximal tibia - that portion closest to the knee - is more commonly affected while in adults, the middle to distal portion of the tibia are more frequently affected.
Stress fractures of the lower extremities will typically cause pain over days or weeks first with exercise and then progressing to pain with daily activities. Pain is usually relieved by rest or some less stressful cross training exercise. The area immediately over the stress fracture may be tender to touch and sometimes accompanied by redness or swelling. If the athlete continues to exercise these findings may become severe.
The evaluation for stress fracture requires a history and physical exam by a qualified Orthopedic provider. X-rays are typically negative for stress fractures for the first 3-4 weeks and even then, at times, can be of little value. MRI and bone scan are the most accurate and available imaging technology to diagnose stress fractures.
Stress fractures must be differentiated from other causes of pain such as medial tibial stress syndrome, exercise induced compartment syndrome, infection, plantar fasciitis and many other possible conditions.
The treatment for stress fracture depends on the location and the type of stress fracture. All stress fractures require that you stop running on land but most will allow you to cross train and possibly run in water. Some stress fractures don't require immobilization while others do. Bone growth stimulators can be beneficial in some cases.
I would recommend that if you have an unusual discomfort over an area in your lower extremities that is increased with exercise, that you decrease your running for 2 weeks and cross train on the bike or in a pool. If this rest does not relieve your pain with return to running, get evaluated soon to lessen the potential for further complications. My goal is to provide you with a rapid, accurate workup and treatment plan to keep you off the couch and on the road.