Stress Fractures
What is stress fracture?
A stress or fatigue fracture is the one occurring in normal bone of a healthy patient, not due to any specific traumatic incident, but because of small repetitive stresses of two main types namely, bending and compression. As the name suggests, such fractures are caused due to repetitive stress on a bone which later develops a crack, resulting into a fracture.
- Bending stress causes deformation and bone responds by changing the pattern of remodelling. With repeated stress, osteoclastic resorption exceeds osteoblastic formation and a zone of relative weakness develops, ultimately leading to a breach in the cortex. This process affects young adults undertaking vigorous physical routines and is probably due to muscular forces acting on bone. Athletes in training, dancers and military recruits build up muscle power quickly but bone strength slowly; this accounts for the high incidence of stress fractures in these groups.
- Compressive stresses act on soft cancellous bone; with frequent repetition, an impactful fracture may develop.
- Spontaneous fractures occur with even greater ease in people with osteoporosis or osteomalacia and in patients treated with drugs that affect bone remodelling in a similar way (e.g. corticosteroids and methotrexate). These are often referred to as insufficiency fractures.
Symptoms of Stress fracture
Stress fractures develop when a person is engaged in some kind of an activity. It results into pain which subsides with rest. You might even develop swelling around the affected area.
Causes of stress fracture
A common notion is that fractures are a result of an intensive force applied on a bone. However, in the case of stress fractures, the crack develops due to repetitive forces applied on a specific bone over time. The intensity of these forces may be less, but the intervals at which they occur are small which becomes the cause of increased stress on a bone; more than what it can bear. Following are the causes of stress fracture-
- Rapid increase in the intensity of an activity you are engaged in.
- Use of improper equipment.
- Weak bones are unable to handle stress properly and tend to develop cracks at a rate faster than healthy bones.
- Improper intake of nutrients makes it more likely for a person to develop stress fracture.
Clinical features
- There may be a history of unaccustomed and repetitive activity or a strenuous physical exercise programme. A common sequence of events is: pain after exercise, pain during exercise, pain without exercise.
- The patient is usually healthy. The affected site may be swollen or red. It sometimes become warm and usually tender; the callus may be palpable. Springing the bone (attempting to bend it) is often painful.
Treatment
- Most stress fractures need no treatment other than an elastic bandage and avoidance of any activity that causes pain until the lesion heals. Surprisingly, this can take many months and the forced inactivity is not easily accepted by the hard-driving athlete or dancer.
- An important exception is stress fracture of the femoral neck. This should be suspected in all elderly people who complain of pain in the hip for which no obvious cause can be found. If the diagnosis is confirmed by a bone scan, his femoral neck should be internally fixed with screws as a prophylactic measure.
Prevention
In order to prevent the occurrence of stress fractures, the following points should be kept in mind-
- Whenever you engage in any physical activity, make sure not to increases its intensity rapidly. Rather, set incremental goals and go about them slowly.
- Always use appropriate equipment while working out.
- It is very important to maintain your bone health. For this, make sure your diet has foods rich in calcium and vitamin D.
- Follow an exercise regime which is a mix of various exercises and not just exercises that focus on a specific area of your body.