April 2003 Bulletin

Stress fractures

One of the most common injuries in sports is a stress fracture. Overcoming an injury like a stress fracture can be difficult, but it can be done. Here are some facts about stress fractures from the American Academy of Orthopaedic Surgeons (AAOS).

What is a stress fracture?

A stress fracture is an overuse injury. It occurs when muscles become fatigued and are unable to absorb added shock. Eventually, the fatigued muscle transfers the overload of stress to the bone causing a tiny crack called a stress fracture.

What causes a stress fracture?

Stress fractures often are the result of increasing the amount or intensity of an activity too rapidly. They also can be caused by the impact of an unfamiliar surface (a tennis player who has switched surfaces from a soft clay court to a hard court); improper equipment (a runner using worn or less flexible shoes); and increased physical stress (a basketball player who has had a substantial increase in playing time).

Are women more susceptible to stress fractures than men?

Medical studies have shown that female athletes seem to experience more stress fractures than their male counterparts. Many orthopaedic surgeons attribute this fact to a condition referred to as "the female athlete triad" — eating disorders (bulimia or anorexia), amenorrhea (infrequent menstrual cycle) and osteoporosis. As a female’s bone mass decreases, the chances of getting a stress fracture increase.

Where do stress fractures occur?

Most stress fractures occur in the weight-bearing bones of the lower leg and the foot. More than 50 percent of all stress fractures occur in the lower leg.

What activities make athletes most susceptible to stress fractures?

Studies have shown that athletes participating in tennis, track and field, gymnastics and basketball are very susceptible to stress fractures. In all of these sports, the repetitive stress of the foot striking the ground can cause trauma. Without sufficient rest between workouts or competitions, an athlete risks developing a stress fracture.

How are stress fractures treated?

The most important treatment is rest. Individuals need to rest from the activity that caused the stress fracture and engage in a pain-free activity during the six to eight weeks it takes most stress fractures to heal.

If the activity that caused the stress fracture is resumed too quickly, larger, harder-to-heal stress fractures can develop. Re-injury also could lead to chronic problems where the stress fracture might never heal properly.

Preventing stress fractures

Here are some tips developed by the AAOS to help prevent stress fractures:

It is important to remember that if you recognize the symptoms early and treat them appropriately, you can return to sports at your normal playing level.

Content is drawn from the AAOS patient education Web site, Your Orthopaedic Connection. For more information about stress fractures or other musculoskeletal conditions, visit the Web site at http://orthoinfo.aaos.org.

© 2003 American Academy of Orthopaedic Surgeons.

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