Stress Fractures

Stress fractures occur in all age groups of people in sports, where the body or body part is not suited to the repetitive activity being performed. They are partial or complete fractures of the bones, and the location depends on the activity. As runners and walkers, we are most likely to experience stress fractures in the tibia and metatarsals. The diagnosis of a stress fracture is highly dependent on the clinician's ability to assess common signs and symptoms. Stress fractures can be characterised by the following signs and symptoms

  • Pain that is worst when exercising, but that may also be present at rest
  • Pain over a specific area of bony surfaces when those surfaces are palpated or percussed
  • History of repetitive microtrauma resulting from exercise, usually as a result of a sudden increase in exercise intensity, frequency or duration
  • Possible low dietary calcium and, in women, low serum oestrogen, sometimes accompanied by amenorrhoea or other menstrual disturbances
  • Possible reddening of the skin and swelling of the tissues over the painful area.
Looking at these points, the measures that one needs to take to avoid such an injury become obvious.

The application of sound training principles is essential in order to ensure that your body is adequately prepared to endure the high repetitive impact that running places on your body. And of course, adequate nutritional intake includes high dietary calcium.

However, should a stress fracture catch up with you, there are a few strict rules that you should follow to ensure that your rehabilitation program is maximised.

  • Active rest via cross-training mechanisms including water running and cycling
  • Nutritional and hormonal therapy is sometimes appropriate for some patients
  • The possible need for a bio mechanical assessment. When body alignment is poor, redevelopment of the fracture is highly likely
If you have injuries that reoccur, it is likely that your training is in error. Common training errors include an overly aggressive approach to increasing mileage and intensity, running/walking only on concrete and asphalt surfaces that absorb force poorly and running/walking on excessively crowned roads that cause unequal distribution of weight on the foot.

At the beginning of your program post injury, you should run, swim and cycle on alternate days to decrease the cumulative effects of weight bearing. If the pain associated with weight bearing does not return, you can gradually increase the amount of running/walking you are doing. A 10-15% weekly increase is advised in either intensity, frequency or duration.