We are excited to kick off a new series in partnership with Sports Injury Clinic. www.sportsinjuryclinic.net This site has been a well used site by me over the last year as I have worked through various injuries. It provides the right amount of detail about the injury and tips on treatment as well. And while we hope you don' t have the need for the resources, we are pleased to offer articles in tips in the event you are dealing with a running injury.
Stress fractures are microfractures which occur as a result of repetitive loading of the bone. They can occur due to increased stress at a focal point in the bone due to biomechanical issues, or through the action of a muscle pull across the bone.
In runners, stress fractures can occur in a number of locations, with the most common being:
ØThe foot – Metatarsals or Calcaneus
ØThe lower leg – Tibia
ØThe thigh – Femur
Metatarsal stress fractures
There are 5 metatarsals in each foot, which are the ‘rays’ leading towards each toe. They can be fractured through an impact, as seen in sports such as soccer, or through repetitive impact, as is the case with a stress fracture. The 2nd, 3rd and 4th metatarsals are the most commonly injured.
ØForefoot pain aggravated by running/walking etc
ØPain gradually worsens with activity
ØTenderness when applying pressure to the metatarsal
Calcaneal stess fractures
The calcaneus is the heel bone. Stress fractures most commonly occur at the back or inside of the bone.
ØHeel pain that comes on gradually
ØPain aggravated by running or even weight bearing in more severe cases.
ØPain when squeezing the sides of the heel together at the back
Tibial stress fractures
The Tibia is the larger of the two lower leg bones, and the only bone which is ‘weight-bearing’. The most common area for a tibial stress fracture is 2-3 inches above the medial malleolus (bony part on the inner ankle).
ØGradual onset of leg pain
ØPain is aggravated by activity
ØThe Tibia may be tender when touched
ØCalf pain my be present
Femoral stress fracture
The Femur is the thigh bone and the largest bone in the body. Stress fractures can occur either in the mid-shaft of the bone, or at the neck of the femur, just below the hip joint.
ØA dull ache in the thigh
ØPoorly localised pain
ØPain may refer to the knee
ØPain may be exacerbated by sitting with the leg hanging over the edge of a bench/high chair, especially if a downward pressure is applied to the knee.
A stress fracture of the femoral neck may produce:
ØPain in the groin which comes on gradually
ØThe pain is poorly localised and aggravated by activity
ØPain at the extremes of hip joint motion
Stress fractures are overuse injuries. In runners, this usually means, running too far or for too long, too soon, with insufficient rest! It is one of the main reasons behind the 10% increase rule.
Other issues can also contribute to the development of a stress fracture. Usually these are biomechanical issues which place extra stress on the bone. For example, the 2nd metatarsal is most commonly fractured in people who overpronate, and Tibial fractures can be caused by a leg-length discrepancy.
Generally, the treatment of a stress fracture involves plenty of rest (usually 4 weeks of partial or non-weight bearing), correction of any biomechanical factors, followed by a very gradual return to activity. This should only commence when walking is pain free and bone tenderness has cleared. Non-impact exercise should be introduced initially (e.g. cycling/cross-training, swimming), followed by a gradual return to running.
There is one major exception to this rule. A stress fracture to the femoral neck can be on either the superior (tension) side, or the inferior (compression) side. Those to the superior aspect should be treated as an emergency, with either surgical fixation or complete bed rest. The reasoning for this, is that due to the tension on the upper surface, there is a possibility of the stress fracture developing into a full fracture, which would stop the blood supply to the head of the femur, leading to a possible avascular necrosis – bone death.
Stress fractures can be prevented by following these simple rules:
ØDon’t overtrain – increase mileage by no more than 10% per week.
ØGet a gait analysis to determine if you overpronate, oversupinate or have a neutral foot.
ØMake sure you are wearing the correct trainers for you
ØChange your trainers before they get worn out
ØDon’t run on hard surfaces (i.e. concrete) all the time
ØTry to mix it up and include grass, sand and tarmac running