Why Stress Fractures Are Common in Athletes

Hairline fractures in the bone might seem insignificant, but they can have tremendous impacts.

Often referred as stress fractures, they have ended careers (Yao Ming of the Houston Rockets), sidelined young players in their rookie season (Mo Bamba of the Orlando Magic), dashed Olympic hopes (British marathoner Paula Radcliffe), and forced Rumer Willis to bow out of Dancing with the Stars Live Tour.

Professional and amateur athletes put their bodies through intense training and repetitive movements in their efforts to master their craft. That dedication can get them to the top of their game, but that consistent stress can also create wear and tear of muscles, bones, tendons, and ligaments.

What Is a Stress Fracture?

A stress fracture is an overuse injury, which is often the result of increasing the amount or intensity of an activity too quickly, resulting in microscopic tears in the bone.

Intensifying your training to prepare for a big race or having more playing time in a basketball game are examples of what can create stress fractures, but there are other causes:

  • Improper equipment, such as running in worn shoes
  • Practicing incorrect technique
  • Changing the surface of your exercise, like going from an indoor track to outside on cement
  • Running on a sloped surface.
  • Doing repetitive activity in certain high-impact sports
  • Insufficient rest between workouts

Where Do Stress Fractures Occur?

The repetitive stress of the foot striking the ground in running and jumping makes athletes in tennis, gymnastics, track and field, and basketball particularly vulnerable to stress injuries. Stress fractures were first reported in the mid-1800s and were referred to as “march foot” because it was often noted in military recruits.

While most stress fractures occur in the weightbearing bones of the lower leg and the foot, they can occur in any bone. Baseball and tennis players are known to suffer stress fractures in their upper bodies.

What Are the Symptoms of a Stress Fracture?

Pain while engaging in activity is the most common complaint with a stress fracture. This pain may subside with rest. Other symptoms include:

  • Swelling around the injury
  • Tenderness when touching the bone
  • Pain that begins after starting an activity and then resolves with rest
  • Pain felt during the activity and does not go away afterward
  • Pain that is worse when shifting weight to one side

Stress Fractures in Youth and Nonathletes

Athletes are not the only ones going to the doctor with pain from stress fractures. Deconditioned nonathletes can experience the same type of injury after beginning an exercise regimen. Similarly, an uptick in cases was reported in people returning to activities and sports after COVID-19 quarantine mandates were lifted. Youth are not immune. Specializing in one sport and playing year-round without a break also increases the likelihood of stress fractures.

Other contributing factors include:

  • Poor diet with inadequate caloric intake for the activity level
  • Low vitamin D level
  • Older age
  • Underweight or overweight
  • Osteoporosis
  • Medications that weaken bones, such as medications for cancer, heartburn, and autoimmune diseases

Preventing Stress Fractures

The lists above of possible causes and contributing factors provide a great starting point for ways to proactively prevent stress fractures.

While there is no absolute guarantee against stress fractures, doing the following will help:

  • Set incremental goals when participating in a new athletic activity. For example, do not immediately set out to run five miles a day; instead, gradually build up your mileage on a weekly basis.
  • Cross-training is helpful. If you are a runner, incorporate rowing or another activity for cardio and add in strength and flexibility training.
  • Maintain a healthy diet that includes foods rich in calcium and vitamin D.
  • Use the proper equipment for the activity, including the right footwear.
  • If pain or swelling occurs, immediately stop the activity and rest for a few days.

Diagnosing Stress Fractures

Your doctor will first assess your risk factors for stress fractures. X-rays are commonly used to identify fractures, but some fractures are too small to show in an X-ray. In those cases, digital imaging such as CT (computed topography) scans or MRIs (magnetic resonance imaging) will be necessary.

Treating Stress Fractures

With proper treatment and rehabilitation, most stress fractures heal, and most people can resume normal activities. When caught early and with proper rest, these injuries heal in about six to eight weeks. Larger, more difficult to treat fractures can occur if precautions are not taken or if activity is resumed too quickly. A re-injury can lead to long-term problems and potentially never completely heal.

There are surgical and non-surgical protocols, depending on the fracture:

  • RICE. Rest (stop the activity), Ice (apply an ice pack for 10 to 20 minutes up to three times a day), Compression (wrap the area with an elastic bandage but not too tightly), and Elevation (lift the area, above heart level if possible, anytime you are sitting or lying).
  • Modify activities. Enjoy activity that put less stress on the injured area.
  • Protective footwear. Your doctor may prescribe that you wear special shoes or a brace.
  • Casting. Some stress fractures take longer to heal, so your doctor may suggest a cast to keep your bones in a secured position.
  • Surgery. If a stress fracture requires surgery, the surgeon may use pins, screws, or plates to hold the bones in place. This is called internal fixation.

The doctors at Orthopedic Specialists of SW Florida combine orthopedics and sports medicine to diagnose, treat, and rehabilitate your stress fracture. Our highly skilled staff aims to return you to your favorite activity and help prevent future injury.

Do not continue to live with pain. Call us at (239) 215-2008 or use our online form to schedule an appointment with one of our specialists.