What is a stress fracture?

One of the fun aspects of rehabilitation is the ability of our bodies, bones specifically, to adapt to the forces we place on them. Unfortunately, we can push our bodies too far, which can prevent our bones from adequately remodeling and adapting. A stress fracture results from the breakdown of bone cells without necessary remodeling which leads to a fracture. In most cases, point tenderness along a bone can be a good indicator of the stress reaction progressing towards a fracture. There are two general causes of a stress fracture. One occurs when the force placed on the bone changes faster than the bone can remodel. The other occurs when the bone has difficulty adapting to the stressors placed on it due to underlying conditions. An example of the first cause may occur in a person that increases his/her activity rapidly. This person may notice pain at the start of the activity that gradually gets worse and may eventually persist after the activity has ceased. These symptoms may progress to the point where they continue throughout the day and night. An example of the second cause may occur in a person who has or is at risk for, osteoporosis or another condition in which bones have trouble remodeling.

Where do stress fractures most often happen in the body?

Stress fractures from excessive activity usually occur in the lower body, specifically in the bones of the foot, lower leg, and hip, and may also occur in the back or pelvis. Though it is less common, bones in the upper body may also develop stress fractures. The most common occurrences of an upper-body stress fracture are in gymnasts, weight lifters, and throwing athletes. The location of a stress fracture typically occurs fracture is one where there is increased compressive load to the bone from impact to the ground or pulling from tendons. Stress fractures can occur more frequently and, in more locations when a person has an underlying medical condition.

What kind of common activities can cause stress fractures?

Repetitive impact or forces from training errors are common causes of stress fractures. Your body needs time to adapt, so if you begin to run or jump at a higher volume than your body is prepared for, your risk of developing a stress fracture may increase. An upper body stress fracture can occur from gymnastics, a high volume of throwing, or even from weightlifting if it is too frequent at a high intensity.

How can physical therapy help with recovery from a stress fracture?

A physical therapist will guide you through recovery in stages. Our first priority is to protect the affected area so your body can heal. The next progression is an active rest, where we will introduce cardiovascular, strengthening, and flexibility activities in a controlled, protected environment. Finally, we will show you safe ways to strengthen the area of healing, while gradually reintroducing more activities to help return you to the activities you enjoy. Please note: stress fractures often require an orthopedic consult to determine the severity before treatment begins.

How can physical therapy help prevent stress fractures from happening?

A physical therapist will help you understand physical habits that may increase your risk for stress fractures. Physical therapists can also determine strength and muscle imbalances, and flexibility deficits, and work with you to maximize your muscle control. A common notion indicates that as you fatigue, your muscles have difficulty controlling the position of your limbs, which may increase your risk for developing stress fractures. Physical therapists work with you to develop muscle control and endurance to decrease this risk.

What else can I do to prevent stress fractures? (Diet, exercise, medication, etc.)

There are many lifestyle habits that can contribute to the development of a stress fracture, including smoking, poor diet, a sedentary lifestyle, and more. Developing a well-balanced, healthy lifestyle should always be a goal, not only to prevent injury but to improve your quality of life. While physical therapy focuses mainly on the activity and progression of forces, other professionals may be recruited in conjunction with physical therapy to provide you with the best possible outcome for recovery and/or prevention of a stress fracture. By collaborating with multiple professionals, such as a counselor, dietician, family physician, physical therapist, etc., you create a team that is working with you, for you.