Stress Fractures and Rehab

Stress fracture is an umbrella term for ranging from periostitis (Inflammation of the periosteum covering your bones) to a complete stress fracture.

Stress fractures are a fairly common injury happening to long bones like your shin bone (Tibia) when they are repetitively loaded. They are often seen in running and jumping athletes and happen after an increase in either training volume or intensity.

Stress fractures are either a partial or complete fracture of a bone due to sub-maximal loading. The fracture is not due to the loading alone, but they occur when the loading is repetitive with inadequate recovery. 

One of the most common forms of an early stress injury is medial tibial stress syndrome, otherwise known as shin splints. Repeated loading after first feeling shin splints can eventually lead to a stress fracture in the shins. Non weight bearing limbs are most often affected but stress fractures in the elbow can also happen.

Factors including your risk of stress fractures include:

• Low bone density
• Females are at higher risk
• Having a previous stress fracture
• Low BMI
• Thyroid dysfunction

A stress fracture typically presents with pain that usually gets better after rest. Pain usually gets worse when continuing the activity that caused the initial pain and there may be some swelling in the affected area.

Treatment

The first stages of treatment of a stress fracture would be pain management, decreased weight bearing on the affected side and activity modification. This means stopping the aggravating activity and substituting it with things like cycling or swimming where there is no impact but you are still able to maintain your fitness. 

Return to activity needs to be gradual and constantly monitored for pain. Strengthening the muscles around the affected area can help. Exercises for tibial stress fractures include:

• Controlled calf raises 
• Toe taps
• Heel toe walking

All exercises should be pain free and should not get worse after exercise. If pain returns, change the activity once again by decreasing load and amount of impact. Other prevention techniques include:

• Using the proper footwear for the activity you are doing
• Don’t increase your exercise intensity too fast. Increases of 5-10% per week is a good increase in volume.
• Make sure you warm up properly

The basic treatments for stress fractures are basically pain management, avoiding the aggravating activity and rest.