As soon as doctors and scientists did not name a stress fracture: fatigue, creeping, chronic, pseudo-fracture, marching foot tumor, and even pathological bone rearrangement, etc. Today, most often they talk about a stress fracture — a frequent problem of athletes, both professionals and amateurs. Given the influx of people who want to play sports and set personal bests in videos and texts from the Internet, we can expect that the proportion of patients with stress fractures will only grow in the coming years.
MedAboutMe found out what it is, who is at risk, and how to recognize the problem.
From military personnel to athletes
For the first time, military doctors started talking about a stress fracture — in 1855, the Prussian military doctor Breithaupt described a mass phenomenon in Prussian soldiers during long marches — swelling of the foot. In 1897, with the help of X-rays, it was possible to confirm that we are talking about bone damage.
Times have changed, but the military continued to deal with stress fractures, which is not surprising. In 1932, German military doctors reported that during the First World War, from 10 to 16 thousand soldiers of the German army suffered from stress fractures. Doctors noted the “battery”, mass nature of this disease. In India, where there were practically no mechanized means of transportation for the army, there were outbreaks of fatigue fractures, even to the point that specialized hospitals had to be opened. Today, thanks to mechanization, the proportion of fatigue fractures is decreasing.
And the military was replaced by athletes and ballet dancers. Now they are gradually becoming the leading risk group for stress fractures. The first reports of sports fatigue fractures date back to the late 1980s: American adolescent athletes who were engaged in an enhanced program showed signs of stress fractures, which were later confirmed using the scintigraphy method.
What is a fatigue fracture?
Based on the above, we can already guess that the cause of a stress fracture is stress: first, excessive, so-called submaximal — on the verge of possible, and secondly, long-term.
Bone tissue is constantly destroyed (the process of bone resorption) and formed anew. If the process of destruction due to mechanical fatigue of bone tissue begins to prevail, the prerequisites for a stress fracture are created.
First, a microscopic crack is formed. If you don’t start treating it in time, or at least don’t allow the bone tissue to recover on its own, it begins to gradually increase in size — and sooner or later a full-fledged bone fracture develops.
What, in addition to excessive long-term loads, contributes to the development of stress fractures? Anything that somehow weakens bone tissue, makes it more fragile, that is, shifts the balance between its formation and destruction in the direction of the latter.
These include taking nonsteroidal anti-inflammatory drugs (NSAIDs), osteoporosis, hormonal disorders, radiation exposure, sleep deprivation, impaired collagen production, and even nutrition. Other risk factors include age, quality of athletic shoes, gender, and anatomical features.
Stress fracture: features of trauma
A fatigue fracture is different from the usual image of a broken bone. Because of this, errors in the diagnosis of stress fractures used to reach 96-100%! Why did this happen? To study stress fractures in the armies of Great Britain and Israel, specialized centers were even created. Experts of these centers speak about three main features of this group of injuries:
The peculiarity of such a fracture is that it is not visible in the early stages. There are already clinical manifestations, but there is nothing on the X-ray — doctors talk about the X-ray negative period of the disease.
Another important point: a stress fracture does not occur as a result of a single short-term traumatic event that would lead to a fracture. It develops gradually, under the influence of chronic stress, and the nature and extent of damage depends on the degree of its intensity.
Common fractures in different parts of the body can manifest differently, and the symptoms of stress fractures are identical, regardless of their location.
Errors in the diagnosis of stress fractures can be avoided if highly sensitive methods using radionuclides are used. In the late 1980s, the results of an American study were published, during which a stress fracture was detected in this way in 31% of almost 300 infantry recruits. And not all of them could be seen on the X-ray. Today, MRI is used for diagnosis.
Which bones are particularly affected by stress fractures?
Most often, fatigue fractures affect the bones of the lower extremities. Among them, the leaders are the long tubular bones of the lower leg (50% of all stress fractures occur in the tibia) and the metatarsal bones of the foot (especially the 2nd metatarsal bone). Less commonly, these are the ribs, pelvic bones, thighs, and calcaneus.
But depending on what kind of sport a person is engaged in (or what kind of activity), the frequency of different locations of stress fractures can vary. So, ballet dancers have a leading fracture of the posterior process of the talus; skiers have long tubular bones; gymnasts and female rowers, as well as baseball players, often break their ribs “from fatigue”; tennis players, boxers and hammer throwers have their own specifics: a stress fracture of the ulnar process.
Finally, this type of fracture has gender characteristics: women, according to various sources, are 1.5-12 times more prone to such injuries, and they are more likely to have bilateral symmetrical lesions.
According to sports doctors, female athletes often have a dangerous triad: osteoporosis, amenorrhea, and nutritional problems. This puts them at an increased risk of developing stress fractures. It also includes men with low testosterone levels who engage in sports that require high levels of endurance.
How to recognize a stress fracture?
Given the growing popularity of healthy lifestyle and fitness of all stripes among the population, you should know the main symptoms that can indicate a stress fracture. You should not think that this is a problem only for professional athletes, ballet dancers or marching military personnel. With a certain combination of risk factors, you can get a fatigue fracture just by regularly going to the gym.
First of all, it’s a pain. At first, the pain is felt only during activity, but over time it becomes constant, up to pain at rest and even during sleep. In the affected area, there may be a slight swelling, slight redness. You can feel the pain point with your finger. An important marker is significant physical prolonged overexertion shortly before the first symptoms appear.
If we are talking about the lower limbs, then you need to pay attention to the length of the person’s legs — they will differ from each other. Leaning on one of the legs will cause pain. Doctors in this case talk about antalgic gait — a slight limp, which is associated with an instinctive desire to reduce pain when moving. For yourself, this gait can be traced by varying degrees of wear on the sole, as well as by feelings of body skew, excessive movement of the body and accumulated stiffness of movements.
Features of treatment of stress fractures
Some bones (talus, scaphoid, sesamoid bones of the big toe, etc.) are considered areas of high risk of injury progression to a full-fledged traumatic fracture, so stress fractures in these areas are often treated with surgery. If the bone is well supplied with blood, conservative treatment is usually prescribed.
This unusual fracture develops “in its own” way and is also treated differently than we are used to-plaster and immobility for a long time. Plaster immobilization and anti-inflammatory drugs impair the blood supply to the area of injury and significantly slow down the healing process. Therefore, the main methods of treating stress fractures are swimming pools and physical therapy. Naturally, the loads that caused the fracture are canceled for 4-8 weeks.
In any case, if you suspect a stress fracture, you should consult a doctor. Self-treatment is unacceptable, since with incorrect diagnosis and incorrect choice of treatment method, there is a risk of deterioration of the situation, the development of a full-fledged fracture. And this means long-term treatment and long-term rehabilitation.