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Every week, Dr. Jean-Marc Sène, sports doctor, presents his sports column in Priorité Santé. This week, he tells us all about the stress fracture.
What is a stress fracture?
A stress fracture is a bone hypersolicitation or overtraining lesion which generally indicates overexertion. These fractures occur in athletes when a “healthy” bone is subjected to repeated and/or excessive pressure. The pressures to which it is subjected impose too rapid a rate of renewal on it: it therefore becomes fragile and ends up breaking.
Most of the time, fractures occur in the pelvis or lower limbs: tibia, knee, tarsal bones (foot bones), metatarsals (toe bones), femur, fibula (fibula).
In theory, the bones are able to adapt to the practice of physical activity: they reshape themselves regularly to be able to support the increase in the loads which weigh on them. This remodeling consists of resorption or destruction of bone tissue, followed by reconstruction.
In the case of a stress fracture, the intensity and/or regularity of physical activity increases too suddenly: the bones are subjected to an unusual force and no longer have time to remodel. This is why it is advisable to resume physical activity gradually.
Athletes who practice running and athletics are particularly exposed to it. Similarly, adults are more at risk, since the bones of children and adolescents are more elastic and their cartilage absorbs physical stress much better.
How to recognize a stress fracture?
Regardless of the location of the fracture, it is manifested by progressive pain. Initially, the pain occurs only at the beginning of the effort and ceases at the end of the sporting activity. The more you practice, the sooner the pain manifests itself: it becomes more and more intense, from the start of training, to the point of preventing activity. In some cases, it can even persist when the patient is not weight-bearing.
Edema may also form, or even a slight swelling warm to the touch.
Diagnosis is based on clinical examination, but must be confirmed with X-rays. However, these examinations are often useful only 2 to 3 weeks after the injury, because the micro-fractures can be almost invisible. The diagnosis is then made using X-rays only when the fractures have healed.
Earlier diagnosis is also possible using a bone scan or MRI.
How to treat a stress fracture?
The treatment of the stress fracture is mainly based on complete rest, in order to allow time for the bone to rebuild. Movement and pressure applied to the fractured area should be limited.
Healing can take up to 12 weeks. This can be difficult for great athletes, but it is the most effective solution for recovering properly and resuming physical activity without pain as soon as possible.
Using crutches or support shoes/boots can make recovery more bearable. A cast is sometimes necessary. And according to the patients, in rare cases, surgery may be considered.