Not All Stress Fractures are Created Equally

At Winning Health Sports Medicine, we frequently encounter stress fractures in our athletic patients. While not necessarily as dire as a full break, stress fractures can greatly impact an athlete’s physical abilities, and could even progress into a more serious injury over time. It’s important for athletes to understand stress fractures in order to care for them properly and avoid further injury.

What is a stress fracture? 

Think of stress fractures as  microfractures. When the body cannot keep up with and repair the demands placed on a bone, it develops a stress reaction and ultimately a stress fracture. If the process continues, the bone can go on to have a complete break -- or a fracture as we normally think of them. 

Stress Fracture Causes

One of the most common reasons we see stress fractures in our patients is overuse. From zealous athletes pounding the pavement without adequate rest to military recruits marching every day, the demands on the bone exceed the body’s ability to heal.

Another potential cause of stress fractures is that the body’s ability to heal cannot keep up with normal demands on the bone. In this instance, it’s not that the demands are excessive, it’s just that the body cannot do its day to day repair. Poor nutrition, side effects from medication, and certain diseases can all impact the healing process.

Part of the suspect body part depends on which body part is stressed. For example, the tibia (or shin bone) and the metatarsal bones in the forefoot are very common areas for runners to experience stress fractures. Gymnasts who are often weight bearing on their hands may get stress fractures in their forearms. Rowers tend to get them in their ribs.

Low Risk Vs. High Risk

Stress fractures can be “low risk” or “high risk.” Low risk stress fractures such as those in the middle toes frequently just need rest. Some stress fractures are high risk due to poor blood supply such as the navicular bone in the foot. These require more careful attention to ensure they heal well. Other stress fractures are considered high risk because they are under tension and have the potential to become a complete break.

Evaluation for stress fractures requires a careful evaluation from a sports medicine physician who will look not only at the body part but at the nutritional and medical aspects of the athlete to figure out why the fracture happened and determine the best course of treatment.