What causes stress fractures in the shin. How are stress fractures diagnosed. What are the treatment options for shin stress fractures. What are the symptoms of a stress fracture in the shin. How can shin stress fractures be prevented.

Understanding Stress Fractures: From Reaction to Fracture

Stress fractures are a common overuse injury, particularly in athletes and active individuals. They develop when bones are subjected to repetitive force or impact without adequate time for recovery and remodeling. Understanding the progression from stress reaction to stress fracture is crucial for early intervention and proper management.

What is a stress reaction?

A stress reaction can be considered a precursor to a stress fracture. It’s similar to a deep bone bruise, resulting from trauma or overuse. At this stage, the bone is weakened but hasn’t yet developed a visible crack. If left untreated, a stress reaction can progress to a stress fracture.

What is a stress fracture?

A stress fracture is a small crack in the bone that develops due to repetitive trauma or overuse. It’s a more severe progression of a stress reaction. Stress fractures account for a significant portion of sports-related injuries, with some estimates suggesting they make up nearly 50% of all sports injuries.

Common Sites of Stress Fractures: Focus on the Shin

While stress fractures can occur in various bones throughout the body, they are most commonly found in the lower extremities due to the impact and weight-bearing nature of many activities. The shin bone, or tibia, is particularly susceptible to stress fractures.

How common are tibial stress fractures?

The tibia accounts for a significant proportion of all stress fractures, with estimates ranging from 20% to 75%. This high prevalence is often associated with running-related injuries. Other common sites for stress fractures include:

• Metatarsal bones in the foot (especially the second and third metatarsals)
• Calcaneus (heel bone)
• Proximal femur (hip)
• Lower back vertebrae

Risk Factors for Shin Stress Fractures

Understanding the risk factors for stress fractures is essential for prevention and early intervention. These factors can be broadly categorized into extrinsic (environmental) and intrinsic (individual-specific) factors.

Extrinsic Risk Factors

External factors that can contribute to the development of stress fractures include:

• Improper training techniques or rapid increases in training volume
• Sudden changes in exercise surface (e.g., transitioning from soft to hard surfaces)
• Running on uneven or sloped surfaces
• Inadequate or worn-out footwear
• Participation in high-impact sports (e.g., long-distance running, basketball, gymnastics)
• Poor nutrition and inadequate caloric intake
• Low vitamin D levels
• Early sports specialization without adequate rest periods

Intrinsic Risk Factors

Individual-specific factors that may increase the risk of stress fractures include:

• Age (older athletes may have underlying bone density issues)
• Weight (both underweight and overweight individuals may be at higher risk)
• Foot anatomy and biomechanical issues
• Muscle weakness or imbalances
• Sex (females with irregular menstrual cycles may be at higher risk)
• Medical conditions affecting bone strength (e.g., osteoporosis)

Recognizing the Symptoms of Shin Stress Fractures

Early recognition of stress fracture symptoms is crucial for prompt treatment and prevention of further damage. The symptoms of a stress fracture in the shin can vary in intensity and may develop gradually over time.

What are the common symptoms of a shin stress fracture?

Typical symptoms include:

• Localized pain, swelling, or aching in the shin area
• Tenderness or “pinpoint pain” when the affected area is touched
• Pain that begins during activity and subsides with rest
• Persistent pain that continues after activity has ended
• Pain during normal daily activities or even at rest
• Increased pain when hopping on the affected leg
• Inability to bear weight on the affected limb

It’s important to note that if left untreated, the pain associated with a stress fracture can become severe. Additionally, there’s a risk that the fracture may become displaced, meaning the fractured bone moves out of its normal alignment. This is particularly concerning for certain high-risk stress fractures, such as those in the hip, which may require surgical intervention if not identified early.

Diagnostic Approaches for Shin Stress Fractures

Accurate diagnosis of stress fractures is essential for appropriate treatment and management. Healthcare providers may employ various diagnostic techniques to confirm the presence and severity of a stress fracture.

What diagnostic methods are used for shin stress fractures?

Common diagnostic approaches include:

1. Physical examination: The healthcare provider will conduct a thorough physical exam and discuss risk factors for stress fractures.
2. Medical history: A detailed medical history helps identify potential contributing factors and patterns of symptoms.
3. Imaging studies: Various imaging techniques may be used, including:
   • X-rays: While not always effective for early detection, x-rays may show evidence of stress fractures in later stages.
   • Bone scans: These can detect stress fractures earlier than x-rays but lack specificity.
   • MRI (Magnetic Resonance Imaging): Considered the gold standard for diagnosing stress fractures, MRI can detect both stress reactions and fractures with high sensitivity.
   • CT (Computed Tomography) scans: These may be used in certain cases to provide detailed bone imaging.

Treatment Strategies for Shin Stress Fractures

The treatment of shin stress fractures aims to promote healing, reduce pain, and prevent future injuries. The specific approach will depend on the severity of the fracture and individual patient factors.

What are the primary treatment options for shin stress fractures?

Treatment strategies typically include:

1. Rest and activity modification: Reducing or eliminating weight-bearing activities is crucial for allowing the bone to heal.
2. Pain management: Over-the-counter pain medications may be recommended to alleviate discomfort.
3. Ice therapy: Applying ice to the affected area can help reduce inflammation and pain.
4. Protective footwear: Special shoes or braces may be used to reduce stress on the injured area.
5. Physical therapy: Once healing has progressed, physical therapy can help restore strength and flexibility.
6. Nutritional support: Ensuring adequate calcium and vitamin D intake can support bone healing.
7. Gradual return to activity: A carefully planned program to reintroduce weight-bearing activities.

In rare cases, particularly for high-risk stress fractures or those that don’t respond to conservative treatment, surgical intervention may be necessary.

Prevention Strategies for Shin Stress Fractures

Preventing shin stress fractures involves addressing both extrinsic and intrinsic risk factors. By implementing appropriate preventive measures, individuals can significantly reduce their risk of developing these injuries.

How can shin stress fractures be prevented?

Key prevention strategies include:

• Proper training techniques: Gradually increase training intensity and volume to allow for bone adaptation.
• Appropriate footwear: Wear well-fitting shoes with adequate support and cushioning, replacing them regularly.
• Cross-training: Incorporate low-impact activities to reduce repetitive stress on the shins.
• Nutrition: Maintain a balanced diet rich in calcium and vitamin D to support bone health.
• Rest and recovery: Allow for adequate rest between training sessions and incorporate rest days into training schedules.
• Biomechanical assessment: Address any underlying biomechanical issues or muscle imbalances that may contribute to stress fractures.
• Surface consideration: Vary training surfaces and avoid sudden transitions from soft to hard surfaces.
• Listen to your body: Pay attention to early warning signs and avoid pushing through pain.

Long-Term Outlook and Return to Activity

The prognosis for shin stress fractures is generally good with appropriate treatment and management. However, the timeline for recovery and return to activity can vary depending on the severity of the injury and individual factors.

What is the typical recovery timeline for a shin stress fracture?

Recovery times can range from 4 to 12 weeks, with some cases requiring longer periods of rest and rehabilitation. A gradual return to activity is crucial to prevent re-injury and ensure complete healing. This process typically involves:

1. Initial rest and pain management
2. Progressive weight-bearing as tolerated
3. Low-impact activities and strength training
4. Sport-specific exercises and drills
5. Gradual return to full activity levels

Throughout the recovery process, it’s essential to work closely with healthcare providers and follow their guidance to ensure a safe and effective return to activity.

Conclusion: Navigating Shin Stress Fractures with Knowledge and Care

Shin stress fractures, while common among athletes and active individuals, can be effectively managed and prevented with proper understanding and care. By recognizing the risk factors, symptoms, and appropriate treatment strategies, individuals can take proactive steps to protect their bone health and maintain their active lifestyles. Remember, early intervention is key in managing stress fractures, so don’t hesitate to seek medical attention if you suspect you may be developing this condition. With the right approach, most people can fully recover from shin stress fractures and return to their desired activities safely and confidently.

Causes, Symptoms, Tests & Treatment

Overview

The bones of the foot.

What is a stress reaction or stress fracture?

A stress reaction can be considered similar to a deep bone bruise, which arises from trauma or overuse. Stress injuries can be classified on a spectrum upon diagnosis: early (stress reaction) or late (stress fracture). A stress reaction that goes untreated will develop into a stress fracture. In a stress fracture, a small crack develops from repetitive trauma, which is usually caused by overuse. Overuse injuries account for almost 50% of all sports injuries.

Where do stress fractures happen?

Stress fractures can occur anywhere there is overuse, but they’re most commonly found in the lower extremity as a result of impact and weight bearing activities. The most common bone is the shin bone or tibia (20% to 75% of all stress fractures — often running injuries). Stress fractures can also occur in the foot. The foot is made up of several small bones. The bones running to the toes are called metatarsals. There are five metatarsals in each foot. It is most common for a stress fracture to happen in the second and third metatarsals. Stress fractures can also be seen in the heel (calcaneus), hip (proximal femur) and even the lower back.

Symptoms and Causes

What causes a stress fracture?

Risk factors for stress fractures can be divided into two basic categories: extrinsic and intrinsic.

Extrinsic factors happen outside of the body. These can also be called environmental (nature) factors. These factors can include:

• Practicing incorrect training or sport technique.
• Having too rapid of a training program or volume of activity or changing your activity level without a gradual break-in period.
• Changing the surface you exercise on, such as going from a soft surface (like an indoor track) to outside on gravel or concrete.
• Running on a track or road with sloped surface.
• Using poor equipment or improper footwear (shoes that are too worn out, too flimsy or too stiff).
• Doing repetitive activity in certain high-impact sports, such as:
  • Long-distance running (tibia, hip).
  • Basketball.
  • Tennis.
  • Track and field.
  • Gymnastics (wrist stress fractures from weight bearing on hands/wrists, low back).
  • Dance (feet, low back).
• Having a poor diet that has inadequate caloric intake for volume of sport.
• Having a low vitamin D level.
• Experiencing early specialization in sports. Youth who play one sport year-round without a break are at risk of stress fractures.

Intrinsic factors are things that are related to the athlete or patient and aren’t impacted by outside forces. These factors can include:

• Age: Older athletes may have underlying bone density issues such as osteoporosis. Already weakened bone will develop a stress reaction and/or fracture sooner than healthy bone.
• Weight: Both ends of the spectrum seem to be at risk for stress injuries. Someone with a low BMI or underweight individual may have weakened bones and someone with a high BMI doing repetitive loading with their body weight would also be at risk for injuries.
• Anatomy: Foot problems can affect the way the foot strikes the ground. These foot problems can include bunions, blisters, tendonitis, and low or high arches. Muscle weakness, imbalances or lack of flexibility can also be a factor.
• Sex: Females may be at risk if they have irregular menstrual periods or no periods.
• Medical conditions: Osteoporosis or other diseases that weaken bone strength and density (thickness). The weak or soft bones may not be able to handle the changes in activity.

What are the symptoms of a stress fracture?

The symptoms of a stress fracture can include:

• Pain, swelling or aching at the site of fracture.
• Tenderness or “pinpoint pain” when touched on the bone.
• Pain that begins after starting an activity and then resolves with rest.
• Pain that’s present throughout the activity and does not go away after the activity has ended.
• Pain which occurs while at rest, during normal activity or with everyday walking.
• Pain which is worse with hopping on one leg or an inability to shift weight/hop on affected leg/foot.

If a stress fracture is not treated at an early stage (stress reaction), the pain can become severe. There is also a risk that the fracture may become displaced (the fractured bone moves out of normal alignment). Certain stress fractures (hip) are considered “high risk” stress fractures because they may have a poor outcome (such as needing surgery) if not identified early.

Diagnosis and Tests

How is a stress fracture diagnosed?

Your doctor may need to do several tests to see if you have a stress fracture and the severity of the fracture. These tests can include:

• Physical examination: During your first visit, your doctor will do a physical exam and discuss your risk factors for developing a stress fracture. When discussing risk factors, you will be asked about:
  • Your medical history.
  • Your work.
  • Your activities.
  • Any medications you might be taking.
• X-Rays: Your doctor may order an X-Ray to look for a fracture. However, a stress fracture can be difficult to see on an X-Ray because the bone often appears normal and the small cracks can’t be seen on the image. X-rays actually miss about ⅔ of stress fractures. X-Rays may not help diagnose a stress fracture unless it has started to heal. When the bone starts to heal, it creates a callus, or lump, that can be seen on X-Rays. With a high index of suspicion for a stress fracture, your doctor may recommend an imaging test that is more sensitive than an X-Ray and will pick up a stress reaction even before it may become a stress fracture. These tests can include:
  • Magnetic resonance imaging (MRI).
  • Bone Scan.
• Bone scan: A bone scan may be used to see stress fractures that cannot be seen on an X-Ray. During a bone scan, a tracer (a radioactive substance) is injected into your bloodstream. The tracer collects in the bone and settles in the areas where the bone is being repaired. The area that is affected by a stress fracture will appear darker on the bone scan that an uninjured area.
• Magnetic resonance imaging (MRI): When your doctor needs very detailed images of the injury, an MRI may be used. Magnetic resonance imaging (MRI) is a test that uses a large magnet, radio waves and a computer to produce very clear images of the human body. An MRI is preferred in many cases because:
  • There is no radiation exposure.
  • It takes less time than other imaging tests.
  • It is better at diagnosing different types of bone and or soft tissue problem.

Management and Treatment

Do I need to treat a stress fracture?

Yes, you need to treat a stress fracture. If you think you have a stress fracture, the first thing to do is rest. Stop any activities which may be contributing to the injury. Schedule an appointment and see your doctor. It’s important to follow the treatment guidelines he or she gives you to prevent further injury.

If a stress fracture is not treated, the fracture may get worse. It can heal improperly, lead to arthritis or may even need surgery. Definitely do not ignore the pain. Ignoring the pain can lead to serious problems in the future, so it is important to see your doctor when you start feeling the pain.

If you have an underlying medical condition like diabetes or neuropathy, it is very important to see your doctor if you are experiencing any pain with your legs, ankles or feet.

How is a stress fracture treated?

Stress fractures are treated in several ways. Your doctor will discuss your options based on the location and severity of your fracture. Also, your provider will aim to treat any risk factors you have for future injuries.

Treatments your doctor may recommend can include:

• Stopping the activity that is causing pain. Stress fractures happen because of repetitive stress and overuse, so it’s important to avoid the activity that led to the fracture.
• Applying an ice pack (10 minutes) or ice massage (ice cube rub for three to five minutes) to the injured area.
• Resting for roughly two to eight weeks.
• Cross training by doing non-impact exercise (like a using a pool or bike) after discussion with your doctor may be allowed. Eventually, once you can perform low-impact activities for extended periods without pain, you can start doing high-impact exercises. Often, physical therapy can be very helpful in returning to activities and making adjustments to avoid reinjury.
• Adjusting your position if there is swelling in your leg, ankle or foot. You can lessen the swelling by elevating your leg — raising your foot above the level of your heart — while you’re lying on your back.
• Taking nonsteroidal anti-inflammatory medicines to help relieve pain and swelling.
• Using protective footwear to reduce stress on your foot or leg. This may be stiff-soled shoe, a wooden-soled sandal, or a post-op shoe which has a rigid sole.
• Using crutches to keep weight off your foot or leg until the bone heals.

Will I need a cast if I have a stress fracture?

Your doctor may need to put a cast or fracture boot on your foot to keep the bones in a fixed position. Using a cast or boot help remove the stress on the leg and promote healing.

Do you ever need surgery for a stress fracture?

Some stress fractures need surgery to heal properly. This is called internal fixation. Depending on the location of fracture, the surgeon may use pins, screws or metal plates.

How should I modify my activities when recovering from a stress fracture?

When you are recovering from a stress fracture, it is important to follow your doctor’s instructions. Ignoring your recovery plan and returning to your full activities too quickly can lead to more severe injuries in the future. There are two things to remember when you are starting to exercise again:

• Take it slowly.
• Introduce activities that place less stress on the injury.

During the early phase of healing, the doctor may recommend that you change your schedule so that you rest one day, do an activity the next day and then rest the next day. An example of this schedule is:

• Rest one day.
• Do an activity the next day.
• Rest the next day.

Alternating your activity and rest days allow your body to ease back into fitness. You should slowly increase how often and how vigorously you exercise. If the activity that caused the stress fracture is started too quickly, you may develop a larger fracture that is harder to heal. If you re-injure the bone, it can lead to long-term problems, and the stress fracture might never heal properly.

Prevention

How can a stress fracture be prevented?

These steps can help prevent a stress fracture:

• Once you feel pain, stop exercising. Only return to exercise if you are pain-free.
• See your doctor as soon as possible if you have a persistent area of concern or discomfort.
• Use the correct sports equipment.
• Wear the proper running shoes. Running shoes should be replaced every 300 miles.
• Add new physical activities (for example, switch running with swimming).
• Start new sports activities slowly and gradually increase the time, speed and distance.
  • When restarting a sport or activity, reduce your intensity by 50%. Follow the 10% rule — no increases of more than 10% per week.
• Make sure to properly warm up and cool down before activities.
• Practice strength training to help prevent early muscle fatigue, and to help prevent the loss of bone density that comes with aging.
• Follow a healthy diet full of calcium and vitamin D foods that will keep your bones strong. A sports nutritionist can be helpful if you are extremely active and have a history of stress fractures.
• If you decide to increase your activity level, ask your doctor for a recommendation of how much to add and when to add it.
• Optimize your bone health. If you have a known history of osteopenia or osteoporosis, discuss with your doctor how to medically manage these conditions. For an active person, treatment is best before an injury occurs. A stress fracture with a weak bone is harder to heal.
• If pain or swelling returns, stop the activity and rest for a few days. If pain continues, see your doctor.
• Check with your doctor before starting an exercise program or before taking a job that will involve a higher level of physical activity than you are used to.
• Follow all the rules your doctor gives you.

Outlook / Prognosis

How long does it take to recover from a stress fracture?

As long as you can feel pain, the bone is still fragile in that area, and could break again in the same place. It takes roughly six to eight weeks for a stress fracture to heal, so it is important to stop the activities that caused the stress fracture. Always ask your doctor before you fully return back to exercise to make sure the area is healed and you are ready to go.

Causes, Symptoms, Tests & Treatment

Overview

The bones of the foot.

What is a stress reaction or stress fracture?

A stress reaction can be considered similar to a deep bone bruise, which arises from trauma or overuse. Stress injuries can be classified on a spectrum upon diagnosis: early (stress reaction) or late (stress fracture). A stress reaction that goes untreated will develop into a stress fracture. In a stress fracture, a small crack develops from repetitive trauma, which is usually caused by overuse. Overuse injuries account for almost 50% of all sports injuries.

Where do stress fractures happen?

Stress fractures can occur anywhere there is overuse, but they’re most commonly found in the lower extremity as a result of impact and weight bearing activities. The most common bone is the shin bone or tibia (20% to 75% of all stress fractures — often running injuries). Stress fractures can also occur in the foot. The foot is made up of several small bones. The bones running to the toes are called metatarsals. There are five metatarsals in each foot. It is most common for a stress fracture to happen in the second and third metatarsals. Stress fractures can also be seen in the heel (calcaneus), hip (proximal femur) and even the lower back.

Symptoms and Causes

What causes a stress fracture?

Risk factors for stress fractures can be divided into two basic categories: extrinsic and intrinsic.

Extrinsic factors happen outside of the body. These can also be called environmental (nature) factors. These factors can include:

• Practicing incorrect training or sport technique.
• Having too rapid of a training program or volume of activity or changing your activity level without a gradual break-in period.
• Changing the surface you exercise on, such as going from a soft surface (like an indoor track) to outside on gravel or concrete.
• Running on a track or road with sloped surface.
• Using poor equipment or improper footwear (shoes that are too worn out, too flimsy or too stiff).
• Doing repetitive activity in certain high-impact sports, such as:
  • Long-distance running (tibia, hip).
  • Basketball.
  • Tennis.
  • Track and field.
  • Gymnastics (wrist stress fractures from weight bearing on hands/wrists, low back).
  • Dance (feet, low back).
• Having a poor diet that has inadequate caloric intake for volume of sport.
• Having a low vitamin D level.
• Experiencing early specialization in sports. Youth who play one sport year-round without a break are at risk of stress fractures.

Intrinsic factors are things that are related to the athlete or patient and aren’t impacted by outside forces. These factors can include:

• Age: Older athletes may have underlying bone density issues such as osteoporosis. Already weakened bone will develop a stress reaction and/or fracture sooner than healthy bone.
• Weight: Both ends of the spectrum seem to be at risk for stress injuries. Someone with a low BMI or underweight individual may have weakened bones and someone with a high BMI doing repetitive loading with their body weight would also be at risk for injuries.
• Anatomy: Foot problems can affect the way the foot strikes the ground. These foot problems can include bunions, blisters, tendonitis, and low or high arches. Muscle weakness, imbalances or lack of flexibility can also be a factor.
• Sex: Females may be at risk if they have irregular menstrual periods or no periods.
• Medical conditions: Osteoporosis or other diseases that weaken bone strength and density (thickness). The weak or soft bones may not be able to handle the changes in activity.

What are the symptoms of a stress fracture?

The symptoms of a stress fracture can include:

• Pain, swelling or aching at the site of fracture.
• Tenderness or “pinpoint pain” when touched on the bone.
• Pain that begins after starting an activity and then resolves with rest.
• Pain that’s present throughout the activity and does not go away after the activity has ended.
• Pain which occurs while at rest, during normal activity or with everyday walking.
• Pain which is worse with hopping on one leg or an inability to shift weight/hop on affected leg/foot.

If a stress fracture is not treated at an early stage (stress reaction), the pain can become severe. There is also a risk that the fracture may become displaced (the fractured bone moves out of normal alignment). Certain stress fractures (hip) are considered “high risk” stress fractures because they may have a poor outcome (such as needing surgery) if not identified early.

Diagnosis and Tests

How is a stress fracture diagnosed?

Your doctor may need to do several tests to see if you have a stress fracture and the severity of the fracture. These tests can include:

• Physical examination: During your first visit, your doctor will do a physical exam and discuss your risk factors for developing a stress fracture. When discussing risk factors, you will be asked about:
  • Your medical history.
  • Your work.
  • Your activities.
  • Any medications you might be taking.
• X-Rays: Your doctor may order an X-Ray to look for a fracture. However, a stress fracture can be difficult to see on an X-Ray because the bone often appears normal and the small cracks can’t be seen on the image. X-rays actually miss about ⅔ of stress fractures. X-Rays may not help diagnose a stress fracture unless it has started to heal. When the bone starts to heal, it creates a callus, or lump, that can be seen on X-Rays. With a high index of suspicion for a stress fracture, your doctor may recommend an imaging test that is more sensitive than an X-Ray and will pick up a stress reaction even before it may become a stress fracture. These tests can include:
  • Magnetic resonance imaging (MRI).
  • Bone Scan.
• Bone scan: A bone scan may be used to see stress fractures that cannot be seen on an X-Ray. During a bone scan, a tracer (a radioactive substance) is injected into your bloodstream. The tracer collects in the bone and settles in the areas where the bone is being repaired. The area that is affected by a stress fracture will appear darker on the bone scan that an uninjured area.
• Magnetic resonance imaging (MRI): When your doctor needs very detailed images of the injury, an MRI may be used. Magnetic resonance imaging (MRI) is a test that uses a large magnet, radio waves and a computer to produce very clear images of the human body. An MRI is preferred in many cases because:
  • There is no radiation exposure.
  • It takes less time than other imaging tests.
  • It is better at diagnosing different types of bone and or soft tissue problem.

Management and Treatment

Do I need to treat a stress fracture?

Yes, you need to treat a stress fracture. If you think you have a stress fracture, the first thing to do is rest. Stop any activities which may be contributing to the injury. Schedule an appointment and see your doctor. It’s important to follow the treatment guidelines he or she gives you to prevent further injury.

If a stress fracture is not treated, the fracture may get worse. It can heal improperly, lead to arthritis or may even need surgery. Definitely do not ignore the pain. Ignoring the pain can lead to serious problems in the future, so it is important to see your doctor when you start feeling the pain.

If you have an underlying medical condition like diabetes or neuropathy, it is very important to see your doctor if you are experiencing any pain with your legs, ankles or feet.

How is a stress fracture treated?

Stress fractures are treated in several ways. Your doctor will discuss your options based on the location and severity of your fracture. Also, your provider will aim to treat any risk factors you have for future injuries.

Treatments your doctor may recommend can include:

• Stopping the activity that is causing pain. Stress fractures happen because of repetitive stress and overuse, so it’s important to avoid the activity that led to the fracture.
• Applying an ice pack (10 minutes) or ice massage (ice cube rub for three to five minutes) to the injured area.
• Resting for roughly two to eight weeks.
• Cross training by doing non-impact exercise (like a using a pool or bike) after discussion with your doctor may be allowed. Eventually, once you can perform low-impact activities for extended periods without pain, you can start doing high-impact exercises. Often, physical therapy can be very helpful in returning to activities and making adjustments to avoid reinjury.
• Adjusting your position if there is swelling in your leg, ankle or foot. You can lessen the swelling by elevating your leg — raising your foot above the level of your heart — while you’re lying on your back.
• Taking nonsteroidal anti-inflammatory medicines to help relieve pain and swelling.
• Using protective footwear to reduce stress on your foot or leg. This may be stiff-soled shoe, a wooden-soled sandal, or a post-op shoe which has a rigid sole.
• Using crutches to keep weight off your foot or leg until the bone heals.

Will I need a cast if I have a stress fracture?

Your doctor may need to put a cast or fracture boot on your foot to keep the bones in a fixed position. Using a cast or boot help remove the stress on the leg and promote healing.

Do you ever need surgery for a stress fracture?

Some stress fractures need surgery to heal properly. This is called internal fixation. Depending on the location of fracture, the surgeon may use pins, screws or metal plates.

How should I modify my activities when recovering from a stress fracture?

When you are recovering from a stress fracture, it is important to follow your doctor’s instructions. Ignoring your recovery plan and returning to your full activities too quickly can lead to more severe injuries in the future. There are two things to remember when you are starting to exercise again:

• Take it slowly.
• Introduce activities that place less stress on the injury.

During the early phase of healing, the doctor may recommend that you change your schedule so that you rest one day, do an activity the next day and then rest the next day. An example of this schedule is:

• Rest one day.
• Do an activity the next day.
• Rest the next day.

Alternating your activity and rest days allow your body to ease back into fitness. You should slowly increase how often and how vigorously you exercise. If the activity that caused the stress fracture is started too quickly, you may develop a larger fracture that is harder to heal. If you re-injure the bone, it can lead to long-term problems, and the stress fracture might never heal properly.

Prevention

How can a stress fracture be prevented?

These steps can help prevent a stress fracture:

• Once you feel pain, stop exercising. Only return to exercise if you are pain-free.
• See your doctor as soon as possible if you have a persistent area of concern or discomfort.
• Use the correct sports equipment.
• Wear the proper running shoes. Running shoes should be replaced every 300 miles.
• Add new physical activities (for example, switch running with swimming).
• Start new sports activities slowly and gradually increase the time, speed and distance.
  • When restarting a sport or activity, reduce your intensity by 50%. Follow the 10% rule — no increases of more than 10% per week.
• Make sure to properly warm up and cool down before activities.
• Practice strength training to help prevent early muscle fatigue, and to help prevent the loss of bone density that comes with aging.
• Follow a healthy diet full of calcium and vitamin D foods that will keep your bones strong. A sports nutritionist can be helpful if you are extremely active and have a history of stress fractures.
• If you decide to increase your activity level, ask your doctor for a recommendation of how much to add and when to add it.
• Optimize your bone health. If you have a known history of osteopenia or osteoporosis, discuss with your doctor how to medically manage these conditions. For an active person, treatment is best before an injury occurs. A stress fracture with a weak bone is harder to heal.
• If pain or swelling returns, stop the activity and rest for a few days. If pain continues, see your doctor.
• Check with your doctor before starting an exercise program or before taking a job that will involve a higher level of physical activity than you are used to.
• Follow all the rules your doctor gives you.

Outlook / Prognosis

How long does it take to recover from a stress fracture?

As long as you can feel pain, the bone is still fragile in that area, and could break again in the same place. It takes roughly six to eight weeks for a stress fracture to heal, so it is important to stop the activities that caused the stress fracture. Always ask your doctor before you fully return back to exercise to make sure the area is healed and you are ready to go.

Causes, Symptoms, Tests & Treatment

Overview

The bones of the foot.

What is a stress reaction or stress fracture?

A stress reaction can be considered similar to a deep bone bruise, which arises from trauma or overuse. Stress injuries can be classified on a spectrum upon diagnosis: early (stress reaction) or late (stress fracture). A stress reaction that goes untreated will develop into a stress fracture. In a stress fracture, a small crack develops from repetitive trauma, which is usually caused by overuse. Overuse injuries account for almost 50% of all sports injuries.

Where do stress fractures happen?

Stress fractures can occur anywhere there is overuse, but they’re most commonly found in the lower extremity as a result of impact and weight bearing activities. The most common bone is the shin bone or tibia (20% to 75% of all stress fractures — often running injuries). Stress fractures can also occur in the foot. The foot is made up of several small bones. The bones running to the toes are called metatarsals. There are five metatarsals in each foot. It is most common for a stress fracture to happen in the second and third metatarsals. Stress fractures can also be seen in the heel (calcaneus), hip (proximal femur) and even the lower back.

Symptoms and Causes

What causes a stress fracture?

Risk factors for stress fractures can be divided into two basic categories: extrinsic and intrinsic.

Extrinsic factors happen outside of the body. These can also be called environmental (nature) factors. These factors can include:

• Practicing incorrect training or sport technique.
• Having too rapid of a training program or volume of activity or changing your activity level without a gradual break-in period.
• Changing the surface you exercise on, such as going from a soft surface (like an indoor track) to outside on gravel or concrete.
• Running on a track or road with sloped surface.
• Using poor equipment or improper footwear (shoes that are too worn out, too flimsy or too stiff).
• Doing repetitive activity in certain high-impact sports, such as:
  • Long-distance running (tibia, hip).
  • Basketball.
  • Tennis.
  • Track and field.
  • Gymnastics (wrist stress fractures from weight bearing on hands/wrists, low back).
  • Dance (feet, low back).
• Having a poor diet that has inadequate caloric intake for volume of sport.
• Having a low vitamin D level.
• Experiencing early specialization in sports. Youth who play one sport year-round without a break are at risk of stress fractures.

Intrinsic factors are things that are related to the athlete or patient and aren’t impacted by outside forces. These factors can include:

• Age: Older athletes may have underlying bone density issues such as osteoporosis. Already weakened bone will develop a stress reaction and/or fracture sooner than healthy bone.
• Weight: Both ends of the spectrum seem to be at risk for stress injuries. Someone with a low BMI or underweight individual may have weakened bones and someone with a high BMI doing repetitive loading with their body weight would also be at risk for injuries.
• Anatomy: Foot problems can affect the way the foot strikes the ground. These foot problems can include bunions, blisters, tendonitis, and low or high arches. Muscle weakness, imbalances or lack of flexibility can also be a factor.
• Sex: Females may be at risk if they have irregular menstrual periods or no periods.
• Medical conditions: Osteoporosis or other diseases that weaken bone strength and density (thickness). The weak or soft bones may not be able to handle the changes in activity.

What are the symptoms of a stress fracture?

The symptoms of a stress fracture can include:

• Pain, swelling or aching at the site of fracture.
• Tenderness or “pinpoint pain” when touched on the bone.
• Pain that begins after starting an activity and then resolves with rest.
• Pain that’s present throughout the activity and does not go away after the activity has ended.
• Pain which occurs while at rest, during normal activity or with everyday walking.
• Pain which is worse with hopping on one leg or an inability to shift weight/hop on affected leg/foot.

If a stress fracture is not treated at an early stage (stress reaction), the pain can become severe. There is also a risk that the fracture may become displaced (the fractured bone moves out of normal alignment). Certain stress fractures (hip) are considered “high risk” stress fractures because they may have a poor outcome (such as needing surgery) if not identified early.

Diagnosis and Tests

How is a stress fracture diagnosed?

Your doctor may need to do several tests to see if you have a stress fracture and the severity of the fracture. These tests can include:

• Physical examination: During your first visit, your doctor will do a physical exam and discuss your risk factors for developing a stress fracture. When discussing risk factors, you will be asked about:
  • Your medical history.
  • Your work.
  • Your activities.
  • Any medications you might be taking.
• X-Rays: Your doctor may order an X-Ray to look for a fracture. However, a stress fracture can be difficult to see on an X-Ray because the bone often appears normal and the small cracks can’t be seen on the image. X-rays actually miss about ⅔ of stress fractures. X-Rays may not help diagnose a stress fracture unless it has started to heal. When the bone starts to heal, it creates a callus, or lump, that can be seen on X-Rays. With a high index of suspicion for a stress fracture, your doctor may recommend an imaging test that is more sensitive than an X-Ray and will pick up a stress reaction even before it may become a stress fracture. These tests can include:
  • Magnetic resonance imaging (MRI).
  • Bone Scan.
• Bone scan: A bone scan may be used to see stress fractures that cannot be seen on an X-Ray. During a bone scan, a tracer (a radioactive substance) is injected into your bloodstream. The tracer collects in the bone and settles in the areas where the bone is being repaired. The area that is affected by a stress fracture will appear darker on the bone scan that an uninjured area.
• Magnetic resonance imaging (MRI): When your doctor needs very detailed images of the injury, an MRI may be used. Magnetic resonance imaging (MRI) is a test that uses a large magnet, radio waves and a computer to produce very clear images of the human body. An MRI is preferred in many cases because:
  • There is no radiation exposure.
  • It takes less time than other imaging tests.
  • It is better at diagnosing different types of bone and or soft tissue problem.

Management and Treatment

Do I need to treat a stress fracture?

Yes, you need to treat a stress fracture. If you think you have a stress fracture, the first thing to do is rest. Stop any activities which may be contributing to the injury. Schedule an appointment and see your doctor. It’s important to follow the treatment guidelines he or she gives you to prevent further injury.

If a stress fracture is not treated, the fracture may get worse. It can heal improperly, lead to arthritis or may even need surgery. Definitely do not ignore the pain. Ignoring the pain can lead to serious problems in the future, so it is important to see your doctor when you start feeling the pain.

If you have an underlying medical condition like diabetes or neuropathy, it is very important to see your doctor if you are experiencing any pain with your legs, ankles or feet.

How is a stress fracture treated?

Stress fractures are treated in several ways. Your doctor will discuss your options based on the location and severity of your fracture. Also, your provider will aim to treat any risk factors you have for future injuries.

Treatments your doctor may recommend can include:

• Stopping the activity that is causing pain. Stress fractures happen because of repetitive stress and overuse, so it’s important to avoid the activity that led to the fracture.
• Applying an ice pack (10 minutes) or ice massage (ice cube rub for three to five minutes) to the injured area.
• Resting for roughly two to eight weeks.
• Cross training by doing non-impact exercise (like a using a pool or bike) after discussion with your doctor may be allowed. Eventually, once you can perform low-impact activities for extended periods without pain, you can start doing high-impact exercises. Often, physical therapy can be very helpful in returning to activities and making adjustments to avoid reinjury.
• Adjusting your position if there is swelling in your leg, ankle or foot. You can lessen the swelling by elevating your leg — raising your foot above the level of your heart — while you’re lying on your back.
• Taking nonsteroidal anti-inflammatory medicines to help relieve pain and swelling.
• Using protective footwear to reduce stress on your foot or leg. This may be stiff-soled shoe, a wooden-soled sandal, or a post-op shoe which has a rigid sole.
• Using crutches to keep weight off your foot or leg until the bone heals.

Will I need a cast if I have a stress fracture?

Your doctor may need to put a cast or fracture boot on your foot to keep the bones in a fixed position. Using a cast or boot help remove the stress on the leg and promote healing.

Do you ever need surgery for a stress fracture?

Some stress fractures need surgery to heal properly. This is called internal fixation. Depending on the location of fracture, the surgeon may use pins, screws or metal plates.

How should I modify my activities when recovering from a stress fracture?

When you are recovering from a stress fracture, it is important to follow your doctor’s instructions. Ignoring your recovery plan and returning to your full activities too quickly can lead to more severe injuries in the future. There are two things to remember when you are starting to exercise again:

• Take it slowly.
• Introduce activities that place less stress on the injury.

During the early phase of healing, the doctor may recommend that you change your schedule so that you rest one day, do an activity the next day and then rest the next day. An example of this schedule is:

• Rest one day.
• Do an activity the next day.
• Rest the next day.

Alternating your activity and rest days allow your body to ease back into fitness. You should slowly increase how often and how vigorously you exercise. If the activity that caused the stress fracture is started too quickly, you may develop a larger fracture that is harder to heal. If you re-injure the bone, it can lead to long-term problems, and the stress fracture might never heal properly.

Prevention

How can a stress fracture be prevented?

These steps can help prevent a stress fracture:

• Once you feel pain, stop exercising. Only return to exercise if you are pain-free.
• See your doctor as soon as possible if you have a persistent area of concern or discomfort.
• Use the correct sports equipment.
• Wear the proper running shoes. Running shoes should be replaced every 300 miles.
• Add new physical activities (for example, switch running with swimming).
• Start new sports activities slowly and gradually increase the time, speed and distance.
  • When restarting a sport or activity, reduce your intensity by 50%. Follow the 10% rule — no increases of more than 10% per week.
• Make sure to properly warm up and cool down before activities.
• Practice strength training to help prevent early muscle fatigue, and to help prevent the loss of bone density that comes with aging.
• Follow a healthy diet full of calcium and vitamin D foods that will keep your bones strong. A sports nutritionist can be helpful if you are extremely active and have a history of stress fractures.
• If you decide to increase your activity level, ask your doctor for a recommendation of how much to add and when to add it.
• Optimize your bone health. If you have a known history of osteopenia or osteoporosis, discuss with your doctor how to medically manage these conditions. For an active person, treatment is best before an injury occurs. A stress fracture with a weak bone is harder to heal.
• If pain or swelling returns, stop the activity and rest for a few days. If pain continues, see your doctor.
• Check with your doctor before starting an exercise program or before taking a job that will involve a higher level of physical activity than you are used to.
• Follow all the rules your doctor gives you.

Outlook / Prognosis

How long does it take to recover from a stress fracture?

As long as you can feel pain, the bone is still fragile in that area, and could break again in the same place. It takes roughly six to eight weeks for a stress fracture to heal, so it is important to stop the activities that caused the stress fracture. Always ask your doctor before you fully return back to exercise to make sure the area is healed and you are ready to go.

Shin Splints or a Stress Fracture? How To Tell

If you’re an athlete and your shins begin to hurt, you might think it’s “just” shin splints, keep right on with your running program and try to train through the pain.

But that pain between your knees and your ankle could be a stress fracture.

Whether your shin pain is due to shin splints or a stress fracture, it’s important not to keep training the same way through either injury. You can take steps to heal and avoid making the injury worse or getting it again later.

Different Conditions With a Common Cause

Shin splints happen when the muscles, tendons and bone tissue around your shin bone – the tibia – become inflamed. They are a common problem for runners, gymnasts and dancers.

Stress fractures are tiny cracks in the bone. They also are a common problem for runners, gymnasts or dancers and athletes in high-impact sports such as track and field, basketball or tennis.

While they are different medical conditions, shin splints and stress fractures share the same causes: an overload problem, says Laura Goldberg, MD, a pediatric sports medicine specialist with UH Sports Medicine.

Shin splints and stress fractures happen when you overtax your leg muscles, tendons or shin bone through a sudden increase in training.

“One of the most common causes is a sudden increase in weight-bearing exercise,” Dr. Goldberg says. “A runner may be progressing with running, but has added other weight-bearing activities such as plyometrics and is not allowing enough recovery time.”

If a patient mentions shin pain, one of the first things she asks her patients is to review their workout log. Dr. Goldberg recommends athletes keep a training log, which can help to identify training errors or pinpoint problems.

“The history really clues me in,” she says. “Sometimes people don’t realize how much they are doing or how much they are increasing.”

How To Tell Shin Splints From a Stress Fracture

How to tell these two conditions apart? With a stress fracture, the pain gets worse as you run and persists in a smaller location after you run, Dr. Goldberg says.

With shin splints, pain often occurs over a broad area, although it may be localized, affecting a small area. The pain usually lessens after you warm up, Dr. Goldberg says. In addition, shin splint pain may be more tolerable than pain from a stress fracture.

If you develop shin splints, avoid activities that cause pain, swelling or discomfort, but don’t stop all physical activity. It’s better to switch to low-impact exercises such as swimming, cycling or water running until you heal, she says. The pain will lessen over time as you get stronger.

You can treat shin splints at home by applying ice packs to the painful area for 15 to 20 minutes at a time, four to eight times a day for several days. You also can take an over-the-counter pain reliever such as ibuprofen (such as Advil or Motrin), naproxen (such as Aleve) or acetaminophen (such as Tylenol).

To avoid shin splints, make sure you’re wearing the right shoes for your foot and ones that are not too well-used.

“A lot of people try to treat it themselves, but it if recurs, it needs evaluation,” she says.

Why It’s Important to Get Medical Care for Shin Pain

Stress fractures are the most serious of all running injuries.

Many runners will wave off shin pain and continue to train, Dr. Goldberg says. This is dangerous with stress fractures, however, because your bones can’t repair themselves while you’re increasing the duration, intensity or frequency of your training.

“Any pain that persists after you rest should be evaluated by a sports medicine specialist, and anything that causes you to limp should be evaluated,” she says. “If you’re limping, you shouldn’t be running.”

A stress fracture can cause chronic problems if not allowed to heal properly. Also, if the underlying causes of your stress fracture are not taken care of, you may be at higher risk for more stress fractures.

“The biggest thing with a stress fracture is that it’s an imbalance. Your body can’t keep up with the training and the healing process,” she says. “At some point, the damage from training gets ahead of the healing.”

Stress fractures won’t go away without some modification to your training routine, Dr. Goldberg says.

What to Expect From Treatment for Shin Pain

If you are diagnosed with a stress fracture, your sports medicine specialist may recommend wearing a walking boot, brace or crutches.

A sports medicine specialist can help design a training routine that will keep you moving but allow you to heal, too. A sports medicine specialist will consider your overall load, maintain your cardio and keep building strength. Your training routine may be modified to include cross-training and low-impact activities, such as low-gravity treadmills, ellipticals, pool running or cycling.

The sports medicine specialist also will look for an underlying cause, which might be a gait abnormality or a bone problem, to pinpoint how and why it’s happening.

“You may be out from running from four to six weeks,” Dr. Goldberg says, “but when you return, you’ll be ready for running.”

Related links

The Sports Medicine program at University Hospitals provides specialized, integrated services for the diagnosis and treatment of conditions that affect athletes of all ages and abilities. Learn more about what UH Sports Medicine can do for you.

Stress Fracture or Shin Splints? How to tell the difference

In time for running season, here’s what you need to know about how to prevent and treat shin splints and stress fractures.

These common overuse injuries are usually caused by training errors and running too much, too quickly. Poorly fitting footwear, running on hard surfaces, and a lack of flexibility and muscle imbalance can also play a role.

The lower leg pain of shin splints is caused by inflammation and micro-tears in muscular attachments and tissue around the shin. A stress fracture is a tiny crack in the bone and usually occurs in the lower leg, hip or foot.

I see many runners in my primary care sports medicine practice at the University of Chicago Medicine. To make the diagnosis, I start with with a complete history from athletes about their running routine, including mileage, intensity, pace, terrain and footwear, as well as any recent changes in training regimen.

Shin splints

This condition — medial tibial stress syndrome, or MTSS — is common among new runners, runners returning to the sport after an extended break and runners who have rapidly increased their mileage and training intensity.

Symptoms: Lower leg pain while running, especially at faster speeds. Shin splints don’t usually cause pain while walking or during daily, non-running activities. The pain often goes away once running is stopped.

Treatment: I start runners with rest, ice and anti-inflammatory medication for pain. Stretching and low-impact activities that don’t cause pain, like swimming and cycling, can help maintain strength and conditioning. Sometimes, decreasing running frequency, distance and intensity by half can improve symptoms while allowing somone to keep running.

I advise patients to return to their running program slowly, increasing the load by no more than 10 percent per week. Flexibility exercises and strength training are also very important as part of the comprehensive treatment plan and to prevent recurrence.

Stress fractures

Stress fractures result from cumulative strain on the bone, without enough time for proper recovery. Eventually, the bone weakens and becomes susceptible to tiny cracks, or stress fractures.

Symptoms: Pain while running, but over time, runners also will experience pain while walking and doing other activities. If the stress injury is significant, pain may persist at rest, too. Pain is often localized in one spot, rather than a spread out over a small area, as with shin splints.

Treatment: Runners with a stress fracture have to stop running until it heals. To ensure proper healing, I often place the runner in a walking boot and may even add crutches. Anti-inflammatory medication is used for pain. After several weeks, runners can gradually return to pain-free activities, while addressing risk factors that may have contributed to the stress fracture. This includes a proper diet with enough calories as well as calcium and vitamin D supplementation to optimize bone health.

Preventing overuse injuries

Here are some ways you can prevent shin splints and stress fractures:

• Don’t do too much, too quickly. If you’re new to running, start with a run/walk regimen. Consult a physical therapist, coach or personal trainer to set up a smart running program.
• Don’t run through pain.
• Slowly ramp up your training regimen, adding 10 percent maximum (mileage, intensity) per week.
• Cross-train with a focus on strength and resistance training, especially for the core, hips and legs.
• Maintain overall flexibility with a good stretching program.
• Ice after runs if you are sore, and avoid hard surfaces when possible.
• Properly fitting running shoes are essential. Orthotics also may be helpful.
• Ensure a well-balanced diet with adequate calorie intake for your activity level and target a healthy body weight.

Tibial Stress Fracture – Symptoms, Causes, Treatment & Rehabilitation

A tibial stress fracture is a hairline fracture of the tibia bone in the lower leg caused by overuse or repetitive stress. Symptoms are very similar to ‘shin splints’ with gradual onset pain on the inside of the shin. Here we explain the symptoms, causes, and treatment for a stress fracture of the tibia.

Symptoms

Symptoms of a tibial stress fracture are very similar to shin splints (medial tibial stress syndrome) and include:

• Pain on the inside of the shin, usually on the lower third.
• Symptoms often occur after running long distances.
• When pressing in over the area your leg will feel tender and sore.
• You may even have swelling over the site of the fracture.
• If you have a stress fracture you may also feel a particularly tender spot at the exact point of the stress fracture.

Diagnosis

It can be difficult to distinguish a tibial stress fracture from a case of shin splints. This is because a stress fracture will not show up on an X-ray until it has begun to heal. It is the new cells along the line of the fracture which will become visible.

• If you suspect a stress fracture of the tibia then a period of at least 4 weeks rest is required before a second X-ray is taken.
• Often new bone growth can be seen where it has begun to heal.

What is a tibia stress fracture?

The lower leg consists of two bones, called the tibia and fibula. The tibia is the larger, thicker of the two and its role is load-bearing. The fibula is the smaller, thinner bone and its purpose is mainly as an area for muscles to attach. Either of these bones can develop stress fractures.

The most common site, however, is two to three inches above the bony bit on the inside of the ankle (called medial malleolus) on the tibia bone.

Long bones such as the tibia have an outer sheath surrounding the hard compact bone called the periosteum with the inner core containing bone marrow. The bone is overloaded through continuous muscle contractions and stress forces of impact when running.

In particular, when fatigued, the distribution of the forces in the bone is altered because your muscles are unable to absorb some of the load. Therefore, there is more load on the bone. Lots of small impacts on the bone even though they may be very small, a cumulative effect can build up.

What causes a tibia stress fracture?

The obvious cause of a tibial stress fracture is overuse, however, there are a number of factors which can increase the chances of sustaining a tibial stress fracture.

Training – a sudden change in a running surface, for example, going from grass training to lots of track or road running can increase the chances of a stress fracture.

Foot biomechanics – such as overpronation or oversupination can increase the stress on the tibia bone. If your foot overpronates and rolls in, flattening the arch of the foot, this has the effect of rotating the shin bone inwards. As a result, additional torsion or twisting stresses are placed on the bone.

Tibial stress fracture treatment

What can the athlete do?

• If a stress fracture is suspected then a sustained period of rest is needed to allow the injury to begin to heal. Rest for around eight weeks, avoiding weight-bearing exercise especially running.
• Substitute swimming or cycling if it can be done pain-free or use the opportunity to work on upper body strength in the gym, or technical aspects of your sport if possible. Running in water with a buoyancy aid or belt is also an excellent substitute for running on the road.
• A simple shin taping technique can help reduce the strain on the shin. It works by supporting the muscles of the lower leg, pulling them towards the bone and helping to reduce rotation of the tibia. But do not use the tape to resume running if you have a suspected tibial stress fracture.
• Exercises to maintain strength and flexibility in the lower leg such as light calf raises as long as they are not painful and wobble balance board training can be done.
• It is especially important to stretch and strengthen the muscles at the back of the lower leg when returning to weight-bearing exercise. After a period of rest, they may be tight and in poor condition. This increases the likelihood of sustaining further shin pain from medial tibial stress syndrome (shin splints).

Training methods should be analyzed to try and identify if or how this has contributed to your injury. Does footwear need to be changed? Running shoes should have a life of about 500 miles after which they should be changed.

What can a sports injury specialist or doctor do?

• A doctor will x-ray the leg and advise on when it is safe to resume training. Initially, the stress fracture will not show up on an x-ray, however, some signs may be seen after 2 or 3 weeks so it is important to follow up with another x-ray after a period of rest.
• Gait analysis can identify any biomechanical problems of the foot which may have increased the chances of injury. Orthotic inserts worn in the shoes can correct foot problems such as overpronation.
• Sports massage for the calf muscles at the back of the lower leg can relax them, releasing any muscle spasm, tight knots, lumps or bumps in the muscle, making them more efficient at absorbing running forces when normal training resumes.

References & further reading

Related articles

• Here we explain the common and not so common causes of shin pain as well as other injuries and conditions which should not be missed.…

• Shin splints is not a specific injury itself, but a general term people often use to describe pain on the inside of the shin. Here…

• This simple shin splints taping technique can help recovery from shin splints pain on the inside of your lower leg (medial tibial stress syndrome). How…

• Foot biomechanics is the study of how the foot moves during the gait cycle. You wouldn’t build a house without getting the foundations right, and…

• Choosing running shoes, as every runner knows, is fundamental to any training regime and subsequent competitive performance. For runners , selecting a new set of…

• Overpronation is often recognised as a flattening or rolling in of the foot but it is not quite as simple as that. If you overpronate,…

• A fibula stress fracture is a small fracture or hairline crack in the bone. It is not as common as a stress fracture of the…

Stress Fracture of the Tibia

Modified activity is the basis of stress fracture rehab. Staying active and training around the injury without further stressing the bone is important. Timing your return to weight bearing activity and carefully monitoring training load in the longer term is also paramount.

Phase 1

Day to day activity: Weight-bear as tolerated. For occupations with significant walking/ weight-bearing a walking boot may be required. Limit any unnecessary walking wherever possible.

Exercise: You can undertake non weight bearing exercise including swimming, upper body weight training only and grinder. You should not undertake any unnecessary walking, running, cycling, rowing, elliptical or anything with weight bearing attached to it. A sample exercise session for an endurance athlete may include swimming preferably with pull buoy to limit kicking, intervals on the grinder, high rep no rest circuit of upper body weights.

Phase 2

Day to day activity: Weight-bear as tolerated. For occupations with significant walking/ weight-bearing a walking boot may be required. Limit unnecessary walking wherever possible.

Exercise: Swimming, upper body weight training and cycling however there can be no walking, running or rowing. A sample exercise session for an endurance athlete might be as previously stated above in phase 1 but including cycling. You should aim to be performing a spin class by the end of week 4. It needs to be noted that the increase in exercise needs to be done gradually. You cannot expect to recover fully if you are increasing your high resistant loads 7 days a week. Best results will occur if your exercise regime is done slowly and progressively while adding variety wherever possible.

Phase 3

Day to day activity: Weight-bearing as tolerated.

Exercise: Swimming, upper body weight training, cycling and rowing while avoiding unnecessary walking and definitely no running. A sample exercise session for an endurance athlete might be as previously stated above in phase 2 but including rowing.

Sample rowing targets

• Aim for 2500m in 10 minutes. 1 minute row with 1 minute of rest. 10 intervals of 250m per minute.
• 2000m in the shortest time possible
• Concept 2 have a VO2 max calculator and well established records which you can test yourself against. Refer to:-http://www.com/us/interactive/ calculators/vo2max.asp

Phase 4

Day to day activity: Weight-bear as tolerated.

Exercise: Swimming, upper body weight training, cycling, rowing, low volume jogging on grass but definitely no running.

sample exercise session for an endurance athlete: trial of 4 x 500m jog on grass 3 times over 2 weeks separated by at least 2-3 days

Phase 5

PODIATRY REVIEW WITH TREADMILL RUN TO ASSESS BIOMECHANICS

Day to day activity: Weight-bear as tolerated.

exercise: No restrictions but be careful not to do too much, increase distance slowly. As an example:-

• Week 1: 2km run 3 times per week
• Week 2: 4km run 3 times per week
• Week 3: 6km run 3 times per week
• Week 4: 8km run 3 times per week
• Week 5: 12km and onwards

Progress to greater distances but you will need to carefully monitor your biomechanics or there you will have an increased chance of re injury.

Pneumatic leg brace

Pneumatic leg brace can help with symptom relief and allow you to tolerate earlier weight bearing activity without slowing recovery. A relatively aggressive rehabilitation protocol allows a quicker return to sport for uncomplicated, low-risk fractures. For these fractures, a systematic review found that treatment with a long air splint, also called a long air cast, enables return to activity up to six weeks sooner than standard casting and other treatments.

Exogen:

Exogen is a form of Low Intensity Pulsed Ultrasound (LIPUS) which
has been shown to accelerate bone healing. For best results the unit needs to be used at approximately the same time each day. Sports Clinic NQ can provide the Exogen unit as a free service however bookings for its use need to be made to ensure availability.

Alter G:

Sports Clinic NQ has the only publicly available ALTER G treadmill in Queensland. Previously only available to professional athletes and members of the armed forces, the Alter G treadmill allows you to run at only a fraction of your bodyweight. The ALTER G treadmill allows you to run at, as little as, 20% of your bodyweight. This unit provides the following benefits:-

1) Sport specific conditioning
2) Graded return to running
3) Appropriate bone loading to assist healing.

90,000 Fracture of the leg bones – symptoms of trauma, first aid and treatment, rehabilitation – Traumatology Department of the Central Clinical Hospital of the Russian Academy of Sciences

According to statistics from the Central Clinical Hospital of the Russian Academy of Sciences in Moscow, shin fractures account for 1/10 of all visits with bone fractures to our hospital. In most cases, both the tibia and the tibia are damaged at the same time.

Possible causes of the fracture

A direct blow, a car accident are all common causes of lower leg fractures. The bone cannot withstand the pressure exerted and breaks. Often, a fracture occurs in the event of an unsuccessful fall – when the leg is fixed (skates, mountain boots) or bent in an uncomfortable position.

Symptoms of a fracture of the shin bones

• Severe pain;
• Swelling of the limb;
• Skin redness;
• An attempt to move a leg is accompanied by a characteristic “crunch” – this is how the fragments rub against each other;
• Visually, a broken cannabis may appear shorter or, on the contrary, longer than an intact limb.
• An open fracture shows a bleeding wound.
• If the peroneal nerve was injured at the time of the fracture, the foot will hang limply, without the ability to move it.

Diagnostics

• Clarification of the circumstances that led to the traumatic action
• Inspection, check of pulse and sensitivity in the damaged area
• Radiography
• Computed tomography;
• MRI of the ankle;
• If necessary, a consultation of a narrow specialist – neurosurgeon, angiosurgeon can be carried out

Treatment

In the treatment of fractures, therapeutic and surgical methods are used, depending on the clinical picture. Mandatory is the immobilization of the limb for the period of fusion. Physiotherapy procedures have proven themselves well. Correct rehabilitation is of great importance in the process of restoring leg functionality.

Possible consequences and complications without timely treatment

An urgent visit to a doctor is mandatory in case of a fracture of the lower leg. Any delay will prolong the suffering of a person and can lead to serious irreversible consequences – for example, complex displacements.

Which doctor to contact

Traumatologists of the Central Clinical Hospital of the Russian Academy of Sciences in Moscow identify fractures using many years of experience and advanced diagnostic equipment, which is equipped with one of the main clinics in Russia. If you suspect that the leg bone is broken, immediately come to the trauma center of the Central Clinical Hospital, if you need to get additional information about the conditions for transporting the patient, call +7 (499) 400-47-33.

Transverse stress fracture of the proximal patella

case presentation

Boy 10 years old
was admitted to the clinic with a complaint of moderate to severe knee pain
the severity that arose during the game of football.The boy was an athletic child
and took an active part in various sports games including basketball,
running competitions, javelin throwing, etc. In the last month and a half, he
experienced mild knee pain. Parents went to the clinic in connection with
a gradual increase in pain. On initial examination for signs of external trauma or
no bleeding was found.

Most likely diagnosis based on
cl Inicheskaya picture:

• Transverse stress fracture
• Dislocation of the knee joint
• Overstrain / sprain of the capsular-ligamentous
  apparatus
• Ligament / tendon rupture

Stress
fractures are one of the most common types of sports injuries. They often present with localized pain in the bone or periosteum, especially during
time of physical activity or play. Stress fractures can occur when
various activities and physical activity, especially when walking,
jumping and repetitive movements accompanied by tension. However, they
rarely seen in sports such as hockey, golf, swimming,
fencing and softball. The share of athletic disciplines, namely athletics,
accounts for 50% of all stress fractures in men and 64% of stress fractures
fractures in women.Patellar fractures account for about 1% of all
stress fractures, which indicates their rare prevalence.
Treatment recommendations for these fractures include surgical or
conservative approaches.

medical history

EXPERTISE AND LABORATORY STUDIES

Features
ligamentous laxity and joint effusion were not found. Range of motion in
joints were preserved. However, there was a slight stiffness at the level
the proximal part of the left patella. X-ray showed transverse
fracture of the proximal left patella, on the basis of which there was
suggested diagnosis of proximal transverse stress fracture
left patella. The femoral-tibial angle was 174 ° on the left and
176 ° right. Radiographic congruence of articular surfaces
The femoral-patellar joint was practically unchanged.

control

Was first
an attempt was made to conservative treatment for several months,
during which the boy was asked not to play sports. However, the conservative
the approach was unsuccessful, because the pain did not completely disappear, and therefore
the boy was admitted to the orthopedic department of the hospital. After
radiographic confirmation of the diagnosis of nonunion of transverse stress
fracture of the proximal patella was surgically
intervention. The operation included a 2 cm incision of the anterior longitudinal ligament
over the upper part of the patella, osteoperforation of bone fragments and internal
fixation using Acutrak Mini screws. At the time of inspection after three
months after the operation, the pain in the knee joint completely disappeared, the patient
returned to normal sports and daily activities.

discussion

Stressful
fractures in adult athletes are usually localized in the tibial region
bones, bones of the tarsus and metatarsus, femur, fibula, bones
pelvis, sesamoid bones and spine.The most common places
stress fractures in children are the tibia, fibula,
femur, radius, metatarsus and humerus. Risk factors
stress fractures are listed in Table 1. Patellar stress fractures
are relatively rare. In this case, the patient had a fracture in
the area of ​​the proximal third of the patella.

Previous publications reported stress fractures of the patella
from football players, basketball players and runners.In this case, the development of stress
transverse fracture of the patella could have been facilitated by a multiple increase in
resistance forces of the femoral-patellar joint during exercise
kendo, as well as sprinting.

There is evidence of the effectiveness of such methods of surgical correction
stress fractures, such as internal fixation using
loops, cannulated screws, curettage, bone grafting or osteoperforation.

studying:

In this case
a transverse stress fracture of the proximal patella may have occurred
due to repeated flexion movement in the left knee joint on
90 ° when running short distances.With non-union of the transverse
stress fracture, good results are obtained by internal fixation with
using Acutrak screws.

Recommendations

1. Sanderlin BW, Raspa RF, et al. Common
   Stress Fractures. Am Fam Physician. 2003 Oct 15; 68 (8): 1527-1532.
2. Sayum Filho J, Lenza M, Teixeira
   de Carvalho R, et al.Interventions for treating fractures of the patella in
   adults. Cochrane Database Syst Rev. 2015 Feb 27; 2: CD009651.
3. Atsumi S, Arai Y, Kato
   K, Nishimura A, et al. Transverse Stress Fracture of the Proximal
   Patella: A Case Report. Medicine (Baltimore). 2016 Feb; 95 (6): e2649.

Fracture | MyPathologyReport.ca

What is a fracture?

Fracture is the medical term used to describe a bone fracture. When a bone breaks, muscles and blood vessels around the broken bone are usually damaged.Most fractures are caused by trauma to the body as a result of severe impact or stress. A pathologic fracture is a special term to describe a bone fracture resulting from a bone disorder. It usually takes very little effort to cause a pathological fracture because the diseased bone is weaker than normal bone. Bone conditions that can lead to pathological fractures include osteoporosis (or thinning of the bones), cancer and / or bone infections, and certain medications.

Bone fractures and osteoporosis

Osteoporosis is a disease that usually affects the elderly. The result is thin and delicate bones that break more easily than normal, healthy bones. Osteoporosis is more common in older men and women, especially in women during menopause. Fractures associated with osteoporosis usually involve the vertebrae (spine), hip (thigh), lower radius (wrist), or upper humerus (shoulder).

Cancer in the bone

Cancer cells found in bone are divided into two categories: primary bone tumors (a tumor that started in the bone) and metastasis (cancer that originated elsewhere and has spread to the bone). In older people, bone metastases are much more common than primary bone tumors. The types of tumors that commonly spread to bone include invasive ductal carcinoma of the breast, adenocarcinoma and squamous cell lung cancer, clear cell renal cell carcinoma of the kidney, adenocarcinoma of the prostate, and papillary thyroid cancer. In contrast, primary bone tumors such as osteosarcoma are more common in children and young adults. Lymphoma: A type of cancer that begins in the cells of the immune system can be seen in the bones of both children and adults.

Types of bone fractures

• Simple fracture : Broken bone without affecting the overlying skin.
• Fracture : Broken bone with damage to surrounding muscles and overlying skin.
• Comminuted fracture : A bone that has fractured into many pieces.
• Offset fracture : A fracture where the broken ends of the bone no longer match.
• Stress fracture : Small fractures resulting from repeated exposure to bone.Stress fractures are common in athletes. For example, runners can experience stress fractures in their legs and feet when they hit the ground repeatedly.
• Greenstick Fracture : A type of fracture that occurs in the softer bones of children and babies. The tear does not go all the way through the bone.
• Pathologic Fracture : A type of fracture that occurs in a previously affected bone.

How do pathologists make this diagnosis?

Most fractures are diagnosed only on the basis of X-rays.However, a pathologist may be involved in making this diagnosis if the operation is performed to remove part of the broken bone. For example, a severe hip fracture is usually treated with hip replacement surgery (hemiarthroplasty). The broken bone is removed by a surgeon and examined by a pathologist under a microscope, who closely examines the architecture of the bone and the healing process of the fracture. When pathologists examine bone under a microscope, they look for conditions that could weaken the bone and lead to a fracture.Most importantly, they are looking for diseases such as bone cancer that require urgent treatment.

What does a bone fracture look like under a microscope?

The appearance of a fracture under a microscope depends on the time elapsed since the fracture occurred, the cause of the fracture and the age of the patient. Pathologists usually examine representative sections, which means that some, but not all, of the tissue will be examined under a microscope.

Early microscopic signs include blood and acute inflammatory cells around the fracture.Broken pieces of bone usually die in a process called necrosis. Some pathologists describe dead or necrotic bone as not viable. In contrast, living bone is said to be viable. Dead bone and blood can form a mass called soft tissue callus or procallus. Callus acts as a glue that holds the bone together as it heals. These early changes are visible immediately after the fracture and disappear after about seven days.

Late microscopic features include the development of callus, consisting of new bone and cartilage.The new bone in the callus is less organized and not as strong as normal, healthy bone. The repair process is completed when the callus is replaced with well-organized new bone.

When examining a bone sample under a microscope, your pathologist will also look for conditions that may have caused the fracture. Specifically, your pathologist will take a close look at the bone to look for any signs of infection, cancer, osteopenia (weak bones), or osteoporosis. Finally, your pathologist will look for trilineal hematopoiesis, which is the normal process of new blood cells forming inside the bone.

Zuzanna Gorski M.D. and Bibianna Purgina M.D., FRCPC (revised July 28, 2021)

90,000 STRESS (FATIGUE) FRACTURES

The most common sports injury is stress fracture or stress fracture. Treating stress injuries is challenging.

What is a stress fracture?

Stress fracture is an overuse injury. It occurs when the muscles are overstrained, which are no longer able to absorb the load on the bones.Ultimately, the excessive load is transferred to the bone tissue, which is accompanied by the appearance of cracks in the bone, that is, a stress fracture.

What is the cause of the stress fracture?

A stress fracture is the result of too rapid an increase in volume or intensity on the bone. It is also possible when playing on unfamiliar surfaces, for example, when changing from a soft clay court to a hard court in tennis, when using inappropriate equipment, for example, shoes with excessively soft or worn out soles when running, or excessive physical stress, for example, playing for a long time. basketball.

Which bones are affected by stress fractures?

Most stress fractures occur in the shin and foot bones, which carry the bulk of the body’s weight bearing. These bones are affected in 50% of cases.

What sports are most commonly associated with stress fractures?

Research shows that stress fractures are most common in tennis players, runners, gymnasts, and athletics. In these situations, injury occurs against the background of constant loads on the foot when it hits the ground.Athletes are particularly at risk of stress fracture if they do not get enough rest between workouts or competitions.

Which gender is more prone to stress fractures?

Stress fractures occur in individuals of all ages who participate in active sports activities such as running. Studies show that fatigue fractures are slightly more common in women than in male athletes. Most orthopedic surgeons attribute this to the so-called “female athlete triad,” which is a combination of eating disorders (anorexia or bulimia), menstrual disorders (amenorrhea or dysmenorrhea), and osteoporosis.As bone density and bone mass decrease, the risk of developing a fatigue fracture in an athlete increases.

What are the symptoms of a stress fracture?

The most common complaint of a stress fracture is pain associated with physical activity. With rest, the pain usually diminishes or disappears.

How is stress fracture diagnosed?

During a medical examination, the doctor must evaluate the presence of risk factors for a stress fracture in the patient.

X-ray examination is most often used in the diagnosis of stress fractures. In some cases, a routine X-ray does not show the fracture. In addition, its signs may be absent for some time after the onset of pain. In such situations, it is necessary to carry out computed or magnetic resonance imaging.

How is stress fracture treated?

The most important therapeutic point is adequate rest.When a stress fracture occurs, it is very important to rest from the stress that caused it for 6-8 weeks. However, it is necessary to maintain physical activity, which is not accompanied by pain.

If the victim stops moving abruptly, it can lead to more extensive stress fractures, which will be very difficult to cope with. Repeated injuries are also often accompanied by chronic disorders, in which the fusion of a stress fracture is not always possible.

In addition to resting, in case of fatigue fractures, special shoe inserts or retainers must be used.

Prevention of stress fractures

Specialists from the American Academy of Orthopedic Surgeons have developed specific guidelines for the prevention of stress fractures:

• Any new sport should be started gradually. For example, when jogging, you need to start from 3-5 km a day, gradually increasing the load over several weeks.
• Engaging in the main sport should be interspersed with other loads that are aimed at achieving the same goals.So, instead of daily jogging to train the cardiovascular system, you can alternate between running and cycling. For best results, strength training should be combined with flexibility exercises.
• A healthy diet is important. The diet should contain foods rich in calcium and vitamin D.
• Use only good equipment. Do not use old or worn running shoes.
• If pain or swelling occurs, stop immediately and rest for several weeks.If pain persists, seek help from a podiatrist.
• It is very important to remember that a return to sports activities at the same level is possible only with early detection of symptoms and treatment of the cause that caused them.

Sports injury

Sports injury is an inevitable component of active physical activity. In recent years, more and more people are paying serious attention to health, showing an interest in sports. It should be remembered that sports not only promote health, but are also closely linked to injuries.

Sports injury is an injury accompanied by a change in the anatomical structures and functions of the injured organ as a result of exposure to a physical factor that exceeds the physiological strength of the tissue during exercise and sports.

Sports competitions and training are not complete without injuries.

Inadequate preparation of the body (too short warm-up) to perform the exercises, lack of body control skills and ignorance of safety requirements are the main causes of injuries in amateur athletes.Sports injuries are almost always (90%) associated with various injuries of the musculoskeletal system.

First aid for sports injuries should be provided as quickly as possible to prevent re-injury. In this case, it is necessary to correctly carry out actions to stabilize the state of the injured part of the body. An accurate diagnosis must be made by a medical professional.

The European Orthopedics Medical Center successfully treats fractures, dislocations, sprains, ligament ruptures and other injuries.

We carry out such complex operations as: restoration of menisci, ligaments, cartilage of joints; prosthetics of the joints of the shoulder, hand, knee, hip.

Effective treatment of post-traumatic and metabolic changes in soft tissues and musculoskeletal system; correction of all kinds of limb deformities;

In order to prevent complications, after an injury it is necessary to undergo a rehabilitation course, which will be developed individually for the patient by our rehabilitation therapist.

In the European Orthopedics Medical Center, there is a rehabilitation center for sports injuries.The center’s specialists have developed programs for the recovery of athletes, which include the use of modern techniques such as physiotherapy, massage, myostimulation, taping, etc. The duration of the rehabilitation period depends on the type and severity of the injury.

Types of sports injuries. Causes. First aid.

1. Injuries to the foot, ankle and lower leg

These parts of the leg allow you to walk, run, jump, provide shock absorption and support the body in an upright position.

Sprain or rupture of the Achilles tendon

This is a damage to the tissue fibers that connect the triceps muscle and the heel bone. Sharp pain and severe swelling occurs in the ankle. With a complete rupture of the tendon, a characteristic crackle is heard and the triceps muscle contracts into a lump.

The cause of injury could be:

• unsuccessful landing after a jump;
• sharp acceleration or jerking from an uncomfortable position;
• insufficient warm-up;
• Poor fixation of the foot in the shoe.

First of all, it is required to limit the mobility of the joint with an eight-shaped bandage, apply cold and raise the limb. In the future, a doctor’s examination is required to establish an accurate diagnosis and prescribe treatment. A ruptured tendon requires immediate hospitalization and surgery.

The best prevention is to maintain muscle tone and mobility of the joints by performing an appropriate set of exercises daily, as well as using sports shoes that reliably hold the foot.

Sprained ankle

This is a partial or complete rupture of the fibers of the ankle ligaments.

Acute pain syndrome in the foot that intensifies over time – it is impossible even to stand on a sore leg. Redness and swelling occur, in severe cases – hematoma and blood entering the joint cavity.

The main causes of sprains are falls, bruises, or blows to the ankle. Exercising on uneven or unprepared surfaces can also lead to this injury.

To avoid further damage, a fixation bandage or an L-shaped splint is applied to the foot and lower leg. It is advisable to cool the lesion site with a compress. Then – put the injured leg on a comfortable elevation. In difficult cases, treatment is carried out in a hospital and surgery may be required.

Prevention measures include various types of exercises that strengthen and stretch muscles and ligaments. Saturation of the body with vitamins and minerals also helps to maintain the working capacity of tendons and joints.

Ankle fracture

This is a fracture of the process of the fibula (lateral, outer malleolus) or tibia (medial, inner malleolus).

A characteristic crunch or click combined with a sharp pain in the ankle and inability to step on the leg may result from a fracture. Severe edema and hematoma quickly appear. Painful sensations do not decrease over time, and pathological joint mobility arises. When you press on it or the fibula, severe pain is felt.

Depending on the severity of the injury, first aid is provided in the following sequence:

1. Raise the injured limb and place it on a soft roller.
2. In case of an open fracture, apply a sterile bandage without deforming the wound and without displacing bone fragments. If there is bleeding, then take measures to stop it.
3. Fix the joint with a splint or other available means.
4. Apply cold to the injury site.
5. Reduce pain with an analgesic.
6. Ensure the delivery of the victim to a medical clinic.

Accurate diagnosis and treatment is carried out in a medical facility.

Falling or failing to land after a tuck jump are the main causes of ankle fracture.

Stretching or tearing of the leg muscles

This is an overstretching, partial or complete rupture of muscle fibers.

Sharp and severe pain, which may be accompanied by convulsions, difficulty in limb movement, the appearance of swelling and bruising at the site of injury, and a clear change in the shape of the lower leg are the main signs of a sprain or rupture.

Insufficiently warmed up muscles, their increased stiffness, weakness or, on the contrary, overtraining are the main reasons for such an injury. Most often this happens with intense running loads, sudden accelerations or jumping. Various squats and other similar weight training exercises in bodybuilding often lead to such damage.

First aid consists in ensuring a fixed and comfortable position of the injured limb. Cold is applied to the lower leg and a fixing bandage is applied.

In mild cases, complete absence of load is sufficient to provide for two or three days. If the muscles are torn, longer drug treatment and the use of physiotherapy procedures will be required.

Before any competition, training or physical exercise, it is imperative to warm up to stretch and warm up the muscles.

2. Knee injury

The knee joint is the largest and most stressed of all human joints.It has a very complex structure and consists of many different elements: bones, cartilage and ligaments, muscle and nerve tissues, blood vessels. All active movements – walking, running, jumping, are possible only when this important organ is fully functional.

Knee pain

Pulsating or persistent knee pain is a symptom of a malfunction in one or more of its components.

Pain syndrome may appear immediately after injury or after a while.In this case, the process of flexion or extension becomes more difficult.

A hit or fall on the knee can cause various inflammation or stretching of muscle and connective tissues. Such types of injuries are typical for team sports. Running and walking at medium and long distances with a violation of technique or excessively intense training can lead to pathological changes in the relative position of parts of the knee joint.

Cold is applied to relieve pain and reduce inflammation.Until a diagnosis is established and treatment is prescribed, all loads on the affected leg are stopped.

Exercises that improve joint mobility, increase the firmness and elasticity of its muscle tissues and ligaments can reduce the likelihood of injury.

Patella offset

This is an abnormal change in the position of the patella.

Immediately there is a sharp and intolerable pain, the knee takes on an unnatural appearance. Full displacement occurs from a strong blow, incomplete – from an unexpected lateral tilt or a sharp turn of the leg.

Stress fracture

This is the destruction of the bones of the knee joint due to constant intense loads, which do not allow timely restoration of bone tissues.

Pain sensations appear in the joint, which are almost imperceptible in a stationary state and intensify in movement and under load. If untreated, they become permanent. Edema and hematoma may occur.

To relieve acute pain, apply cold to the knee.To clarify the reason – consult a doctor. When confirming the diagnosis, avoid stress on the injured limb until the end of the rehabilitation period.

To prevent the development of this pathology, regular excessive loads on the knee joints should be avoided, always follow the recommendations of the trainer when performing exercises.

Anterior cruciate ligament rupture

A sharp twisting movement of the leg leads to excessive tension and rupture of the anterior cruciate ligament.There is severe pain and swelling in the front of the knee. It hinders freedom of movement, and the supporting functions of the leg are lost.

Abnormal knee rotation is often caused by falls while skiing or snowboarding. In contact sports, collisions with an opponent often lead to such injuries.

It is necessary to fix the knee with a tight bandage or splint, apply cold and comfortably position the injured leg on an elevated position. Further treatment is carried out with conservative methods or with the help of surgical intervention.With an incomplete rupture, the recovery period takes about a month, and in severe cases it can last six months or more.

3. Injuries of the thigh and hip region

The femur and hip joint provide all human motor functions.

Stress fracture of the femur

This is a violation of the normal recovery process of the bone tissue of the femur, caused by excessive stress.

In the initial period, pain occurs only with movements of the thigh and is felt in the groin and inner thigh.If the stressful conditions persist, the pain syndrome increases and a complete bone fracture may occur.

Constant intensive training or a sharp increase in their intensity lead to an imbalance in the tone of the thigh muscles and create an increased load, which provokes the occurrence of a fatigue fracture.

If you suspect a stress fracture, you should immediately contact the medical center to confirm the diagnosis and receive recommendations for treatment and recovery.

Bursitis of the hip joint

This is an inflammation of one of the bursae of the hip joint.

A sharp pain is felt in various parts of the outer side of the thigh, which intensifies during flexion and extension of the thigh.

Prolonged intense loads on the hip joint or its severe contusion during a fall can provoke the onset of an inflammatory process in the synovial bursa.

Stop exercising, minimize movement of the affected limb, and contact a medical center for specialist advice.

Groin stretch

This is a partial or complete destruction of connective tissues at the site of attachment of the long adductor muscle to the femur or pubic bone.

Immediately there is a sharp pain and a characteristic crunch, which is sometimes accompanied by convulsions, swelling and hematoma at the site of injury.

Poor physical fitness and technical errors when performing exercises are the main causes of groin stretching.

To reduce swelling and pain, apply cold and fix the joint with a bandage or splint.Anesthetic ointment can be applied to the damaged area.

Stretching the muscles of the back of the thigh

This is a tear of one of the three muscles of the back of the thigh (most often the biceps).

The appearance of aching pain and some restrictions on movement occurs in mild cases. Sharp pain syndrome, significant limitation of mobility, multiple hemorrhages along the entire back of the thigh are signs of a severe degree of sprain.

Jerking loads and sudden accelerations with unheated or weakened muscles are typical causes of such injuries.

Cold compresses, an elastic bandage and limiting the load on the affected limb are sufficient measures for minor injuries. In difficult cases, you should contact a medical specialist to clarify the diagnosis and prescribe treatment.

4. Back and neck injuries

Overexertion of muscles when exercising with weights, falls and abrupt changes in the position of the body in space in playing and extreme sports often lead to trauma to the spine, muscles and ligaments of the back and neck.

Lumbar pain

This is a violation of the normal functioning of the components of the lumbar spine (muscles, ligaments, vertebrae).

Acute or pulling pain arises in the region of the sacrum and intensifies when walking and sitting, in case of infringement of the nerve endings, it can be given to the leg.

Excessive stress on the lumbar spine due to improper exercise technique or falling on the back are the main causes of such pathologies.

Short-term and non-acute pains most often disappear after reducing the load, applying massage and warming ointments.

Stress fracture of the lumbar vertebrae

This is a violation of the structure of the bone tissue of the vertebrae due to constant intense loads on the lower back.

At the initial stage, the symptoms are similar to other variants of lumbar pain. Lack of treatment leads to a complete fracture and then the pain increases sharply when turning and tilting.Hypertonicity of the back muscles and edema appear. When nerve endings are pinched, the sensitivity and tone of individual muscles may decrease.

If you suspect a stress fracture, you should stop exercising and immediately consult a doctor to clarify the diagnosis and further treatment.

Herniated disc

This is a partial or complete loss of functionality of the vertebrae due to deformation or destruction of its individual components.

There is a constant or periodic pain syndrome in the affected area of ​​the spine, which increases with bending.Depending on the site of injury, pain radiates to different parts of the body (buttocks, thigh, or shoulder). Dizziness, headache, numbness in the fingers, and weakness in the legs may also occur.

Prolonged exercise in an uncomfortable stance and uncontrolled efforts when exercising with weights can provoke such a pathology of the spine.

5. Shoulder injuries

This is a part of the arm from the elbow to the shoulder joint, which has a complex structure and is constantly under significant stress and therefore is often injured.

Dislocation of the shoulder joint

This is a displacement of the head of the shoulder bone, which leads to a loss of contact with the scapula bed and a complete loss of joint performance.

Severe pain immediately occurs, the possibility of controlled shoulder movements is lost, a visually distinguishable change in its shape and edema appear.

Fall on the shoulder, impact or sudden muscle tension in an unnatural position of the arm are typical cases of dislocation of the shoulder joint. Most often this happens when playing volleyball, basketball, equestrian sports or contact martial arts.

First of all, it is necessary to ensure the immobility of the joint and a comfortable position of the arm with the help of a bandage (the forearm is bent at 90 degrees to the shoulder).

Apply cold and anesthetic medicine to relieve pain. To correct the dislocation of the victim, it is necessary to take it to a medical institution.

Clavicle fracture

This is the destruction of the bone that connects the shoulder blade and the sternum.

The injury is accompanied by acute pain at the site of injury, which sharply increases when the shoulder hangs down.

Overloading from a sideways fall on a straight arm or shoulder often results in this injury.

First aid consists in relieving the acuteness of the pain syndrome with the help of an analgesic and immobilizing the broken collarbone. For this, various types of support bandages are used, which help to reduce pain and prevent repeated damage to the surrounding tissue. The victim must be taken to a medical clinic as soon as possible.

Rotator cuff injury

This is a damage to the joints of one or more muscles of the rotator cuff.

There are painful sensations in the area of ​​the shoulder joint, which intensifies with any movement of the hand and can be given to other parts of the body (forearm, hand, neck). Sometimes weakness is felt, and the range of changes in the position of the joint decreases.

In case of minor damage, it is enough to ensure the rest of the injured limb and periodically apply a cold compress to the shoulder during the first two days. Then use warming ointments. In case of acute pain, ligament rupture is possible, and it is better to see a doctor right away.

6. Injuries to the elbow, forearm, wrist and hand

These parts of the hand perceive loads of various directions and intensities, perform many power and precisely coordinated movements, take on shock loads when falling and performing vaults. Therefore, according to statistics, they account for more than 50% of all injuries.

Tennis Elbow

This is a violation of the integrity of the flexor fibers of the hand at the junction with the outer side of the humerus.

There is a pain syndrome in the elbow joint, which increases with extension or load on the arm. The sensitivity of certain areas of the forearm worsens, muscle weakness and limited movement appear.

In mild forms of damage, to restore full performance, it is enough to eliminate the load on the elbow and use: joint massage, heating procedures, anti-inflammatory drugs. Acute and advanced cases require accurate diagnosis and treatment in a medical facility.

Effective warming up of the muscles during warm-up, dosed strength loads on the muscles of the forearm and regular use of relaxing procedures (massage, bath) help to prevent such an injury.

Elbow neuropathy

These are various options for dysfunction of the ulnar nerve.

A small painful area appears in the elbow joint, which gradually expands and passes to the palm and the inner surface of the fingers, their sensitivity decreases and extension becomes difficult, and hand movements are limited.

Prolonged immobility of the elbow under load, dislocations and fractures of the forearm bones, bruises and sprains are the main causes of this neuropathic lesion.

In cases of minor damage to the ulnar nerve, anti-inflammatory ointments, dry heat and light joint massage are used. For acute symptoms, treatment is only prescribed by a doctor.

Reducing the duration of the static load on the elbow and performing special exercises to strengthen the muscles and stretch the tendons of the elbow joint reduces the risk of developing the above pathology.

Elbow fracture

This is an extra-articular or intra-articular fracture of one of the three bone fragments of the elbow joint.

Pain immediately occurs in the elbow. Depending on the type of damage, it can be strong or weak. Edema appears and the mobility of the joint is lost.

This fracture occurs when a fall on the elbow or a direct impact to the joint.

It is necessary to immobilize the injured limb and immediately ensure the delivery of the victim to a medical clinic.

Carpal tunnel syndrome

This is a violation of the normal functioning of the median nerve as a result of its compression in the carpal canal.

At the first stage of the disease, at night pain and numbness appear in the fingers. Then the pain begins to appear during the day, increases with hand movements and begins to spread to the palm and forearm. Grasping functions become difficult.

The main causes of trauma are bruises, sprains, dislocations and fractures of the bones of the hand.

First of all, it is required to provide complete rest of the injured limb for at least two weeks. To eliminate edema, cold and anti-inflammatory compresses are used.

Wrist sprain

This is a partial or complete violation of the integrity of the wrist ligaments.

Depending on the severity of the injury, the pain may be severe or mild. The mobility of the hand is limited or completely blocked.Edema appears, and in severe cases, hematoma.

Severe impact, falling on the hands, excessive stress on the wrist when lifting weights, or performing physical exercises often lead to injury to the wrist ligaments.

To relieve swelling and pain, apply cold to the injury site and fix the wrist joint and palm with a bandage. In mild cases, immobilization, limitation of loads and the use of anti-inflammatory drugs can restore performance within two weeks.

In case of severe pain, be sure to contact a specialist at the medical center to clarify the diagnosis.

90,000 What is a stress fracture of the lower leg?

An injury commonly experienced by runners and other athletes is a fracture from the tension of the lower leg, where the load that must be absorbed by the muscles of the lower leg is transferred to the bone, causing a small crack in that bone. The load is transferred to the bone because the muscles are overloaded and, therefore, weaker than usual, therefore, after overstraining the muscles, a fracture from the tension of the lower leg can occur.The injury is sometimes mistaken for shin splints. A stress fracture of the lower leg can be quite painful; it often takes several weeks or even months to heal completely, during which adequate rest is necessary.

Some runners may mistake a stress fracture for a less severe splint because the pain may be somewhat similar. Splinters occur when muscles or tendons in the lower leg become inflamed from overuse, causing pain when weight is applied to the legs.A stress fracture of the shin also becomes painful when a weight is placed on the leg, but a shin splint is likely to heal in a relatively short amount of time, while stress fractures can heal or even worsen. The pain from a stress fracture of the lower leg will become more significant over time than the pain from the lower leg.

In most cases, a stress fracture of the lower leg heals without any surgery or special treatment other than rest and pain relief, but in more serious cases, when the fracture worsens, surgery may be required to correct the problem.The person who has suffered a fracture will have to remain almost completely on the leg for several weeks or even months before the injury heals. The leg muscles also need to regenerate in order to properly support body weight, rather than transfer weight to the bone. Once the injury has healed, the runner will need to change his training program to avoid future fractures; a runner may even consider doing a gait analysis to ensure that his or her running on the run is not causing injury in the first place.

Athletes are not the only people at risk of lower leg fractures. Injury can result from a sudden impact, such as a collision or even a jump from a height. Walking more often than usual can also lead to a fracture of the lower leg tension, especially if the person’s usual routine is rather sedentary.

OTHER LANGUAGES

90,000 Marching foot – causes, symptoms, diagnosis and treatment

Marching foot is a pathological change in the structure of the metatarsal bones, resulting from excessive loads.It develops in soldiers, especially at the beginning of service, as well as after intensive drill, marches and crosses. It can occur in people whose profession requires constant standing on their feet, carrying heavy objects, or walking for a long time. Predisposing factors are flat feet and uncomfortable tight shoes. It manifests itself as pain in the area of ​​the foot, sometimes – sharp, unbearable. The pain increases with exertion and is accompanied by local swelling of the foot. The diagnosis is confirmed by X-ray.Treatment is conservative, the prognosis is favorable.

General information

Marching foot (recruits’ disease, marching fracture, Deutschlander’s disease) is a disease caused by pathological rearrangement of the metatarsal bones due to excessive stress. It can be acute or chronic, but more often it has a primary chronic course. It is treated conservatively, carried out by specialists in the field of traumatology and orthopedics, and ends with a full recovery.

Marching foot

Causes

Marching foot is observed in soldiers, athletes and people whose profession is associated with prolonged walking, standing or carrying weights. The likelihood of development increases with the use of uncomfortable shoes and flat feet. According to studies conducted in different countries, people with a low level of habitual physical activity are more likely to develop a marching foot after an intense exercise. This is believed to be due to lower bone strength.It is no coincidence that tourists are increasingly becoming another category of such patients today – office workers who actively “run” around tourist attractions in uncomfortable shoes during their holidays.

Pathogenesis

In Deutschlander’s disease, changes occur in the middle (diaphyseal) part of the metatarsal bones. Pathological restructuring of bone tissue in this case is due to changed mechanical and static-dynamic factors. The process most often involves the II metatarsal bone, less often – III, even less often – IV and V.This distribution is due to the peculiarities of the load on the foot when standing and walking, since in such cases the inner and middle parts of the foot are more “loaded”. The first metatarsal bone is never affected. This is probably due to its higher density and strength.

Usually one bone is affected, although both simultaneous and sequential damage to several bones on one or both feet is possible. It has been established that the marching foot is a special type of bone tissue transformation that is not associated with tumor or inflammation.

At the same time, the views of experts on the nature of the damage are still divided. Some believe that bone remodeling is accompanied by an incomplete fracture or the so-called “microfracture”. Others believe that the term “marching fracture” should be considered outdated and inconsistent with reality, since there is only local resorption of bone tissue, which is subsequently replaced by normal bone without the formation of callus.

Symptoms of the marching foot

There are two clinical forms of the disease: acute and primary chronic.The first is observed less often, develops 2-4 days after significant overvoltage (for example, a long march). The second appears gradually, gradually. Symptoms are less pronounced with it. There is no acute trauma with a marching foot in the anamnesis. Patients with this diagnosis complain of intense, sometimes unbearable pain in the midfoot.

Lameness appears, gait becomes uncertain, patients try to spare the injured limb. On examination, local swelling is determined over the middle section of the metatarsal bone and more dense swelling in the affected area.Skin sensitivity in this area increases. Hyperemia (redness of the skin) is quite rare and never severe. Patients also never have general symptoms: there is neither an increase in body temperature, nor a change in the biochemical or morphological picture of the blood. Pain can persist for weeks or even months. The average duration of the disease is 3-4 months. The disease ends with complete recovery.

Diagnostics

The diagnosis is made on the basis of a survey, examination and X-ray data.In this case, the picture obtained during the X-ray examination is of decisive importance. With Deutschlander’s disease in the diaphysis of the affected metatarsal bone (sometimes closer to the head, sometimes to the base, depending on the localization of the most functionally congested area), a change in the structural pattern is revealed. An oblique or transverse band of enlightenment is determined (the area of ​​enlightenment of Loozero) – the area of ​​bone restructuring. It looks like the metatarsal bone is split in two pieces.However, in contrast to the X-ray picture with a fracture, displacement in this case is not observed.

Subsequently, around the affected part of the bone, periosteal growths appear. At first they are thin and delicate, then – dense, similar to a fusiform callus. Later, the zone of enlightenment disappears, and sclerosis occurs. Over time, the periosteal layers dissolve. At the same time, the bone remains thickened and compacted forever. The defining signs are the absence of acute trauma, typical localization of the injury, as well as the presence of a restructuring zone in the absence of displacement of fragments and preservation of the correct shape of the bone.It should be borne in mind that during the first few days or weeks, radiological signs of the disease may be absent. Therefore, with characteristic symptoms, it is sometimes necessary to perform several radiographs at a certain time interval.

Treatment of the marching foot

Therapy is performed by traumatologists. Treatment is strictly conservative, surgical interventions are contraindicated. In the acute form, a plaster cast is applied to the patient and bed rest is prescribed for a period of 7-10 days.After the acute manifestations of the disease have subsided, as well as in the primary chronic form of the disease, massage and thermal (paraffin applications, baths) and other physiotherapeutic procedures are prescribed. Subsequently, patients are advised to use insoles and avoid long walking.

Prognosis and prevention

The prognosis is favorable, with the elimination of stress and adequate conservative therapy, all symptoms disappear within 3-4 months. Prevention consists of choosing comfortable footwear, choosing reasonable physical activity and careful medical supervision of the recruited soldiers.