Stress fractures are a common affliction. While they’re especially prevalent in athletes and sports enthusiasts, stress fractures can happen to anyone.
Dr. Jesse Shaw, Sports Medicine Physician with Pullman Regional Hospital, shares helpful information about stress fractures, including how they differ from a broken bone, treatment options, and what individuals can expect in terms of recovery time.
Broken Bone vs. Stress Fracture
Dr. Shaw describes stress fractures on an injury continuum—going from stress responses to stress fractures, and then to a broken bone.
“The biggest thing that really separates a stress fracture from a broken bone is the acuity of the injury. With acute trauma, we develop fractures that we can see on x-rays and clinically diagnose,” he explains. “With stress fractures or stress responses, they're really overuse pathologies. They develop from the inability of the bone to withstand external mechanical load, which ultimately results in structural fatigue of the bone itself.”
What causes a stress fracture?
Stress fractures develop from any activity that causes repetitive mechanical loading. Not surprisingly, they typically occur in athletes or individuals who are very active. “I think the statistics say something like one-third to two-thirds of runners have a history of some sort of bone stress injury, which includes stress fractures,” notes Dr. Shaw.
The majority of stress fractures are found in the lower extremities (tibia, fibula, metatarsals). However, they can also develop in the upper extremities. For example, among individuals who do a lot of repetitive mechanics with their arms, such as rowers or people who repeatedly throw a ball. “Obviously, baseball players, but also if you have a dog and you're throwing the ball a lot, you can develop stress fractures in your humerus and other bones in your arm,” he adds.
How is a stress fracture diagnosed?
One of the first indicators of a stress fracture is pain that doesn’t alleviate with conservative treatments such as anti-inflammatory medications, ice/heat, or bracing. While x-rays are standard in the field of orthopedics, a stress fracture may not show up on this type of imaging. Dr. Shaw says an accurate diagnosis often requires advanced imaging.
“The number-one thing, with all diagnoses that we deal with, is getting an appropriate and accurate diagnosis. I advise individuals to come in if you have pain, if you have a new training regimen that you think you've done too much with. We can give you the appropriate recommendations on training modification or specific treatment if needed.”
How are stress fractures treated?
An important first step in addressing a stress fracture is to modify your activity or completely avoid it. This helps offload the pressure being put on the affected bone, using things like an assistive device (crutches), a boot to provide stability, or a sling if the fracture exists in an upper extremity. A very small subset of patients undergo surgery to help address a stress fracture. This approach is typically reserved for high-level athletes or those who hold specific responsibilities in the military.
Dr. Shaw also shares there are some newer technologies emerging to treat stress fractures, including bone stimulators. “They're not really the standard of care. So, the current recommendation is going to be some sort of deloading all the way to complete offloading of that bone that's injured, depending on where you are within the stress response to stress fracture continuum.”
How long does it take a stress fracture to heal?
Unfortunately, stress fractures do take time to heal. Depending on the severity of the fracture, complete recovery may take anywhere from four to 12 weeks. This involves activity modification or activity restriction. Dr. Shaw also considers certain metabolic processes that could be causing the stress fracture to be worse or keep progressing.
“Four to 12 weeks is kind of a wide window. Usually, it's on the upper end of that in terms of a road to recovery,” he states. “We really individualize everyone's evaluations and treatment plans. The goal is to get you back to doing the things you want to do from a health and wellness perspective, and to be able to live your life the way you wish. We use the mantra that exercise is medicine.”
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