Stress Fracture

What is a Stress Fracture?  

A stress fracture is an injury to a bone caused by repeated stress. There are two types of stress fractures. A “fatigue” stress fracture occurs when a healthy bone sustains abnormal stress and partially breaks. An “insufficiency” stress fracture occurs when a bone that has been weakened by disease partially breaks under normal stress. Fatigue stress fractures are the most common type of stress fractures observed in active children and teens. Stress fractures are typically found in the weight-bearing bones.  

Stress fractures are more common in females or in sports that require a great deal of high-impact activity, such as running, basketball, cheerleading, and gymnastics.  

What causes Stress Fractures? 

It is believed that most fatigue stress fractures are caused by too much stress applied too quickly and frequently for the bone to fully heal during a rest period. With continued stress, the weakened bone may fracture. 

Risk factors include:

• alignment abnormalities
• improper nutrition
• training errors (such as a rapid increase in intensity/duration)
• inflexible or weak muscles
• improper rest between activities
• inappropriate shoes
• change in the playing/running surface
• personal or family history of low bone density. 

Additionally, females with irregular menstrual cycles are at an increased risk of a stress fracture and poor bone health.  

What are the symptoms of Stress Fractures? 

Stress fractures often occur in the bones of the lower leg or foot. Those suffering from a stress fracture usually experience a gradual increase in localized pain, starting with pain after activity that can progress to pain during activity and weight-bearing.  Pain typically resolves with rest. In more advanced cases, patients may have pain during inactivity and/or at night.  

How is a Stress Fracture diagnosed? 

Based on the patient's history and physical examination, the doctor may suspect a stress fracture. X-rays, bone scans, or MRIs can be used to confirm the diagnosis. 

How is a Stress Fracture treated? 

It is important to allow the stress fracture to fully heal before returning to activity. To protect the injured bone, the doctor may place a patient on crutches or use other equipment to take stress off the bone, such as a walking boot.  Physical therapy may play an important role by helping to treat the underlying factors that contributed to the injury. The goal of therapy is to help the athlete return to his or her previous level of activity, slowly and safely. 

References 

Field AE, Gordon CM, Pierce LM, Ramappa A, Kocher MS. Prospective study of physical activity and risk of developing a stress fracture among preadolescent and adolescent girls. Arch Pediatr Adolesc Med. 2011;165(8):723-8. 

Anderson SJ and Harris SS, eds. Care of the Young Athlete, 2nd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2010. 

Sarward JF and LaBella CR, eds. Pediatric Orthopaedics and Sports Injuries. Elk Grove Village, IL: American Academy of Pediatrics; 2010.