Can stress give you a fracture? Orthopaedician has an answer

New Delhi: Stress fractures are tiny cracks in a bone caused by repetitive and excessive stress. While commonly seen in athletes and military recruits due to intense physical activity, they are also increasingly prevalent in fitness enthusiasts and young individuals participating in sports. These fractures primarily occur in weight-bearing bones such as the tibia, femur, pelvis, and spine, which endure continuous strain during high-impact activities. Patients often report localised pain and swelling that worsen with activity and improve with rest.

How do stress fractures occur?

Talking about stress fractures, Dr Brahmaraju T J, Sr Consultant – Orthopaedics & Joint Replacement Surgery, Gleneagles BGS Hospital, Kengeri Bengaluru, said“Stress fractures result from an imbalance between bone formation and resorption. Repeated stress on the bone causes microdamage, which the body typically repairs. However, when the stress is too frequent or intense, the repair process falls behind, leading to a fracture.”

Key contributing factors include:

1. Sudden increases in activity levels without proper preparation.
2. Improper footwear or equipment may increase stress on certain bones.
3. Nutritional deficiencies such as low calcium or Vitamin D, weaken bones.

Risk Factors

While anyone can develop stress fractures, some are at higher risk:

1. Excessive physical activity: Running, jumping, or intense sports without adequate rest.
2. Poor nutrition: Insufficient calcium and Vitamin D levels compromise bone health.
3. Alcohol consumption: Drinking more than 10 alcoholic beverages weekly reduces bone density.
4. Recreational overuse: Running more than 25 miles per week significantly increases strain.
5. Smoking: Negatively affects bone healing and density, increasing fracture risks.

Diagnosing Stress Fractures

Early diagnosis is essential for effective treatment and prevention of complications. Diagnosis typically includes:

1. Medical history and physical examination to identify pain patterns and swelling.
2. Imaging studies: While X-rays are the first-line diagnostic tool, early-stage stress fractures may not appear on
3. them. Advanced imaging like CT or MRI scans can detect fractures and assess severity.

Treatment Options

Treatment focuses on promoting bone healing and preventing further damage:

1. Rest and activity modification: The most critical step is avoiding activities that stress the injured bone, allowing it to heal.
2. Braces or casts: Immobilisation may be necessary for fractures in weight-bearing bones like the tibia or femur.
3. Nutritional supplementation: Adequate intake of calcium and Vitamin D is vital for recovery.
4. Surgical intervention: Severe or recurrent fractures may require surgery to stabilise the bone using screws or plates.

Preventive Strategies

Preventing stress fractures involves addressing modifiable risk factors and adopting healthy habits:

1. Gradual activity progression: Avoid sudden increases in physical activity. Gradually build up intensity, duration, and frequency.
2. Proper footwear: Use supportive, well-fitting shoes designed for specific activities. Replace them regularly to maintain adequate support.
3. Balanced diet: Ensure sufficient calcium and Vitamin D intake through foods like dairy, leafy greens, nuts, and fortified cereals. Sunlight exposure also boosts Vitamin D levels naturally.
4. Cross-training: Incorporate low-impact activities like swimming or cycling to reduce repetitive stress on specific bones.
5. Lifestyle modifications: Limit alcohol intake and quit smoking to improve bone density and overall health.

Recovery and Rehabilitation

Rehabilitation is critical to a full recovery from stress fractures. Once the rest phase is complete, patients can gradually reintroduce physical activity under professional guidance. Physical therapy helps restore strength and flexibility, reducing the likelihood of recurrence. Key elements of rehabilitation include:

1. Low-impact exercises: Start with walking or swimming to ease back into activity without overloading the bone.
2. Strength training: Build muscle to support bones and reduce stress on them.
3. Biomechanical assessment: Correct running form, posture, or other factors contributing to the injury.

Conclusion

Stress fractures, though common, are preventable and treatable. Understanding risk factors, recognizing symptoms early, and adopting preventive strategies can significantly reduce the risk of these injuries. For those already affected, a combination of rest, nutritional support, and medical intervention ensures effective recovery. By maintaining bone health through gradual training, proper nutrition, and healthy lifestyle choices, individuals can remain active and injury-free, safeguarding both performance and overall well-being.