More and more people are hitting the roads and their treadmills to get in shape. As such, the number of exercise-related stress fractures has risen considerably over the last five years.
If you're a long-distance walker or runner, you could be a candidate to develop a stress fracture somewhere in your foot or leg. Although they appear most often in the bones of the feet, stress fractures of the shin and thigh bones are not uncommon and can be the source of a great deal of pain.
Classified into two main groups, stress fractures are hallmarked by their "hairline crack" appearances on the bone or by the visually appreciable changes that occur to the casing of the bone when it's inflamed.
A bone scan is the gold-standard diagnostic tool to identify a stress fracture. Bone scans show areas of increased metabolic activity in the presence of a fracture — a sign that the body is trying to heal itself.
Bone scans use radioactive tracer agents to visualize areas of bone under duress. A bone scan is often referred to as a "diagnostic shotgun blast," meaning it must be matched with a thorough clinical exam in order to have real diagnostic potential.
Because of their low sensitivity, X-rays, ultrasound and other imaging modalities — even MRI — have a limited diagnostic value when it comes ruling in or out a stress fracture.
Clinically speaking, it is rare that patients present to a clinic with these tests already in hand. Fortunately, a complete history and physical exam are all that's needed to formulate a working hypothesis and initiate an effective treatment protocol.
Patients of all shapes and sizes are at equal risk for acquiring a stress fracture if the conditions are right. A sudden increase in activity or a substantial change in exercise training patterns are notorious causes of the disorder.
Those at the highest risk of sustaining a fracture are people who participate in endurance-type or highly-repetitive weight bearing activities such as marathon training, long hikes or even walking for a few hours each day.
Certain professions that are linked to stress fractures also tend to be associated with prolonged weight bearing or standing in one place for ample periods of time such as police officers, military personnel and roadside construction workers.
Stress fractures require specific attention and plenty of rest in order to heal properly. While stress fractures are generally benign with excellent prognoses, they can progress towards more serious conditions such as a complete fracture or a limb-threatening bony infection in the absence of conservative management.
Rehabilitation of a stress fracture is fairly straightforward and for the most part, painless. Nearly all patients will achieve a full recovery under the supervision of a rehab clinician, but the rate is variable — some patients heal in two months while other cases may span a half-year.
Perhaps the biggest regularly-made mistake is to exercise through pain. This prolongs healing time by re-catalyzing the inflammatory reaction in the bone and could further damage it in the process.
Only rest and a carefully selected exercise program will bridge the gap between you and your bones — so don't wait too long to get checked out.
Gloucester resident Joe DiVincenzo is a physical therapist and clinical specialist in manual therapy. He writes "On the Mend" weekly. Questions may be submitted to Joe by email at joedivincenzo@comcast.net.
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