By Ed Ireland – Perform Birmingham Deputy Physiotherapy Manager
Recently there have been a few cases of high profile athletes that have been reported to have stress fractures and have as a result had to stop competing. From Paula Radcliffe to Katarina Johnson-Thompson we read about them. Also with the recent huge rise in popularity of sports such as triathlons and running, more people from a wide range of fitness backgrounds are taking to the streets, parks or treadmills to get the miles under their belts.
So what exactly is a stress fracture? Well, a stress fracture is essentially an overuse injury of a bone. Usually bones are constantly adapting to the workload that is placed upon them by laying down calcium to become tougher in areas that need to take more load. Additionally when the demands on the bones are less, there is less calcium laid down and the bones become less tough. Over time if repeated workloads are placed on the bones faster than the body can respond by laying down more calcium, small areas of ‘stress’ can appear, and if continued can form a small crack. It is this crack that is the stress fracture.
The most common areas are the bones of the feet and the shin bone. Generally pain is felt locally over the site of the stress fracture, and often builds up during activity. If your doctor or physiotherapist suspects a stress fracture, usually an MRI scan will be ordered. This is needed to double check that the problem is in fact a stress fracture and this can also tell you what degree of stress in the bone is present. They can be graded between 1 (low amount of reaction in the bone) to 4 (high amount of reaction). The initial treatment is essentially just to rest and stop whatever activity is causing the problem. If the stress fracture is in the foot or shin, usually people will be placed in a supportive boot to ensure minimal further stress is placed on the bone, and to allow healing. Depending on what grade of stress fracture there is will determine how long the protective boot needs to be worn. Generally this would usually be between two and twelve weeks.
An important part of the management of stress fractures is to establish why they may have happened in the first place. Common causes in runners or athletes are usually the result of increasing your training load too much, too quickly. This could be your mileage, pace or volume of training. By speaking to someone such as a physiotherapist or running coach, who can help you plan your training load, is a good idea. Generally speaking the tried and tested runners method of “the 10% extra only a week” rule is a sensible start point. Additionally having a professional assessment to ensure you have good muscle strength, control of movement and running biomechanics can help ensure that the muscles have greater capacity to share the workload of the bones and thereby reducing the likelihood this type of injury when you return to your sport or activity.
At Perform Birmingham we are also lucky enough to have an AlterG treadmill, which can reduce your bodyweight to as little as 20%. This means alongside your rehabilitation program, when you are returning to running you can gradually re-introduce the stress to the bone allowing it time to adapt and strengthen while you build your cardiovascular fitness back up.
If you would like to book a consultation, running screening or AlterG session with Ed or any of the Perform team you can contact then at the Perform Physiotherapy department at Spire Little Aston hospital on 0121 5807131.