Stress fractures among marathon runners

Dr K J Reddy, Chief Joint Replacement and Arthroscopic Surgeon,Apollo Hospitals says a stress fracture from running is one of the most frustrating injuries a runner can face.

What is a stress fracture?
A stress fracture is an overuse injury. It occurs when muscles become fatigued and are unable to absorb added shock. Eventually, the fatigued muscle transfers the overload of stress to the bone causing a tiny crack called a stress fracture.

What causes a stress fracture?
Most stress fractures are caused by overuse and repetitive activity, and are common in marathon runners and athletes who participate in running sports, such as soccer and basketball. They, often are the result of increasing the amount or intensity of running activity too rapidly. High impact loading during running leads to tibial stress fractures.

Where do stress fractures occur?
Runners can get a wide variety of stress fractures, but the most common stress fractures in runners are (in order) tibia (bigger shin bone),metatarsal, femur, fibula and navicular.

What are the symptoms of a stress fracture?
The most common symptom of a stress fracture is pain. The pain usually develops gradually and worsens during weight-bearing activity. Other symptoms may include:

• Pain that diminishes during rest
• Pain that occurs and intensifies during running and also normal, daily activities
• Tenderness to touch at the site of the fracture
• Rarely bruising or swelling

How are stress fractures diagnosed?
X-rays are commonly used to determine stress fracture. Sometimes, the stress fracture cannot be seen on regular x-rays or will not show up for several weeks after the pain starts. Occasionally, a computed topography (CT) scan or magnetic resonance imaging (MRI) will be necessary. A full medical work-up with laboratory tests to check for nutritional deficiencies such as low calcium or Vitamin D may also be required.

How are stress fractures treated?
The goal of treatment is to relieve pain and allow the fracture to heal so that you are able to return to your running activities.. The majority of stress fractures are treated nonsurgically.

Since stress fractures most often occur as a result of overuse, A period of rest is needed. Complete rest and a cast or walking boot are usually used for a period of four to eight weeks In addition to rest, shoe inserts or braces may be used to help these injuries heal. Calcium and vitamin D supplements often are prescribed.

With severe stress fractures, surgery may be needed for proper healing. Surgery would usually include placing pins, screws or plates to secure the bone during healing process.

How to avoid stress fractures?
The following guidelines can help you prevent stress fractures in the future:
Eat a healthy diet. A balanced diet rich in calcium and Vitamin D will help build bone strength.

• Use proper equipment. Old or worn running shoes may lose their ability to absorb shock and can lead to injury. In general, athletic shoes should have a softer insole, and a stiffer outer sole. Consider rotating shoes to prevent future fractures.
• Start new activity slowly. Gradually increase your time, speed, and distance. In most cases, a 10 percent increase in mileage per week is appropriate for most runners.
• Cross train. Vary your activities to help avoid overstressing one area of your body. For example, alternate a high-impact sport like running with lower-impact sports like swimming or cycling.
• Add strength training to your workout. Strength-training exercises use resistance methods like free weights, resistance bands, or your own body weight to build muscles and strength.
• Stop your activity if pain or swelling returns. Rest for a few days. If the pain continues, see your doctor.
• Stride frequency is another factor that affects your impact and active forces. Higher stride frequencies and avoiding over-striding prevents stress fractures.