Athlete bone fracture prevention -
Nutrition in bone health revisited: A story beyond calcium. Journal of the American College of Nutrition. Skip to main content Skip to header right navigation Skip to site footer Fort Worth — Mansfield — Decatur — Orthopedics Today Urgent Care Physical Therapy Fort Worth — Physical Therapy Willow Park Prevent Broken Bones.
Bone Health to Prevent Broken Bones Fractures Bone DensitometryBBone Densitometryones are comprised of living tissue that grows and changes throughout our lives. Protecting Your Bones from Osteoporosis and Fractures There are some risk factors for osteoporosis and bone loss that cannot be changed—such as gender women have increased risk , age, body size, and family history.
Get adequate calcium: The best food sources of calcium are dairy, leafy greens, sardines, and orange juice, but you may need to supplement as well. Vitamin D: Vitamin D is another important ingredient for bone health. Vitamin D helps promote calcium absorption and build skeletal health.
Women who take more than international units IUs of vitamin D per day are 30 percent less likely to experience hip fractures. Extreme dieting or eating disorders pose a risk because they deprive bones of protein. Your bones will thank you. Weight-bearing exercise: Weight-bearing exercise has been shown to increase bone density and improve bone health.
Walking or lifting weights are excellent activities to promote fitness and build strong, healthy bones. Cut the caffeine : Caffeine leaches calcium from the body and therefore, can have a negative impact on bone health, especially if calcium intake is too low.
If you are a caffeine junkie, you may want to consider increasing your calcium intake. Be sure to discuss the side effects of medications with your physician and take precautions for your bone health.
References [1] Bischoff-Ferrari HA, Willett WC, Orav EJ, et al. In an IDF study, Milgrom et al. Clinical assessment and bone scans were used to establish the diagnosis of stress fracture.
Use of orthotics reduced the incidence of femoral stress fracture by 46 percent, but the overall reduction in stress fractures was not statistically significant table 6.
The injury experience of those lost to follow-up was not reported. In another IDF study, investigators randomly provided basketball shoes to Recruits wearing basketball shoes did report a decrease in overuse injuries metatarsal stress fractures, plantar fasciitis of the foot Quality scores for the randomized controlled trials ranged from 12 to 59 out of a possible for the individual rater scores; the median scores for the nine studies ranged from 16 to 55 table 6.
The design or reporting of the randomization process employed in most of the studies was inadequate. In military studies, particularly if randomization is by unit, the randomization should include enough units of test and control groups to account for interunit variation in injury rates, which may be greater than the effect size expected from the intervention.
The case definition of a stress fracture and the manner in which diagnostic tests are employed should be reported for all studies. Statistical methods were reported incompletely in all nine studies. Most of the studies reviewed did not indicate whether sample size estimates or power calculations had been performed in advance of the study.
Sample sizes should be calculated while taking into account the sensitivity of the diagnostic approach employed. For instance, if only radiographically confirmed clinical cases are included in the analysis, much larger sample sizes will be necessary than if bone scan confirmation is employed.
Sample size estimates should take into consideration the subpopulation being studied. For instance, studies of women will probably require fewer subjects than studies of men because of the higher incidence of stress fracture women experience given comparable exposures.
Investigators should do a better job of tracking and reporting on persons lost to follow-up, documenting possible differences in personal characteristics, risk factors, injury incidence, and reasons for dropping out.
In addition, interpretation of results was hampered by the lack of attention to possible confounding factors and by both information and selection biases. In a number of the studies reviewed, multivariate analysis controlling for potential confounders would have been instructive.
Our review identified more than papers on stress fractures and related overuse injuries. Of these, addressed the etiology, epidemiology, or prevention of stress fractures table 2. In addition to the research papers cited, 25 were review articles 2 , 4 — 6 , 8 — 9 , 14 , 32 — 36 , — Only nine of the reports reviewed examined interventions aimed at preventing stress fractures.
All nine were military studies. Fifty-two papers studied the epidemiology of and risk factors for stress fracture, and 42 of these were military studies.
Most of the 10 civilian risk factor studies focused primarily on the role of menstrual irregularity and bone density on stress fracture risk among female runners and athletes.
The military studies were more diverse and identified a number of significant risk factors, including female gender, age, lower bone density and indices of bone strength, low aerobic fitness, low past physical activity levels, cigarette smoking, and greater amounts of running.
The risk factors and general principles of stress fracture prevention discovered through military studies should be applicable to similarly physically active civilian populations. The civilian exercise and sports communities are concerned for similar reasons 2 , 4 , 6.
While stress fractures in military populations result in lost duty time and, in some cases, discharge from the military, among civilians these injuries result in decreased physical training and sometimes cessation of exercise. Thus, finding ways to prevent stress fractures would benefit both the military and civilian exercise and sports participants.
Unfortunately, the greatest weakness of the stress fracture literature for both groups is the limited number of studies, even studies of those interventions most commonly recommended by sports medicine experts. The nine intervention trials identified in this review examined only two of the many possible strategies for preventing stress fracture suggested by the literature—alterations of training and modifications of footwear.
The one training intervention involved providing military trainees with a week-long break from running in the early weeks of training, and results did not appear to be promising enough to warrant further research. Of the interventions involving footwear, the trial of orthotic inserts appeared to be the most promising.
In addition, intervention trials on some of the shock-absorbent boot insoles indicated that this approach might also be fruitful. Thus, further research into the efficacy of preventing stress fracture through modification of footwear is recommended.
Perhaps the most important insights gleaned from this quality review of stress fracture prevention studies pertain to the design and implementation of future military and sports medicine intervention trials. Other investigators have also suggested that careful attention to study design, execution, and reporting is critical , Subjects in both intervention and control groups should be subject to uniform, consistent, and ongoing monitoring for the occurrence of injuries.
Randomization should be blinded when possible, and the method of randomization used should be described clearly. Whereas a double-blind study is often not feasible for studies of athletic injuries for example, users of orthotic devices know they are wearing them , blinded allocation of subjects is essential in order to minimize bias.
Case definitions must be explicit and easily replicable. In calculating rates of injury, careful consideration must be given to the choice of denominators e.
Appropriate statistical methods should be used for data analysis, and these methods should be described clearly in published articles. Among other things, investigators should avoid comparing mean values for risk factors, such as bone density, flexibility, or percentage of body fat, in injured versus uninjured persons when it is possible to determine and compare the risks or incidence rates of stress fracture among persons exhibiting different degrees of the risk factors.
Finally, the reporting of results should be improved so that the methods employed can be understood and replicated by other investigators, and published study conclusions should be supported by the data presented. Better information on how to prevent stress fractures will depend on valid and reliable results from intervention trials.
In turn, the success of future trials will depend not only on the application of improved methodology but also on knowledge of modifiable causes and risk factors. This review has identified a number of potentially modifiable risk factors that could be used to design prevention strategies.
Of the strategies for preventing stress fracture suggested by this review, modulation of amounts of running and other weight-bearing activities to reduce the total amount of activity performed is one of the most promising. Stress fractures of the lower extremities occur most commonly in association with weight-bearing sports, physical training, and exercise, so it makes sense that modifications of training or exercise programs would reduce the incidence of such injuries.
One of the studies on runners reviewed indicated that persons who run more miles experience a higher incidence of stress fracture In assessing running-related injuries in general, injury incidence can be 1. If reductions in training mileage could reduce stress fracture incidence in proportion to the degree to which higher mileage elevates overuse injury risk, reductions of 50—80 percent could be achievable.
A study of Marine recruits suggested that reductions in running mileage can produce decreases in stress fracture on this order of magnitude table 5 , A recent study of Army trainees confirmed the validity of this approach, showing that a 50 percent reduction in total running miles resulted in a 40 percent reduction in overall injury rates, with no decrease in performance on a final 2-mile 3.
A classic study by Pollock et al. Such research would benefit competitive and recreational runners, track athletes, fitness program participants, other sports participants, and military personnel. Several studies reviewed showed that persons who have led more sedentary, physically inactive lifestyles in the past are more likely to suffer stress fractures when they begin to engage in physically demanding military training , , A number of studies also indicate that higher levels of aerobic fitness protect military trainees from stress fractures and other training injuries , , Research should be conducted to determine whether gradually increasing physical fitness prior to initiating a vigorous physical training program prevents stress fractures, not just in military recruits but in civilian populations as well.
Those who might benefit in addition to military recruits include novice runners, first-time sports participants, and persons beginning fitness or aerobics programs. The literature reviewed also suggested several other potentially promising approaches.
Bone research suggests that it may be possible to design physical training programs not just to increase aerobic fitness and muscle strength but also to increase bone strength and dimensions , , Several civilian investigators have studied the associations among amenorrhea, menstrual regulatory hormones, and bone density because of the suspected association between menstrual irregularity and stress fractures , On the basis of an extensive sports medicine review, Nattiv and Armsey 34 suggested that, while a relation is not proven, oral contraceptives may exert a protective effect for female athletes that deserves further research.
Table 7 lists other recommendations for research suggested in the papers reviewed. As a general strategy, it may be helpful to focus research on the sports and activities in which stress fractures occur most frequently and on the bones where they occur most frequently.
The larger clinical case series 1 , 3 , 59 and some epidemiologic studies suggest that stress fractures occur more frequently among runners than among participants in other weight-bearing sports such as basketball, soccer, field hockey, or tennis.
Research is needed to determine whether this is the result of greater numbers of runners, greater exposure of runners, or some other possibly protective factor in other sports, such as a more varied plane of motion that distributes forces more widely over bone.
A number of studies of weight-bearing physical activity and sports have shown that the tibia is the bone most commonly reported to undergo stress fracture 3 , 16 , 20 , The greater relative frequency of tibial stress fractures observed among runners as compared with military recruits suggests that the type and nature of the activity engaged in may influence the location of a stress fracture.
Future prevention research focused on specific bones and high-risk sports or exercise activities might have a greater chance of success. This review summarizes an extensive body of literature on stress fractures.
It also highlights how little we know about what works to prevent one of the most common and potentially serious sports- and exercise-related overuse injuries. The available research suggests that for many persons, stress fractures and other physical training-related injuries can be prevented by reducing the amounts of weight-bearing exercise performed without sacrificing fitness.
The data also suggest that the most sedentary and least physically fit persons are most vulnerable to stress fractures when starting a vigorous exercise program and that they would benefit most from starting exercise gradually and reducing training volume. Until more definitive solutions become available, a common-sense approach to training and overuse injury prevention must be recommended Reprint requests to Dr.
Jones, US Army Center for Health Promotion and Preventive Medicine, Black Hawk Road attention: MCHB-TS-EIP , Aberdeen Proving Ground, MD e-mail: bruce. jones apg. Layout of quality review score sheet used to assess published articles on stress fracture prevention.
Distribution of published studies of stress fracture by type of study, population studied military vs. civilian , and date of publication. Results of studies of the association between aerobic physical fitness and risk of stress fracture. Results of studies of the associations of past physical activity and amount of current training running with risk of stress fracture.
Recommendations for research on the prevention of stress fractures, by category of intervention. Hulkko A, Orava S. Stress fractures in athletes.
Int J Sports Med ; 8 : —6. Jones BH, Harris JM, Vinh TN, et al. Exercise-induced stress fractures and stress reactions of bone: epidemiology, etiology and classification.
Exerc Sports Sci Rev ; 17 : — Matheson GO, Clement DB, McKenzie DC, et al. Stress fractures in athletes: a study of cases. Am J Sports Med ; 15 : 46 — McBryde AM Jr.
J Sports Med ; 3 : — Sterling JC, Edelstein DW, Calvo DR, et al. Stress fractures in the athlete: diagnosis and management. Sports Med ; 14 : — Belkin SC.
Orthop Clin North Am ; 11 : — Bernstein A, Childers MA, Fox KW, et al. March fractures of the foot: care and management of patients.
Am J Surg ; 71 : — Foster FP. Pied forcé in soldiers. Markey KL. Stress fractures. Clin Sports Med ; 6 : — Berkebile RD. Stress fracture of the tibia in children. Am J Roentgenol ; 91 : — Blazina ME, Watanabe RS, Drake EC.
Fatigue fractures in track athletes. Calif Med ; 97 : 61 —3. Burrows HJ. Fatigue fracture of the middle third of the tibia in ballet dancers. J Bone Joint Surg ; 38B : 83 — Devas MB. Proc R Soc Med ; 62 : —7. Hartley JB. Fatigue fracture of the tibia. Br J Surg ; 30 : 9 — Ha KI, Hahn SH, Chung M, et al.
A clinical study of stress fractures in sports activities. Orthopedics ; 14 : — Hulkko A, Alen M, Orava S. Stress fractures of the lower leg. Scand J Sports Sci ; 9 : 1 —8.
Brubaker CE, James SL. Injuries to runners. J Sports Med ; 2 : — Gudas CJ. Patterns of lower-extremity injury in runners.
Exerc Sports Med ; 6 : 50 —9. Orava S, Puranen J, Ala-Ketola L. Stress fractures caused by physical exercise. Acta Orthop Scand ; 49 : 19 — Jansen M. March foot. J Bone Joint Surg ; 8 : — Krause GR, Thompson JR Jr. March fracture: analysis of cases.
Am J Roentgenol ; 52 : — Leavitt DG, Woodward HW. March fracture: a statistical study of forty-seven patients. J Bone Joint Surg ; 26 : — Tyner FH, Hileman WT.
March fracture: an analysis of cases. March fracture of the tibia. Radiology ; 41 : —5. Leveton AL. March fatigue fracture of the long bones of the lower extremity and pelvis. Carlson GD, Wertz RF. March fracture, including others than those of the foot. Radiology ; 43 : 48 — Mansi RL.
A case of insufficiency fracture occurring in the neck of the femur. Br J Radiol ; 16 : — Garcia JE, Grabbon LL, Franklin KJ. Factors associated with stress fractures in military recruits. Mil Med ; : 45 —8. Giladi M, Ahronson Z, Stein M, et al. Unusual distribution and onset of stress fractures in soldiers.
Clin Orthop ; : —6. Hallel T, Amit S, Segal D. Fatigue fractures of tibia and femoral shaft in soldiers. Clin Orthop ; : 35 — J R Coll Gen Pract ; 19 : 34 —8.
Hershman E, Mailly T. Clin Sports Med ; 9 : — Nattiv A, Armsey TD Jr. Stress injury to bone in the female athlete. Clin Sports Med ; 16 : — Daffner RH. Stress fractures: current concepts. Skel Radiol ; 2 : —9. Daffner RH, Martinez S, Gehweiler JA.
Stress fractures in runners. JAMA ; : — Friedenburg ZC. Fatigue fractures of the tibia. Clin Orthop ; 76 : — Greaney RB, Gerber FH, Laughlin RL.
Distribution and natural history of stress fractures in U. Marine recruits. Radiology ; : — Roub LW, Gummerman LW, Hanley EN Jr, et al. Bone stress: a radionuclide imaging perspective. Radiology ; : —8. Floyd WN Jr, Butler JE, Clanton T, et al. Roentgenologic diagnosis of stress fractures and stress reactions.
South Med J ; 80 : —9. Scully TJ, Griffith JC, Jones B, et al. Bone scans yield a high incidence of false positive diagnoses of stress fractures. Presented at the American Academy of Orthopaedic Surgeons Annual Meeting, San Francisco, California, February 18—23, Ross J, Woodward A.
Risk factors for injury during basic military training: is there a social element to injury pathogenesis? J Occup Med ; 36 : —6. Scully TJ, Besterman G. Stress fractures—a preventable training injury.
Mil Med ; : —7. Thacker SB, Stroup DF, Branche CM, et al. The prevention of ankle sprains in sports: a systematic review of the literature. Am J Sports Med ; 27 : — Chalmers TC, Lau J. Meta-analytical stimulus for change in clinical trials.
Stat Methods Med Res ; 2 : — Geslien GE, Thrall JH, Espinosa JL, et al. Early detection of stress fractures using 99m Tc-polyphosphate. Radiology ; : —7. Meurman KO, Elfving S. Stress fractures in soldiers: a multifocal bone disorder. Prather JL, Nusynowitz ML, Snowdy HA, et al. Scintigraphic findings in stress fractures.
J Bone Joint Surg ; 59A : — Saunders AJ, Sayed TF, Hilson AJ, et al. Stress lesions of the lower leg and foot. Clin Radiol ; 30 : — Wilcox JR, Moniot AL, Green JP.
Bone scanning in the evaluation of exercise related stress injuries. Zwas ST, Elkanovitch R, Frank G. Interpretation and classification of bone scintigraphic findings in stress fractures.
J Nucl Med ; 28 : —7. Milgrom C, Chisin R, Giladi M, et al. Negative bone scans in impending tibial stress fractures. Am J Sports Med ; 12 : — Devereaux MD, Parr GR, Lachman SM, et al.
The diagnosis of stress fractures in athletes. JAMA ; : —3. Edelman B. Orthop Today ; 13 : 1 — Scintigraphic uptake of 99m Tc at non-painful sites in athletes with stress fractures. Sports Med ; 4 : 65 — Brill DR.
Bone imaging for lower extremity pain in athletes. Clin Nucl Med ; 8 : —4. Mills GQ, Marymont JH III, Murphy DA.
Bone scan utilization in the differential diagnosis of exercise-induced lower extremity pain. Clin Orthop ; : — Norfray JF, Schlachter J, Kernahan WT Jr, et al. Early confirmation of stress fractures in joggers. JAMA ; : —9. Rupani HD, Holder LE, Espinola DA, et al. Three-phase ra-dionuclide bone imaging in sports medicine.
Radiology ; 86 : — Groshar D, Lam M, Even-Sapir E, et al. Stress fractures and bone pain: are they closely associated? Br J Accid Surg ; 16 : —8. Kuusela TV. Stress response of the tibial cortex: a longitudinal radiological study.
Ann Clin Res ; 16 suppl 40 : 14 — Bernstein R. March fracture: a report of three hundred and seven cases and a new method of treatment.
Hullinger CW, Tyler WL. March fracture: report of cases. Bull US Army Med Dept ; 69 : 72 — Hullinger CW. Insufficiency fracture of the calcaneus: similar to march fracture of the metatarsal. J Bone Joint Surg ; 26 : —7.
Blickenstaff L, Morris JM. Fatigue fracture of the femoral neck. J Bone Joint Surg ; A : — Milgrom C, Giladi M, Stein M, et al. Stress fractures in military recruits: a prospective study showing an unusually high incidence.
J Bone Joint Surg ; B : —5. Wilson ES, Katz FN. Stress fractures: an analysis of consecutive cases. Radiology ; 92 : —6. Orava S. Br J Sports Med ; 14 : 40 —4. Clement DB, Taunton JE, Smart GW, et al. A survey of overuse running injuries. Phys Sportsmed ; 9 : 47 — Sullivan D, Warren RF, Pavlov H, et al.
Stress fractures in 51 runners. Taunton JE, Clement DB, Webber D. Lower extremity stress fractures in athletes. Phys Sportsmed ; 9 : 77 —81, 85—6.
Berkman E. Etiological possibilities of march fractures. J Bone Joint Surg ; 25 : —7. Breck LW, Higinbotham NL. March fractures: a new concept of their etiology and a logical method of treatment. Mil Surg ; 95 : — Childress HM. March fractures of the lower extremity: report of a case of march fractures of a cuneiform bone.
War Med ; 4 : — DeVan WT, Carlton DC. The march fracture persists: a report on cases during a fifteen-month period at an infantry basic training center. Am J Surg ; 87 : — Johnson LC, Stradford HT, Geis RW, et al. Histogenesis of stress fractures.
J Bone Joint Surg ; 45A : Proctor SE, Campbell TA, Dorelle M. March fractures of the tibia and femur. Surg Gynecol Obstet ; 78 : — Volpin G, Petronius G, Hoerer D, et al.
Lower limb pain and disability following strenuous activity. Yale J. A statistical analysis of 3, consecutive fatigue fractures of the distal lower extremities. J Am Podiatry Assoc ; 66 : — Hamilton AS, Finklestein HE. March fracture: report of a case involving both fibulae. J Bone Joint Surg ; 16 : —7.
Blank S. Transverse tibial stress fractures: a special problem. Am J Sports Med ; 15 : — Brahms M, Fumich RM, Ippolito VD. Atypical stress fracture of the tibia in a professional athlete. Am J Sports Med ; 8 : —2. Butler JE, Brown SL, McDonnell BG. Subtrochanteric stress fractures in runners. Am J Sports Med ; 10 : — Clayer M, Krishnan J, Lee WK, et al.
Longitudinal stress fracture of the tibia: two cases. Clin Radiol ; 46 : —4. Clement DB. Tibial-stress syndrome in athletes. J Sports Med ; 2 : 81 —5. Dodd H. Pied forcé or march foot. Br J Surg ; 21 : — Engber WD. Stress fractures of the medial tibial plateau.
J Bone Joint Surg ; A : —9. Engh CA, Robinson RA, Milgrom J. Stress fractures in children. J Trauma ; 10 : — Goldman SE. March foot, with fracture of metatarsal bone: report of case.
J Bone Joint Surg ; 10 : — Graham C. Stress fractures in joggers. Tex Med ; 66 : 68 — Harolds JA. Fatigue fractures of the medial tibial plateau.
South Med J ; 74 : — Maseritz IH. March foot associated with undescribed changes of the internal cuneiform and metatarsal bones. Arch Surg ; 32 : 49 — Orava S, Hulkko A. Stress fracture of the mid-tibial shaft.
Acta Orthop Scand ; 55 : 35 —7. Pilgaard S, Poulsen JO, Christensen JH. Acta Orthop Scand ; 17 : —9. Roberts SM, Vogt EC. Pseudofracture of the tibia. J Bone Joint Surg ; 21 : — Schlefman BS, Arenson DJ.
Recurrent tibial stress fractures in a jogger. J Am Podiatry Assoc ; 71 : —9. Singer M, Maudsley RH. Fatigue fractures of the lower tibia. J Bone Joint Surg ; B : — Speed JS, Blake TH.
J Bone Joint Surg ; 15 : — Stanitski CL, McMaster JH, Scranton PE. On the nature of stress fractures. Am J Sports Med ; 6 : —6. Swart HA. March fracture as a complication of pregnancy.
Am J Surg ; 59 : —4. Bensel CK, Kish RN. Lower extremity disorders among men and women in Army basic training and effects of two types of boots. Natick, MA: US Army Natick Research and Development Laboratories, Bijur PE, Horodyski M, Egerton E, et al.
Comparison of injury during cadet basic training by gender. Arch Pediatr Adolesc Med ; : — Brudvig TJ, Gudger TD, Obermeyer L. Stress fractures in trainees: a one-year study of incidence as related to age, sex, and race. Canham ML, Knapik JJ, Smutek MA, et al.
Training, physical performance, and injuries among men and women preparing for occupations in the Army. In: Kumar S, ed. Advances in occupational ergonomics and safety: proceedings of the XIIIth Annual International Occupational Ergonomics and Safety Conference Washington, DC: IOS Press, — Gardner LI, Dziados JE, Jones BH, et al.
Prevention of lower extremity stress fractures: a controlled trial of a shock-absorbent insole. Am J Public Health ; 78 : —7.
Jones BH, Bovee MW, Harris JM III, et al. Intrinsic risk factors for exercise-related injuries among male and female Army trainees.
Am J Sports Med ; 21 : — Jones BH, Cowan DN, Tomlinson JP, et al. Epidemiology of injuries associated with physical training among young men in the Army. Med Sci Sports Exerc ; 25 : — Jones BH, Shaffer RA, Snedecor MR.
Injuries treated in outpatient clinics: surveys and research data. Mil Med ; suppl : to Kowal D. Nature and causes of injuries in women resulting from an endurance training program. Am J Sports Med ; 8 : —9. Reinker K, Ozbourne S. A comparison of male and female orthopaedic pathology in basic training.
Mil Med ; : —6. Almeida SA, Williams KM, Shaffer RA, et al. Epidemiological patterns of musculoskeletal injuries and physical training. Med Sci Sports Exerc ; 31 : — Beck TJ, Ruff CB, Mourtada FA, et al. Dual energy x-ray absorptiometry derived structural geometry for stress fracture prediction in male U.
Marine Corps recruits. J Bone Miner Res ; 11 : — Shaffer RA, Brodine SK, Almeida SA, et al. Use of simple measures of physical activity to predict stress fractures in young men undergoing a rigorous physical training program. Am J Epidemiol ; : — Beck TJ, Ruff CB, Shaffer RA, et al. Stress fracture in military recruits: gender differences in muscle and bone susceptibility factors.
Bone ; 27 : — Shaffer RA, Brodine SK, Ito SI, et al. Epidemiology of illness and injury among U. Navy and Marine Corps female training populations. Mil Med ; : 17 — Reynolds KL, Heckel HA, Witt CE, et al. Cigarette smoking, physical fitness, and injuries in infantry soldiers.
Am J Prev Med ; 10 : — Black JR. Stress fractures of the foot in female soldiers: a two-year survey. Mil Med ; : —2. Linenger JM, Shwayhat AF. Epidemiology of podiatric injuries in US Marine recruits undergoing basic training. J Am Podiatr Med Assoc ; 82 : — MacLeod MA, Houston AS, Sanders L, et al.
Incidence of trauma related stress fractures and shin splints in male and female Army recruits: retrospective case study. BMJ ; : Proztman RR, Griffis CC. Comparative stress fracture incidence in males and females in an equal training environment. Athletic Train ; : — Bennell KL, Malcolm SA, Thomas SA, et al.
The incidence and distribution of stress fractures in competitive track and field athletes: a twelve-month prospective study.
Am J Sports Med ; 24 : — Goldberg B, Pecora P. Stress fractures: a risk of increased training in freshmen. Phys Sportsmed ; 22 : 68 — Brunet ME, Cook SD, Brinker MR, et al. A survey of running injuries in competitive and recreational runners.
J Sports Med Phys Fitness ; 30 : — Lloyd T, Triantafyllou SJ, Baker ER, et al. Women athletes with menstrual irregularity have increased musculoskeletal injuries.
Med Sci Sports Exerc ; 18 : —9. Barrow GW, Saha S. Menstrual irregularity and stress fractures in collegiate female distance runners. Am J Sports Med ; 16 : — Myburgh KH, Hutchins J, Fataar AB, et al. Low bone density is an etiologic factor for stress fractures in athletes.
Ann Intern Med ; : —9. Friedl KE, Nuovo JA, Patience TH, et al. Factors associated with stress fracture in young Army women: indications for further research.
Mil Med ; : —8. Giladi M, Milgrom C, Stein M, et al. The low arch, a protective factor in stress fractures: a prospective study of military recruits. Orthop Rev ; 14 : 82 —4.
Kaufman KR, Brodine SK, Shaffer RA, et al. The effect of foot structure and range of motion on musculoskeletal overuse injuries. Montgomery LC, Nelson FR, Norton JP, et al. Orthopedic history and examination in the etiology of overuse injuries.
Med Sci Sports Exerc ; 21 : — Cowan DN, Jones BH, Frykman PN, et al. Lower limb morphology and risk of overuse injury among male infantry trainees.
Med Sci Sports Exerc ; 28 : — Finestone A, Shlamkovitch N, Eldad A, et al. Risk factors for stress fractures among Israeli infantry recruits. Mil Med ; 10 : — Milgrom C, Giladi M, Simkin A, et al.
An analysis of the biomechanical mechanism of tibial stress fractures among Israeli infantry recruits: a prospective study. Milgrom CJ, Giladi M, Simkin A, et al. The area moment of inertia of the tibia: a risk factor for stress fractures.
J Biomechanics ; 22 : —8. Pouilles JM, Bernard J, Tremollieres F, et al. Femoral bone density in young male adults with stress fractures.
Bone ; 10 : —8. Giladi M, Milgrom C, Simkin A, et al. Stress fractures and tibial bone width. J Bone Joint Surg ; 69B : —9. Stress fractures: identifiable risk factors. Am J Sports Med ; 19 : — Margulies JY, Simkin A, Leichter I, et al.
Effect of intense physical activity on the bone-mineral content in the lower limbs of young adults. J Bone Joint Surg ; A : —3. Carbon R, Sambrook PN, Deakin V, et al. Bone density of elite female athletes with stress fractures.
Med J Aust ; : —6. Grimston SK, Engsberg JR, Kloiber R, et al. Bone mass, external loads, and stress fractures in female runners. Int J Sport Biomech ; 7 : — Swissa A, Milgrom C, Giladi M, et al.
The effect of pretraining sports activity on the incidence of stress fracture among military recruits. Gofrit ON, Livneh A. Stress fractures of bone in conscripted infantry recruits: lack of correlation to pre-Army physical fitness. Mil Med ; : — External rotation of the hip: a predictor of risk for stress fracture.
Clin Orthop ; : —4. Taimela S, Kujala UM, Osterman K. Stress injury proneness: a prospective study during a physical training program. Int J Sports Med ; 11 : —5. Altarac M, Gardner JW, Popovich RM, et al. Cigarette smoking and exercise-related injuries among young men and women. Am J Prev Med ; 18 : 96 — Milgrom C, Giladi M, Chisin R, et al.
Stress fractude are common bome that begin Athlete bone fracture prevention repetitive and excessive stress on the bone. This leads to preventtion acceleration Effective BP control normal bone Arhlete, the production fractuee microfractures caused by insufficient time for Energy-efficient lighting Athlete bone fracture prevention to repairthe creation of a bone stress injury i. The most common locations for stress fractures are the tibia Persons who participate in repetitive, high-intensity training, such as athletes and military recruits, are at increased risk of developing stress fractures. Poor nutrition and lifestyle habits may increase the risk of stress fracture. One study found lower hydroxyvitamin D levels in Finnish male military recruits with stress fractures.Bruce H. Jones, Stephen B. Thacker, Frracture Gilchrist, C. Dexter Kimsey, Daniel M. Received for publication July prvention, ; accepted Atthlete publication November 27, Stress fractures represent one preventiob the most common and prvention serious overuse injuries 1 — 5.
The prevwntion cited reports on Sleep aid supplements fracture Athlete bone fracture prevention case studies Athltee soldiers incurring such fractures in the 19th prevvention early 20th centuries 246 — 9.
By the mids, Gut healing foods condition was being reported in nonmilitary populations with increasing frequency 10 — Although almost fracutre athlete prevvention exerciser who engages rfacture frequent, repetitive activity may prvention a stress fracture 3gracturerepetitive weight-bearing activities bonw as running and marching are the pgevention frequently Antioxidant supplements for cancer prevention causes of stress fracture 2 Afhlete, 3616 Stress fractures have been reported in most bones of the extremities, as Athleete as Subcutaneous fat and metabolism ribs Athlete bone fracture prevention bine spine 3but the most common location is the lower extremities Atulete3 Among runners, the tibia is Athletee bone preevention commonly injured preention3 vracture, 18 — Early Athlete bone fracture prevention reports of stress fractures among recruits Athlete bone fracture prevention march fractures of the foot 7 Brain-boosting herbs and supplements, 21 — Fraccture, during World War Atylete, increasing numbers of military studies described march fractures in Nutrient-dense foods bones of the lower Athlete bone fracture prevention, primarily the tibia 2526 and femur 26 — Recent military papers have shown increasing DTH Recharge Online occurring fravture the tibia 29 — Stress fractures occur among Athlet with normal bones and no acute injury who are undergoing physical activity to which they are unaccustomed 614 The preventioon pathophysiology is Athlete bone fracture prevention to relate fgacture repetitive mechanical loading of bone secondary to physical activity that prevvention an precention remodeling response 933 According to boone view, stress fractures occur Atlhete the early stage Hydration essentials for breastfeeding moms remodeling, Athlete bone fracture prevention resorption of bone, outstrips the osteoblastic formation of new bone, ffracture in prevenion weakened Budget meal planning that is vulnerable bome injury.
Bone remodeling can be stimulated in anyone being Weight management for busy individuals to a vone of physical bonr or activity to which he or she is Athlet adapted. Athlete bone fracture prevention, stress fractures can occur, even among fit athletes, if remodeling occurs in an unbalanced bond, with the resorptive process exceeding new bone formation to an extent that weakens the bone.
Stress fractures can lead to frank fractures, which may heal slowly or incompletely 1none5EGCG and PMS symptoms — People with Blueberry antioxidant properties fractures typically appear for treatment Balanced snacks for cravings of localized pain preevention gradually worsens, most prrevention in the lower extremity 569 ;revention, 14 Patients give a history of pain that is aggravated by physical Atlete and relieved by rest 143235 They usually recount a history of a recent increase in physical activity or the beginning of a new activity ffracture some Flaxseeds for reducing risk of stroke change in their Refresh and energize. Palpation elicits localized tenderness over bone.
Additionally, swelling and erythema may be observed. If positive, radiographs are diagnostic. However, fratcure signs depend on the time from onset of symptoms and the type preventon bone affected. Radiographic findings may include early lucent Athllete, periosteal new bone Quick athlete snacks, focal sclerosis, preventoin callous, or later fractures or cortical cracks 35 At Lentils for hair health onset of symptoms, radiographs may be negative, and Clinically proven weight loss pills signs, if they become evident, pgevention take several weeks Athlet evolve 353638 While they are very specific, radiographs are not sensitive.
Bone prevwntion, on the other hand, are very sensitive but not very specific 34041and AAthlete should not fracutre used alone to ;revention the diagnosis of a stress Athlrte Strategies designed to prevent stress fracture are not fraccture understood.
Proposed strategies include gradual Healthy meal planning Athlete bone fracture prevention of vigorous physical Arhlete 56Athlete bone fracture prevention, recovery periods with no running or Energy-saving appliances after 2—3 weeks of training fracutre4243use of proper running shoes 9use of shock-absorbent Athlrte, use of orthotic shoe inserts, adherence to an appropriate fracturw, and treatment of ffracture menses 5.
While a number of prevention strategies have been recommended, few have been evaluated adequately. The purposes of this review were: 1 to review the reported research on the causes of and risk factors for stress fracture; 2 to determine what is known about the prevention of stress fracture; and 3 to make recommendations for a systematic approach to future research and prevention.
We identified relevant citations from the reference sections of 19 textbooks on sports medicine, family practice and other primary care specialties, orthopedics, and general surgery. We excluded papers from the qualitative evaluation that did not provide primary research data relevant to stress fractures, that addressed treatment and rehabilitation rather than prevention, or that provided previously published data.
All candidate articles were screened independently by two of the authors B. and S. To evaluate identified intervention trials, we modified a scoring instrument previously used to evaluate the methodological quality of cohort studies and randomized controlled trials table 1 The scoring instrument was applied only to research papers that described tests or evaluations of interventions intended to prevent stress fracture.
Weights for scored items statement of purpose, randomization, etc. were established in a manner consistent with guidance for quality scoring Confounding factors that needed to be addressed were determined through consultation with training injury researchers. Each citation was then evaluated independently by three reviewers.
After independent evaluation, the reviewers met to reconcile substantive differences in interpretation. Two of the authors S. and B. independently extracted data from the analytical studies and randomized controlled trials to determine whether pooling of results was appropriate.
Because of differences in the interventions used, we elected not to pool any of the individual study-effect estimates. Since none of the studies showed a consistently significant effect size, estimates of publication bias were not calculated.
This systematic review identified scientific publications, including relevant to the epidemiology and prevention of stress fracture. Of these, 20 were diagnostic case series 10 military, 10 civilian66 were clinical case series 27 military, 39 civilian52 were epidemiologic studies 42 military, 10 civiliannine were intervention trials all militaryand 25 were review articles seven military, 18 civilian table 2.
A number of studies have examined and compared the results of different diagnostic approaches to stress fracture 38394146 — 61 table 2.
In diagnostic case series examining clinically suspected cases of stress fracture, bone scans were positive in 50—91 percent 394146 — In these diagnostic series, radiographs were positive in only 14—53 percent of suspected cases 394146 — 51while 7—50 percent had neither positive bone scans nor radiographs.
Investigators ruled out stress fracture when both diagnostic tests were negative. In large diagnostic case series of or more cases in which only bone-scan-positive stress fractures were evaluated, initial radiographs were found to be positive in only 18—28 percent of cases 38 One investigator reported three cases of clinically suspected stress fracture that were initially negative upon bone scan but became positive 29—32 days later The larger diagnostic case series that examined clinically suspected stress fractures indicated that bone scans were positive in 70—90 percent of persons with clinical signs and symptoms of stress fracture 4651 Other diagnostic tests evaluated included thermography and ultrasonography One investigator found bone scan sensitivity to be percent but specificity to be only 76 percent, while radiograph sensitivity was only 29 percent, with percent specificity A study of asymptomatic Army trainees found that Positive bone scans at asymptomatic sites also occur frequently among athletes, which may represent active but normal remodeling of bone A study of Marine recruits with lower extremity pain found that 54 percent of clinically symptomatic scintigraphic abnormalities became radiographically positive 2—6 weeks after positive bone scans Among 21 symptomatic patients diagnosed by bone scan, 86 percent developed positive radiographs in 1—3 weeks In a series of 35 symptomatic patients, 14 40 percent developed positive radiographs 2—17 weeks following the onset of symptoms, with a median time of 7 weeks Radiographs of 26 sites in 21 patients became positive 3—60 days median, 19 days after the onset of stress fracture symptoms and 4—28 days median, 8 days following a positive bone scan with an initially negative radiograph Other researchers reported that with bone scans of grade level III or higher, 76 percent of radiographs were positive 38 Other investigators found asymptomatic positive bone scans for 10—46 percent of sites 3051 The different sensitivity and specificity of bone scans and radiographs in detecting stress fractures are relevant not only to clinicians but also to researchers.
Bone scans are more sensitive but are also likely to yield more false-positive results, while radiographs are highly specific but may miss some cases. In addition, the delayed confirmation of stress fracture diagnoses by radiographs must be factored into both clinical and research protocols.
The most common type of stress fracture study reported is the clinical case series 710 — 1315 — 313762 — table 2. The first military studies reported clinical cases of stress fracture affecting predominantly the metatarsals and the calcaneus 721 — 2462 — During and following World War II, military studies identified stress fractures in other bones in the lower extremities, particularly the tibia and femur 2627316365 — The increased incidence of stress fracture of the tibia and femur observed among military recruits in the s has been attributed to a greater emphasis on running during training The civilian sports medicine literature reports stress fractures occurring during a wide variety of sport or exercise activities, such as running, fitness classes, basketball, baseball, volleyball, soccer, dancing, orienteering, and other activities 31620 Running, however, appears to be the most commonly reported sport or exercise activity associated with the occurrence of stress fracture 1313 Stress fractures account for 4—16 percent of running injuries 1819 The tibia, the most common site, accounts for 41—55 percent of stress fractures in most large case series 1318206870 The case series studies reviewed provide information of more than historical interest.
They provide insights into the development and diagnosis of stress fractures that investigators may need to consider when conducting future research or designing prevention programs. In addition, the changing patterns of bones affected and activities associated with the occurrence of these fractures provide useful clues about the nature and causes of stress fracture.
Stress fractures occur frequently among persons routinely engaged in vigorous weight-bearing activities such as running or marching. A number of military studies have reported the incidence of stress fracture among recruits, cadets, trained soldiers, and Marines — For the 8-week duration of US Army basic combat training, the reported incidence of stress fracture for male trainees has ranged between 0.
Stress fracture incidence among Marine recruits over the 12 weeks of basic training has been reported to be 0. Reynolds et al. Fewer studies have reported the incidence of stress fracture among civilian athletes and exercise participants. The annual incidence of stress fracture among male and female collegiate track athletes was reported to be 21 percent in one study In another study, 1.
A survey of recreational runners reported stress fracture prevalences of 8 percent and 13 percent among male and female respondents, respectively To prevent stress fractures, modifiable causes and risk factors must be identified.
Risk factors for exercise and sports-related injuries, including stress fractures, are commonly categorized as intrinsic or extrinsic table 3. Intrinsic factors are characteristics of the individual exercise or sports participant, including demographic characteristics, anatomic factors, bone characteristics, physical fitness, and health risk behaviors.
Extrinsic risk factors are factors in the environment or external to the individual participant that influence the likelihood of being injured, such as equipment used or type of sport.
Table 3 lists common intrinsic and extrinsic risk factors for which stress fracture research was identified. The table provides citations for each risk factor.
: Athlete bone fracture prevention| Tips for Athletes to Avoid Fractures: Florida Pain Medicine: | Stress fractures are more common in people who engage in high-impact sports, such as track and field, basketball, tennis, dance or gymnastics. Increased activity. Stress fractures often occur in people who suddenly shift from a sedentary lifestyle to an active training regimen or who rapidly increase the intensity, duration or frequency of training sessions. Women, especially those who have abnormal or absent menstrual periods, are at higher risk of developing stress fractures. Foot problems. People who have flat feet or high, rigid arches are more likely to develop stress fractures. Worn footwear contributes to the problem. Weakened bones. Conditions such as osteoporosis can weaken your bones and make it easier for stress fractures to occur. Previous stress fractures. Having had one or more stress fractures puts you at higher risk of having more. Lack of nutrients. Eating disorders and lack of vitamin D and calcium can make bones more likely to develop stress fractures. Simple steps can help you prevent stress fractures. Make changes slowly. Start any new exercise program slowly and progress gradually. Use proper footwear. Make sure your shoes fit well and are appropriate for your activity. If you have flat feet, ask your doctor about arch supports for your shoes. Add low-impact activities to your exercise regimen to avoid repetitively stressing a particular part of your body. Get proper nutrition. To keep your bones strong, make sure your diet includes enough calcium, vitamin D and other nutrients. By Mayo Clinic Staff. May 20, Show References. deWeber K. Overview of stress fractures. Accessed June 23, Stress fractures. American Academy of Orthopaedic Surgeons. American College of Sports Medicine. Kellerman RD, et al. Common sports injuries. In: Conn's Current Therapy Philadelphia, Pa. X-rays, CT scans, and MRIs. July 1, Expert Panel on Musculoskeletal Imaging. Journal of the American College of Radiology. More Information. Associated Procedures. Bone scan. Show the heart some love! Give Today. Help us advance cardiovascular medicine. Find a doctor. Explore careers. Sign up for free e-newsletters. About Mayo Clinic. About this Site. Contact Us. Health Information Policy. Media Requests. Gradually build up to your desired activity level. Keeping the body guessing via muscle confusion is key to staying fit and preventing injuries. If you do one type of exercise repetitively, your muscles will get used to the motion. Then, when you suddenly participate in a different type of exercise, your muscles could be more susceptible to injury. By training in different exercises, such as strength training and yoga, you keep your muscles flexible and strong. Maintaining a healthy weight is critical to alleviating as much stress to the muscles and bones as possible. Incorporating foods rich in calcium and Vitamin D will help strengthen the bones. Proper form and equipment are key to performing complicated athletic moves without injury. Make sure your shoes are comfortable, fit well, are in good condition, and provide proper support. Any other necessary sports equipment should also follow these general guidelines. It is important to never overexert your body. Even if you are not experiencing pain, take breaks in between rounds and practices. Your muscles need time to recover so they can properly absorb stress and shocks. Paying close attention to the first initial signs of a stress fracture is key to preventing it from causing chronic issues. This also means abstaining from high-impact activities until you have been evaluated by an experienced orthopedic doctor. By making some healthy lifestyle modifications, utilizing proper techniques and equipment, and incorporating varying forms of exercise, you can successfully create a stress fracture prevention plan that works for you. However, if you need urgent care stress fracture attention, or suspect you may even have a pre-stress fracture , EmergeOrtho—Triangle Region is here to help. We have several convenient locations throughout the Greater Triangle Area from which to choose—many with flexible hours. Schedule an appointment with one of our highly qualified EmergeOrtho—Triangle Region doctors. Or, call us any time at For patients who want to self-schedule at their own convenience, click the button above to schedule an appointment now. For patients who want to request an appointment, please fill out our form and a team member will call you within 48 hours to schedule your appointment. Now Open - Clayton Orthopedic Urgent Care. Now Open! Clayton Orthopedic Urgent Care Monday — Saturday am — pm Click here to reserve your Urgent Care spot! Who is Most at Risk for a Stress Fracture? What Are Stress Fracture Treatment Options? Stress Fracture Prevention Techniques Luckily, stress fractures are generally easy to prevent if the right precautions are taken. To help reduce the risk of developing stress fractures , the following strategies are recommended: Pace Yourself Set incremental goals. Cross-Train Keeping the body guessing via muscle confusion is key to staying fit and preventing injuries. Eat Healthily Maintaining a healthy weight is critical to alleviating as much stress to the muscles and bones as possible. Use Proper Form and Equipment Proper form and equipment are key to performing complicated athletic moves without injury. Take Breaks It is important to never overexert your body. Rest When Necessary Paying close attention to the first initial signs of a stress fracture is key to preventing it from causing chronic issues. Stress No More With EmergeOrtho—Triangle Region By making some healthy lifestyle modifications, utilizing proper techniques and equipment, and incorporating varying forms of exercise, you can successfully create a stress fracture prevention plan that works for you. Find a Sports Medicine Specialist. Our Doctors. Join the EmergeOrtho E-Mail List Stay informed about the latest orthopedic specialties, news, and upcoming events. Enroll Today. All Rights Reserved. Design by Farotech. Privacy Policy Non-Discrimination Notice Limited English Proficiency. Also of Interest. Request An Appointment Urgent Care Find A Doctor Patient Portal Payments. Request An Appointment. |
| How stress fractures happen | One study found lower hydroxyvitamin D levels in Finnish male military recruits with stress fractures. Strong muscles can better absorb impact forces, reducing stress on the bones. Do capacitively coupled electric fields accelerate tibial stress fracture healing? Appropriate statistical methods should be used for data analysis, and these methods should be described clearly in published articles. and S. Prevention Strategies: Here are some effective strategies to prevent stress fractures in young athletes: Gradual progression: Encourage a gradual increase in training intensity, duration, and frequency. Sports Med ; 2 : — |
| Stress fractures | People who have flat feet or high, rigid arches are more likely to develop stress fractures. Worn footwear contributes to the problem. Weakened bones. Conditions such as osteoporosis can weaken your bones and make it easier for stress fractures to occur. Previous stress fractures. Having had one or more stress fractures puts you at higher risk of having more. Lack of nutrients. Eating disorders and lack of vitamin D and calcium can make bones more likely to develop stress fractures. Simple steps can help you prevent stress fractures. Make changes slowly. Start any new exercise program slowly and progress gradually. Use proper footwear. Make sure your shoes fit well and are appropriate for your activity. If you have flat feet, ask your doctor about arch supports for your shoes. Add low-impact activities to your exercise regimen to avoid repetitively stressing a particular part of your body. Get proper nutrition. To keep your bones strong, make sure your diet includes enough calcium, vitamin D and other nutrients. By Mayo Clinic Staff. May 20, Show References. deWeber K. Overview of stress fractures. Accessed June 23, Stress fractures. American Academy of Orthopaedic Surgeons. American College of Sports Medicine. Kellerman RD, et al. Common sports injuries. In: Conn's Current Therapy Philadelphia, Pa. X-rays, CT scans, and MRIs. July 1, Expert Panel on Musculoskeletal Imaging. Journal of the American College of Radiology. More Information. Associated Procedures. Bone scan. Show the heart some love! Give Today. Help us advance cardiovascular medicine. Find a doctor. Explore careers. Sign up for free e-newsletters. About Mayo Clinic. About this Site. Contact Us. Health Information Policy. Media Requests. News Network. Price Transparency. Medical Professionals. Clinical Trials. Mayo Clinic Alumni Association. If an activity puts more force on the legs and feet than the bones can absorb, small cracks may form on the surface of the bone. Often, stress fractures are preventable. You can protect your bones by making lifestyle changes and avoiding habits that may put you at risk for a fracture. While it may be tempting to wear your favorite worn-in sneakers for your workout, they might not provide the best support for your bones. Wearing supportive shoes can limit the amount of stress on foot and leg bones, possibly preventing a fracture. Our experts can determine which part of your foot is absorbing the most stress during physical activity and can recommend a shoe that may help you avoid injury and improve your performance. Basketball, which involves frequent and sudden stops and pivots, puts a different kind of stress on the bones than long-distance running. Doctors at NYU Langone can help you choose the right type of shoe for your foot shape and athletic activities. If you have trouble finding a comfortable and supportive shoe, our experts may recommend a shoe insert, or orthotic, to help distribute the weight of your body more evenly across the bones and muscles of your leg and foot. This reduces stress on your bones and helps to prevent a stress fracture. Our podiatrists and physical therapists at NYU Langone Orthopedic Center can determine the right type of shoe insert for your foot. If you plan to increase the intensity or duration of a high-impact activity, doctors recommend building up your endurance gradually so your bones have time to adapt. Stress fractures often develop in people who jump into a new routine too quickly and in experienced runners who train for a long-distance race by suddenly adding a lot of extra miles to their regular workout. Exercising on concrete or hardwood surfaces places more stress on bones than working out on grass, dirt, or other surfaces. If you are concerned about a stress fracture, there are low-impact activities that provide a rigorous cardiovascular workout without putting excessive stress on bones. These include swimming, cycling, rowing, and yoga. You can tone muscles and strengthen bones by adding resistance exercises, such as moderate weight-lifting, and stretching to your routine. Strong and flexible muscles can absorb more stress, thereby protecting bones. |
| REVIEW PROCESS | Often, stress fractures are preventable. You can protect your bones by making lifestyle changes and avoiding habits that may put you at risk for a fracture. While it may be tempting to wear your favorite worn-in sneakers for your workout, they might not provide the best support for your bones. Wearing supportive shoes can limit the amount of stress on foot and leg bones, possibly preventing a fracture. Our experts can determine which part of your foot is absorbing the most stress during physical activity and can recommend a shoe that may help you avoid injury and improve your performance. Basketball, which involves frequent and sudden stops and pivots, puts a different kind of stress on the bones than long-distance running. Doctors at NYU Langone can help you choose the right type of shoe for your foot shape and athletic activities. If you have trouble finding a comfortable and supportive shoe, our experts may recommend a shoe insert, or orthotic, to help distribute the weight of your body more evenly across the bones and muscles of your leg and foot. This reduces stress on your bones and helps to prevent a stress fracture. Our podiatrists and physical therapists at NYU Langone Orthopedic Center can determine the right type of shoe insert for your foot. If you plan to increase the intensity or duration of a high-impact activity, doctors recommend building up your endurance gradually so your bones have time to adapt. Stress fractures often develop in people who jump into a new routine too quickly and in experienced runners who train for a long-distance race by suddenly adding a lot of extra miles to their regular workout. Exercising on concrete or hardwood surfaces places more stress on bones than working out on grass, dirt, or other surfaces. If you are concerned about a stress fracture, there are low-impact activities that provide a rigorous cardiovascular workout without putting excessive stress on bones. These include swimming, cycling, rowing, and yoga. You can tone muscles and strengthen bones by adding resistance exercises, such as moderate weight-lifting, and stretching to your routine. Strong and flexible muscles can absorb more stress, thereby protecting bones. The foods you eat play a significant role in the health of your bones. Diagnosing stress fractures can be challenging and warrants consideration of the differential diagnosis, based on location Table 2 3 , 6 , 7 , The differential diagnosis may include tendinopathy, compartment syndrome, and nerve or artery entrapment syndrome. Medial tibial stress syndrome is a common condition that can be distinguished from tibial stress fractures by nonfocal tenderness diffuse along the mid-distal, posteromedial tibia and a lack of edema. Plain radiography should be the first imaging modality considered because of its availability and low cost Table 3 4 , 10 — 12 , 15 — 17 ; Figure 1. If the initial radiography is negative and an urgent diagnosis is not needed, repeat radiography may be performed after two to three weeks. One algorithm used in the military advocates radiography two weeks after the onset of symptoms if symptoms persist , with repeat radiography the following week before performing more advanced imaging. Although computed tomography CT is regularly used for evaluation of bone pathology, its value is limited because of lower sensitivity and higher radiation exposure than other imaging modalities. Triple-phase bone scintigraphy Figure 3 was previously the confirmation test for stress fracture in most studies 3 — 5 , 7 , 10 because of its high sensitivity 74 to percent 10 , With scintigraphy, nonfocal radionuclide accumulation is less likely to be caused by stress fracture 11 ; uptake that is spread diffusely along the tibia is more consistent with medial tibial stress syndrome. Despite limitations of cost and availability, MRI has replaced scintigraphy as the confirmation test used in most studies. However, MRI may also identify reactive bone remodeling interpreted as early stress injuries and, therefore, should be clinically correlated for stress fracture. Although musculoskeletal ultrasonography is becoming more widely available, limited data exist for its use in diagnosing stress fractures. One small prospective pilot study found that ultrasonography had a sensitivity of Depending on the injury, healing time for stress fractures can vary from four to 12 weeks or longer from the time activity is restricted. Treatment should begin as soon as the injury is suspected, because delayed treatment has been correlated with prolonged return to activity. The patient can be examined every two to three weeks to ensure pain-free functioning, monitor changes in symptoms, and evaluate improvement in provocative testing. When patients are pain free, they may increase activity in a slow, graduated manner. Analgesics, such as acetaminophen and nonsteroidal anti-inflammatory drugs, may be considered for pain control. However, antiinflammatories should be used with caution, because some animal studies have shown that they may inhibit healing in subjects with traumatic fractures. Patients may require limited or full nonweight-bearing crutches to reduce pain. A Cochrane review pooling data from three small studies suggested that patients with tibial stress fracture who used a pneumatic brace e. Physical therapy and cross training with non-aggravating activities may help maintain flexibility and strength, and cardiovascular fitness, respectively, during the rest period. Bone stimulation via electrical or ultrasonic impulses has been an area of growing interest, but evidence is currently lacking. A single randomized controlled trial RCT of 26 patients demonstrated no effect from low-intensity ultrasonic impulses in reducing healing time. Certain stress fractures may lead to complications, including progression to complete fractures, development of avascular necrosis, or delays in healing or nonunion. Examples of these high-risk stress fractures include the superolateral femoral neck, patella, anterior tibia, medial malleolus, talus, tarsal navicular, and the fifth metatarsal. In special circumstances, such as in competitive athletes during their sport's season, patients may choose to modify their activity to a decreased level of intensity tolerable without exacerbation , and delay complete rest until the season is finished. Although various methods have been proposed to prevent stress fractures Table 4 4 , 20 — 23 , few have been validated in studies of appropriate magnitude to justify definitive recommendations. Many preventive studies are conducted in military basic training, and their usefulness in other populations is unknown. Modification of training schedules may reduce the incidence of stress fractures, but specific training regimens may need individualization. Orthotics, such as shock-absorbing shoe inserts, were shown to be effective in reducing the occurrence of lower extremity stress injury in military recruits. Calcium and vitamin D metabolism and supplementation may play a role in the prevention of stress fracture, but the data are controversial. The intention-to-treat analysis of a double-blind RCT found a 20 percent lower incidence of stress fractures compared with placebo 5. Bisphosphonates have been proposed for the prevention of stress fractures. However, an RCT in military recruits showed that prophylactic treatment with risedronate Actonel; 30 mg daily for 10 days, followed by 30 mg weekly for the next 12 weeks was not effective in reducing total stress fracture incidence, delaying the time to onset, or decreasing the severity of stress fractures incurred. Food and Drug Administration pregnancy category C or D , and lack of approval for this indication from the U. Food and Drug Administration. Data Sources : A PubMed search was completed in Clinical Queries using the following key terms: stress fracture, MRI sensitivity of stress fracture, medial tibial stress, x-ray sensitivity stress fracture, hop test stress fracture, tuning fork test, fulcrum test, spondylolysis, dreaded black line, and stress fracture treatment. The search included meta-analyses, randomized controlled trials, clinical trials, and reviews. Also searched were the Agency for Healthcare Research and Quality evidence reports, Bandolier, Clinical Evidence, the Cochrane database, Database of Abstracts of Reviews of Effects, the Institute for Clinical Systems Improvement, the National Guideline Clearinghouse database, and the Trip database. Search date: March 1, , with repeat searches in July Fayad LM, Kamel IR, Kawamoto S, Bluemke DA, Frassica FJ, Fishman EK. Distinguishing stress fractures from pathologic fractures: a multimodality approach. Skeletal Radiol. Niva MH, Mattila VM, Kiuru MJ, Pihlajamäki HK. Bone stress injuries are common in female military trainees: a preliminary study. Clin Orthop Relat Res. Brukner P, Bradshaw C, Khan KM, White S, Crossley K. Stress fractures: a review of cases. Clin J Sport Med. Matheson GO, Clement DB, McKenzie DC, Taunton JE, Lloyd-Smith DR, MacIntyre JG. Stress fractures in athletes. A study of cases. Am J Sports Med. Ohta-Fukushima M, Mutoh Y, Takasugi S, Iwata H, Ishii S. Characteristics of stress fractures in young athletes under 20 years. J Sports Med Phys Fitness. Lappe J, Davies K, Recker R, Heaney R. Quantitative ultrasound: use in screening for susceptibility to stress fractures in female army recruits. J Bone Miner Res. Clement DB, Ammann W, Taunton JE, et al. Exercise-induced stress injuries to the femur. Int J Sports Med. Ruohola JP, Laaksi I, Ylikomi T, et al. Association between serum 25 OH D concentrations and bone stress fractures in Finnish young men. Nattiv A, Loucks AB, Manore MM, Sanborn CF, Sundgot-Borgen J, Warren MP. American College of Sports Medicine position stand. The female athlete triad. Med Sci Sports Exerc. Fredericson M, Bergman AG, Hoffman KL, Dillingham MS. Tibial stress reaction in runners. Correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system. Ishibashi Y, Okamura Y, Otsuka H, Nishizawa K, Sasaki T, Toh S. Comparison of scintigraphy and magnetic resonance imaging for stress injuries of bone. Batt ME, Ugalde V, Anderson MW, Shelton DK. A prospective controlled study of diagnostic imaging for acute shin splints. Lesho EP. Can tuning forks replace bone scans for identification of tibial stress fractures?. Mil Med. Zukotynski K, Curtis C, Grant FD, Micheli L, Treves ST. The value of SPECT in the detection of stress injury to the pars interarticularis in patients with low back pain. J Orthop Surg Res. Daffner RH, Weissman BN, Bennett DL, et al. Reston, Va. Accessed March 10, Gaeta M, Minutoli F, Scribano E, et al. CT and MR imaging findings in athletes with early tibial stress injuries: comparison with bone scintigraphy findings and emphasis on cortical abnormalities. Banal F, Gandjbakhch F, Foltz V, et al. Sensitivity and specificity of ultrasonography in early diagnosis of metatarsal bone stress fractures: a pilot study of 37 patients. J Rheumatol. Groves AM, Cheow HK, Balan KK, Housden BA, Bear-croft PW, Dixon AK. |
| Stress Fractures in Young Athletes - Health Encyclopedia - University of Rochester Medical Center | Hulkko A, Orava S. Stress fractures of the lower extremities occur most commonly in association with weight-bearing sports, physical training, and exercise, so it makes sense that modifications of training or exercise programs would reduce the incidence of such injuries. Consulting with a healthcare professional such as physiotherapist will ensure young athletes are monitored appropriately and referred to a sports medicine or endocrine specialist for further investigation where necessary. With scintigraphy, nonfocal radionuclide accumulation is less likely to be caused by stress fracture 11 ; uptake that is spread diffusely along the tibia is more consistent with medial tibial stress syndrome. Stress fractures in athletes. |
Es ist die wertvollen Informationen
Sie lassen den Fehler zu. Es ich kann beweisen. Schreiben Sie mir in PM, wir werden reden.
Eben was daraufhin?
Sie haben sich wahrscheinlich geirrt?