Stress Fractures in Runners
Section snippets
Pathophysiology of stress fractures
An understanding of stress fractures requires an understanding of basic bone biology and the general response of bone remodeling to applied stress. There are two subtypes of bone. Cortical (compact) bone is located in the diaphysis of long bones and the shell of square bones (vertebral bodies and tarsals). Cortical bony turnover is much slower and most stress fractures occur in cortical bone. Cancellous (trabecular) bone is located in the metaphysis and epiphysis of long and square bones. More
Risk factors
Defining the causative risk factors for stress fracture is difficult because there are many interrelated variables that make a risk assessment problematic to independently study. Most studies are case series and many pertain to general overuse injuries in runners, which are not necessarily specifically focused on bone injury. However, these risk factors can be subdivided into extrinsic and intrinsic factors.
History and Physical Examination
The typical history of a stress fracture is localized pain of insidious onset that is initially not present at the start but occurs toward the end of a run. If the athlete continues to run regularly, the pain typically occurs earlier in successive runs. A sign of a more advanced fracture is pain progressing to occur during non-running related activities, affecting day-to-day ambulation.
It is important to elucidate any predisposing factors while interviewing the runner with a suspected stress
General treatment principles
In guiding treatment, it is not only important to understand the significance of protection and rest but also to understand the predisposing factors to the injury. Treatment is the time to explore and treat the contributing risk factors. If there is a history of stress fracture or the fracture is of cancellous bone, a BMD assessment is indicated. If low bone density is found, appropriate treatment of the source (energy balance and nutritional issues or metabolic bone disease) is mandatory.
Preventing deconditioning
Maintaining fitness during treatment of a lower-limb stress fracture is of significant concern to the running athlete. There are multiple non-weight–bearing methods to maintain cardiovascular fitness. These methods include cycling, swimming, deep-water running, and gravity-eliminated running. For the less competitive athlete, cycling and swimming may be adequate to maintain some form of aerobic fitness. However, for the competitive athlete, it is important to abide by the principle of sport
Femoral Neck
Femoral neck stress fracture is an infrequent, but important injury in the runners. Diagnosis is frequently delayed and serious complications are common. The exact incidence in competitive and recreational runners is difficult to determine. In a series of 1049 stress fractures occurring in athletes, femoral neck stress fractures represented 5%.29 Some authors suggest that femoral neck stress fractures may represent an even higher percentage of stress fractures in athletes because of under
Sacrum
Sacral stress fracture is an important diagnosis to consider because it often mimics other causes of back and gluteal-region pain, but requires a much different approach to treatment. The exact incidence of sacral stress fractures in runners is unknown; however, there have been multiple case reports and series describing this injury.78, 79, 80 The sacrum serves as the keystone in the arch of the pelvis and is subject to multiple forces that may cause stress fracture. Patients generally have
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