Persistent pain and swelling after a workout may mean you need to do more than apply ice. You may have a stress fracture and should see a sports medicine doctor.
“The injury usually starts as a stress response, which is swelling or bruising of the bone and then progresses to a stress fracture – or actual disruption of the bone – if it is not recognized and treated,” explained Dustin Volkmer, MD, an orthopedic surgeon and sports medicine specialist with Avera Orthopedics.
What’s the difference between a stress fracture and bone bruise?
Swelling is the telltale sign of a stress fracture. “Swelling, if present, is more common with a stress fracture but is not always readily visible. A stress response or “bone bruise,” does not typically involve swelling,” Volkmer said.
What is a stress fracture?
A stress fracture is a tiny crack in a bone that occurs when a bone is not strong enough to handle the repetitive stress put upon it.
“We commonly see stress fractures in gymnasts, dancers or long-distance runners,” Volkmer said.
What causes stress fractures?
Stress fractures happen when the bone is not strong enough to handle repetitive stress or activity.
The risk of a stress fracture increases if an athlete has bone density issues. In young athletes, bone density issues can occur when nutritional needs are not met. A stress fracture may be an indicator of RED-S, or relative energy deficiency in sports.
“We see stress fractures when young athletes who are still growing and maturing are not getting the proper nutrition and calories to support training several hours a day, several days a week,” Volkmer said.
Stress fractures can also happen in healthy athletes who overtrain or have poor mechanics. Poor mechanics can include flat feet or high arched feet. Poor mechanics can also result from muscle weakness of the hips and core, which places more stress on knees and lower legs.
How do you treat a stress fracture?
Schedule an Appointment
See a Sports Medicine specialist for your pain.
Find a Provider
To allow for healing of a stress fracture, athletes must quit all impact activity for six weeks to three months depending on the severity and location of a stress fracture.
Typically, braces are not required, but depending on the location of the stress fracture, they can be helpful to keep weight off the affected area.
While athletes are resting, they can work with a sports medicine team to prevent future injuries. For example, if lack of adequate nutrition is determined to be the root cause of a stress fracture, athletes can meet with an Avera Sports Medicine dietitian.
If poor mechanics are the cause, then athletes can meet with physical therapists to strengthen support muscles and correct any imbalances caused by weak muscles or tight tissues. Physical therapists may also be able to recommend proper equipment and shoes to protect from repetitive stress.
Physical therapists may also be part of the recovery plan to prevent secondary muscle weakness.
Volkmer said he appreciates the team approach when treating stress fractures or other injuries sustained by athletes.
“We have a very comprehensive team of specialists within sports medicine, so together we can maximize outcomes and get the patient back to doing the activity they love,” Volkmer said.
How do you prevent stress fractures?
Athletes can ask for a referral to meet with a sports medicine dietitian to ensure they are consuming enough healthy calories to support bone and muscle health.
Along with proper nutrition, Volkmer recommends high-level athletes work off days or low-impact cross training activities, like swimming, into their training schedule.
