Stress Fractures in Athletes
What is a stress fracture in athletes?
A stress fracture is a partial or complete bone fracture that results from repeated application of stress lower than the stress required to fracture the bone in a single loading. Otherwise healthy athletes, especially runners, sustain stress injuries or fractures.
Dr. Patrick Ling, MD, discusses stress fractures in athletes.
What is a femoral hairline fracture developed in sports?
A femoral neck stress fracture is essentially a hairline fracture or crack in the bone at the femoral neck of the hip joint.
That occurs as a result of fatigue of the bone when placed under extreme pressure or stress or it can happen after repeated activity load on a bone that is unprepared. Imagine if you will, a paper clip that’s bent back and forth many times and then snaps. Three to five times the load for a runner’s body is placed through the femoral neck when running. Fifteen percent of runners experience stress fractures of which ten percent are femoral neck stress fractures.
This type of fracture results in a deep ache experience at the hip, which radiates into the groin and the lower back. Pain often comes on initially just after activity and then as it progresses over weeks, perhaps the pain will be felt during activity such as running and then it will be experienced during activities of daily living and then the runner will be limping following activity unable to walk and then may even experience pain during sleep.
Because of the anatomy of the hip, not treating this problem can lead to very serious outcomes. The hip, if you will, is a ball and socket joint with the femoral head serving as the ball and a sort of a cup shaped acetabulum, which is part of the pelvis, being the socket that it fits in. The femoral neck is where the blood supply runs to the femoral head.
A stress fracture at this site if untreated can go on to a full fracture at the femoral head which can disrupt the blood supply to the femoral head and lead to bony death which is called a vascular necrosis, which can have catastrophic consequences requiring hip replacement in otherwise healthy young adults.
Often a change in training intensity, frequency or duration can result in this type of stress fracture is particularly worsened by doing hill work or running on hard surfaces when the body is not accustomed to doing so. Gender and age are also predisposing factors to this injury. So women and people in older age groups are disproportionally affected.
If a femoral neck stress fracture is suspected, medical treatment should be sought right away, not only to get a proper history and physical, but also to have the appropriate imaging done. An x-ray as well as a bone scan, possibly an MRI will be necessary to confirm the diagnosis.
Once the diagnosis is known, the treatment is actually fairly conservative and it’s simple. Stop running, it means being non-weight bearing that is on crutches for six to eight weeks, and to follow the healing progress.
If you feel you may have this condition, or have general questions about femoral neck stress fractures, please consult your family physician or sport medicine physician right away.
Local Practitioners: Sports Medicine Physician
Stress fractures in athletes
Stress fracture is a term used to describe bony or osseous injuries.
They occur in athletes who are involved with repetitive activities, such as runners, track and field athletes, dancers, and anyone who is involved with a degree of training and running.
Stress fractures or stress injuries present with pain over the overlying bone. Initially, the pain is resolve with rest. However, with repetitive activities and stress on the bones, the pain becomes unremittent or constant.
Stress fractures are diagnosed based upon clinical suspicious, a good history, and imaging. X-ray imaging is okay for identifying the late stages of stress fracture but is not ideal.
Bone scanning can be used. However, it lacks the specificity for determining the location and the severity of illness.
Ultrasounds, in particular MSK ultrasound, can identify some of the bony reaction that can occur. However, MRI is considered the standard for evaluating the severity and grade of an osseous or stress injury.
The mainstay for treatment of stress fractures is immobilization, activity modification, and pain control. In some instances, the stress fracture may not heal adequately.
In that case, it may go on to nonunion. In those cases, there may be an indication for ultrasound or low-intensity ultrasound as a bone stimulator to facilitate union or healing of the bone. In some cases, surgery may even be indicated for treatment of nonunion stress fractures.
If you have any questions about the treatment of stress fractures, please consult with your local family physician, orthopedic surgeon, or sports medicine specialists.
Local Practitioners: Sports Medicine Physician
Larissa Roux, MD FRCP Dip Sport Med, MPH, PhD, discusses What is a Femoral Hairline Fracture Developed in Sports.
Larissa Roux, MD FRCP Dip Sport Med, MPH, PhD, discusses dancer’s fractures, a common dance injury.