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Stress Fractures

Watching runners recently at South Bend’s annual Sunburst Races weekend, brought to mind the topic of stress fractures. The result of overtraining, stress fractures can be seen in all levels of athletes - from the weekend warrior who picks up his or her activity level too quickly from their low-level baseline, to the elite athlete whose skills allow them to occasionally do too much.

Most people know that if you hit a bone hard enough, for example with a car bumper, the bone will break into two or more pieces. But what some people don’t know is that bone has plastic properties. In other words, when it is mechanically stressed, a bone can be made to bend slightly. In a runner’s stride, this means bones in the foot and leg go through many cycles of bending and straightening. The process is similar to holding a wire coat hanger in your hands and bending it back and forth repeatedly. Eventually it will fall apart in your hands. There is no resounding crack or snap, but you are now holding a hanger in two pieces. The same phenomenon can occur in bone. As the bone fatigues, the athlete experiences gradually increased pain.

Of course, the stronger the bone, the more resistant it is to these stress (or “fatigue”) fractures. The best way to build strong bones is through a healthy diet, enhancing the bone strength over time to maximize its resistance to fatigue. For instance, when a woman in her later years is diagnosed with osteoporosis, the doctor typically prescribes weight-bearing exercises such as walking through her neighborhood. A modest walk in the evening is a great way to strengthen bones gradually, but if you pick up the amount of walking too quickly, you put yourself at risk.

In the 1940s these fractures were known as “march” fractures because they resulted from hours of marching when people were recruited into the military and overnight were required to put in significant hours of training. It’s in these hours of training where stress fractures develop. I’ve seen baseball players with stress fractures of their arm from constant throwing and in their hands from swinging a bat over and over again. Basketball and football players typically get stress fractures in their feet. Distance runners can get them anywhere from their hips down. The key is to get up to your desired activity level slowly and to allow the bone to keep pace. If your rate of training is too fast, the bone can’t keep up and stress fractures result.

The best treatment is usually rest to allow healing and then a gradual return to the sport. If stress fractures are a recurring problem, a doctor can usually pinpoint a dietary issue and certainly a sports medicine doctor can help you best define the pace at which you can elevate your activity level to avoid future problems.

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