Stress Fractures & physiotherapy

What are Stress Fractures?

Stress fracture refers to a bone fracture that is the result of repeated loading. Stress fractures most commonly occur in the bones of the lower limbs, but they can also occur elsewhere in the body, such as in the spine. Stress fractures occur eg. for runners and dancers.

Stress fractures can occur when large amounts of skeletal load are exerted without proper progression, and also sudden increases in training intensity can be the cause of stress fractures. Even if the muscles are strong enough and the progression is good strength-wise, the bone tissue might not be able to recover and hyper compensate as quickly as muscle tissue and as a result of this the training might lead to stress fracture. On the other hand, stress fractures can occur if the bone tissue is abnormal, for example due to osteoporosis.

The initial fracture is painful at the site of the fracture only at exertion, but little by little the pain also begins at rest.

How are stress fractures treated?

The key is to stop loading of the fractured area. Generally, stress fractures do not require gypsum or surgical treatment, and the fracture heals on its own over time. 

Is Physiotherapy Needed After Stress Fractures? 

My own opinion is definitely yes. Whenever a fracture occurs, one should consider what caused it. Was it a one-sided load or a poor technique when exercising? Is there something you need to correct in your movement patterns to avoid being exposed to new injuries?

Too often, after an exercise fracture, an athlete will continue to exercise / practice after the fracture, just as they have in the past. If the root cause of the stress fracture is not determined, the athlete will expose himself to new stress fractures. Stress fractures are not “just occurring” for anyone, but there is always a reason behind them, that should be fixed.

What is Physical therapy like after a stress fracture?

For example, in the case of a bone fracture of a runner’s ankle, it is wise to study the client’s running technique. Is the foot loaded optimally and is there some abnormalities in the movement patterns of the lower limbs? What is the position of the upper body while running? Do the muscles support the running position optimally or is there a possible weakness in some part of the body? Physiotherapy seeks to find the cause of the stress fracture and seeks to fix the cause, not the consequence.

On the other hand, for example, a gymnast or dancer may have a stress fracture in the lumbar spine, which may be due to an extension of the lumbar spine to a specific vertebral space (eg, L3 / L4) and lack of spine control. In this case, the physiotherapist will guide the client trough exercises that will help with the control and extension of the lumbar spine. So that the load can be more evenly distributed between different vertebras and no single vertebra will take too much of a load.

So the goal of physiotherapy, after stress fracture is to help the client distribute load more evenly between structures of the body. So that  in the future stress fractures can be avoided.