November 23, 2022

Recovery Roundup: Injury Spotlight – Stress Fractures

by Scott Robin, DPT

Our SHIFT physical therapists continue the Injury Spotlight series, highlighting common ailments and providing exercises to aid in pain relief. Please visit our previous blog post to read other Injury Spotlights and find more information about common injuries and physical therapy solutions.

What are they?

Stress fractures are microscopic fractures that occur from consistent, repetitive mechanical stress. Stress fractures often follow a sudden increase in physical activity, such as running, walking, or jumping. Sudden increases in the intensity, duration, or frequency of high-impact activity, especially if the activity continues without adequate recovery, do not allow your bone structure the time to adapt and grow stronger. Bones in the lower extremities are at a higher risk for stress fractures due to weight-bearing demands. Lower body stress fractures are most common in the tibia (shin bone), tarsal navicular (foot), metatarsals (foot), femur, and pelvis. Although rare, upper body stress fractures can occur in gymnasts, weightlifters, and overhead athletes (baseball, tennis, volleyball, or softball).

Common Symptoms and Presentations

  • The initial onset of pain is progressive, not occurring from a sudden event
  • Pain increases with activity and decreases with rest
  • Localized tenderness to touch
  • Pain in the morning following a day of activity

Risk Factors

Intrinsic Factors

  • Osteoporosis (poor bone density)
  • Reduced muscle mass (secondary to either drastic weight loss or general malnutrition)
  • Vitamin D or calcium deficiencies
  • Smoking
  • Gender (women are at higher risk than men)
  • Hormone dysfunction (e.g., low estrogen)
  • Knee misalignment

Extrinsic Factors

  • Abrupt increase in activity
  • (Over)training without proper recovery
  • Poor or worn-out footwear
  • High-impact activities, such as running, jumping, dancing, basketball, or gymnastics
  • Running 25+ miles/week

Solutions

  • Immobilization to allow the bone to heal (e.g., boot, splint, or cast)
  • Strengthen surrounding musculature
  • Progressive loading exercise program
  • Adjustment in gait (walking or running) mechanics

Physical Therapy Exercises

Calf (gastrocnemius/soleus) Release: Place a lacrosse ball on the calf muscle belly. Search for tender trigger points or muscle knots. Hold the lacrosse ball on each trigger point while flexing/pointing your foot up and down. Spend no more than 30 seconds on each trigger point. Repeat the process on other trigger points found in the muscle, spending no more than 2 minutes total on each leg. (1-2 minutes per leg)


Shin Muscle Release (tibialis anterior): Place the lacrosse ball on the outer shin muscle belly while avoiding the shin bone itself. Search for tender trigger points or muscle knots. Hold the lacrosse ball on each trigger point while flexing/pointing your foot up and down. Spend no more than 30 seconds on each trigger point. Repeat the process on other trigger points found in the muscle, spending no more than 2 minutes total on each leg. (1-2 minutes per leg)


Ankle Circles: Draw the largest circle you can with your foot in a clockwise direction. Separate motion of the whole leg from the ankle (i.e., do not rotate your entire leg while moving your ankle). Repeat the same in a counterclockwise direction. (15 reps per leg)


Ankle Mobilization: Anchor a thick resistance band to a sturdy surface. Place opposite end of the band around the ankle with your foot on a 6-12″ box. The band should be located below the two big bones on each side of the ankle. Step forward to apply tension to the band. Then, attempt to bring your knee as far over your toes as possible without lifting your heel off the box. Hold the end-range position for 2 seconds. (15 reps per leg)


Lateral Step Down: Stand tall off the edge of a sturdy step. While keeping 100% of your body weight on the foot planted on the step, lower your body to tap your opposite foot flat on the ground without transferring your weight to the tapping foot. Return to starting position. (3 sets x 12 reps per leg)


Heel Raises: Stand tall near a wall for balance support. While keeping your knees straight, lift your heels as high as you can. Slowly return to the starting position. (3 sets x 15-20 reps)

If following these recommendations does not help to relieve pain, please contact your SHIFT physical therapist team at physicaltherapy@shiftlife.com or schedule a physical therapy appointment for an in-person assessment of symptoms and to create a more individualized care plan. 

In Real Health,

Scott Robin, PT, DPT & Avis Jason, PT, DPT

SHIFT Physical Therapists


Tags

injury prevention, mobility, physical therapy, recovery exercises, stress fracture


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