Posts Tagged ‘Stress Fracture’

When Can I Run Again After a Stress Fracture ?

October 11th, 2010 by Dr.Chang

I have seen an unusually large amount of running related stress fractures recently in the office.  I thought I would blog on a common concern of my athlete patients.

A runner with a Stress Fracture, often times have a burning desire to return to running.  Some think a stress fracture really in not a “real” fracture, so return to activity should take less time.  Right?  I say maybe ……A fracture of any type is a challenge as is significantly alters ones lifestyle.  Particularly runners.  They may end up forgoing a race, a goal they have set for achievement, or just miss the “runner’s high” they get from getting out on the road.  In find that  runners often get in a hurry to get back into the activity and can cause additional injury from not waiting until the appropriate time to return.

While it is true stress fractures are not “true” and complete fractures … the condition does require similar protocols for fracture healing.  However, in my experience, the traditional fracture healing times may by truncated.

Generally speaking an osseous injury requires 6-8 weeks of protection and relative inactivity to heal adequately.  This is a “rule of thumb” benchmark which has been made over time by medical professionals based on experience, x-ray evidence and patient feedback in the healing process.  It is individual dependent, fluid, but very close to accurate in my experience.

What are the biggest factors that influence my determination of healing?  !) X-Ray evidence.  2) Resolution of pain.
So, how do I transition back to running?

- What is the most accurate indication of healing? Bone healing, as with fractures, is usually confirmed on x-ray.  If the x-ray shows sufficient callus formation around the fracture and “filling” fracture by reduction of fracture line lucency, the area is healed.  This means the bone is sufficiently stable for return to activity and re-injury risks are reduced.  It is best to wait until this has occurred to return to any running type of exercise….  If your goal is to get back to running pain free, hastening your return to running is not advised.

-         Pain is improved can I run? Depending on the type and degree of the fracture, pain can improve and sometimes resolve by 2-3 weeks.  I often see most fractures being pain free at week 4.  Absence of pain is a good sign, but not a guarantee that healing is complete.   If you were to run too soon, I could create a situation requiring a return to cast or boot and possibly even surgery.

- How do I get back to running? The best way to get back to running is to do it progressively and gradually. .  Expect recovery to normal to be 3 times that (at least) to what your recovery time was observed at.  This means a recovery time of 6-8 weeks is a 18-24 gradual return to activity. .  Start slow, preferably on a surface that will protect you from re-injury.  As you transition back running, try up to 1 mile only for the first 3-5 days, and then start adding mileage to your normal running routine.  Pain is always a good guide to prevent re-injury.  Too much too soon, and your body will tell you.  Don’t ignore these signs.
Anything worth doing, is worth doing right.  This is especially true in an orthopedic injury.  There will always be another race.  There will be another time to set fitness goals.  Take time to respect your body and appreciate the remarkable ability you have to affect healing to an injury.  Your body thanks you!

See our website fracture informtion pages here and here , for more information.

Stress fractures can result from a number of reasons. Most common causes for stress fractures are decreased bone density, post-op complications from a foot surgery, and athletic training error / overuse injury in athletes, dancers, and “weekend warriors.” It typically occurs in the second metatarsal…. The longest of all central foot bones and the one subject to the most loading forces. Since the second metatarsal tends to carry more of the body’s weight during athletic and dance activities, the increase in pressure results in osteoclastic activity and compensatory osteoblastic activity becoming imbalanced.

Symptoms:
- Increasing pain in the midfoot
- Pain at rest
- Pain during activities
- Swelling on the dorsum of the foot
There is a lack of physical signs in making this diagnosis. Stress fractures cannot be seen on plain film x-rays until a few weeks later when healing begins. For this reason, when patients present with the associated signs and symptoms podiatrists often prefer the use of bone scans that typically reveal hot spots in the area of the mid-foot in patients with common stress fractures. CT’s and MRI’s are also helpful in pinpointing the exact location of the stress fracture.
Upon diagnosis, the hallmark of treatment is immobilization through a casting boot for up to 3-4 weeks. Follow this with progressive ambulation and support in customized orthotics or shoe padding for 4-6 weeks and an intermission of the associated activity to promote healing. For the competitive athletes that require a faster recovery time, podiatrists may consider a bone growth stimulator to expedite the healing process. Anti-inflammatory drugs are also given to assist in relieving the pain associated with these fractures. Conservative management is usually successful when treating stress fractures and surgery is rarely required. Use of menthol cooling gels, like Biofreeze, has shown to be helpful in alleviating pain.
More information can be found here:
http://www.aapsm.org/ct0398.html
http://www.foothealthfacts.org/what-is/ns_stress-fracture.htm

APPOINTMENT REQUEST

WE ARE ALWAYS ACCEPTING NEW PATIENTS.

To request an appointment, please fill out the form below. Our scheduling coordinator will contact you to confirm your appointment.

captcha


Please leave this field empty.

Join Our Mailing List:

Enter your E-mail in the box below:

Our Affiliations

Monticello Community Surgery Center

Augusta Health

Martha Jefferson

APMA

ACFAS

AAPSM

VPMA