How to self-diagnose and treat a stress fracture

The nature of triathlon means that bone stress and stress fractures make an appearance year after year. To help reduce the frequency and severity of these injuries we’ve implemented a thorough medical screening process. But what can you do to identify if stress fractures are the problem affecting you?

Many athletes complain of a persistent niggle that they can’t seem to shake and that just doesn’t seem to respond to rest. You have a week or two off training, but as soon as you restart, the pain returns. Use the guide below to see if stress fractures could be the culprit.

What are stress fractures and where do they occur?

A stress fracture is a partial fracture (or break) of the bone that usually only goes a little way through. It is an overuse injury, where the bone is unable to withstand a repetitive mechanical loading. This is different from a full fracture or break of the bone caused by a sudden traumatic mechanical stress.

In triathlon, most injuries are in the lower limbs and can be attributed to the running discipline. Commonly they occur in the tibia, fibula, metatarsals (small bones of the foot), navicular and femurs.

Who and why?

The most common precursor to a stress fracture is previous bone stress or an injury history of stress fractures. However, this is not the only cause. You’re more prone to stress fractures if you suddenly increase your volume of running or are new to the sport.

It can also be as a result of changes in the type of load (addition of speed sessions) and running terrain. If you’re unfortunate enough to have poor lower limb and foot biomechanics this can also lead to bone stress.

Finally, poor conditioning and lower limb strength can be a cause, as the stronger the muscles supporting the bone, the more force they can absorb and therefore the less is transferred to the bone.

There are other factors that can contribute to bone stress, too, including low vitamin D levels, poor dietary intake and irregular or a lack of a normal menstrual cycle in females. However, if you feel that these are an issue in your specific case, it’s important that you consult a doctor.

Signs and symptoms of stress fractures

The signs and symptoms to look out for in the case of a stress fracture are as follows:

■ Pinpoint pain: this may be specific to the bone itself, which then radiates around the point.

■ Pain on mechanical loading: ie pain when you run, get out of the saddle when you’re cycling or push off the wall in swimming. (At other times you may be completely pain-free.)

■ Persistent pain: pain persists after the aggravating activity. You might get an ache/pain at night, there may be a small area of swelling around the fracture site and the pain returns if you only rest it for up to a week.

Diagnosis

Your GP or physiotherapist will take a thorough look at your history and after a number of clinical tests will be able to diagnose a stress fracture.

Although sometimes helpful, X-rays often won’t detect a stress fracture in the early stages. Your doctor can refer you for an imaging scan, CT or MRI to confirm their diagnosis.

Treatment

Treatment is very much dependent on how early you identify the correct diagnosis, as well as the location of the injury.

Sadly there’s no quick fix to a bone injury and most will need completely offloading and immobilising (in a boot, cast/splint or crutches) for up to six weeks to give them time to heal.

A gradual return to training follows, where the bone is progressively loaded back to your normal level. During this time it’s vital that you’re pain-free, but the majority of athletes will return to full fitness.

Three steps to finding a good, local physio…

1. First, try word of mouth and see if anyone can recommend one in your local area that they have personally used. Ask around at your gym or local tri/running club.

2. Some physio clinics have a sports doctor, who will hold regular clinics, podiatry services, nutrition and associated strength and conditioning classes. These links are really useful and can lead to a much more holistic and integrated approach to your recovery.

3. The Association of Chartered Physiotherapist in Sport and Exercise Medicine (ACPSM) has an online database where you can find physiotherapists in your local area: www.physiosinsport.org.

(Main image: Delly Carr)

Have you suffered from stress fractures? What helped you? Let us know in the comments!