• Matthew Anstey MCSP HCPC

Changed your exercise of choice during lockdown?

Watch out for stress fractures!



With everyone going outside for their hour of exercise (I’ve certainly seen more runners out and about than normal), I thought I would give some information on stress fractures and how to help reduce your chance of getting one.


A stress fracture is when a small crack or break occurs in the bone. Normally, this will onset after repetitive force, especially if that force has been recently increased in intensity or volume. So, with all of these people running and walking instead of doing their normal activities, I would bet there are a few people out there developing new aches and pains (especially if their normal activities include lower impact exercise like cycling, cross-trainer, weight-training etc.)


The most common place to get a stress fracture is in the foot. The second and third metatarsals (long bones in the mid foot) are especially susceptible, but also the navicular bone (a bone closer to your ankle joint on the inside), as well as the bones of the lower leg. However, it is possible to develop a stress fracture just about anywhere from overuse.


So what are the symptoms of stress fractures?


· Pain can often start as quite low level pain in the area of the break

· Normally this pain is quite a deep ache within the foot, ankle, or toe

· Site tenderness when you press on the site of the fracture.

· Swelling around the site of pain over the foot or ankle.

· A big clue is that the fracture occurs during or after normal activity, and is relieved with rest.


If a stress fracture is missed, or ignored, the pain can become more significant. In some cases, the fracture can also become displaced (the bones move out of alignment) and often this is a much bigger challenge to treat.


Risk factors for stress fracture include:


· New or excessive impact beyond what your bones are used to.

· A change in the type of activity you are doing; for example, an increase in running or walking without sufficient time to adapt (sound familiar during this lockdown!?)

· Changes in surfaces e.g changing from running on a treadmill which has shock absorbing, to a harder surface like tarmac

· Repetitive activities in high impact sport

· Wearing improper footwear (shoes with no support, or that are too stiff/worn out)

· Change in running style due to other issues e.g if you get a blister during your run and it forces you to change your gait but you continue to run excessively.

· Osteoporosis is a big risk factor as it reduces bone density and these bones are more susceptible to overload.

· Low Vitamin D which also affects bone density – so make sure you are getting some sunshine or at least eating vitamin D rich food e.g fatty fish, egg yolks, soy milk, and also calcium rich food e.g soybeans, kale, spinach and certain types of fish.



And if you ignore your stress fracture?


It is likely to get worse if you keep doing the activity that brought it on in the first place. It can become a complete break if you are not careful. This takes much longer to heal at best, and can throw up more long term pain and functional issues if you are not careful.


So whilst it is super important to stay active and fit during these strange times, make sure you have sufficient rest from high impact activities if you’re getting aches and pains. You can expect to suddenly run every day, if pre-lockdown you were running once a week and doing weight training the rest of the time. The body has an incredible ability to adapt to stress, but it takes a little time.


I will be doing a guest video interview with Mr James Lee MSc about stress fractures soon which we will upload with some ideas about how to treat stress fractures and practical ways to reduce your chance of developing them. Not only is he a great Physiotherapist, he also recently had many of the symptoms related to stress fractures in his foot recently, so we can use him as a case study.


Remember, we are doing video consultations, so if in doubt you can always access our service here at Azzurro Physiotherapy. Stress fractures are managed by modification of activity in the first instance so video consultations work well to catch them early! Call 01628 290 491 to book if required!

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