Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Stress fractures

One-sided loads on the skeleton can, when intensity and load are too high, lead to stress fractures or fatigue fractures if the adaptive ability of the body is insufficient to cope. Stress fractures can affect children who begin athletic training as early as the age of 7 years. The frequency of stress fractures in adolescents is increasing. The injury can be caused by frequently repeated movements under normal load, e.g. longdistance running, or by movements of a lower frequency but with a higher load, e.g. weightlifting. The most dangerous combination, however, is a high load and a high frequency.

In principle, stress fractures can occur in any bone of the body, but are most common in the lower limbs. They occur mainly in the metatarsal bones, and in the tibia, fibula, femur, hip and pelvic bones, and vertebral bodies. Stress fractures should always be suspected in people who are subjected to repeated movements or heavy loads and who complain of pain on exertion. Usually there is no pain or discomfort at rest. Local tenderness and swelling over the painful area are found and a clinical examination usually leads to the diagnosis. If no fracture is discovered on X-ray examination, it should be repeated 3–4 weeks later if the symptoms persist. The diagnosis can then be confirmed. A bone scan can confirm the diagnosis at an early stage.

The risk of stress fracture can be reduced primarily by increasing training gradually but also by varied training alternating with regular rest so that the body has time to recover. The surface that athletes use in training can also be of importance, and the construction of the shoes is vital. Anyone running on a hard surface should always wear shoes with good shock-absorbing properties. When there is a change from a hard to a soft surface or vice versa, the intensity of training should be reduced during the transition period.

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