What you should know about stress fractures & how to avoid them!

Following a year that witnessed a raging pandemic, lockdowns leading to work from home as the paradigm shift, more people, the world over have grown a healthy appreciation towards their bodies and their overall physical well being. It is anticipated that more people will begin to venture outdoors, play sports, and engage in other physical activities to get back in shape and shake off the fatigue from being cooped up indoors for much of the historic year. Medical professionals in the disciplines of sports medicine and kinesiology anticipate an overall spike in musculoskeletal injuries, which are common with sudden exposure to increased physical activity following prolonged phases of living a sedentary lifestyle.

“Overuse injuries” result from recurring strain to muscles in and around joints, bones compounded over time. This is seen in individuals who suddenly spike up exercise after leading a largely sedentary lifestyle and even athletes, who ramp up training for the next season after barely rehabilitating from an injury. The most common such injury comes in the form of ‘stress fractures, especially in the feet. The key reasons why the feet are the most vulnerable to stress fractures and other musculoskeletal injuries are manifold.

Firstly, walking, jogging, and running are the most commonly sought-after exercises by novices looking to get into shape or incorporate healthy living, the sheer volume of runners, both experienced and inexperienced is a factor in the number of such cases. Furthermore, novice runners are often found to possess poor running form, and inefficient foot strikes, compounding impact to the feet, and joints in the ankle and knees. Records from popular running apps show that the number of people signing up and recording their activities has risen exponentially the past year, making this hypothesis more plausible.

The foot, with 26 small bones, 33 joints, and a network of more than 100 muscles, tendons, and ligaments that work together to support our body weight, provide stability, and allow movement is designed to absorb a tremendous amount of force with every step we take, however, by nature the most prone and localised to impact, thus the most common area for stress-related fractures to occur.  Experts explain that repeated impact on bone weakens it from overuse and can eventually lead to a small break or crack. Bones like tree branches are known to bend, and repeated contortion without adequate recovery affects the bones’ structural integrity and results in more serious forms of fractures. Most prone to such injuries are runners, senior citizens, and individuals with a history of steroid use.

Evidence of an in increase in stress fractures in people who were inactive during the pandemic lockdown and then resumed an activity too quickly is already out there. People the world over drastically ramped up activity without seemingly adhered to a progressive training plan. The key is to gradually build up activity to make sure your body can handle the load. For instance, if one has never run before and is looking to get in shape, then the individual could start with walking first, then jogging, and then gradually start running, to better condition the joints to adapt to the impact.

Pain is usually the first indicator of a stress fracture and is generally localised. This is followed by swelling and bruising. This is usually a sign that the body needs recovery and is advised that physical activity be put on a halt or alternate non-impact training methods be followed, for instance non-impact cardio, specific resistance training of the upper body, certain floor exercises etc. The physical pain can be dealt with on one’s own by icing the area where the sensation is and elevating their foot to see if the pain persists. If the pain continues then it is advised medical assistance is sought after.

The diagnosis for a stress fracture can be carried with a verbal discussion with a medical professional about recent to past physical activities, following which the doctor may examine the injured area and call for an X-ray or in rare instances a CT/MRI scan. The overuse injuries generally self-heal and do not require any medical procedure. Recovery may take anywhere from a month to a month and a half depending on the individual case. A medical professional may prescribe a hard-soled shoe or a specialised orthopedic boot, which enables patients to shift their body weight effectively during their recovery. 

Good training practices, high-quality footwear, rest and recovery, and good nutrition and lifestyle choices significantly reduce the risk of sustaining stress fractures. Calcium and vitamin D consumption is paramount to overall skeletal health, injury prevention, and recovery. Footwear must also be laid emphasis on, as people take anywhere between 50,000 to a million steps a year, doing so wearing the right footwear may make all the difference in joint health!

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