Bone is perhaps the strongest and toughest component of your connective tissue framework. It provides stability, structure and functional capacity to your organs, tissues and system. It is imperative to understand that bones are made up of several molecular units such as proteins (like collagen), minerals like (calcium, phosphate, sodium) and glycoproteins like chondroitin sulfate and glycosaminoglycan.
Moreover, the structure and composition of bones is not absolute. In fact, your bones and connective tissue components are always in a state of re-modelling and rebuilding. With this background in mind, let’s discuss what are the 7 prevention tips which are effective in reducing your risk of stress fractures and to enhance bone strength.
What Are Stress Fractures?
The re-modelling and rebuilding of bones is under the influence of a wide variety of hormones, enzymes and nutritional factors. Often times when the bone building forces are weaker than the bone dissolving forces, your connective tissue elements get vulnerable to injury.
Stress fracture can be defined as appearance of small cracks in the complex architecture of your bone due to structural deficits. Besides bone factors, there are a number of other conditions that may lead to stress fractures such as:
- Repeated physical motion across the affected joint (most frequently reported in sports like badminton or tennis).
- Abuse or overuse due to constant application of force (most frequently reported in porters or weight lifters).
Other risky activities or behaviors that are frequently associated with stress fractures are long distance running, bungee jumping or skiing. A normal bone may also undergo stress fracture if it gets weak and mineral-deficient due to osteoporosis or chronic inflammation. In simple words, bones or joints that are associated with weight bearing or repetitive functions are more likely to undergo stress fractures, such as the bones of foot and lower leg.
What are some classic symptoms of stress fracture?
Stress fracture are different from traditional fractures in a number of ways. For example:
- Unlike traditional fractures, most cases of stress fracture presents with minimal to no pain.
- Although, more than 75% cases are provoked by trauma or sudden forceful muscle action, a fair percentage of stress fractures are unprovoked (not associated with force or trauma).
- Stress fracture related pain and discomfort aggravates with the passage of time. Initially, a particular spot or area becomes tender. If proper rest or relaxation is obtained, the tenderness or swelling disappears without any treatment. However, if the inciting events are repeated again and again, the symptoms get worsen over time and ultimately culminating in full blown injury or fracture.
Consult your doctor right away if you are experiencing:
- Persistent pain even after rest or inactivity
- Severe pain with movement
- Visible swelling
- Limited range of motion due to stiffness or pain
Pathophysiology Of Stress Fracture
In order to learn the preventive tips to minimize the chances of developing stress fractures, it is very important to understand the events that leads to this type of bone injury. Scientists have identified three primary theories which are:
- Microtrauma Theory
When you expose the weight bearing bones to massive amount of poorly coordinated force, the small cartilage, ligaments and other supporting tissues undergo minimal injury. Since major muscles and tissue fibers are more strong and capable of withstanding pressure and stress, you would not feel much pain or discomfort. Likewise, the small injured fibers undergo inflammation as part of the repair mechanism.
In this scenario, with optimal rest and relaxation, complete recovery of injured fibers can be completed in a small period of time. However, if the inflammatory process is severe, it can lead to the weakening of surrounding normal tissue and ‘stress fracture will occur’ even with less than normal application of force.
The causative agent is excessive inflammation of normal tissues.
- Osteoporosis Theory
As discussed previously, your bones are in constant state of re-modelling and repair. In the presence of poor nutritional intake or mineral deficits (due to hormonal or age related factors), the bone forming forces lag behind. As a result of this, an imbalance is established between the ongoing bone growth and resorption, leading to stress fractures.
The causative agent in weak bone.
- Bone Fatigue Theory
Although exercise and physical activity promotes the formation of new bone, but at the same time, it also promotes bone resorption or dissolution. In case the bone is exposed to a lot of force with no recovery period, the bone cells will be resorbed quicker than they get replaced. This consequently leads to bone fatigue. Continuous exposure to the unbalanced force results in the appearance of small cracks in the fatigued bones. As they progress, these cracks transform into stress fractures.
The causative agent is weak bone combined with mechanical forces.
Risk Factors Associated With Stress Fractures
Given below are the risk factors that may increase your chances of developing stress fractures:
- Sports: Sporty people like ones who participate in gymnastics, tennis, basketball or track and field are exposed to higher risk of developing stress fractures.
- Sudden increase in the activity status: Sudden shifting from inactive lifestyle to active lifestyle may also put you at higher risk. For example, an athlete may put himself at risk by increasing the frequency, duration or intensity of the training periods too rapidly. Besides, a military recruit may also be at risk if he is ordered to do excessive marching exercises.
- Sex: Stress fractures are more likely to occur in women with no or abnormal menstrual period or after menopause.
- Foot problems: People having rigid, high arches or flat feet are more at risk of developing stress fractures.
- Weakened bones: The conditions that involve weakening of bones such as osteoporosis may also increase your risk of developing stress fracture.
Complications Of Stress Fractures
Sometimes, stress fractures fail to heal appropriately, as a result you can experience:
- Chronic pain
- Bone weakness
- Full-blown fracture
Therefore it is essential to pinpoint the underlying culprit in order to heal these fractures completely.
7 Tips To Reduce Your Risk Of Stress Fractures
Listed below are 7 helpful tips that may significantly reduce your risk of developing stress fractures:
Tip # 1: Lifestyle Modification
Poor lifestyle choices are greatly associated with high risk of stress fractures. For example, a lot of us are hooked on soda beverages that are known to extract calcium and phosphate from your bones (leading to bone weakening). Likewise, poor intake of high quality dairy products or water intake can also compromise your bone health. Some lifestyle modifications are:
- Continuous sitting or standing position can also result in painful joints.
- Try changing your routine and allow the body to rest frequently.
- If your job requires sitting all day, then you can get up for a while and walk around to break free from the routine and to keep the body in a good shape.
- Avoid smoking as it minimizes the bone density and increase the chances of fracture. This may be due to poor absorption of calcium and hormone production like that of testosterone and estrogen which equally affect the bone strength and its growth.
Tip # 2: Rest After Physical Activity
No matter what exercises you do or how many weights you have lifted, your body requires a certain period for repair. You are more likely to suffer from chronic joint pain or injuries if you exercise intensively without taking optimal gap or rest. Ligaments, tendons and muscles require optimal relaxation and rest after the exhausting workout. This allows them to get stronger with the passage of time.
Tip # 3: Prefer Holistic Treatment Over Surgical Treatments And Home Remedies Over OTC Medications
Injuries or pain in the musculo-skeletal tissues can be effectively managed by home remedies or holistic treatment protocols.
- Rest: Keep your affected limb free from all sorts of stress until you get the green flag from your doctor.
- Ice: For alleviating pain and minimizing swelling, you can start cold therapy. This include using ice packs on the affected areas for 10 minutes, approximately 3-4 times each day.
- Heat therapy: Often times, when your muscles or surrounding tissues are also involved, it is recommended to use warmth or heat therapy to improve the blood circulation and alleviate inflammation for better function.
Other home remedies are massage therapy, use of splints or support and local application of herbal agents to reduce swelling and inflammation.
Tip # 4: Minimize activity after an injury
Make sure you give your bone the adequate time to heal properly. It might take a while like several months or probably more. In addition, make sure to resume the activities on a gradual pace after getting the green signal from your healthcare provider.
Some helpful tips in this regard are:
- Commence the physical motion with non-weight bearing activities like swimming, yoga or meditation.
- Activities that are high impact, like running, should be carried out with much needed care and must be resumed slowly.
- Make sure you gradually increase the distance and time.
- Perform low intensity exercises if you have pre-existing health issues. The logical explanation is the fact that inflammation makes it difficult to perform high impact exercises. You can also rest for 2-3 days to alleviate the inflammation.
- You can also perform hydrotherapy. If you find your body comfortable with walking in the water then go ahead but do not push your body beyond its limits if your joints are inflamed or achy.
- Seek a doctor’s advice to learn what workout exercises are helpful in your situation.
Tip # 5: Maintain your body weight in normal limits
The risk of cartilage and bone degeneration increases if you are already overweight due to excessive strain on the joints. It has been observed that obese individuals experience silent osteoarthritis of major weight-bearing joints of the body like knees, hip and spine. Weight loss reduces the pressure off the joints and facilitates recovery by promoting blood circulation.
However, it is also important to keep in mind that more cases of stress fracture are reported in under-weight individuals. Therefore, if your body mass index is lower than normal, make sure to gain healthy weight.
Tip # 6: Consider nutritional supplementation
If you are metabolically or physically active, your requirement of certain nutrients will be higher. Obviously, if your diet cannot supply all the essential nutrients, supplementation is a helpful option. Few supplements that are statistically proven to reduce the risk of stress fractures are:
- Omega-3 fatty acids alleviate inflammation in joints and enhance the density of bone minerals. Sources of omega-3 fatty acids include: nuts, seeds and fatty fish and veggies like corn. Consumption of salmon or other fatty fish 2 times a week is very beneficial. However, you can also consider over-the-counter supplements.
- Vitamin D promotes the growth of bone and assists the body in absorbing calcium and balancing phosphate levels within the blood. It has been observed that poor exposure to sun, renal disease or advancing age can decrease the vitamin D levels in your body and can lead to bone disorders like osteoporosis and osteomalacia. Vitamin D deficiency is also a notable cause of muscular weakening and cartilage disorders, which may result in stress fracture as you age. Excellent natural vitamin D source remains sunlight; however supplements may also be used. Recommended daily dose of vitamin D is 600-800 IUs.
Other healthy nutritional supplements that should be considered are:
- Chondroitin sulfate
- Vitamin C
Tip # 7: Choice of appropriate footwear
If you want your bones and joints to remain healthy and strong then make sure your footwear is not only comfy but also capable of supporting your pedal arches. According to a new study, footwear that simulate barefoot (due to poor support) can lead to moderate to severe injury to metatarsals and severe pain due to stress fractures.
It’s quite common how women consider high heeled shoes as ultimate fashion statement, but what they do not see is wearing such shoes put them on a 10 times greater risk of developing joint associated problems and pains. Nonetheless heels that are less than 3 inches are okay for the health of bones and joints.
Other points that should be considered are:
- Every foot size and shape is different; therefore the choice of shoe should be made in accordance with your foot shape.
- Make sure your front of the foot is not be too tight and must have an excellent supporting arch. You may also place a cushion in the shoe to support the heel and ball of the foot.
In conclusion, if your career revolves around field and track, you should know that your joints and bones are prone to stress fractures. Be careful while initiating a new exercise regimen strategy as too much of a certain type of exercise can cause transient or permanent damage to your musculo-skeletal architecture. No matter which activity or exercise you engage in, consider adopt the above 7 tips on reducing your risk of stress fractures and to avoid other bones or joints injuries.