In this episode: We cover stress fractures, or what would be called stress reactions, what they are, where they typically happen, what sports and activities most commonly cause them and some treatments.
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Stress fractures not a good term. Lets start with that. It is a bit of a misnomer. It is not always a fracture. Just like people confuse fractures, breaks and cracks they are all kind of synonyms for the same word, a disruption of the bony structure.
But stress fractures are more of an irritation of the bone then an actual true fracture. Which is why they don’t tend to show up on x-rays. The more common vernacular is stress reaction.
Stress reaction is more closely associated with what is actually going on. There is a spot in the bone that is getting stressed. The body can’t quite cope with that stress and as a result you get a reaction. Pain is the main culprit that limits people. Pain, inflammation, muscle irritation, not usually a lot of swelling or visible irritation but pain is usually the first thing people notice. We discussed this a little bit when we did the shin splint episode.
Stress fractures or as we are going forward from here stress reactions are much more common in females. That is partly hormonal, partly to due with alignment, So excessive stresses and imbalances. What is interesting is there is more evidence to suggest varus malalignment (genu, tibial, subtalar and forefoot) versus valgus.
At the Division 1 level females have a nearly 2:1 ration to have a stress reaction versus males. In the military this is almost a 3:1 ratio female to male. Running accounts for close to 50% of all case and you tend to see more stress reactions in the younger populations.
This could be due to activity but also to an immature skeleton. The most common is in the tibia (shin splint). Not as common but also seen is the femur, pelvis and the 5th metatarsal (outside of the foot).