Download - Stress Fracture: Tibial Stress Fractures
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7/30/2019 Stress Fracture: Tibial Stress Fractures
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What is this?
This is an injury to the tibia (shin bone). The
condition usually develops over a period of
time resulting in a progressive overload to the
muscle and bone..
Causes
There are a few factors that are thought to
contribute to the development of stress
fractures and these include:
What Structures can be affected?
Pain and Symptoms
Symptoms can include some or all of the
following:
Diagnosis
The diagnosis is usually made from the history
and from clinical testing. Further investigations
such as x-ray, MRI and ultrasound can be
undertaken to confirm the diagnosis and to
assess other structures. Bone scan or an MRI will
be the most sensitive form of imaging to assess
for a stress frac ture.
Treatment
One of the main focuses of treatment involves
trying to correct the predisposing factors that
contributed to the stress fracture.
Conservative management would usually
involve the following:
Tb al Stress Fracture
Patient Information Sheet
Tbal Stress Fracture
335 Hillsborough Rd, Warners Bay NSW 2282
Pain will usually be aggravated by exercise
and slowly settle with rest.
Localised tender area over the tibia at the
site of the lesion.
Can sometimes develop significant night
pain.
Rest A period of rest from aggravating
activities is important to allow the area to
settle. This may even involve a period of
non-weight bearing on crutches until thepain settles
Bracing In severe cases the use of a splint
can be helpful in controlling the symptoms
and allowing the stress fracture to settle.
Address Biomechanics If there is poor foot
biomechanics i.e. over pronating feet then
orthotics may be indicated to help unload
the area both in the short term and long
term.
High levels of running especially on hard
surfaces.
Sudden change in training volumes
Poor foot and ankle biomechanics
Lower limb weakness
High impact sports
Poor bone density
Dietary
Hormonal
Muscle Periosteum
Tibia
(02) 4954 5330 | F.(02) 4954 5380 | [email protected] | W.www.advancephysio.co m.au
Arrow showsthickened boneindicating tibial
stress fracture
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Rehabilitation and Prevention will address the
following:
Rest from aggravating activities Stress fractures
generally follow a predictable course and will
recover clinically within several weeks of rest
and activity modification.
Hormonal Overtraining or low body weight has
the potential to cause lowering of oestrogen
and subsequently lower bone density,
accelerated bone remodelling or a negative
calcium balance. Other endocrine fac tors that
have the potential to influence bone health
and therefore stress fracture risk are
glucocorticoids, growth hormone and thyroxin.
Nutritional FactorsAbnormal eating behaviours
or poor diet can increase the risk of stress
fractures and need to be addressed inmanagement. Calcium balance can be
affec ted by other dietary fac tors such as a high
intake of salt, phosphorus, fibre, protein,
caffeine and alcohol. The evidence is
uncertain as to whether dietary
supplementation with calcium or inadequate
calcium in the diet is a factor in stress fractures
but it is clear that restrictive or abnormal eating
behaviours are a risk.
Gait mechanics / foot mechanics.
Over-pronation or under-pronation have
potential to cause respectively greater muscle
activity/fatigue or less ability to absorb shock.
Either of these can predispose to stress
fractures. Interventions such as orthotics (for the
over-pronator), foot-ware changes, stretches
and perhaps subtalar and midtarsal
mobilisations and stretches (for the
under-pronator) can be undertaken during the
rest phase. Shock absorbing insoles including
an orthotic can be used for the under-pronator.
Other factors that could adversely affect stress
through the foot are poor flexibility through the
calf, and weakness of any of the muscles of the
lower limb and core which may lead to
suboptimal shock attenuation or adverse
alterations to running mechanics. Leg length
differences may also contribute to bonyoverstress. Poor running technique also needs
to be addressed.
Footware. Footware must be appropriate to
the foot type ie over-pronators require a shoe
that reduces pronation and under-pronators
require a more shock absorbing shoe. The shoes
should have appropriate midsole construction,
heel height, shock absorption and torsional
flexibility. Many race shoes are ultra-light and
sacrifice optimal biomechanics for weight andmay not be appropriate for large volume
training. Shoe age (in time but more importantly
in distance) should not be too old.
Running surface Harder running surfaces are
likely to be a risk factor and should be
minimised early in the return to sport. The overall
volume of road running should be monitored
and modified if necessary.
Cross Training Impact sparing exercise can
be used to help maintain fitness levels and to
make sure that it is an easier transition when
returning to your normal activities e.g.
exercise bike and swimming.
High Level Sport Specific Training If required
a sport specific training program will be
developed to help with your return to
sporting activities.
Patient Information Sheet
TbalStressFracture
(02) 4954 5330 | F.(02) 4954 5380 | [email protected] | W.www.advancephysio.co m.au
335 Hillsborough Rd, Warners Bay NSW 2282
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Training type It is crucial that a detailed training
history prior to the stress frac ture is established
paying particular attention to any significant
changes in training volume or intensity, or
changes to rest periods which may have
occurred prior to the stress fracture occurring.
Any changes to the training environment eg
surface, number of hills should also be
examined as possible causes. If the athlete
does not keep a detailed log book of their
training they should be encouraged to do so in
the future.
Muscle strengthening and endurance of the
whole kinetic chain must be addressed and
much of this can be done during the recovery
period. Muscles exert a protective effect on
bone and muscle fatigue has been associated
with increased bone fatigue.
Return to training This should be gradual to
enable the bone to adapt to the increased
load. The return to training can be determined
on the basis of clinical examination and the
athlete should be able to demonstrate no
discomfort on repetitive impact loading eg
jumping. Cyclic training rather than progressive
training may be preferable to enable both
bone and soft tissue to recover from progressive
loading. Multi-directional and multivariableloading is probably beneficial as it will distribute
the forces variably through bone and may lead
to healthier bone as well as reduce focal stress.
Recovery Time
With a thorough rehabilitation plan this
conditon will usually settle over a 8 -12 week
period, however this can vary according to the
exact site of the injury, the age and health of
the patient and the extent of the injury as wellas other factors
Patient Information Sheet
TbalStressFracture
(02) 4954 5330 | F.(02) 4564 5380 | [email protected] | W.www.advancephysio.co m.au
335 Hillsborough Rd, Warners Bay NSW 2282