Stress fractures

I had a stress fracture. It think it is healed now. This is the story of how it came and went.

What are stress fractures?

When I would tell somebody I had a stress fracture, they would usually ask, “what’s a stress fracture”, or “what happened?”

A stress fracture is a fracture, but an incomplete one (the separation doesn’t go through the entire bone) and it’s caused by repeated impact stress over time and not a single, acute impact. Mine was in my leg (the medial tibia, at the junction of the middle and distal one thirds, to be exact). That’s the most common place for a stress fracture in adults.

What happened?

This is hard to answer, because of the gradual onset of the fracture. This spring, I was playing with UBC Men’s Ultimate B team and training casually for the Vancouver Sun Run, a 10k race. The schedule didn’t seem too intense. Ultimate practices were twice a week, two hours each. Weekend tournaments (infrequent) were two days long, where we would play up to five games in a day. I occasionally went to the gym and included plyometrics in my workouts. I had only one lingering injury… stiffness from a sprained right ankle (this could have reduced my ability absorb impacts as naturally).

What did it feel like?

I first noticed a general pain along my medial right tibia in March. It felt kind of nice to push on it like a massage. The pain gradually increased, but I got used to it. During a game or practice, the pain seemed to go away, but would come back afterwards, even during rest. Eventually, it hurt to step up onto things. The pain was localized to a single point about 1cm in diameter. I could poke at exactly the point on my tibia that hurt.

The Sun Run was when I finally realized/admitted that something was wrong. I ran with a strained left MCL, probably putting more stress onto my right leg than before. MCL strained, a stiff right ankle, and a burgeoning stress fracture in my right tibia: it was too much all at once.

After that run, I had all the symptoms of a tibial stress fracture: pin-point pain, I couldn’t jump on that leg, it hurt to walk for a few steps after standing up from a chair, it hurt to walk up or down stairs, and it hurt to stand on my right leg. But, I didn’t know this was a stress fracture yet.

Diagnosis

My first visit to the doctor was the week after the Sun Run. I waited a few days to confirm that it wasn’t getting any better on its own, then went to a sports doctor at UBC. From my description of the symptoms alone, he was pretty much ready to diagnose me with a stress fracture, but he couldn’t rule out a bone bruise. I was to do my regular activities as able, and if the pain didn’t go away, then he’d be more confident that it was a stress fracture (in which case, I shouldn’t have been doing my regular activities).

I played two more games of ultimate before returning to the clinic and saw a different doctor who ordered a bone scan to confirm the stress fracture. The bone scan was really cool. First, they injected me with technetium-99m-MDP. It’s a radioactive material that’s absorbed by bones undergoing more rapid turnover, like the healing site of a stress fracture. After a few hours of letting that go through my body, I returned for the scan. I lay down while the scanner imaged my leg. It was a slow scan — several minutes at a time for each of the views they wanted to get — and I could see the results of the scan as they filled in on the screen above me. It basically looked something like this:

Bone scan showing a stress fracture of the tibia
The bright white spot is where the radioactive material was being collected more heavily by the damaged and healing bone.

Treatment and progress

The bone scan confirmed my stress fracture. I’d probably had it since about mid-March, played ultimate and ran the Sun Run on it. But now, I had to give it rest. That is the only way a stress fracture will heal. No running, no ultimate. My instructions were to rest until I’d experienced ten consecutive days without pain from the normal activities of life. I was allowed to walk around as normal, and do non-impact activities like biking, but I avoided even jogging to catch up to a bus I was about to miss.

After about two days, it no longer hurt to bike. After five days, it didn’t hurt to walk or stand up anymore. After two weeks, it didn’t hurt to walk up or down stairs, and I’d started to forget occasionally that I was injured (not always a good thing). After three weeks of rest, I went to an ultimate clinic and was able to jog around lightly to participate in some of the drills. After the fourth week, I tried again to do some light drills, but this time, the fracture site hurt again for a few days… too much, too soon. I backed off and took another three weeks off from any jogging. I did a bike trip up the Sunshine Coast during this time, but biking had felt fine for weeks. After those three weeks (6th week after diagnosis), it really felt a lot better. I started practicing ultimate twice a week again, although at a lighter pace at the start. After week 8, I played in a weekend ultimate tournament. It’s now 15 weeks after the diagnosis, and it feels really good. I’ve sometimes tried to ramp up my activities too quickly, and that causes discomfort and sometimes pain at the old injury site. When that happens, I just take time off until it feels better (it’s needed a week at most) and then try again. It’s always been fine the second time.

Prevention

The main advice seems to be to give your bone time to adapt and rebuild in response to increased activity. If you add too much new stress at once, the bone will simply weaken. However, if you increase activity gradually, the bone will have time to heal, adapt, and strengthen in response.

An adequate intake of vitamin D and calcium is also important for maintaining bone density. Taking extra vitamin D supplements seem to decrease the likelihood of a stress fracture.

Actual doctors

If you want to hear what actual doctors have to say, here are some references that I found helpful and interesting:

What’s your story?

Was your recovery similar? Any advice that I missed?

4 thoughts on “Stress fractures

  1. Wow, this is probably the best explanation of a medical condition that I’ve ever heard :)

    Sorry to hear the recovery took so long bit glad to hear that you kicked it.

    This is pertinent advice to me since I’m starting a weight regiment in the near future… I tend to find the pace of the weight increases a little slow. So I guess I should just keep patient and take my Vitamin D :O

  2. Thanks, yeah, it’s all better now :) Just get into it slowly and you should be good. Weight lifting isn’t so high impact either, so not much risk for fractures there. Good luck!

  3. I’ve been suffering from a tibial stress fracture for 6 weeks… While training for a half marathon. Thanks for your Advice!

  4. I was wrestling with my hubby and his tibia criss crossed over mine and all his weight landed on it. I screamed and cried until the pain subsided. The whole leg aches a bit now and I can touch that spot and it’s very tender, but no swelling or bruising and I can bear weight no problem. I worked a 12 hour shift on my feet nursing at a hospital yesterday and it hurts more after a shift but still bearable. Guess the bone is probably broken but incompletely. I don’t have insurance and this really helps a lot! Thanks!

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