Welcome to the Mount Sinai Health Beat, a feature with the official medical provider of USTA Eastern, USTA and the US Open. Each month, the Mount Sinai Medical Center will provide tips to prevent nagging injuries from cropping up, which prevent players from competing in tennis. One of the world’s leading medical institutions, Mount Sinai’s experts are uniquely positioned to help athletes from professionals to club players succeed in sport.
In addition to providing on-site clinical care for the professionals competing in the US Open, Mount Sinai’s team of medical experts aims to lead the development of policies around injury prevention and to conduct educational outreach to promote the health benefits of tennis.
This month, the topic is prevention and treatment of the tibia stress fracture with the advice of Dr. Alexis Colvin, an Assistant Professor of Orthopaedic Surgery at Icahn School of Medicine at Mount Sinai in New York City and the Chief Medical Officer for the USTA.
Dr. Alexis Colvin
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Definition of a Stress Fracture
A stress fracture is a break in the bone. Most stress fractures occur in the lower leg and foot. The tibia is a common area in the lower extremity for stress fractures to occur. They can also occur in the hip and other areas. Most stress fractures can heal spontaneously. However, some may lead to complete fractures, or may require surgery.
Unlike a traumatic fracture which is caused by a hit, a stress fracture is typically caused by repeated stress or overuse. Some causes are:
- Increasing the amount or intensity of an activity too quickly (most common)
- Switching to a different playing or running surface
Stress fractures can worsen by continued physical stress. Smoking can also make stress fractures worse because it interferes with bone healing.
A risk factor is something that increases your chance of getting a disease or condition. Risk factors for a stress fracture include:
- Sex: female
- Certain sports, especially involving jumping or running:
- Track, especially distance running
- Amenorrhea (women only)
- Reduced bone thickness or density
- Poor muscle strength or flexibility
- Overweight or underweight
- Poor physical condition
- Poor nutrition and/or eating disorder
- Localized pain on the bone
- Pain when pressure is applied directly over the fracture and the area around it
- Pain when putting stress on the affected leg
The doctor will ask about your symptoms and medical history, and examine the injured area for localized pain and swelling.
Tests may include:
- Stress fractures are usually not seen on an x-ray until at least two weeks after symptoms begin.
- MRI scan
- Can detect stress fractures earlier than when they appear on x-ray
- Bone scan
Rest is the most important thing you can do for a stress fracture. This includes avoiding the activity that caused the fracture and any other activities that cause pain. Staying away from activities that cause pain is usually for at least 6-8 weeks.
You may need crutches or a walking cane to keep pressure off the leg. A walking boot can also protect your injured leg.
Talk with your doctor about when you can restart activity and how to progress with the amount and type of activity.
A common progression:
- Begin with nonweight–bearing activities, such as swimming or bicycling.
- Next, you can do weight-bearing, nonimpact exercise, such as a stair machine.
- Gradually, you will be able to add low-impact activity, starting with walking.
- Once you can do fast-paced walking with no pain, you can start higher impact activity, such as light jogging.
- This gradual progression continues until you have reached your pre-injury activity level. You can return to full activity once you do not have pain with higher impact activities.
· Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain, but controversy exists about their use for stress fractures. It is possible that NSAIDs adversely affect fracture healing.
To reduce your chance of getting a stress fracture:
- Gradually increase the amount and intensity of an activity.
- Do not overdo any activity.
- Eat a healthful diet, including foods rich in calcium and vitamin D.
- Avoid smoking.