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I have had several patients over the past couple of years that have sustained femoral stress fractures while running. The presentation is not always the same because the fractures happen in different places along the femur. In each case, the patient was referred to me by another medical practitioner for physical therapy to treat their non-specific leg pain. In each case, the pain mimicked muscle pain and only a careful history teased out the possibility that a stress fracture was hiding under the radar.
- First of all, I can say that almost without fail, the fracture occurred as the running intensity was elevated. The patient did not notice the pain immediately, but noticed it soon after, in each case by the next day.
- Second, the pain was exacerbated with running, and specifically elevated with impact (landing on the injured leg).
- Third, no matter what stretches the patient employed, if they used ice or not, the pain did not diminish.
- Fourth, taking meds, like NSAIDs, did not resolve the pain.
- Fifth, a complete orthopedic evaluation ruled out all the muscles as a source of the pain.
A suspicion of a stress fracture needs to be further investigated by a bone scan which shows a 2% change in bone density rather than an x-ray which illustrates a fracture when there is a 50% change in bone density. Some physicians prefer an MRI to rule it out, but most opt for a bone scan.
The treatment for a stress fracture is the same as for any fracture. Non-weight bearing for 6 weeks, followed by 6 weeks of rehab before returning to previous mileages.
I had a stress fracture in my tibial plateau, caused by the reasons that you state above, even though I was wearing nicely supportive running shoes that were fitted by a therapist who analyzed my gait. I took two months off running to heal the bone and am back up to my previous milage using Vibram five fingers… the minimalist shoes you mention above. I run in the Vibram KSOs, they have a more shoe-like cover on the top to keep gravel and sand out. I have no joint pain and no indications of continuing problems at the break site.
My lessons:
1. don’t pick up mileage too fast
2. don’t wear over-kill shoes if there’s nothing to fix about your natural stride
3. Don’t take a lot of NSAIDS (I was taking some ahead of each run to stave off muscle and joint pain. Now I read that NSAIDS can inhibit maintenance bone repair)
Comment by Podzol — July 28, 2009 @ 12:43 pm