Ask Dr. Skendzel: Am I at risk for a stress fracture?
A stress fracture can bring athletic training to a halt, and may require surgery. Dr. Skendzel explains who is at risk, and how to avoid these painful injuries.
A fit 30-year-old woman was in the last stages of training for the Twin Cities marathon. At mile 22 of her run, a sudden severe hip pain brought her to a complete halt. When she consulted sports medicine surgeon Dr. Jack Skendzel, imaging revealed a stress fracture at the top of her femur. Treatment required surgery.
“A stress fracture is a small break or hairline fracture in lower extremity bones including the hip, femur, tibia, and foot,” Dr. Skendzel explains. “Symptoms are pain that appears with repetitive weight-bearing activity such as running or walking. Usually the pain then resolves with rest.”
These overuse injuries are triggered when individuals increase the amount or intensity of training too rapidly; or when they switch to a new playing surface. Dr. Skendzel sees stress fractures in runners, skiers, dancers, and tennis players who switch to a hard court or suddenly see more play time.
“Women are more at risk than men,” Dr. Skendzel points out. Active women at highest risk of a stress fracture have three conditions known as the female athlete triad: they are underweight or have an eating disorder, overtrain to the point where they develop amenorrhea, and have osteopenia (decreased bone mineral density).
Diagnosis is handled through an x-ray and an evaluation by an orthopedic surgeon. Treatment depends on the severity of the fracture. Most stress fractures can be treated with rest and decreased activity, but some do require surgical intervention.
“Some tibial stress fractures develop ‘the dreaded black line’ on x-rays and are notorious for not healing,” Dr. Skendzel explains. “These fractures require surgery. When the injury is in the hip joint, treatment depends on the fracture location. If it’s on the tension side of the hip, we do fixation surgery without delay. However, compression fractures on the bottom side of the hip often respond to nonsurgical treatment via protected weight bearing with crutches. Stress fractures of the femur shaft are also often treated non-operatively.”
Of course, prevention is the preferred solution. “We encourage patients to maintain a healthy diet and body weight, make cross-training part of their exercise program, and refrain from a too-sudden increase in a training regime,” Dr. Skendzel says.
For patients in their 40s and 50s who want to avoid fractures while remaining vibrant and active into their 60s, 70s and beyond, Dr. Skendzel has some suggestions. “Cycling is awesome,” he says. “It is low impact, a great cardiac workout, builds and tones muscle, and you can do it indoors or out. Swimming is also good; you take out the impact with gravity, but you get a thorough workout of your upper and lower body and core. Rowing and elliptical machines are also great low-impact options.
“Part of being a good sports medicine doctor is understanding what my patients want to do, and what gives them satisfaction,” says Dr. Skendzel. “We are here to help our patients find a good balance between what makes them happy and what makes them healthy. Both matter.”
Sports medicine: Expert bone, joint, and muscle care
From Olympians to pro athletes to youth sports and those that just want to be more active – Summit Orthopedics delivers expert care by fellowship-trained sports medicine physicians. If you are recently injured or concerned about ongoing pain, Summit Orthopedics sports medicine specialists have the expertise to evaluate your discomfort and develop a plan to quickly and safely help you get back to being active.
Summit has convenient locations across the Minneapolis St. Paul metro area, serving Minnesota and Western Wisconsin. We have state-of-the-art centers for comprehensive orthopedic care in Eagan, MN, Vadnais Heights, MN, and Woodbury, MN, as well as several additional community clinics.
“An active lifestyle requires superior physical function, and I understand that my patients have exceptionally high standards for their performance and joint health. My goal is to return patients to optimal function so that they can continue to perform and master their personal athletic goals.”
“I enjoy following patients as they progress whether it be in the perioperative period, for wound care or for conservative fracture management. I am always amazed at how the body heals over time and feel it is a privilege to be a support
for patients as this occurs.”