Stress Fractures

Stress fractures can be painful enough to stop you running or even weight bearing. This makes being active or playing sports impossible. Early on they may just make training difficult and uncomfortable.

If the bone is repetitively loaded to the point that it can no longer sustain the load, a hairline crack may occur. This is called a stress fracture. They are common around the knee and most frequently affect females. Certain endurance sports and disciplines are also often the cause. These include running, gymnastics and ballet.

A specific type of stress fracture known as a subchondral insufficiency fracture (SIF) may occur in the over 50s. Frequently the knee may have some very early wear changes. They seem to be precipitated either by heavy lifting or a tear of the medial meniscus. The bone just under the joint lining cartilage develops a hairline crack. It can occur in both femur or the tibia.

• Rest and stop the activities that are causing the pain.
• Non-weight bearing, using crutches can be extremely effective at reducing the pain and can promote healing of the fracture
• Ensure you are eating enough calories and a good-quality balanced diet.
• Reintroducing a light level of training after full recovery from the pain may allow you to recover sufficiently to get back to sports.
• Do some strengthening work

It may be possible to self-manage but stress fractures aren’t always easy to diagnose and require specialist imaging and investigation.

Treatment options for a stress fracture of the knee

• Stress fractures are complex injuries and may involve monitoring and assessing diet, weight, hormones, bone health and training schedules.
• Subchondral insufficiency fractures settle after a week or two of non-weight-bearing using crutches. Generally, if you offload the leg until the pain has completely settled, the reintroduction of weight-bearing does not cause a recurrence of symptoms. This is quite different to the sort of stress fractures that we get in sportsmen and women or ballet dancers.These tend to be more resistant to treatment and certainly don’t completely recover with a brief period of offloading them with crutches.
• Stress fractures rarely require surgery.

Stress fractures aren’t always obvious to diagnose and require investigation to assess the knee for them.

Testing of nutritional status and micronutrient levels is helpful to cure and prevent recurrences.

Stress fractures in younger people are relatively uncommon, but multidisciplinary teams are involved in their management. So while I am quite comfortable making the diagnosis, I would often involve other specialists for some of the hormone and nutritional assessments.

Subchondral, insufficiency fractures are relatively common, and I frequently diagnose these and manage them, but once again will often involve other specialists to investigate the bone health to ensure that pub own health is not the precipitant for the injury.