Overuse injuries and burnout in youth sports: a position statement from the American Medical Society for Sports Medicine. If after that time, the athlete is pain-free, the sports medicine physician is likely to prescribe a gradual return to activity over 4-6 weeks, depending on the previous training schedule, level of physical fitness, and whether the fracture is high or low-risk.ĪMSSM Member Authors: Gloria Rho, MD, Susan Joy, MDĭiFiori JP, Benjamin HJ, Brenner J, Gregory A, Jayanthi N, Landry GL, and Luke A. Most sports medicine physicians recommend a period of complete rest from all physical activity that stresses that area for a period of 4-6 weeks. ”Energy (calories) in” should be balanced with “energy (calories) out ” the maintenance of menses in females is correlated with optimal nutrition.Calcium and vitamin D intake should be optimized with a well-balanced diet.Training surfaces should be optimized to reduce impact.Equipment should fit properly for training demands.Physical activity should be gradually increased by no more than 10%-15% per week.Training schedules should be monitored with a log.Some stress fractures are considered high-risk, and in those cases, surgery may be recommended. This period, which may last 4-6 weeks, is generally followed by a very slow return to activity directed by a sports medicine physician. If a stress fracture is identified, a period of immobilization with a cast or walking boot may be necessary, with or without crutches, to help the athlete become pain-free. If the history and examination are highly suggestive of this diagnosis, but the x-rays do not show the stress fracture, magnetic resonance imaging (MRI), computed tomography (CT) scan, or a bone scan may be ordered to evaluate the painful area further. X-rays of the area where the pain is will be obtained to look for any evidence of a healing fracture. Sometimes it can be difficult to see a stress fracture on x-rays, especially if the pain only started within the past 2-3 weeks, or if there has not been any period of rest to allow for healing. He/she will be particularly interested in finding out if there have been any recent changes in the type, intensity, duration, or frequency of activity in the month prior to the pain starting. The sports medicine physician will ask about the athlete’s training schedule. The pain will develop at the site of the fracture. Generally, there is a gradual onset of pain with activity only that progresses to affect daily activities as well. Increase in training volume or intensity.Upper extremity stress fractures can occur in overhead athletes and gymnasts. It most commonly affects bones of the lower extremity, such as the tibia in the lower leg, the metatarsal bones of the foot, and the femoral neck at the hip joint. It is not typically caused by trauma and it develops gradually over time. This procedure is an excellent alternative treatment for those fractures that have failed nonsurgical treatment.A stress fracture is a fracture that is caused by too much stress being put on a bone. Intramedullary nailing of the tibia for chronic stress fracture has a high union rate, allows for a low complication rate, and allows for an early return to competitive sports. This fracture healed with nonoperative treatment. Another patient sustained a traumatic fracture of the distal tibia 1 year after intramedullary nailing of the tibial stress fracture. One patient developed bursitis at the tibial nail insertion site that was resolved with a steroid injection. At last follow-up, all patients had full range of motion at the knee and ankle joints and were satisfied with the results. The mean duration for return to sports after surgery was 4 months. Clinical and radiological union occurred at a mean of 2.7 and 3 months, respectively. Patients had experienced symptoms for a mean duration of 12 months. All patients had failed nonoperative treatment, including rest, activity modification, use of an orthosis, and low-intensity ultrasound stimulation, for a minimum of 4 months. Seven of the fractures occurred in male athletes, whereas 4 occurred in female athletes. The mean age of the patients at the time of stress fracture diagnosis was 17 years. These patients were followed for a mean duration of 17 months. Seven collegiate-level athletes with 11 chronic anterior midtibial stress fractures were treated with reamed intramedullary nailing between 19. The use of a reamed intramedullary nail for a chronic anterior tibial stress fracture is a safe and effective treatment for an athlete. A chronic anterior midtibial stress fracture is a serious, difficult-to-treat injury that can adversely affect an athlete's career.
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