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#1 Posted : Monday, October 30, 2006 8:15:04 PM(UTC)

Rank: Administration

Groups: מנהל כללי
Joined: 5/6/2016(UTC)
Posts: 205



What is a Stress fracture?
Stress fracture or Fatigue fracture is common in rookies in military units and caused mostly in the legs due to endless journeys they pass. In theory stress fracture can happen in every bone of the body but in practice it almost always occurs in the feet. 


Whats the difference between a Stress fracture and a regular fracture
Regular fracture is caused by a one-time effort bigger than the bone is able to carry.
Stress fracture is caused by the exhaustion of the bone as a result of continuous increasing loads.


How common is it in the military?
Before the army developed awarness to stress fractures, the percentage stood at one-quarter of new recruits. Today, with the development and implementation of the "Increasing Efforts Scale" the percentage dropped to around 10 percent, still a significant amount.  


Is it common for the Appalachian Trail?
That's one of the most common injuries in the first month on the trail, and women tend to develop it more than men.  


Why is this happening?
Healthy individuals who do not suffer from austeoprosis (osteoporosis), other metabolic diseases, or deformations of the foot -  the strain fracture  happens as a result of the quick erosion from high loads on the bone , higher than rehabilitation of the bone and its re enforcement by the body. At any given moment the body creates new bone tissue to replace worn out bone tissue under the day-to-day activity load. This process is generally balanced and bone tissue that is created is identical to the one rubbing, but when suddenly there's high continues load on the bone, the erosion rate to exceeds the body's ability to build and bolster the microscopic cracks and then develop, in the absence of treatment and awareness, to full crisis.


How fast is this happening?
At high loads (+ 20 kg) and without prior preparation, stress factures develop  within a few days, and in extreme cases within a day or two or even several hours.


What bones are bound to suffer from stress fractures?
The common injuries are:
1. in the second and third bones of the foot (metatarsals 2 & 3)
2. two bones: Tibia and Fibula.

Injury in the bones of the foot is typical of new recruits in the army.
Tibia bone injury is less sympathetic type of stress fracture. In this case, for the most part this is not a real fracture , but acute inflammation cortex (the bone) about 5-10 cm above the ankle bone Another bone that could suffer from a strain is the heel bone, but it is actually a relatively rare.    


What's the best way to prevent Stress Fractures?
Since stress fractures is caused in a healthy person resulting from running high loads on the bone without good preperation (we say: too busy, too fast), the best way to prevent stress fractures is a multilevel session of loads. The body is an amazing machine and running a strain on the skeleton, he begins to build, to tight and strengthen bone tissue. But the stress fracture isn't cause by a static load that acts on the body, since the body can carry loads of hundreds of pounds without being damaged. The stress in carring  the load in motion on rough surfaces. In this condition the bones absorbs repeated blows and that causes erosion of the bone tissue. If we're going to jump on the path and go from day one "from dusk till we drop" the chance to develop stress fractures is almost certain and that's a shame, because the stress is not so easy to recover and certainly not if its in the tibia.  


How do we know we develop stress fracture?
Stress fraction causes pain in a restricted area, directly above the point where it injured the bone. The pain starts in low intensity but it goes and gets stronger as the activity persists. In most cases the area will also be swelling and while pressing it we'll feel a pretty sharp pain. What characterizes sress factions (while accuring, not full blown) is that while resting the pain is diminished or even disappears. I want to highlight the symptoms again!

Stress fractue pain starts "from nowhere," suddenly, in the foot or above the ankle. It goes and gets stronger as we continue the activity and deminishs completely or almost completely when we rest. 

If the pain continues while relaxing, with or without swelling,  we probably have a full blown fractue, and thats really terrible news because recovery time is two months.


Two months?
Yes, if it's really bad even three months, which means you're probably not going to be hiking this year. It's crucial to recognize early symptoms of a stress and start healing effort before the pain becomes too stubborn even in resting.  


Say and I recognize initial symptoms of stress within a day's walk from a town. Should I "carry on" to town to rest.
Only if simultanisly ordering  yourself a plane ticket  back home, for your trip at appalachians is done! Please note all  Wise Guys: from the first symptoms of stress to full fractures its five hours walk!!!! If you translate it into recovery times, in five hours we can cause damage that takes your body 12 weeks to fix!!!


So what do you suggest? stay stranded in the middle of the forest until pain stops?
No. even early stress requires at least a week to rest and treat.  What you have to do is reduce to  minimum the weight of the backpack (take out some food and most of the water),  use walking sticks as crutches, and take the first shortcut for a ride to town.  


How can we ensure that we develope stress fractures and this isn't another injury
Identifing stress fracture can be done only in a medical center, and not some unknown clinic along the path. In the medical Center we'll be checked by certified orthopedist which is ten times better then a general practitioner, and his gear, in a town of 25 families. First, the orthopedist will send us to do an x-ray of the injured place. He does that to rule out the possibility that this is a real fracture or a sprain. If the x-ray results were negative, that increases the likelihood that it is a stress fracture.


Why can't I see the stress fracture in an x-ray?
The stress fracture cannot be seen on an x-ray since innitially the crack in the bone is microscopic, and the bone looks whole. The x-ray is effective only after two or three weeks of recovery, since at this time the new bone tissue was built  (a process known as scarring of the fraction) and the new tissue (SCAR) can be identified in x ray.


So isnt it a waiste to  throw our money on x-ray that is not helpful?
It's certainly a shame but the orthopedist had to work "by the book" and its operations:
A. manual examination and diagnosis.
B. x-ray to rule out pathological findings.
C. Bone Scan or MRI


What is bone scintigraphy
Bone scintigraphy or bone scan, is the second best technique after MRI to early detect fracture. In this method,  a radioactive substance is injected into the vains, emitting gamma radiation and tends to get absorbed in the bones (Technetium-99 m). After two or three hours of waiting, during which need to drink a lot, the man stands behind (gamma camera) scanner that checks bone substance concentration. Undamaged bones absorb a small amount of radioactive material, but broken bones ubsorb greater amount that looks like dark stain (Hot Spot) on the white background of the bone scan. Results are received in the shape the x-ray photos. The doctor (or technician) that performs the scan typically refrains determing that this is stress fractures,  and says  the diagnostic shows material concentration indicates  bone rauma or acute inflammation.    


There are dangers in bone scan?
No. the technique is safe, with minimal level of radioactivity. Seldom the subject suffers nausea and vomiting for a short time.  


If the bone scan is the second best technique, why not perform straight MRI?
Because MRI is a very expensive test, and should you pay for it in cash (until getting a refurd) obrdraft will run amok. In MRI (magnetic imaging or Magnetic Resonance Imaging) you enter into big hollow cylindrical electromagnet, and this  innovative technology (I have no idea how it works) produces a color image of the bones that can identify  clearly the microskopic fracture.  


What if the doctor insists to send us to MRI?
If you have enough money (or the insurance pays fast) you should go for it, otherwise you have to insist repiting bone scan.  


How much do these scans cost?
Bone scan costs between 400 to 600 dollars. MRI Between 1000 to 1500 dollars.
These amounts are before tax and not incuding  the doctor examination cost and therefore certainly advisable to stay healthy.  


How long it takes to  recover from stress fractures?
Time of healing from stress fracture depends entirely on the degree of severity. If we were able to diagnose it early, we could heal it completely within two weeks. If the fracture is completed and acute inflammation, take at least 10-12 weeks for a full recovery.    


How to handle stress fracture? with cast? 
No. Stress fracture is a fracture without displacement of the bone and therefore immobilizing in a cast is not needed.
If we were able to diagnose the stress fracture in early stages,   the first smart thing to do will be taking a whole week of complete freedom from stress. During this week we can put pressure on the injured leg but it is important to avoid knocking on the leg  – such as running, jumping, climbing stairs and so on. Who can get himself a bike, or a heated swimming pool, or gym with Stairmaster , all these activities are positive and contribute to strengthening the leg without hurting the problematic leg. During the break week it is important, especially in the early days, to treat the injury like a muscle injury . Meaning to cool the injured erea (to begin with 20 minutes of every hour) to wear a tight bandage (see the treatment of muscle injuries), to lift the injured leg and take 800 mg of iboprupin three times a day + 1500-1000 mg of calcium supplements. In the second week, you can begin walking without the weight. That the best time to make a slack pack i.e. walking on the trail without the pack. Anyway, the second week walking must be graduates. Start a short walk of two hours and arrive at the weekend to a five-hour walk. Through the second week you must continue to take the pills for anti-inflammation (if there is inflammation and swelling) and calcium. In the third week we can go for a walk with a backpack, but be sure to lose weight while stepping on the injured foot. That means while coming off rocks, the shock absorbing leg is the healthy leg. If anything goes well then we have managed to overcome the stress and the body restored the damaged bone so that the area is even more powerful than before.    


Now...Go go Katadin!


I wrote this article in 2003 after expiriancing two stress fractures is two treks, and identified ehead some more developing.  The article was written about the apalachians, but it is valid for any medium or long trek. In the 13 years that have elapsed, the cost of MRI scan was significantly reduced but it's still quite expensive. Stress fracture can demolish monthes of planning and put an end to your trek in a very frustrating way. You must protect yourself from this type of injury and the best way to do that is to carry less weight. keep your backpack light

I wish you the best luck in your upcoming trek. 

Amnon Lengy

Edited by moderator Wednesday, June 1, 2016 1:08:55 PM(UTC)  | Reason: Not specified

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