Other conditions affecting women

Stress Fractures

What are stress fractures and how would I know if I had them?

With recurrent physical stress/loading/training we can develop areas of bony weakness in the bone, causing stress reactions that can then further progress to stress fractures if not well managed.

Stress fractures:

  • Overuse injury affecting the bones
  • Much more common in women
  • More common in the lower limb

Symptoms:

  • Persistent pain, night pain, pain with impact
  • Deep ache that as the condition progresses, lingers after activity

Easy to miss as they can present like many other muscle strain or training aches and pains.

Which is why it is important to be assessed by a professional with experience.

What is the treatment and how long will it take for me to get back to hitting the gym/track/classes/podium?

This is not the type of injury to be stoic about. A period of rest is critical for bony recovery. This can range from weeks to months.

The severity and location of the stress fracture will determine the type of immobilisation required.

As these injuries occur much more often in the lower limb particularly the hip, shin bone and foot, the type of immobilisation may range from wearing a boot or using crutches or in more severe scenarios may require surgical stabilisation.

Once the bone has had time to heal, we can slowly reintroduce load and build up greater tolerance and strength.

Looking at biomechanics, nutrition and training loads are key to getting the timing and specifics of this right.

Do stress fractures present differently in men and women in terms of frequency/severity/recovery time?

Women are particularly at risk as they are more susceptible to the implications of hormonal and energy imbalances as described through the female athlete triad.


Female Athlete Triad

A little known condition that commonly affects female endurance athletes is the female athlete triad.

Female athlete triad Guidelines 2019 outlines this as having one or all of the following:

  1. Low energy availability, with or without disordered eating
  2. Menstrual dysfunction (not a regular menstrual cycle or no cycle)
  3. Low bone density (osteoporosis or osteopaenia)

The female athlete triad is a result of energy imbalance; thus, adjusting energy expenditure and energy availability is the main intervention. In some women this can be associated with thyroid dysfunction so it is important that we liaise with the appropriate medical team to ensure you are managed holistically.

Females affected by the triad are at a much greater risk of bony stress reactions and stress fractures which cause the pain that results in them presenting to physiotherapy. They may also be struggling with reduced athletic performance due to lack of energy availability.

Consequences of these clinical conditions may not be completely reversible, so prevention, early diagnosis and intervention are critical.

Treatment:

Goal is to restore regular menses as a clinical marker of energy balance and bone density.

Pharmacology may be required (medications/supplements) as per your doctor.

Involvement of medical input from a GP or sports physician, dietician, physiotherapist and sometimes mental health provider.

It is important to note that men can also suffer from implications of energy deficiency. As described through the more general classification of RED-S (Relative Energy Deficiency-Syndrome) and we need to be aware of the risk of stress fractures and reactions in this group.