Stress fractures often follow a progression of three stages…
A) Bone Strain – Re-modelling of bone, or increased activity of the cells that build bone is the first sign of an issue with loading in the bone. This stage is very rarely picked up as the dancer does not feel much pain at all. The remodeling may sometimes be picked up by a bone scan looking for other issues.
B) Stress Reaction – Once there is a tender portion of bone, but before the bone shows signs of a fracture, it is called a stress reaction. This stage is often seen in dancers who are increasing hours or changing styles of dance. If problems with technique or footwear are picked up at this stage, it is possible to avoid the development of a stress fracture. Many dancers avoid reporting pain at this stage as they are scared of "Having an injury" however, if it is caught early, and dealt with appropriately, then more severe injury and disability can often be avoided.
C) Stress Fracture – Once there is a development of an actual fault in the bone, it is classed as a stress fracture, and usually, a period of non-weight-bearing is needed to resolve the symptoms. Depending on the risk factors of that particular dancer, treatment may vary considerably, so it is important to be guided by your therapist on any time off, use of a boot, and a gradual build back into class.
Types of Stress Fracture:
There are two common types of Stress Fracture
- Fatigue Fracture. This is the most common form of stress fracture found in dancers and is caused when a normal bone is exposed to repeated abnormal stresses e.g. Jumping, Landing, Balancing on demi Pointe e.t.c. with poor alignment or insufficient control.
- Insufficiency Fracture. This type of fracture occurs when a normal amount of stress is applied to an abnormal bone e.g. bone with Osteopenia, especially in the case of eating disorders.