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What is a Stress Fracture?
For many dancers the fear of getting a stress fracture is a major worry, especially if they start developing foot pain. Many dancers avoid consulting a therapist when they have foot pain for fear of being diagnosed with a Stress Fracture, however catching them early can make the difference between it resolving quickly or becoming a chronic issue. So what is a Stress Fracture? How do you know if you have one? And what should you do if you get one?
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What Is A Stress Fracture?
A “fracture” is a disruption, or break in a bone.
Some fractures, called stress fractures, are microscopic, and develop more over a period of time, rather than with one big incident. Our bodies are amazing, and adapt remarkably well to the things we demand of them. However, if too much load is placed through a bone, in a particular direction, and it does not have the strength to endure such forces, a stress fracture may develop. Over time tiny faults will appear within the bone, and unless the forces imposed in that bone are changed, they will accumulate and develop into a more major fault in the bone.
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 foot wear 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 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.
There are two common types of Stress Fracture
There are several areas of the foot that are most susceptible to Stress Fractures in dancers and athletes alike; the Metatarsal Bones (Especially the first and second MT in Dancers) and the Navicular Bone (More common in athletes, usually caused from running). Stress fractures may also occur in the Tibia (Shin bone), the Calcaneus (Heel bone) and the 5th MT (Outer part of the foot)
Causes of stress fracture include anything that creates load through one part of the bone over another.
General symptoms of a stress fracture include:
In analysing your injury, your therapist or doctor may be able to diagnose your injury strictly on the basis of a physical exam. The therapist will assess the injured area, comparing it to the uninjured leg or knee. He or she will evaluate visible signs of injury such as tender skin, swelling, and differences in joint mobility or appearance.
They should also look at the rest of the body, especially the trunk, spine and pelvis, looking for weaknesses or asymmetries that may have led to the injury occurring. Correctly identifying any contributing factors early will help in devising the most correct, and effective rehab program to help ensure that the injury does not reoccur.
Often people ask whether they should have an X-ray to check for stress fractures. Because they are rarely ‘displaced’ (when the bone has shifted its position), or appear all of the way though the bone (this can happen in very severe cases) Stress Fractures cannot initially be seen on regular x-rays. In addition, many people think that if their x-ray is ‘clear’ then they are fine, however this is not necessarily the case.
IMPORTANT! Correctly diagnosing a stress fracture is very important to ensure that you get the correct treatment. Many different injuries can give pain in similar areas, to this step is extremely important.
Stress fractures are usually treated conservatively, without surgery. Treatment of the stress fracture will depend on the individual dancers risk factors and contributing factors, but may include the following:
NB - we now tend to avoid the traditional R.I.C.E treatment as this can actually reduce blood flow to the area and may delay healing.
A major component of the treatment for a stress fracture must always be in identifying and correcting any contributing factors that led to the injury developing in the first case. This may include, but is certainly not limited to:
Floor barre is an extremely effective way of maintaining dance fitness and technique while enabling the dancer to retrain certain areas of their technique. The absence of gravity in some positions allows dancers to find and activate muscles that are easily overpowered by larger muscles. Often utilising these muscles over the more powerful muscles achieves better control of the movement and a nicer line. A good example is during développés; often the deep core muscles are not used while the quadriceps work strongly. Our video taken from the "Will I Ever Dance Again?" program showcases how effective floor barre can be.
Returning To Dance After A Stress Fracture:
Once the stress fracture heals, normal activities should be gradually incorporated. A dancer should employ the 10% policy – workload should not be increased by more than 10% per week after the treatment period. With this type of injury it is extremely important that the dancer does not start working at full capacity immediately, as the injury could reoccur. It is important to slowly work yourself back to full time training.
It is essential that you are well conditioned and that equal time is given to work and rest to prevent fatigue. Make sure to start each day with warm up exercises and cool down at the end of the period of the exercise period. A balanced diet including vitamin D and calcium-rich foods is important in maintaining bone density and health.
Replace any old or ill-fitting ballet or athletic shoes, and ideally have a individual fitting with an experienced fitter, as the style and size of shoe that is most suitable for you may have changed following your rehab (often strengthen the foot can cause a change in shape)
If you experience pain or swelling in the injury site as you resume dancing, please stop all exercise immediately and seek the advice your health professional.
Due to the extended recovery time (6-10 weeks) for a stress fracture to fully heal, and the effect that this has on a dancers training, preventing stress fractures is of major importance. Gradually increasing workloads at a rate of no more than 10% a week and varying the training by using cross training techniques will help to off set the overload and repetition often associated with stress fractures.
Warming up properly and preparing the body for the workout will help to keep the muscles from fatiguing as quickly. This will also prevent injuries to the muscles and tendons, which could lead to further weakening of the bones. Injuries to the muscles, tendons or ligaments that support the skeletal system could lead to excess, and awkward, pressure on the bones.
Flexibility is essential for dancers and athletes as well. Muscles that are flexible will provide more support and, due to their elasticity, absorb more shock. They are also less susceptible to injury, which could lead to an imbalance or improper gait. Stiff muscles will also lead to incorrect running and landing patterns that could lead to extra stress.
Making sure that you have optimal mobility and control of the foot and ankle during all aspects of your dancing is of utmost importance in preventing stress fractures, so using program such as our Advanced Foot Control for Dancers program is essential.
For more detailed information on specific Rehab Exercises for recovering from Stress Fractures,
please refer to the Stress Fracture Solutions Injury Report
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