Category: Diet

Athlete bone stress fractures

Athlete bone stress fractures

Osteoblastic activity generally lags behind osteoclastic activity tsress when bone is persistently stressed strdss adequate time for recovery, the bone is at Athlete bone stress fractures for fatigue fracture or Common nutrition myths injury Atylete Repetitive loading of srress Athlete bone stress fractures the microstructure of bone and signals bone remodeling by Natural cholesterol remedies osteoclastic and osteoblastic activity 15 One algorithm used in the military advocates radiography two weeks after the onset of symptoms if symptoms persistwith repeat radiography the following week before performing more advanced imaging. The largest group affected were males in track and field. Bones stress injuries have varying levels of severity, and these can be broken up into low- and high-risk fractures Table 2. At Yale Medicine, we have orthopaedists, physical therapists and athletic trainers working together to treat the whole individual, not just the fracture.

Athlete bone stress fractures -

From sports medicine to orthopaedic surgery, our new hospital in King of Prussia will offer every resource a young athlete needs. Learn more. These hormonal changes are tied to development of bone mass.

Without them, bones become weak, and injuries are a risk. But what might look like a healthy diet can actually be missing the mark and putting the athlete at risk.

Calorie requirement will vary from athlete to athlete depending how quickly or slowly their body processes the nutrients in their diet. Athletes must have energy available to meet their needs for basic physiologic processes. It can be hard to determine how much energy is needed, but activity trackers can help estimate the amount of calories burned.

Athletes should snack every three to four hours and treat snacks like a mini-meal, avoiding empty calories found in junk food. For example, a snack should have a good balance of protein, carbohydrates and fat, like peanut butter and apple slices. Consider speaking to a nutritionist to learn more about nutrition for athletes.

Skeletal maturity is reached during the teenage years and early 20s. During this time, bones reach their peak density. To build bone mass, teens need to consume enough calories and nutrients to support the hormones tied to its development the same hormones that regulate the menstrual cycle.

Adolescent bone mineral gains are modified by lifestyle, nutrition, environment and physical activity. Bone mineral density declines as the number of missed menstrual cycles accumulate.

Weight-bearing exercise supervised by an experienced trainer is also important for strengthening bones and preventing injury. The bottom line — it can be hard to tell that an athlete who is in great shape could actually be unhealthy. Pay close attention to menstrual cycles and diet, and make sure strength and cross-training is part of the program.

Are you looking for advice to keep your child healthy and happy? Do you have questions about common childhood illnesses and injuries? Subscribe to our Health Tips newsletter to receive health and wellness tips from the pediatric experts at Children's Hospital of Philadelphia, straight to your inbox.

Read some recent tips. Athletes with low bone mineral density follow a similar trend by having a 4. Low energy availability also increases the risk of stress fracture by 1.

Low energy availability is a pervasive problem among female athletes, and its effects are magnified in athletes who actively restrain or limit their energy intake.

Disordered eating in combination with strenuous training, can lead to hypothalamic-pituitary axis dysfunction, estrogen deficiency and menstrual irregularities that may result in lower bone mineral density that may not be reversible 4 , Aside from adequate caloric intake, vitamin D and calcium are recognized as important nutritional factors to achieve and preserve bone health 9 , While some studies have had conflicting results, a number of studies have shown a reduced incidence of stress fractures with adequate calcium and vitamin D intake 28 - Lappe et al.

placebo Nieves et al. found that female distance runners who consumed less than mg of calcium per day had almost 6 times the rate of bone stress injuries than those who consumed more than 1, mg Overall, most literature supports the importance of active young females meeting or exceeding the current recommended daily levels of vitamin D — IU and calcium 1,—1, mg 14 , Important to the diagnosis and classification of bone stress injuries are the level of symptoms, the anatomic site, and the grade of injury.

Patients typically present with pain in the affected area that is insidious in onsent. Bones stress injuries have varying levels of severity, and these can be broken up into low- and high-risk fractures Table 2.

Low-risk stress fractures tend to be on the compression side of bone and have a favorable history of responding well to activity modification 14 , High-risk fractures are more often on the tension side of bone and have a higher risk of complications including recurrence, nonunion or completion of fracture 14 , When diagnosing a stress fracture, the first line of imaging is typically an X-ray.

However, due to microdamage to bone, they are often undetectable by X-ray While bone scans have traditionally been a preferred imaging modality for diagnosis of bone stress injuries, their accuracy and specificity for stress fractures has been shown to be low Therefore, magnetic resonance imaging MRI has become the modality of choice for grading of severity of stress fractures.

While multiple MRI grading systems exist, the Fredericson MRI Classification System originally made for tibial bone stress injuries remains a frequently used grading system Table 3 14 , Proper diagnosis is important as management can vary from relative rest to surgical 4.

Treatment of bone stress injuries can be approached in a two-phase process Table 4 2 , The first phase involves pain control, activity modification, and identifying and addressing underlying risk factors. Pain control tactics include applying ice to the affected area, physical therapy modalities, and oral analgesics.

Avoiding non-steroidal anti-inflammatory drugs NSAIDs has been recommended by some due to potential adverse effects on bone healing 2 , Weight bearing as tolerated may be allowed in low-risk stress fractures if no pain with ambulation but participation in sports should be stopped.

If unable to walk with a normal gait due to discomfort, partial weight bearing with an assistive device such as crutches or use of a walking boot or post op shoe depending on injury site may be necessary.

A period of relative rest that allows for low impact cross training activities e. Complete rest is indicated if the athlete has pain with cross training activities and in certain recurrent or high-risk bone stress injuries.

Management of high-risk bone stress injuries involves a different initial approach as these are at a higher risk of a poorer prognosis if completion of fracture occurs as well as complications including nonunion, malunion, and refracture Depending on site and grade of the stress fracture the recommended treatment ranges from complete rest to surgical management.

Complete healing should be verified prior to return to sport. Low grade stress injuries at high-risk sites can generally be managed with a period of non-weight bearing. Surgical management of stress fractures at high-risk sites may be appropriate in certain cases to allow for possible expedited healing and return to play for foot fractures such as navicular or fifth metatarsal Possible prevention of recurrence in subsequent seasons of play, and prevention of catastrophic fracture progression as in displaced femoral neck stress fractures or medial malleolus stress fractures During the initial treatment phase both intrinsic and extrinsic risk factors for bone stress injuries should be identified and addressed.

Intrinsic risk factors including disordered eating, nutritional deficiencies, hormonal imbalances, medications and low bone density should be recognized 4. Specific to female athletes, a detailed menstrual history should be taken including age of menarche and menstrual status.

Laboratory testing should be considered if nutritional issues are present or in recurrent stress fractures and should include serum calcium, 25 hydroxy OH vitamin D3, phosphorus, parathyroid hormone, thyroid stimulating hormone, alkaline phosphatase, albumin and prealbumin 33 , Hormonal levels [follicle stimulating hormone FSH , luteinizing hormone LH , estradiol] may be tested in those with menstrual irregularities 33 , Bone density testing with dual energy X-ray absorptiometry DEXA scan may be ordered in those with recurrent or history of multiple bone stress injuries Athletes should undergo a gait and biomechanical analysis to evaluate any deficiencies in gait or form, asymmetrical muscle imbalances, and any structural abnormalities including leg length discrepancies, pes planus or pes cavus 4.

Additionally, a team approach to female athletes with bone stress injuries and the female athlete triad with co-management between the treating physician and potentially a psychologist, gynecologist, and nutritionist as well as family, trainers and coach should be employed.

A detailed physical activity history is important to consider to identify any changes in training including increases in intensity, volume and frequency as to adjust training plans appropriately in the future Pneumatic leg braces may be used in fibula and tibia stress fractures to promote healing and to help foster a pain free gait While some studies have shown some healing benefit using low intensity pulsed ultrasound LIPUS 14 , 43 , a recent systematic review of 26 randomized controlled trials determined based on moderate to high quality evidence studies that LIPUS does not lead to improved patient outcomes and likely has no effect on radiographic bone healing Extracorporeal shockwave therapy has been shown to be effective in treating recalcitrant bone stress injuries and nonunions 14 , 45 , but little evidence exists on its utility in treating acute stress injuries.

Bone stimulators have also been used, however, evidence of their efficacy remains inconclusive 2. Pharmacologic treatments to increase bone mineral strength in the setting of low bone mineral density or nonhealing fractures include bisphosphates and recombinant parathyroid hormone.

However, trials evaluating the safety and efficacy of these medications in this young patient population are limited, particularly with bisphosphonates as they have possible long lasting teratogenic effects Intranasal calcitonin has been shown to decrease pain associated with osteoporotic fractures 47 and possibly strengthen bone microstructure 48 ; however, studies have been only been conducted in postmenopausal women.

While use of oral contraceptives to help regulate hormonal abnormalities has been shown to be protective against bone stress injuries 31 , 49 , some recent data has suggested that the use of combined oral contraceptive pills in adolescents may lead to premature physeal closure 50 and less peak bone mineral density accrual at the hip 51 and spine 52 than non-users.

Phase II involves preparing the athlete to return to impact running or sporting activity. The return to sport protocol for stress fractures is highly individualized.

It is based on the grade and location of injury, as well as the athletic goals of the patient. Overtreatment of a stress fracture results in unnecessary loss of training; while undertreatment results in a high chance of injury progression and extended recovery time This phase can be initiated after the athlete has been pain free for 10 to 14 days 2.

Running can be generally begun 1 week after the resolution of bony tenderness to palpation 2. Timing for return to sports participation varies based on location and severity of the stress fracture.

Miller et al. looked at return to sport timing in 57 Division I collegiate track and cross-country runners with stress fractures and found that mean time to return to unrestricted sport participation was They also found a trend toward increased time to return in women Arendt et al.

reported the return to sports rates of 74 athletes with lower extremity bone stress injuries at their collegiate institution Using MRI for grading severity of stress injury, they found return to sport was 3. Dobrindt et al. additionally aimed to determine return to sport timing based on injury site and MRI grading of bone stress injuries Bone stress injuries are common amongst female athletes and can cause significant morbidity and time away from sport.

Young female athletes are at a particular risk for bone stress injuries due to a number of intrinsic and extrinsic risk factors, with the female athlete triad and low energy availability as the primary factors leading to impaired bone health.

Most low-risk bone stress injuries can be treated with a period of relative rest and addressing underlying risk factors. However, surgical management may be required for certain high risk or recurrent bone stress injuries. Knowledge of the risk factors, classification and treatment of bone stress injuries in females can assist in appropriate management and prevention strategies.

Provenance and Peer Review: This article was commissioned by the Guest Editors Sommer Hammoud and Robin V. The article has undergone external peer review. The authors have no other conflicts of interest to declare.

Skip Athlete bone stress fractures stresa. Published on Jun fractuures, Boen of the Athlwte Athlete bone stress fractures for an athlete to hear is that the Goji Berry Hair Health pain in her leg or foot is a bone stress injury. This common overuse injury often strikes young female athletes, and can take them out of the game, studio or gym for months. When the balance is out of whack in an athlete, injury is much more likely. A Athlete bone stress fractures fracture Apple cider vinegar weight loss a tiny Athlete bone stress fractures that forms in fgactures bone, usually as a Athleye of overuse or repetitive, stress-bearing motions. Most stress fractures occur in the weight-bearing bones of the foot or lower leg. They can also occur in the hip. Most stress fractures affect competitive athletes in their teens or early adult years. While both male and female athletes can get stress fractures, women and girls tend to develop this type of overuse injury more often than men and boys. Athlete bone stress fractures

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