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Stress Reaction Definition: 

A stress reaction is the precursor to a stress fracture.  While at the stress reaction stage, the bone structure is breaking down and becoming weaker, but does not actually contain any fracture.

Stress Fracture Definition: 

A stress fracture means the structure of the bone has been compromised by a crack or fracture.

What Causes Stress Fractures? 

Stress fractures can occur from abnormal force on normal bone (most common in athletes) and with normal force on abnormal or osteopenic bone (more common in older patients or young very thin females).   Routine x-rays rarely show a stress fracture injury.   A bone scan or MRI is needed to confirm the diagnosis.   A bone density scan may be needed if concern for osteopenia exists.  The following phases are assuming the bone quality is normal.  

Phase 1:  Injury Period  ( Usually 4-6 weeks) 

This period begins at the time of diagnosis, not at the time the athlete started feeling pain.  The athlete must stay below their pain threshold throughout this phase.  To accomplish this, weight bearing status is variable for each patient ranging from being on crutches, use of a special walking boot, to being able to swim, aqua jog or even ride the bike.   This may be a trial to see what causes pain.   You must be honest!

Phase 2:  Recovery  (  3-4 weeks)

We now assume the athlete has no pain.  We continue all strengthening, flexibility, and training from phase 1.   Our goal is to understand why the stress fracture has occurred.

Phase 3:  Build Phase  ( 3-4 weeks) 

Phase 4:  Normal Prep for Race 

This is dependent upon the distance of the race , the fitness of the athlete, and the athlete’s expectations.

Phase 5:  Race  

We have found that if you follow these phases step by step, you have a great chance of recovery.  If you skip a step (or phase), you will fall down to the bottom of the steps to restart phase 1.