The Star (St. Lucia) - - LOCAL - • Heavy, ir­reg­u­lar men­stru­a­tion

Do you have pain dur­ing ac­tiv­ity that just won’t go away? You could be suf­fer­ing from a stress frac­ture. A stress frac­ture is a small crack or bruis­ing in the bone, typ­i­cally caused by overuse or a repet­i­tive ac­tiv­ity. The most com­mon of all stress frac­tures are on the tibia bone (the shin) and then the foot, but they can oc­cur any­where in the body. They were ini­tially known as “march frac­tures” as they were typ­i­cally seen in sol­diers af­ter march­ing for too long or too far.

Stress frac­tures of the shin or foot, as well as be­ing seen in sol­diers, are com­mon in run­ners but can oc­cur in any sport, es­pe­cially if there is a lot of jump­ing in­volved. Even sports such as ten­nis, with the repet­i­tive ac­tion of hit­ting the ball, can cause a stress frac­ture of the up­per limb.

But you don’t have to play sports to be af­fected; stress frac­tures can hap­pen if you go hik­ing or spend a long day brows­ing around the shops. Go­ing on sight­see­ing ex­cur­sions can put you at risk. Other risk fac­tors are: • Diet – low cal­cium in­take • Gen­der – women are more prone to suf­fer from stress frac­tures than men • Low body weight • Low bone min­eral den­sity • His­tory of stress frac­tures

There are sev­eral causes of stress frac­tures: weak bones, poor biome­chan­ics, over­train­ing and repet­i­tive move­ments, wear­ing the wrong type of footwear with in­ad­e­quate sup­port, and work­ing out or run­ning on hard sur­faces. Diet can also play a role.

It is thought that one ag­gra­vat­ing fac­tor is when the mus­cles pull on the bone, dur­ing move­ment; in the lower leg this can of­ten be felt as shin splints, a pain ra­di­at­ing over the shin. If the ini­tial warn­ing signs are not acted on and ad­e­quate rest and treat­ment are not taken, shin splints can lead to a frac­ture where pain is then felt in a spe­cific area of the shin. How­ever, unlike shin splints, where pain is felt over a wide area af­ter a work­out, stress frac­tures can usu­ally be felt dur­ing ac­tiv­ity and the source of pain eas­ily iden­ti­fied. Of­ten peo­ple are fooled into think­ing that their prob­lem is re­solv­ing as the area of pain has re­duced; but the warn­ing sign is now there is pain dur­ing ex­er­cise, not af­ter.

Stress frac­tures can be dif­fi­cult to di­ag­nose and, as they are so small, they are of­ten not picked up on an X-ray. The most re­li­able di­ag­nos­tic is an MRI, which can be ex­pen­sive, but if you or your health­care provider sus­pect a stress frac­ture, there are steps you can take to speed up your re­cov­ery.

The most ob­vi­ous signs of a stress frac­ture in the lower limb are pain on weight-bear­ing or ex­er­cise, and in­flam­ma­tion and ex­treme ten­der­ness when the area is touched. The first step to re­cov­ery is rest and re­frain­ing from any ac­tiv­ity that ex­ac­er­bates the prob­lem.

In the case of a stress frac­ture of the tibia or the foot, that usu­ally means us­ing crutches or a walk­ing stick to re­duce weight on the af­fected area. This means the mus­cles no longer pull on the bone, al­low­ing bet­ter heal­ing and a faster re­cov­ery. Your doc­tor may even sug­gest a cast, de­pend­ing on the sever­ity of the pain.

You may also be pre­scribed cal­cium or ad­vised to change your diet to one rich in cal­cium. In ex­treme cases, where the area is not heal­ing, surgery may be in­di­cated. This usu­ally in­volves graft­ing frag­ments of bone onto the af­fected area to speed up the heal­ing process

Pre­ven­tion is al­ways bet­ter than cure and there are things you can do to min­imise the risk of suf­fer­ing from this painful in­jury. Al­ways wear footwear that gives plenty of sup­port where most needed; al­ways build up slowly the in­ten­sity of your ex­er­cise pro­gramme and take plenty of time to rest; al­ways warm up and stretch, and re­mem­ber to cool down. Ex­er­cise is good for us but only if done prop­erly. If you are not fit or are re­turn­ing to ac­tiv­ity af­ter some time off, do not go full speed ahead. Slow and steady wins the race.

Although stress frac­tures oc­cur with ath­letes, any re­peated ac­tion can cause this in other peo­ple too.

Kim Jack­son is a UK-trained phys­io­ther­a­pist with over 20 years’ ex­pe­ri­ence. She spe­cialises in mus­cu­loskele­tal pain and dys­func­tion in­clud­ing back pain and sci­at­ica, stroke and other neuro con­di­tions plus sports phys­io­ther­apy, hav­ing worked with lo­cal, re­gional and in­ter­na­tional ath­letes and teams treat­ing in­juries and analysing biome­chan­ics to im­prove func­tion and per­for­mance. She is reg­is­tered with the Al­lied Health Coun­cil and is a mem­ber of PASL. She cur­rently works at Bay­side Ther­apy Ser­vices in Rod­ney Bay, tel. 458 4409 or 284 5443; www.bayside­ther­a­py­ser­

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