This is a good title.Â Dr. Suzanne Hecht (UCLA>>>now University of Minnesota) and I wrote this article originally for USECA.Â I may have used parts of it before in lectures or after in other articles/lectures; but, here it goes again:
GETTING STRESSED OUT ABOUT STRESS FRACTURES?
So what is a stress fracture?Â Â Dr. Hecht writes –
A stress fracture is an overuse injury to the bone that occurs when the bone cannot keep up with the demand that is placed on it leading to microfractures (mini breaks in the bone) and swelling of the bone marrow.
Dr. Hecht continues by describing typical symptoms of a tibial stress fracture include the following:Â
Â·Â Â Â Â Â Â Â Pain develops gradually
Â·Â Â Â Â Â Â Â Shin pain occurring during or after workouts
Â·Â Â Â Â Â Â Â Pain improves with rest
Â·Â Â Â Â Â Â Â A sudden increase in training time or intensity
Â·Â Â Â Â Â Â Â The shin may be sore to touchX-rays are often negative early on in the course of a stress fracture.Â
Rememberâ€¦just because the x-rays are negative doesnâ€™t mean your gymnast doesnâ€™t have a stress fracture.Â The physician may recommend further testing to confirm the suspected diagnosis or may suggest treatment options and repeat the x-rays in 2-4 weeks to see if the stress fracture can be seen.Â A bone scan is a common test used to look for stress fractures if the x-rays are negative.Â Other physicians might order a MRI scan.
Dr. Hecht emphasizes that stress fractures of the front portion of the tibia (anterior) are very concerning.Â These fractures can show up as a dark black line on the x-rays and physicians commonly refer to this finding as â€œthe dreaded black lineâ€.Â This stress fracture worries physicians since the bone in this area is on tension and doesnâ€™t like to heal.Â The anterior tibial stress fractures should be taken very seriously and treated with extensive rest of the leg or placement of a rod into the tibia to help facilitate healing.Â Stress fractures of the inside, back portion of the tibia (posteromedial) heal better and can be treated more liberally. Â
A note from â€œThe Posture Ladyâ€ regarding
BIOMECHANICS OF THE LOWER BODY
Poor biomechanics of the lower extremities and pelvic area often lead to conditions such as tibial stress fractures.Â Be sure to check for muscle imbalances.Â Finally, emphasizing correct standing posture cannot go unnoticed and should be an important part of the training process.
Comments from “The Posture Lady” 07/21/2008:Â I have seen preschool kids, as young as two or three years old, stand in severe knee hyperextension.Â My 3 and 1/2 year old son stands with “loosey goosey” looking knees, in complete knee hyperextension, every day and I remind him EVERY DAY that he needs to stand with his knees “soft.”Â I believe we need to go this far back and start educating parents and kids about correct standing posture.
There are many elite gymnasts that stand in knee hyperextension.Â This can be seen especially when at the chalk box or awaiting a turn on vault or beam.Â It’s a horrible stance.Â This is not to say that the gymnast’s legs should not look straight and gorgeous once airborne, but just to say we are NOT meant to stand in knee hyperextension.Â I will soon learn how to post a picture from my mentor (RIP) Florence Kendall, PT.Â She gave me permission to use the very picture that best shows the problem and consequences of knee hyperextension.Â From the book, “MUSCLES Testing and Function” 5th edition, page 84, ISBN 0-7817-4780-5Â (I’m in the book too – pages 395,396,397, if you want to see some crazy-short hip flexors and ITBs as a former elite gymnast.Â What a mess.)
Back to the problem with this picture.Â A gymnast that stands in knee hyperextension risks the possiblity of ending up with a posterior (backward) bow in the tibia and fibula.Â I wonder if this helps lead to stress fracturesÂ or bones that “just pop and crack.”Â My gut says, yes.Â It saddens me that an elite gymnast may get to this point from something that might be prevented with education as early as the preschool years.Â Let’s work to help fix the issue.
The gymnast should stand with good posture at all times.Â The femurs (thighbones) should be in neutral rotation with the patellae (kneecaps) facing straight ahead.Â The feet should be in good alignment; turned out only 7 to 10 degrees and arches maintained.Â
If a gymnast has difficulty holding the arches up, the following suggestions may help:
-Reinforce the idea of contracting the side buttock muscles to help align the legs and lift the arches.
-Strengthen the posterior Gluteus Medius muscle with the following exercises and suggestionsâ€¦
KICKS (with good hip turn-out and tight abdominal muscles)Â / JUMPS (pay closeÂ attention to straddle jumpsÂ very early in the gymnast’s career and make sure that they turn the leg out from the hip)Â / SIDELYING HIP ROTATION / HEEL PUSHES / POSTERIOR TIBIALIS STRENGTH / CORRECT WALKING and CORRECT CHOREOGRAPHY
Correct landings during the development of the young gymnast will help that athlete in the future.Â The gymnast should have correct ankle range of motion and correct hip turnout.(â€œQuick Testsâ€ and Corrective Exercises such as knee/foot mechanics and hip turn-out exercise)
The pelvis should be in good alignment with normal back curvature â€“ the low back should curve in only slightly.Â The gymnast should have good lower abdominal muscle control during landings.Â The hip flexors and quadriceps should not be overdeveloped and over-used.Â The Hamstring and gluteal muscles should contract sufficiently during landings.(â€œQuick Testsâ€ and Corrective Exercises such as hip flexor stretch â€“ two- joint muscles)
AVOID PAINFUL TIBIAL STRESS FRACTURES BY REALIZING THAT THE BASICS OF GOOD POSTURE, MUSCLE BALANCE AND BIOMECHANICS ARE THE POINTS THAT NEED TO BE STRESSED!Â Â
More details on specific exercises to come…