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‘Tis the season for stress fractures

It’s that time of year again when I’m seeing an abundance of stress fracture cases in the clinic. After the long winter, athletes are eager to get out there and play hard — a little too hard. That’s when stress fractures occur.

Today, I had the chance to speak with WAKR host Ray Horner about the difference between a stress fracture and a trauma fracture, its causes and the dangers of continuing play with this injury.

Below is an audio file and transcript of our discussion.


Horner: Dr. Joe Congeni now joins us from Sports Medicine Center at Akron Children’s Hospital. Joe, a lot of track runners right now, young and old alike, and stress fractures and some other things go right along with that, my friend.

Dr. Congeni: Yeah, stress fractures are an injury, Ray, that’s really hard to understand, so let me talk about it. If you’re involved at a pediatric sports medicine clinic, you’re gonna see a ton of them. I had a couple of residents, med students, with me the other day. The first five patients I saw, five in a row, were stress fractures, so ‘tis the season.

Everybody, after winter, gets outside and really does a lot. Stress fractures are different than trauma fractures. You know, you go up for a lay-up, land on your wrist and break your wrist. Or, you know, two people collide on a soccer field and you break your ankle. That’s a trauma fracture.

A stress fracture is a hairline or microfracture from doing repetitive activities over and over again. It’s almost always the same story. At first, they start having pain, then nighttime pain, pain during the day, pain walking around at school. They try medicines and they try stretching and they try icing, and nothing [works]. In fact, it gets worse. Then they come in to see us.

Dr. Joe Congeni

Dr. Joe Congeni

Usually, it’s really local pain on the bone. It can be anywhere, the foot, the shin, the hip, the low back. We see stress fractures everywhere. We see some even in the shoulder and arm in throwers and other things.

There are a couple of causes. I mean, we talk a lot about too much too soon, or too much activity, and that is the No. 1 reason why they get stress fractures. But, mechanics of the way people run or throw or play sports — the mechanical aspects — [can cause them]. Particularly when we see a funny pattern of where the fracture is in the bone, we start to think it might be the mechanics of the athlete.

The third area is the bone density issue. That [occurs] more in our female athletes. Upwards of 15 to 20 percent of our female athletes may have weaker bones, bone density issues. To a smaller extent, our guys have strength issues in the bones that set them up for stress fractures.

So the coaches and other people [ask], “Well, what’s the risk if people continue to run or play and they have a stress fracture?” And I tell them one name, you know a guy by the name of Kevin Ware at, you know, Louisville? What happens is, Ray, these people that have a stress fracture, they’re prone to going on to a compound fracture, you know, a worse fracture — and even more so for the runners.

If you remember at the state championships in track the year before last in Ohio, a girl collapsed just before the finish line and another girl came back and helped her up across the finish line. It was a real moving story and everything. But, those kinds of things occur when you miss or you don’t treat a stress fracture.

So, at this time of year, we’re treating a lot of them. It’s kind of late to get them back into competition. If we get them earlier, we have a chance [because we get] them cross-training and strengthening the area to get back so they can finish their sport out for the year.

Stress fractures are real common, and every chance I get I try to talk to coaches and parents so they understand the issue about stress fractures.

Horner: Alright, certainly serious stuff. Joe, as always, thanks for the time. We’ll catch up with you again next week.

Dr. Congeni: Enjoy this great weather, Ray.

Horner: No doubt about it.

Dr. Congeni: Alright, have a good week.

Horner: You too. Dr. Joe Congeni from Sports Medicine Center at Akron Children’s Hospital joining us.

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About Dr. Joe Congeni - Director of Sports Medicine

Dr. Joe Congeni is the Director, Sports Medicine; Clinical Co-Director, Center for Orthopedics and Sports Medicine at Akron Children's Hospital. For the past 25 years, Dr. Congeni has been the “go to” source for national and local media looking for information about pediatric sports medicine.

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