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Kerry
Kerry, Nurse (RN)
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stress fractures in young female athletes

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My daughter is 20 years old, a distance runner in college, has not had regular periods (ever), has low body fat, mild scoliosis, and has now had a stress fracture in both legs. What tests should her physician be doing on her besides the bone density test she just completed? She has an excellent diet, takes calcium and D supplements, has been on birth control pills for a year. (she does not have any eating disorder issues, but does have small bones and there is osteopenia and osteoporosis in her maternal ancestry. She has not had any thyroid or hormonal level tests yet. Thanks

Hi


Here is some information I found. Hope it helps!


Kerry


Prevention
Although the occurrence of stress fractures and stress reactions on the bone is often multi-factorial and not very well understood, there are a number of important preventive measures an athlete can take

1. Avoid abrupt increases in overall training load and intensity. Take adequate rest

2. Buy less expensive shoes and change them frequently. As a general rule, running shoes tend to lose their shock-absorbing capacity by 400 miles

3. Bony alignment may be modified to some extent by the use of orthotics in the shoes and taping the foot and/or ankle. Those with hyperpronating feet may choose shoes with maximally rigid heel counter. Expert advice is needed for correct choice of insoles and taping techniques

4. Women athletes should pay careful attention to training, hormonal status and nutrition, and recognise any eating disorder

http://www.sportsinjurybulletin.com/archive/stress-fractures.html


The diagnosis is made through a careful history and physical. The examination usually reveals a discrete area of pain during palpation and percussion, localized swelling and redness. Sometimes the patient will be unable to hop on the affected extremity because of pain. X rays may show signs of a stress fracture – although x rays are usually normal for about 10-14 days after the onset of pain and swelling. In some cases, the signs of a stress fracture may not show up on an X ray for as long as four or five weeks or may never show up on a conventional X ray. Other forms of imaging, including bone scans, CT scans and MRIs, may detect a stress fracture that does not show up on conventional X rays.


Treatment for stress fractures consists of relative or absolute rest. This will depend on the bone or bones involved, and the severity and stage of the fracture. The activity that caused the injury must be avoided to prevent delayed or improper healing. Athletes wishing to maintain their fitness level may participate in low-impact activities such as swimming, biking or water running – but, again, this would depend on the bone fractured and the stage of healing. Casting or bracing may be indicated for stress fractures that are at risk of complete fracture or displacement. A period of non-weight bearing with crutches may be helpful along with the use of anti-inflammatory medications.


When the rest period is complete and the patient has remained pain-free for two weeks or so, supervised rehabilitation is initiated along with a gradual return to activity. Returning to activity too early or increasing the amount of activity too quickly may initiate the stress fracture process again. Care should be taken during the first four weeks since this is the most vulnerable time during a fracture’s reparative process.


Preventing another stress fracture involves identifying and eliminating the factors that have caused it. This may include modifying equipment or training and/or identifying functional causes that contribute to the trauma. A stress fracture can be caused by something as simple as running on an old athletic shoe that no longer provides much shock absorption or playing tennis frequently on a hard surface (i.e., on asphalt rather than a composite surface). A limb-length discrepancy can lead to a stress fracture in someone who increases his/her level of intensity or runs on the same side of the road (causing one leg to be lower than the other as the feet slant with the crown of the road). Biomechanical imbalances can predispose an athlete to a stress fracture.


Stress fractures can be difficult to manage, especially in the competitive athlete. Failing to recognize the possibility of a stress fracture or to follow a supervised rehabilitation plan can seriously delay athletes’ return to competition and/or predispose them to future stress fractures.


http://www.aapsm.org/ct0398.html













Kerry, Nurse (RN)
Category: Health
Satisfied Customers: 4312
Experience: 35 years in Nursing: OB/GYN, Peds, Oncology, hospice, Ortho, Neuro, Addiction, Recovery, Geriatrics,
Kerry and 5 other Health Specialists are ready to help you
Customer: replied 11 years ago.
Reply to Kerry's Post: Thank you. Very helpful info. I would like to find more information about young female athletes with regard to hormones, amenhoria, bone density, nutrition etc. My daughters track team had 8 women with stress fractures, and other college teams even more. Some of these women have been running since grade school and I wonder about their future health and abilities to get pregnant. With or without eating disorder issues added to the mix. thanks

Hi Again:


I've done some research, and here are some web sites you might want to read. They are very informative regarding the subjects you wish to find out more about.


http://adam.about.com/reports/000029_8.htm


http://www.femaleathletesbodybook.com/excerpt.php


http://www.sportsbiz.bz/womensportinternational/taskforces/triad_tf.htm


http://html.newsnet5.com/yourhealth/yourhealth-93861420010829-130829.html


Sure hope that helps!


Kerry

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