Stress Fractures

Bones are constantly changing. They respond to the work that is being placed on them. Bones also constantly repair themselves by replacing cells. Bones will accumulate a high level of calcium when they are intensely being used. When the bones are not frequently used, less calcium is produced. When too much stress is being placed on a bone inpeding its ability to repair itself, cracks can start showing in the bone structure .

A stress fractures is a crack that happens in the bone because of overuse. They are most common in high impact sports such as baseball, or distance running. Other activities requiring running and jumping or repetitive movements such as cricket, or rowing. They occur most often on the weight-bearing bones of the leg (the metatarsal bones).

Causes of Stress Fractures and symptoms

The most frequent cause of stress fractures is overuse. This means a change in activity. Stress can also result from shoe wear. Cases have been recorded where patient reported stress fractures after having hiked while on vacation for a considerable amount of time. Beside overuse some sports that requires a lot of running and jumping can result in stress fractures and also patient suffering from osteoporosis are at risk. Any bones of the ankles or feet can be affected and particularly weak or soft bones. It develops often in people starting a new exercise or force abruptly the intensity of the workout. Another cause of stress fractures is anatomical abnormalities such as fallen arches which distributes stress unequally to the feet. Stress fractures therefore can result because of:

  • Sudden change in activity
  • Sports requiring lots of running or jumping
  • fragile and soft bones
  • Osteoporosis conditions
  • Anatomical abnormalities

The symptom of stress fractures consist of dull pain near the site of the fracture. Swelling can also be noticed on the location and the pain becomes worst when standing, walking, or exercising. To diagnose stress fractures an examination of the foot is undertaken. Most of the times, an X-ray is performed. Stress fractures often tend to recur. Statistic indicate that about 60% of people suffering from stress fractures have had the same problem previously.

Treatment of Stress Fractures

Most often the treatment would require stopping any activity that may have been the result of the stress fracture. Rest is then recommended for a certain period. Other exercises can be undertaken but with reduced intensity. Ice should be used on the swollen surface for at least 24-48 hours and appropriate rest for at least six to eight weeks from the activity that has caused the stress fracture. Pain killer like paracetamol may be prescribed by a doctor.

A splint or cast can also be recommended depending on which bone is involved, or special shoe wear. Vitamin D and Calcium also are prescribed.
In most cases the above measure should heal the stress structure. A case known as nonunion (when the bone fails to heal) may require surgery. This involves the placement of screws to secure the bone. It sometimes also involves placing fresh bone in the area. Nonunion is the most common complication that can occur with Stress Structures. Another complication is malunion. In the case of malunion, the bone heals but in an abnormal position. Yet another complication is recurrent fractures which often occurs in cases of osteoporosis.

Prevention of Stress Fractures

There are a couple of measures that can be undertaken to prevent stress fractures

  • Use the correct footwear depending on the exercise being undertaken
  • Begin any new exercise slowly resting when necessary
  • Before running or walking, warm up by stretching and walking
  • Strengthen the muscles of the calf
  • Rest properly after intense exercise

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IT Band Issues in Triathletes

The Iliotibial Band also know as the iliotibial tract or IT Band is a fibrous reinforcement or a strip of connective tissue that connect three muscles ( the tensor fasciae latae, the gluteus maximus, and the gluteus medius muscle) to the lateral thigh and leg providing stability to the knee and hip and preventing griperthe dislocation of those joints. It functions to extend and as an abductor, a medial rotator and as a flexor of the thigh. It also plays a role in helping the tensor fasciae latae and gluteus maximus support the extension of the knee while standing or doing other activities. The Iliotibial Band (ITB) Syndrome is a condition that results due to friction of the tract across the tissues on the lateral side of the thigh.

Causes of Iliotibial Band Syndrome

The movement of ITB is posterior over the lateral condyle of the femur and anterior when the knee is extended. Frequent repetitive movement particularly due to overuse such as cycling, hiking, etc., can result in the inflammation of ITB. Some other causes of Iliotibial Band Syndrome (ITBS) include:

  • Muscle imbalances – Mechanical imbalances in the body that results in the poor flexibility of the muscles particularly the pelvis, the knees, the hips and the low back
  • Poor training habits – inadequate warm up and cool down, hiking long distances, consistently running on horizontally banked surface. Etc.
  • Anatomical abnormalities – Anatomy issues such as a difference in the length of the legs, the abnormal tilt of the pelvis causing the ITB to become tight and leading to friction, high or low arches, bowlegs, excessive foot strike force.
  • Various sports that places stress on the iliotibial band

Symptoms of Iliotibial Band Syndrome

A variety of symptoms could result due to ITBS: Pain on the outer part of the knee, swelling and thickening of the tissue in the location, stinging sensation above the knee joint or when the foot strikes the ground. The pain may also persist after certain activities.

To diagnose that a patient is suffering from ITBS often involves the patient describing the kind of pain being felt during certain movement, swelling can also be seen and felt near the femoral epicondyle.

  • MRI scan – helps locate inflammation and exclude other causes of outer knee pain
  • Physical examination – the physical examination of the knees and ankles for potential cause of the pain
  • Discrepancies – the doctor could search for leg-length discrepancies, muscle imbalances, tightness in the leg and back, pelvic tilt.

Treatment of Iliotibial Band Syndrome (ITBS)

In general, the treatment for ITBS start with the RICE (rest, ice, compression and elevation) method. The syndrome is mainly due to overuse resulting in inflammation.  Ice should be applied several times a day in whatever way provides deep cold penetration but is still comfortable.  Compression can be done manually or by using compression gear such as shorts or socks.  For cyclists, you may find that using the best cycling shorts rather than off-brand or cheaper shorts offers better compression and alignment.  ITBS is just such a delicate injury that any adjustment might help.  At occasions anti-inflammatory medication may be prescribed. When no result in obtained from RICE or medication, physical therapy is necessary. Two main types of treatment non-surgical and surgical can be administered depending on the severity.

  • Non-surgical treatment – ultrasound may be used to propel anti-inflammatory medication in the affected location . When the problem is the result of discrepancies, orthotic shoes can be recommended.
  • Surgical treatment – In some cases when non-surgical treatment does not produce any result, orthopedic surgery may become an option. An Arthroscopy is used to locate and cut the inflammation around the iliotibial band or retrieving part of the iliotibial band to allow room for it to move freely across the bone.
  • Physical therapy – In certain circumstances the RICE procedure produces temporary result meaning that once activities have started again, the inflammation may reoccur. Abnormal movement of the pelvis can result in the ITB pulling away from the knee. In such case strengthening the muscles that stabilizes the thigh can help to control excessive movement. Some exercise that strengthens the musculature include: Hip trust, side leg raise exercise, pistol squat, side hip bridge, foam roller IT Band, Hip flexor stretch, outer quadricep tender point exercise.

Prevention of Iliotibial Band Syndrome

Preventing ITB injuries involves taking the necessary steps not to overuse or stress the ITB. The most essential method of prevention for athletes is to use the right kind and quality shoes depending on sport. Runners should also try to maintain a constant pace and not force too hard and undertake frequent exercise to strengthen the musculature.


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Rotator Cuff Problems and Tendonitis

The rotator cuff is a group of muscles that supports the arm and the shoulder joints. They connect the bone of the upper arm (the humerus) with the shoulder blade (the scapula). These consist of four muscles known as; the supraspinatus, the infraspinatus, the teres minor and the subscapularis muscle. The muscles originate from the scapula and attach to the humerus by means of tendons and assist in the movement of the arm and the stabilization of the shoulder joints. Rotator Cuff Tendonitis (also known as impingement syndrome) occurs when these muscles and tendons become inflamed or irritated.

Causes of Rotator Cuff Tendonitis

The shoulder joint type is known as a Synovial Joint, a ball and socket joint, allowing for great freedom of movement. Rotator Cuff Tendonitis or simply Tendonitis can occur when muscles and tendons of the rotator cuff become torn, inflamed , or irritated. Major causes of tendonitis include:

  • Inflammation of the protective sheath that surrounds the tendon – The protective sheath of the tendon (the synovial) produces a liquid (the synovial fluid) that keeps the tendon lubricated. Malfunction of this sheath due to tendon injury may result and cause the sheath not to produce or in insufficient quantity the synovial fluid causing the inflammation or swelling of the sheath.
    • Tendon rupture – The tendon can often support forces 5 times the body weight and at occasions can snap or rupture. Reasons for rupture of the tendon include the use of steroids, certain diseases (gout, hyperparathyroidism), direct trauma, aging, extensive and repetitive use by practicing some sort of sport or other activities.
    • Deterioration of the tendon – The degeneration of the tendon without any apparent inflammation can result due to overuse or age.
    • Inflammation of the tendon – There are a variety of causes resulting in the inflammation of the tendon such as: stress on the tendon, direct trauma, some types of antimicrobial drugs can also cause inflammation, inflammation due to certain types of diseases, and anatomical causes referring how they are actually built.

Most of these conditions are common among athletes and particularly in certain types of sports where there is repetitive and forceful use of the rotator cuff muscle (swimmers, tennis players, basketball players etc.) At occasions it can also be the result from activities work related that requires working with the arm overhead like painting, carpentry, etc. Sleeping on the same arm each night may also cause inflammation of the tendon etc.

Rotator Cuff Tendonitis Symptoms

  • The symptom commonly suggesting a problem with the rotator cuff muscles or tendons is associated with pain near and around the shoulder accompanied with pain during movement of the shoulder for different activities particularly when lifting your arm. Diagnoses of rotator cuff tendonitis would involve describing the type of pain being felt on the shoulder, an x-ray may be recommended as well as ultrasound scan or MRI scan. Often redness or swelling can be seen on the shoulder.
    A drop arm test can be conducted by the doctor consisting of raising your arm 90 degrees and asking you to hold the position for a few minutes
    • X-ray indicate whether there is a dislocation of the humerus
    • The MRI scan assesses the integrity of the rotator cuff
    The pain can come gradually in the case of tendonipathy or it can be sudden and excruciating due to tear because of accident.
    Treatment of Rotator Cuff Injury
    The treatment for tendonitis will largely depend on the type of injury and its severity. In general, beside seeking medical attention , the treatment would involve following the RICE (rest, ice, compression, elevation) principal for home therapy. Depending on the severity, the treatment may or may not involve surgery.
    • Non surgery therapy – Following the RICE principal and adequate medical attention. The doctor could recommend the use of brace or splint to immobilize the rotator cuff so that it can rest. Swelling can be reduced with the application of heat or cold. Some other non surgical therapy include massage, stretching the affected area, Transcutaneous electrical nerve stimulation (TENS), and ultrasound. Medication can also sometimes be prescribed particularly for sheath inflammation which are non-steroidal anti-inflammatory drugs, antibiotics when there is an infection.
    • Surgical intervention – A tear of less than 50% can be repaired by what is known as arthroscopical surgery whereby dead tissues are removed by means of a small incision. In other cases surgical intervention can be undertaken to repair a torn tendon. In most cases, surgery is the preferred choice when a tear is the result of a recent injury, there is a complete and large rotator cuff tear.

Rotator Cuff Tendonitis Prevention
To avoid Tendonitis it is essential to understand the anatomy and biomechanics of the shoulder and to use the proper methods of doing certain activities or exercise. Athlete and those who regularly exercise should not also neglect the rotator cuff muscles and concentrate only on muscles such as the triceps, the deltoid or the pectoralis major. This could cause imbalances that could result in impingement syndrome. Another things to take into consideration is not to push your muscles too hard and be attentive as to how the body reacts for different activities.

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Triathlon Is More Fun When You Are Healthy

TriathlonMD is devoted to helping triathletes train and perform injury-free and in a way that helps them hit their peak performance.  A well-executed training plan, complete with stretching, rest, and strength-training will keep you going strong even when others are challenged.  TriathlonMD explores common triathlon injuries, preferred training plans, triathlon gear that can help you stay more injury-free, and techniques you can use to peak at the right time without burning your body out.

In these pages, we will explore the injuries that most commonly affect triathletes, ranging from IT Band Syndrome to swimmer’s shoulder.

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