Stress Fractures

stress. fractures, tibia, fibula

What’s up ? This is THE stephane ANDRE. With my training, I’m interested in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

A stress fracture is an overuse injury. Human body creates a new bone to replace a bone that has been broken due to the stress of everyday life. This process is done every day to keep the balance. Unfortunately, this balance can be disrupted because of excessive physical training. There are several factors that can prevent the body from creating enough bone and this make microcracking, called « fracture stress ».

The most common factor of fracture stress is an excessive increase in the intensitiy or frequency of physical activity without adequate rest period. Other factors are nutritional deficiencies, mechanical influences, lack of sleep, systemic factors (hormonal imbalance, etc.) and metabolic bone disorders.

There are case of development of eating disorders and/or amenorrhea (infrequent menstrual periods) for some female athletes who are preparing for a competition. These 2 conditions can create a decrease in estrogen that can decrease bone mineral density. This increase the risk of stress fractures.

Stress fractures are often seen in athletes (especially runners) or military recruiting. For an athlete, 1.6km run is 110 tons of force absorbed by the legs. Bones aren’t made to resist this force (energy) so it’s the muscles that have the function of absorbing shocks.

When the muscles get tired, they stop absorbing the forces and eveything transferred to the bones. Stress fractures occur in almost all bones but are more common in lower bone, expecially the tibia. Depending on the type of sport, there’re distinctive stress fractures such as the elbow in throwing sports, the ribs in golfing and rowing, the spine in gymnastics, the lower extremity in running activities and the foot in gymnastics and bascketball.

Diagnosis

stress, fracture, foot, metatarsal, 5th
stress, fracture, foot, x-rays, metatarsal,2nd

Stress fractures create pain in a limited area directly above the tip of the bone where the fracture occurred. The pain is raw because of physical activity and relived with rest. The sensitivity of the bones is the most obvious conclusion to the physical examination.

With regard to X-rays, this isn’t a tool that actually helps to diagnose an early stress fracture because the bone often looks normal and the microcracking aren’t visible. It’s difficult because after several weeks of rest, the bone begins to repair itself and shows a healing reaction or callus on X-rays.

An early stress fracture is usually confirmed by a bone scan or magnetic resonance imaging (MRI).

Treatment

Stress fractures are generally classified as low-risk (will not become a serious fracture) or high-risk (will become a serious fracture).

Low-risk stress fractures usually require a rest period of 1-6 weeks of limited weight bearing activity progressing to full weight bearing may be necessary. Return to physical activity should be a gratual process.

Low impact activities like swimming or biking are recommended to maintain cardiovascular condition when the pain is gone. When the patient can comfortably perform low impact activities for long, pain-free periods, the patient can begin high-impact activities.

High-risk stress fracture have the danger of becoming a complete fracture. For athletes suffering from chronic pain and having normal x-rays results, it’s recommanded to use a bone scan or MRI. High-risk stress fractures should be treated as traumatic fractures (with cast or surgery) because of complications.

Prevent

food, vitamin,d, carrot, papay, meat, ,egg, chees, broccoli, fish, sweet, potato, mango, pepperoni, apricot, peach, melon, avocado
calcium, food, almond, amarant, grain, aparagus, apricot, artichoke, baked, bean, haricot, blackberry, blackstrap, molasse, blackcurrant, bok, choy, brazil, nut, bread, wholemeal, brocolly, chickpeas, cinnamon, edamame, soya, fennel, kale, kidney, olive, orange, sesame, seed, milk, spring, green, tofu, swede, walnut, watercress

Here are tips developed by AAOS to help to prevent stress fractures :

  • When an athete does a new sport activity, it’s necessary to program progressive goals. For example on the 1st day, don’t run 8km but rather increase the distance gradually per week.
  • Cross-training => Alternate activities to achieve the same fitness goal helps to avoid stress fracture injuries. For example to achieve a cardiovascular goal, alternate cycling and running (cycling one day and riding the other day) is excellent. Adding strength training and doing flexibility exercises help improve performance.
  • Have and maintain a heathy diet with foods rich in calcium and vitamin D.
  • Use good equipment. Don’t use running shoes, gloves, etc, very old and very worn.
  • If during physical activity it start to swell or the pain starts, stop the activity right away. It’s essential to rest for a few days. If the pain continue, you should see an orthopedic surgeon.
  • It’s important to recognize early symptoms and treat them appropriately to return to the sport with a normal level of play.

Stats

  • Stress fractures occur less frequently in those of black African descent than in Caucasians, due to a generally higher BMD (bone mineral densitiy) in the former.
  • Women and highly active individuals are also at a higher risk, The incidence probably also increases with age due to age-related reductions in BMD.
  • Children may also be at risk because their bones have yet to reach full density and strength.
  • The female athlete triad also can put women at risk, as disordered eating and osteoporosis can cause the bones to be severely weakened.

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-Steph

P.S. If you’re in Miami and you like Caribbean food, go to my cousin’s bistro to eat Haitian food, click here .

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Acromioclavicular Joint Injury

acromioclavicular joint injury

What’s up ? This is THE stephane ANDRE. With my training, I’m interested in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

Acromioclavicular joint is a joint between the clavicle and the scapula. Acromion is a continuation of the scapular spine and hooks over anteriorly. It articulate with the clavicle (collar bone ) to form the acromioclavicular joint.

Problems types

The most common problems are arthritis, fracture and separation. Arthritis is characterized by a loss of joint’s cartilage. Arthritis of acromioclavicular joint is common with weight lifter, especially with bench press and a little less with shoulder press. When there is a problem with the rotator cuff, it’s possible that there is also acromioclavicular joint’s arthritis.

Acromioclavicular separation

acromioclavicular joint injury type grade

When there is an acromioclavicular joint separation, it means that the ligament that connects the acromion and clavicle is damaged and that the 2 structures don’t align properly. Separation’s state can be weak or severe, that is why there is a system of « grade » according to which ligament is torn and the severity of the tear.

Grade I Injury – This is the weakest damage and the acromioclavicular joint is still aligned.

Grade II Injury – This is an average damage. Ligaments are only stretched but not fully torn. In case of stress (physical effort), the acromioclavicular joint becomes painful and unstable.

Grade III Inury – This is a serious damage. Ligaments are completely torn and the collar bone is no longer attached to the scapula, which creates a visible deformity.

Treatment of acromioclavicular joint arthritis

If the rest, ice, medications and change of the training program (changing the exercises) don’t work, the next step is a shot of cortisone. A shot of cortisone in the joint may have calmed the pain and may be permanently swollen. As each individual is unique, the effects may vary and it’s possible that it doesn’t swell permanently.

If non-surgical methods fail, it’s possible to perform a surgical operation. The pain is localized at the bones end that make contact with each other and the goal of the operation is to remove some of the end of the clavicle. This ambulatory surgery can be done with a small incision of 1 inch (2.5 cm) long or with the arthroscopy technique with 2-3 incisions. The results and recovery of these 2 surgical techniques are about the same. Most patients have a full movement by 6 weeks and can return to do sport by 12 weeks.

Treatment for acromioclavicular separation

Separation can create very painful injuries, so the first thing to do is to decrease the pain. Hold the arm in a sling, put ice and pack the shoulder for 20-30 minutes every 2 hours as needed. Acetaminophen and non-steroidal anti-inflammatory medications can also help calm the pain.

When the pain begins to subside, it’s important to move the fingers, wrists and elbow (and eventually the shoulders) in order to avoid having stiff or « frozen » shoulder. The length of time needed to regain complete movement and function depends on the severity or injury’s grade.

Recovery from Grade I acromioclavicular separation usually takes 10-14 days while Grade III takes 6-8 weeks.

When surgery

Grade I and II separations require very rarely surgery. With a Grade III injury, after surgery, it’s possible to have full body physical activity with some restrictions.

Statistics

  • More males than females suffer acromioclavicular joint injuries

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-Steph

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General Stretching Of The Upper Body

stretching upper body

What’s up ? This is THE stephane ANDRE ! I read a Frederic Delavier’s book « Strength Training Anatomy » and I learned good stuff.

Stand with your feet a little wider than your pelvis width and you back is straight :

  • Hold your ams vertically with your hands clasped and your fingers crossed. Your palms directed upwards :

  • Inhale to inflate your lungs to the maximum and stretch your intercostal muscles. Push your palms up keeping your back and head upright.

  • Exhale slowly by relaxing and starts again.

This stretching exercise stretches intercostal, rectus abdominis, latissimus dorsi, teres major, triceps. When you incline your torso laterally, you stretch more your external oblique and internal oblique, quadratus lumborum and the internal and medium part of your erectors spinae.

stretching upper body lateral

Note

This stretch is great for relaxing the body after a training with heavyweights like leg press, squat, deadlift because the ribcage and spine have been compressed.

This movement may occasionally replace or supplement the stretching at the bar  to rebalance the pressure and tensions of the intervertebral joints.

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-Steph

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Incline Leg Raises

incline leg raises

I read a Frederic Delavier’s book « Strength Training Anatomy » and I learned good stuff.

Lying on the incline bench with your hands gripping the handles :

  • Raise your legs up to the horizontal

  • Raise your pelvis by rounding your spine to try to touch your head with your knees

This exercise works your muscles in 2 phases :

  1. When you raise your legs, it’s iliopsoas, rectus femoris and tensor fasciae latae that work.

  2. When you round your back, it’s your abs, mainly the part under your navel of the rectus abdominis that work.

incline leg raises pelvic movement

Note

This exercise is great for people who have difficulty to feel the work on abs. As this movement is difficult, it’s advisable for beginners to adjust the bench with a low inclination.

incline leg raises

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-Steph

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Abs Stretching

abs stretching anatomy

What’s up ? This is THE stephane ANDRE ! I read a Frederic Delavier’s book « Strength Training Anatomy » and I learned good stuff.

Lying on your stomach on your hands with your arms extended :

  • Straighten up your chest slowly by tilting your head back slightly

  • Maintain this position for few seconds while breathing slowly to feel the stretching of your abs.

Variant

It’s possible to make this movement with your hands on a bench and your feet on the floor, or you’re lying on your back on a big ball (Swissball).

Note

Stretching of abs can be an important element in some sports like throwing sports, especially the javelin. In this type of sports, it’s essential to have good flexibility and a good abdominal amplitude to make the movement perfectly.

Attention

Abs stretching are to be avoided in case of lumbar pathology.

different pelvis position man woman anterior superior iliac spine pubic tubercle anatomy

abs pregnant woman child belly weight antomy

Note

The position tilted forward (anteversion) of women’s pelvis allows a portion of the child’s weight to be transferred to the abs. By analogy, abs muscles can be compared to a « hammock ».

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-Steph

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Specific Bench Sit-Ups

specific bench sit up

I read a Frederic Delavier’s book « Strength Training Anatomy » and I learned good stuff.

Your feet wedged under the pads with your torso in the void and your hands next to each ear :

  • Inhale and raise your torso to try to touch your knees with your head rounding your spine.

  • Exhale at the end of the movement.

specific bench sit up

flexor muscle thigh

This exercise is excellent for working rectus abdominis and a little bit your obliques. It’s good to know that during anteversion of your pelvis, iliopsoas, rectus femoris and tensor fasciae latae are strongly solicited.

Note

This movement requires good power in abs. It’s necessary to do exercise easier before to gain this power.

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-Steph

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Calves Over Bench Sit-Ups

bench sit ups

I read a Frederic Delavier’s book « Strength Training Anatomy » and I learned good stuff.

Your legs are on a bench with your back to the floor and your hands behind your head :

  • Inhale and raise your torso as high as possible to touch your knees with your head by rounding your spine.

  • Exhale at the end of the movement.

bench sit ups

This exercise works recuts abdominis and more intensely the parts above the navel.

It’s good to know that farther is your torso from the bench, this increases the mobility of the pelvis. This allows a greater range of motion and works more flexors muscles of the hips (iliopsoas, rectus femoris and tensor fasciae latae).

bench sit ups hand elbow position

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-Steph

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