Stress fracture healing

[Michelle Lowry]

Anyone know what helps heal stress fractures faster?  I know about the rest.  I am on crutches to take weight of the injured side.  I am applying for a bone stimulator.

Do the following help:

1.  E-stim - I read somewhere that it stimulates the bone to heal faster but that might not be true.
2.  Ultrasound - I found one website that said it reduces heal time, but again that might not be true.
3.  Massage - help or hurt?
4.  Physical therapy exercises - after how many weeks? 
5.  Any supplements beyond calcium and vitamin D?

Thanks!

[David S]

Michelle,

My friend just recovered from a stress fracture.  She wore a boot and nothing else that I know of.  The only activity that she was cleared for was aqua jogging.  Otherwise she just waited for clearance from the Dr.  She was diagnosed right after the Austin Marathon which was in the middle of Febraury.  She just started running a week or two ago.  That works out to be about 2 1/2 months off. 

Good luck,

David

[adam]

Michelle, I wanted to talk to you more at the race the other day but had to run off and set up the course.

Stress fractures can be tough to heal, especially if you want them to heal correctly. Look at people like Ritz as an example. All the medical advancements and technology stuff that he and Nike have at their disposal, and he still gets them. Luckily they have learned to step back and try and catch it first off.

As for the first couple of things you asked about:
E-stim and Ultrasound are useful as modalities in healing...the main purpose of each is to stimulate blood flow to the injured area, which can help "clear out" waste products that have build up around the area. One of the advantages of e-stim is it helps "excite" muscle contraction and enzyme activity. One of the advantages of ultrasound is that it is painless and can penetrate deeper below the skin and surface areas that are heated with heat packs and stim. It can help reduce pain. But, just like just about anything there is out there, there are people who swear by them and people who just see them as useful. They are pretty standard protocol in most PT offices around here I have seen. Also, just like most things for healing, they are generally more effective in the early stages (wks-months) of rehab and less so as time moves on.

Massage is helpful in a number of ways. First, it feels good (depending on who you have doing it). If it is some kid who doesn't know what their doing, its almost not worth it. Still a little helpful, but less so. Second, it also helps to warm up and increase range of motion among muscle groups. If certain muscle groups are tight, they can possibly be pulling on the fractured area, and that tension can be a cause of pain. If you can loosen those muscles up, then you can reduce pain. You can also prepare them for rehab exercises.

Physical therapy exercises, in my experience are significant in helping to heal---BUT how quickly you heal is highly individualized, and the exercises themselves are part supplementary to the manipulations and other things the therapist and your Doctor/surgeon do. I've seen total knee replacements that take 6 wks to get back into normal movement and some that have taken close to a year. Everyone is different, and injuries/healing can be too. Some people come in thinking they are going to be completely cured, and yes that is the goal for the patient and doctor, but sometimes even after everything you do, even after all your commitment and patience, you still may not get 100% better, or even as quickly as you want. But, this is the same for rehab as well as any other type of medical treatment.

The supplements you listed are good. Make sure you add in some Vit C into all of that. And there are probably some osteoporsis type drugs out there that may be beneficial. Ask your doctor about those.

 Do the very best you can so you get as healed as you can and have no regrets. You don't want to have to come back 6 months from now having cut out early or cheated yourself thinking if I had only stayed a few more weeks, or done this or that I wouldn't have another stress fracture.

[Michelle Lowry]

Wow, thank you for the thoughtful responses.

I have a follow up question.  So I got on crutches on Monday after a painful weekend, and have been way low on pain since then.  Even last Monday, my sports doctor (McLane) said I could walk in the pool so long there is no pain, and Steve Orrock said I could swim with just my arms if no pain, both thinking right away.  I am trying to be conservative so I have done nothing since last thursday, so Monday will be 10 days since last activity (that Thursday I did 40 min swimming and 20 min ellyptical).  My pain is just about gone (unless I trip on crutches or do some bizarro twist on accident), so I am thinking it will be ok to try these exercises on Monday.  I am thinking 10-15 min of each if I feel NO pain, then see how I feel the rest of the day to gauge if I am ready for a light routine like that.  Is there a risk in starting small like that now?  I've heard 1-2 weeks of nothing then people generally start pool running, ellyptical, etc, but I'd want a week or more of even less intensity, since its the rotation that can hurt my SI bones.

I want to be conservative and do what I need to, but I don't want to be ultraparanoid.  A hard line to draw.

[Dave Holt]

Michelle, a stress fracture cost me a full year right when I was getting back into running - take a month, come back, hurt, take a month, come back, hurt, two months, same, many months, finally got better - do play it conservative and get that thing better and you'll come back stronger when the time is right - good luck!

[Josse]

Hmm I seem to remember a certain friend of ours Michelle that did the same thing as Dave.  Play it smart and you will be back sooner than later. 

[Maurine Lee]

When I had a stress fracture in my ankle the doctor had me wear a boot constantly (except for showering) for 4 weeks before even allowing me to swim with the boot off and then wear it the rest of the day.  One thing I was told is that it does take up to 12 months for a fracture to completely heal.  Not that you can't stress the bone during that time - but that you have to be aware that it is still in a less than 'whole' state for longer than we expect.