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Stress fracture: When the bone breaks smoothly.

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Dr. St├ęphane Cascua, Medicine and Sports Traumatology.

Your bones can fracture without shock! Running, jumping sometimes enough! It is the stress fracture. How to recognize it How to treat? And especially how to avoid it?

Each receipt jump or stride, your bone is impacted. He is a victim of microscopic cracks. Between workouts, if you give him time, if you bring him the necessary food, it will rebuild. It will even recover louder, as if to take on next constraints. But beware, if the conditions required for repair are not met, if your workouts are too hard or too close, cracks will accumulate, meet and form a real break!

Stress fracture: how to recognize it?

The runner suffers mostly from his shin. A force to compress the inside of her leg, her bone structure cup. He feels pain on the bone just below the calf. It accentuates the kilometers. It does not take long to prevent it from running and then interfere in daily life. Well located, it differs from the "shin" that spans several centimeters. This last lesion corresponds to a shear between the membrane surrounding the bone and the muscle insertion. Less debilitating, it does not impose the automatic discontinuation of the race.

The stress fracture is very fine, "like a hair on a china plate." During the first weeks after the pain, can not see anything on x-ray. It was only after a month that visualizes the bone callus. To enable early diagnosis, scintigraphy is often proposed. To view the fractured zone is injected into the veins a product that attaches where the bone trying to repair. MRI is even better. She further described the fracture or can correct diagnosis by analyzing other tissues.
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PRESUMED GUILTY ALL OS!

Sports and physicians must be vigilant. A painful bone in a stressed area is always suspect of stress fracture! The heel bone may break insidiously. Classically, this damage occurs in the military who are marking time during parades or walk long hours with rigid soles. In athletes, the frail fibula located next to the tibia may be concerned. Bone sticks leading to the toes, metatarsals, accumulating twists at the place of the process, also eventually break. In the marathon, even large bones such as the femur or pelvis can break insidiously. The upper limb and trunk are not spared. An avid tennis player is sometimes the victim of a radius of the stress fracture. A golfer swings chaining even manages to break the ribs!
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Stress fracture: how to avoid it?

Pace mechanics

When you increase your mileage when you change your workout, you impose on your bones new constraints. Prior to rebuild stronger, they become brittle. The rapid destruction period lasts 14 days. During the 3-4 months, it gradually becomes denser and slowly refines its architecture ... it is still very strong! Caution and progressiveness are required. Although already run 2 to 3 times per week, 3 months are required to prepare a marathon. Feel free to include cycling workouts, swimming or cardio. These sessions are less aggressive for your bones and improve your endurance In order to limit the stress on the inner side of the tibia, your foot should not excessively rock at its support hold. Quality shoes, not too worn and especially suited your stride are indispensable. Sometimes insoles specially designed for sport will prove necessary.

Target intensities

The bone disintegrates and abandon its calcium when the environment is acidic. When you are out of breath you produce lactic acid. Mechanically but also chemically, caution is required in programming quick sessions. During the first months of preparation, the split should be avoided. It is better to teach your body to recycle lactic acid. The said training the "threshold" are particularly suitable. They consist, after heating, to keep 15 to 30 minutes "to limit the shortness of breath". During the following weeks, the working power is ideally effected by chaining 30 seconds "fast" 30 seconds "slow". Under these conditions, the short accelerations are quickly followed by recovery and lactic acid does not accumulate too.

Eat, drink!

Vitamin D facilitates intestinal absorption of calcium and its penetration into the bone. We found mainly in fatty fish: tuna, salmon, sardines, mackerel and herring. You should eat at least 3 times a week.

Calcium binds to the fibrous network of the bone and stiffens in the manner of cement surrounding the rods of steel reinforced concrete. Conventionally there are calcium, in yoghurt, cheese or milk. It is advisable to consume 3 dairy products per day. If you do not like or tolerate these foods difficult, complementary solutions exist. Some mineral waters contain calcium in a large quantity, in the case of Hepar, Contrex and Vittel. Studies show that calcium is absorbed properly. Drink at least 6-8 large glasses a day. Finally, fruits and vegetables contain calcium. Do not hesitate to go beyond the instructions, eat more fruits and vegetables 5 a day!

To fight against the acidity of the body disintegrates bone structure, diet is essential. Despite their flavors, fruits and vegetables are always processed by neutralizing substances. The rich mineral waters bicarbonate as Vichy or Baboit are recommended after the sessions have caused a sharp slowdown. Conversely, sweets and more sodas acidify the body ... and scours the bone! Red meat is acid. Also, eat-in maximum 3 to 4 times a week. It is the same hard cheese to cooked pasta, which he should not be abused despite their calcium content.
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THE SEX HORMONES
ARE NOT INNOCENT ...

Sex hormones stimulate bone construction. They come to miss the bone weakens. Menopause is the usual circumstance to the origin of osteoporosis. But the sporting overwork also reduces the secretion of sex hormones. It is as if the body had to devote all his energy to physical activity at the expense of procreation. This is true for men as for women! In the latter, this phenomenon is known as it is manifested by irregular menstrual cycles or stopping rules. In addition, it is often associated with great emaciation aggravating bone degradation. Indeed, as the ovaries, women's fat cells are involved in the secretion of sex hormones. Decidedly, excessive sport and inadequate nutrition contribute fractures of tiredness!
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This is a real break!

If preventive advice comes too late, follow the instructions of your doctor! Know that patience suitable nutritional intake, lack of pain, stress and fitness progressiveness are the key points of the treatment.

Wait ...

The bone consolidation time is 3 months! This is true for fractures by accident! This is true for fatigue fractures! Three to four months is the minimum time that requires your shin to cash without flinching running and jumping!

Eat, drink, fill ...

Nutritional strategies to reduce the risk of stress fracture are now unavoidable ... In addition, vitamin D is also produced by our body through sunlight and studies show that, in our latitudes, the majority of the hungry population. Your doctor will probably prescribe. It is the same calcium if it detects insufficient food intake. There are also supplements to fight against acidity. Some therapists also offer the 'calcitonin' a hormone stimulating bone building.

Avoid pain

The "rule of non-pain" is a good criterion to guide your treatment and your activities. If you have trouble walking, a few days without support are needed. One may even add a long leg splint Velcro, comparable to that used for the rolled ankles. On resumption of the march, moderation is required and the soles are welcome. Exceptionally, if the pain does not give, if the callus does not correctly, intervention is necessary. Most often, the surgeon will put in place a nail in the center of the tibia.

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THE CORRECTIVE SOLES: A REAL PLUS!
With the collaboration of Olivier TRIBUTE, podiatrist sports.

Attention! This is no shock absorbing soles, type "ready to wear" sold in stores. No, they are "haute couture", tailored to your injury and imperfections of your stride. They are made "to measure" by a podiatrist sports. He knows the injuries encountered in sports. It does not use cork or leather. It uses synthetic materials flexibility cleverly distributed, which tolerate sweat and mechanical stress.

In case of stress fracture, the soles reduce the stress on the broken bone. To limit the compression of the internal surface of the tibia when the heel lands on the ground, the podiatrist reduces the rocker heel outwards. For this, it often places the heel a small external terrain. When the foot rolls on the floor, do not block his rocker inwards but to control it. In order not to pull on the surface of the tibia, an arch support is frequently useful. In the jargon of podiatrists, this dynamic control during all phases of support is called "discharge chute."

Inserting too absorbing materials in the sole is not advised. Initially, their softness causes instability of the support from the opposite of the desired control. Later, they are bunched together quickly and become more binding.

In practice, the wearing of the sole is possible in everyday life during the consolidation period. It is essential in the months following the sports recovery. A distance when the fracture is not a bad memory, it is advisable to change them. Now, these new insoles are designed to prevent recurrences while limiting pressure on other structures of the musculoskeletal system. Often the relief is reduced and modified, they are mainly adapted to the aftermath of the rider.

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move gradually

If your bone must be relieved to consolidate, it must also readjust gradually to the stresses of everyday life and sport. Schematically, the first month you can keep fit in the pool practicing swimming and aqua jogging. During the second month, add bike. Start cranking then increase the resistance and finally put on the pedals. In the third month after clearance from your doctor, it is possible to reintroduce the race ... in all humility. Walk trottinez ... a few strides and then 3 to 5 minutes ... increase 3 to 5 minutes on each output ... finish your workout by as many bike as you like! A 3 or 4 months of your injury, jogging thirty minutes is often possible.

Doctor St├ęphane CASCUA. - 16 juillet 2010.

Conflicts of interest: the author or authors have no conflicts of interest concerning the data published in this article.

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The Iroman lack of iron, the other sports too!

Doctor St├ęphane CASCUA.

Iron is essential to your health and performance. It is a central component of hemoglobin. The latter is contained in red blood cells and gives it color. It is the iron that captures oxygen when blood passes through the lungs. It carries the precious gas to muscles. When they arrived, it drops its cargo which then allows the burning of energy substances and muscle contraction.

When you run or when you jump, your heels hit the ground and the fat pad of the foot of the plant is crushed. It is through many blood vessels. These red blood cells burst and release their hemoglobin. Iron is released into the blood and pass into urine.

Muscle contains a twin sister of hemoglobin, myoglobin. The latter also contains a lot of iron which sets some oxygen. This small local reserve allows starting the contraction before the blood vessels do not provide the necessary complement. When you experience aches, your muscle membranes are victims of micro-fissures. Myoglobin and iron leaves the muscle and gaining the blood. The precious metal is eliminated in the urine.

When you make an effort, the majority of blood flow is directed towards your muscles. There remains very little to the digestive tract and the bladder wall. These organs suffer from lack of oxygen and are shaken with every stride. Small areas are damaged and start to bleed. Red blood cells and iron are lost in the feces and in urine.

You enter the assiduous why athletes often lack iron, especially if they do not take care to concoct "menus and recipes" adapted. Sports are even more concerned since all these iron losses are added the massive elimination of blood during menstruation!

That is why it is good to occasionally perform a blood test to assess the stock in body iron. This levy is necessary when it comes to review a state of fatigue. It unnecessary to dose iron in the blood because the body is able to keep within the limits of normal while the reserves are at their lowest! It is necessary to measure levels of "serum ferritin" because this structure is the storage form of iron.

The bone is strengthened or crack in contact sports

Doctor St├ęphane CASCUA.

Each sports movement constitutes a solicitation for the bone structure. At each reception process, the tibia runner undergoes vibratory impacts. Unrolling not, the hiker twists slightly small bone in his foot. Even the body-builders, powerfully contracting its muscles, pulls on his bone.

Each strain injures a little bone of sports. Fortunately, during the rest period, the bone trying to rebuild. If time allows, if they bring him the necessary food, it is repaired! It reconstructs even louder than before as if to prepare for new mechanical attacks. This phenomenon is called by coaches cycle decompensation / overcompensation. This process has been described in many body organs and functions: muscle, stock energy, hormones, etc. It is a key driver of growth.

Thus, it was shown that the well-trained marathoner had stronger bones than sedentary. Indeed, its more dense bone structure, higher in fiber and calcium. In addition, the microscopic architecture of the bone is perfectly oriented along the axis of mechanical stresses.

Indeed, the chemical structure of the bone is comparable to reinforced concrete. The protein network is the steel rods. Calcium is comparable to concrete mired these metal axes. At the hip and pelvis direction of the bone structure is very characteristic. On a radiograph, it is found that the fibers leave the femur, the thigh bone, tilt in, come from hip to withstand the weight of the body resting on the hips. The lines of force from the right leg and left leg meet in the middle of the basin and support each other in the manner of the nave of a church.

Physical activity associated with a sufficiently high protein diet, vitamin D and calcium is a great engine of bone construction. This cocktail is particularly useful to hinge periods of life. During growth, it is necessary to eat 4-5 dairy products every day to build strong bones. It should also move: it is essential to practice a sport requiring the running and jumping at least 3 times a week for 30 minutes. In the absence of impact, bones harden less. It has been shown that a young competitive swimmer had lower bone density than sedentary because he was deprived of gravity during those long hours of pool training. In addition, bone densification stops 25 years. At this age you have made up your bone capital for life!

In adulthood, sport reinforces very hard bone and the amount of calcium necessary for the maintenance of bone is still debated. In case of fracture, the rest of the broken area needed a few weeks to allow to "ensnare" the broken area. In addition, gradually increasing mechanical stress are indispensable to "mechanize" the callus. Again, they help to guide the fabric of the bone in the center of the constraints to prepare him for his mission. An increase in calcium intake in consolidation period is proposed by some doctors without that interest has been really shown.

After menopause, the bone structure is gradually degraded to make the brittle bones is osteoporosis. Ladies, remember, your resistance to hip fracture depends on your diet and your sport for 25 years! If physical activity after menopause can no longer denser bones, reduces the loss of bone tissue. So it is advisable to go see jumping around or jog. It is also good to make the soft gym to maintain bone strength to strength. To make the most of this stimulation, it is again necessary to take 4-5 dairy products daily. It should also go out every day to enjoy the sun and make the vitamin D essential for the absorption and calcium binding. Fresh coordinating sports such as Thai Chi or "balance workshops" have proven effective in reducing the risk of falls and fractures.

If the sporting activity is excessive, the micro-cracks caused by impacts on the bones fail to consolidate over the rest. Rather, these lesions worsen in the next workout. Finally the splits right through bone, it breaks without any violent trauma. It is the stress fracture. In a postmenopausal woman, it was demonstrated that 6 hours of sport load per week may be sufficient to break insidiously bones. Among younger adults, this type of injury is favored by dietary deficiencies and hormonal disorders. Lack of calcium, vitamin D and protein alters the rebuild bone victim of microcracks in the exercise. Insufficiency sex hormones reduces the stimulation microscopic chemical plants be responsible for the synthesis of bone tissue. Functional changes occur when the deep depletion of the body. That kind of burnout is most often diagnosed in women because it causes menstrual irregularities and a cessation of menses. The victim is found in a state of "early menopause". In humans this hormone suffering is more insidious but it exists and its effects on bone density are comparable. The sports overwork cocktail, dietary deficiencies and disappearance of rules typically found in young women anorexic. Faced with a stress fracture, the sports physician must remain vigilant. It should not simply treat a "bone". It has an obligation to support a whole person, he is responsible for seeking overtraining or behavioral disorders.



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