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Management of thigh stress fracture in sports

WYCLEF ODUO @PeopleSports11

A thigh bone stress fracture is a condition characterised by an incomplete crack in the thigh bone. Several muscles of the hip, knee and thigh attach to this bone. When these muscles contract, a pulling force is exerted on the bone.

In addition, weight-bearing activity such as running, sprinting or jumping places compressive forces on it. When these forces are excessive or too repetitive and beyond what the bone can withstand, bony damage can gradually occur. This initially results in a bony stress reaction. However, with continued damage may progress to a stress fracture.

This condition often occur following a recent increase in activity or change in training conditions (such as surface, footwear or technique) and are particularly common in long distance runners.

Sports individuals with this condition typically experience a poorly localised pain in the front of the thigh that increases with impact activity (such as running, jumping, sprinting and hopping) and decreases with rest. Pain may also cause the patient to cease activity.

Occasionally, pain may radiate to the knee or back of the thigh. In severe cases, walking or standing may be enough to aggravate symptoms. Other symptoms may include night ache, pain when sitting with the thigh over the edge of a chair (especially if a downwards force is applied to the end of the thigh) or pain on firmly touching the affected region of the bone.

A thorough subjective and objective examination is required to diagnose a thigh stress fracture. Further investigations such as an X-ray, MRI, CT scan or bone scan are usually required to confirm and determine the severity of injury.

With appropriate physiotherapy management, most patients with this fracture can make a full recovery and return to sport or normal activities in a period of three-12 months. In more severe cases, recovery may take one to two years, or longer, depending on the intervention required and a range of other factors.

In rare cases, some patients may experience ongoing symptoms or complications which may require further management. Treatment for a stress fracture of the thigh typically involves an initial period of rest from weight bearing activity. This may involve a period of reduced activity or the use of crutches for a number of weeks.

Following this, a gradual increase in weight bearing activity and exercise can usually occur as tolerated, provided symptoms do not increase. This should take place over a period of weeks to months with direction from the treating physiotherapist and will vary depending on the severity of the injury.

Ignoring symptoms or adopting a “no pain, no gain” attitude is likely to cause further damage and may slow healing or prevent healing of the thigh stress fracture altogether. Immediate, appropriate treatment is essential to ensure a speedy recovery.

Trigger point release techniques, dry needling, joint mobilisation, stretches and electrotherapy can assist with hastening healing, improving range of movement, pain and function and correcting factors contributing to the development of the stress fracture.

This can generally commence once the physiotherapist has indicated it is safe to do so. Patients should also perform pain-free flexibility and strengthening exercises as part of their rehabilitation to ensure an optimal outcome.

Alternative activities placing minimal weight bearing forces through the affected bone should be performed to maintain fitness such as swimming, cycling and water running.

The treating physiotherapist can advise which activities are most appropriate for the patient and when they should be commenced. The writer is a physiotherapist, Harambee Stars & Mathare United [email protected]

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