What is a stress fracture?

San Diego Padres fans groaned when they saw superstar Fernando Tatis Jr. placed on the injured list in June with a stress reaction — often a precursor to a stress fracture — in his thighbone. It came just as the slugger was in the midst of his best stretch of the season. The injury to his femur has already kept him out for more than a month and caused him to miss the MLB All-Star Game.

“Stress reactions are repetitive use injuries, so they are common among athletes,” explains Dr. Joel Smith, an orthopedic surgeon affiliated with Sharp Memorial Hospital.

As the name suggests, the injury occurs when repeated stress on a bone causes microscopic damage. For professional baseball players such as Tatis, who play, practice and work out daily with very few days off, the activity that caused the injury continues to be repeated, which means the bone doesn’t have time to heal.

While a stress injury is possible in any bone, they are most common in the legs, ankles and feet. According to a study published by the National Institutes of Health, 11% of all stress fracture injuries in athletes occur in the thighbone.

Who’s at risk for a stress reaction?

You certainly don’t need to be a professional athlete to develop a repetitive use injury, such as a stress reaction or fracture. Any activity that involves running and jumping can cause the injury, with basketball, track and field, gymnastics, volleyball and tennis frequently mentioned as top contributors.

“The symptoms usually start with pain in the area around the bone,” says Dr. Smith. “With repeated activity, the pain could get worse over time and swelling may develop. And, if left unaddressed, the bone could develop a crack, which is a more severe injury, known as a stress fracture.”

In the case of Tatis, he reports that he’d felt discomfort for most of the season. While he played through the pain, his doctors ultimately recommended he stop playing so the injury wouldn’t get worse.

Preventing stress reactions and fractures

There are actions you can take to limit the risk of developing a stress reaction through repeated activity:

• Gradually increase intensity of workouts.

• Warm up before activity to prepare your body for repeated action.

• Alternate types of exercise.

• Use the right equipment and shoes.

• Maintain a healthy diet and appropriate nutrition.

• Allow time for your body to recover from activity.

However, if you do feel persistent pain, it’s a good idea to talk with your doctor. If they suspect a stress reaction or fracture, they may order X-rays.

“The damage to the bone may be so small that it may not show up in an X-ray,” Dr. Smith says. “In that case, an MRI may needed to identify the source of the pain.”

How stress reactions are treated

Fortunately, the best and most common treatment for a stress reaction or fracture is rest. Simply avoiding the activity that caused the damage for a significant period, likely several weeks, may give the bone time to heal. Depending on the location of the injury, it may even be possible to stay active during the recovery time by switching to a low-impact form of exercise, such as swimming or cycling.

In more painful cases, a boot or crutches may be needed. And if a stress fracture is significant enough that it doesn’t heal on its own with rest, surgery may be required. However, according to Dr. Smith, those cases are few and far between.

“The good news is that with stress reactions and fractures, rest and being smart about recovery really can work wonders,” he says. “So, surgery is only needed for the most severe cases where recovery just isn’t happening the way we would like.”

Dr. Smith says a six- to eight-week recovery time is not uncommon. If that holds true for Tatis, that would put him back in the Padres lineup sometime in August, just in time for the Friars’ run to the playoffs.

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