No Pain, No Gain?


By Anthony Mechrefe, MD

It’s back to school time, and with that comes back to sports. Many student athletes have taken a well deserved break over the summer, and as they get back to school, athletic programs quickly take off with whipping students back into shape. Some students, in the ever increasing pressure to excel on the athletic fields, do not get the luxury of a break, and spent the summer bouncing between fields and tournaments, and never let their bodies truly recover. It’s at this time of year that stress fracture occurrence begins to spike.

The hallmark of any stress fracture is pain. The coach's mantra ingrained in the young athletes mind is “No pain, No gain.” But when it comes to young athletes restarting sports, or in athletes that are playing multiple sports on multiple teams and never give their bodies a break, this is one area where continued pain is an ominous sign.

Stress fractures, as the name imparts, occur when the bones of the body are seeing too much stress, and are not given enough time to recover. With the ongoing pressure on the bones from the sport, the bone fatigues and breaks, and causes significant pain, swelling, and limitation in an athletes ability to perform. This occurs when athletes ramp up their training too quickly, or play multiple sports and don’t give their bodies the rest they require to heal and recover.

Stress factors are diagnosed by understanding the history of exactly what the athlete plays, when the symptoms appeared, and where on their body they are having pain. They often will have a pinpoint area that is painful to the touch, but sometimes it can be diffuse. Pain typically occurs while the activity is being performed, but can also only be noticed after activity. Swelling can occur with the stress fractures, but not always, so is not a reliable hallmark for the diagnosis of stress fractures. Pain in athletes that persists more than 5-7 days, and is not relieved with ice and a short course of an anti-inflammatory medication, needs to be evaluated by a medical professional to evaluate for a stress fracture. This is done with a careful history and physical examination, and likely a set of X-rays. Keep in mind, X-rays for a stress fracture typically are negative for the first 3 weeks, and depending on the location, may require an MRI to diagnose.

The treatment for all stress fractures initially is the same. TAKE THE STRESS AWAY. Rest and ice can often ease the symptoms, and prompt cessation of running and sports is necessary to let the bones heal. While anti-inflammatory medications (ibuprofen, Motrin, Aleve, Naprosyn, etc) can help the pain symptoms, they can often delay healing of the bone. Acetaminophen (Tylenol) is preferable, as it does not delay bone healing. Often crutches, braces, and in some cases, surgery is necessary to heal the broken bone. It can take upwards of 6-8 weeks for healing to occur. Once pain at the site of the stress fracture subsides, athletes can then gradually get back to sports. But this needs to be a gradual return, as repeat stress fractures can occur as athletes are often pushed to get back as fast as possible.

So while kids are getting back to school and back to sports, student athletes and parents need to be educated about stress fractures and armed with the knowledge that “No Pain, No Gain” doesn’t work when it comes to stress fractures in athletes. If an athlete has pain that doesn’t go away with a short period of rest, ice and and an ant-inflammatory medication, then its time to visit your healthcare professional.