COLUMBUS, Ohio - That sharp pain in a golfer's lower rib or the unrelenting soreness in a gymnast's forearm could mean more than a sore muscle - it may indicate a stress fracture.
Stress fractures are frequently thought of as affecting the bones in the lower body. But as more people take up sports, stress fractures are also being recognized as a prevalent problem in the upper body.
Chances are good that most physicians do not accurately diagnose stress fractures, said Chris Kaeding, a clinical associate professor of orthopedics at Ohio State University and co-author of a new study on upper-body stress fractures.
"Yet as participation in sports increases, physicians need a greater knowledge of the unique physical demands - and consequences -- of different sporting and recreational activities," he said.
The research appears in a recent issue of the Clinical Journal of Sports Medicine.
The researchers separated 44 patients with stress fractures into four groups: weight lifters; upper-extremity weight bearers; throwers; and swingers. Each group had a specific pattern of stress fracture:
- Weight lifters (example: football players): injuries throughout the upper extremity, but none affecting the ribs.
- Weight bearers (example: gymnasts, cheerleaders):
fractures below the elbow, with no injuries to the upper
arm, shoulder area, or ribs.
- Throwers (example: softball pitchers): nearly all fractures were in the shoulder area.
- Swingers (example: golfers): fractures mainly in the lower ribs.
All groups had fractures on the ulna - one of the two bones in the lower arm. Only the weight lifters and throwers had stress fractures in the first rib, while hand and wrist fractures occurred only in the weight lifters and bearers. Weight lifters also had fractures throughout the upper body.
"Upper extremity stress fractures result from repeated movement or impact to a specific area," Kaeding said. "Simply put, they stem from overusing a bone."
For example, most of us are walking around with tiny fractures in our feet. "With each step we take, there's a tiny, microscopic failure that occurs in the bone," Kaeding said. "Usually, the bone can repair itself and even get stronger as a result. Yet if someone accumulates micro-damage too rapidly, these tiny fractures can coalesce and cause a stress fracture."
Tired muscles may also make bones more susceptible to stress fractures, since weakened muscles can't protect bones and joints adequately during high-intensity activity.
Left untreated, a stress fracture can grow. In the worst-case scenario, it can lead to a broken bone, putting an athlete out of commission while he recovers.
"Doctors should consider the possibility of a stress fracture when an athlete complains of upper body pain that seems to stem from overuse," Kaeding said. "Diagnosing it right away can prevent the injury from progressing to the point where the athlete cannot perform his sport."
Kaeding co-authored this study with Aasha Sinha, a veterinarian in the department of clinical sciences at North Carolina State University and Gail Wadley, an assistant trainer in the department of sports medicine at Ohio State.
Contact: Chris Kaeding, (614) 293-8813; Kaeding.1@osu.edu
Written by Holly Wagner, (614) 292-8310; Wagner.235@osu.edu