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By Louise Drysdale, Physiotherapist

Bone stress fractures is a common cause of concern with my dance clients and so I’ve outlined in this article more information about them, and the best way to deal with a fracture if you do experience one.

What is a stress fracture?

A stress reaction or fracture in bone occurs when the rate of bone cell death is higher than the rate of new cells forming. This can be for a number of reasons, and is related to several complicated physical, chemical and hormonal processes.

How do I know whether I have a stress fracture?

The beginnings of a stress reaction or fracture are often “silent” in terms of symptoms, however some warning signs include pain over a bone or to touch/ press on a hard bony area. Pain with impactful exercise (running, jumping, pointe work, high heels) may hurt initially and when a stress reaction is advanced, simple activities such as walking can become painful. In the lower limb, you might find there is pain to move when there is weight placed through the bone but perhaps not if the limb is free (pointing the foot vs demi pointe or full pointe). Night pain can also be a sign of stress fracture, as can swelling or hotness over the painful area.

If I am a dancer, which areas should I look out for?

Dancers usually experience stress reactions or fractures in the lower limb, typically the metatarsals, navicular bone, talus, tibia and sometimes in the groin area. Due to the large ranges of motion dancers require in the lumbar spine, this also becomes an area of concern.

Can I still dance with a stress reaction or fracture?

Sadly, time off is required for a bone to heal properly and reduce the risk of the injury occurring again and again. The fracture may be immobilised in a boot or brace, or crutches may be required to take weight off the limb.

Why do dancers get stress fractures?

Dancers may find bones cannot accommodate physical loading because they have undertaken a sudden increase in activity too quickly, there is not enough energy being consumed to maintain healthy bones and dance at a high level or intensity, there is an imbalance of hormones (for example, thyroid and female sex hormones), there has been a sudden change in dance style or shoes/ floor or occasionally there are genetic factors that predispose dancers to bone injuries.

Why do I need to see a Physio if I have a stress fracture?

Physios can give you specific rehabilitation exercises and fitness alternatives to try whilst the bone heals. We also help you work out why you sustained a bone stress injury and if you need to see other health professionals to optimise your recovery (Sports Doctors, Dietitians, Podiatrists etc) and build future resilience, we can help you find them. Once the bone has healed, Physiotherapists will help you return to dance slowly and safely, making sure you are strong enough for class and performance.

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