Most people think of bone fractures as being traumatic blows or sudden snaps, but stress fractures are quite different from the typical acute bone fracture. A stress fracture is a failure of bone tissue to withstand human biomechanical forces, and such injuries usually take a long time to happen, after continuous loading at a specific vulnerable spot. Eventually, a fissure occurs in the bone which often goes unnoticed.

An Australian sportsmedicine clinic kept track of the types of stress fracture its personnel treated over a two-year period, and the rustling data indicates that the most common sites of injuries are the metatarsal bones in the balls of the feet; the tibias, which is the large bone of the lower leg; and the fibula, the narrow bone of the lower leg. It makes sense that all three common fractures sites are below the knee because the bones at the location experience more stress than those below the knee. The three most common stress-fractures-producing sports are jogging and distance running, track sprinting and dancing, with runners and sprinters experiencing these injuries in their tibias and fibulas and dancer getting them in their metatarsals.

For runners the best preventive measure is to run on a soft surface like grass, sand or dirt as opposed to concrete or asphalt. Sturdy running shoes are of paramount importance for distance runners, as light running shoes, which are often called racers, are not as effective at shock absorption. Orthotics, or shoe inserts, which you can get with a physician's referral, also help to distribute biomechanical loads properly.

For dancers it's important to practice on relatively resilient surfaces like wood floors as opposed to concrete floors. Taping the feet for added stability is an effective preventive tool, especially for ballet dancers.

Athletes often experience early warning signs of impending stress fracture. For example, runners discover very specific dime-size areas along the tibia or fibula that are extremely tender to pressure, while dancers feel it coming in the second metatarsal, the second ball of the foot, which is the bone that gets the most loading and so is the most susceptible.
The best treatment for stress fractures is to alleviate the compressive forces and allow the bone to remodel and heal itself. Injured athletes should temporarily stop running or dancing until the bone tissue grows over the fracture, a process that can take anywhere from six weeks to six months, often without a cast.

March 1995

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CARPAL TUNNEL SYNDROME

Carpal tunnel syndrome is an injury that causes numbness and loss of feeling in your fingers and hands. The symptoms result from impingement of the muscles and tendons of the forearms on the nerves that feed into the hands. On the underside of each wrist there is a connective tissue band that holds all the tendons and nerves leading to the hand. As the muscles of the forearm strengthen and the tendons grow, pressure builds up in the limited space below the connective tissue band. Relatively minor surgery is required to loosen the band and remove the pressure.

Two top bodybuilders, Lou Ferrigno and Bev Francis, recently underwent corrective surgery to alleviate the symptoms of carpal tunnel syndrome, and at the time of this writing they are both back to intense training. While you might expect that bodybuilders and weightlifters would be susceptible to this ailment due to their training and muscle hypertrophy, you may not realize how commonplace carpal tunnel syndrome is becoming in our automate society. Check-out clerks who use the new bar-code scanners and repeatedly flex their wrists all day long are becoming increasingly susceptible to these symptoms, as are workers who perform certain computer functions repeatedly. Although prevalent injury in bodybuilding, it does occur, as witnessed by the experience of Francis and Ferrigno. Both stretching and slowly increasing the workload on your forearms will help you to avoid it.
Sept92IM
 

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ELBOW PAIN FROM BICEPS TRAINING

Many lifters experience pain on the medial portion of their elbow joints. Often bodybuilders aggravate the pain by performing biceps curls with a straight barbell or by doing the eccentric, or lowering, phase of dumbbell curls with their forearm in a supinated position. If you understand the anatomy and biomechanics of the elbow joint, you can see why this stress occurs.

To determine how you should perform an exercise to avoid undue stress and injury to joints and to focus the work on the correct muscle, you must observe how your body functions naturally. For example, when your arm hangs naturally at your side, your palm faces your thigh. When you raise your hand to touch your shoulder-that is, perform elbow flexion, or a biceps curl-your palm rotates to face your shoulder during the upward motion. This is supination. As you lower your arm to the starting position, your forearm rotates back, or pronates, so that your palm once again faces your thigh. This natural rotation places the work on your biceps and relieves the stress on the joints.

When you perform biceps curls with a straight bar, your forearms are in a fully supinated position at the bottom of the exercise, not the natural pronated position. This exposes the medial regions of your elbow joints to excess stress. It stands to reason, then, that if you do your biceps curls with dumbbells, you will place less stress on your elbow joints and reduce the likelihood of injury.
Feb92IM
 

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WEIGHTLIFTING FOR INJURY TREATMENT

Heavy resistance exercise, not rest, is the new prescription for treating mild inflammatory injuries such as tennis elbow and shin splints. These are common overuse injuries in sports that require repetitive movements by a specific joint. Injuries to the shoulder, elbow and wrist joints are also common among workers whose jobs require similar repetitive movements.

Frequently, the injury involves a slight tearing in the ligaments that attach tendon to muscle or to bone, which results in pain and inflammation. The initial treatment starts with the patient discontinuing the activity that precipitated the injury. Rest, ice and the possible use of an anti-inflammatory agent such as aspirin or ibuprofen come next, and the resistance therapy begins after only the initial swelling and pain have subsided. Weight training stresses the injured ligament and helps form a dense, collagenous scar that doesn't hurt.

While this type of treatment remains controversial, it has been used successfully in controlled situations, such as supervised rehabilitation centers, and it opens a new avenue for our sport's expansion. You should consult your physician before beginning any weightlifting program for injury treatment.
June91IM

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