Like many people, Jeanette Pallister wanted to intensify her practice during lockdown. The 49-year-old bar owner had regularly attended fitness classes at a gym in the two years before the pandemic hit, but when they closed again last December, she decided to go jogging.
Starting with a running-walking program — alternating between running and walking — she gradually built up so that within four weeks she was jogging two miles three days a week.
She had also started every other day with 45-minute High Intensity Interval Training (HIIT) online workouts, which included lots of lunges, stretches, and jumps.
All of this came to a halt less than two months after the start, when Jeanette, of Mayfair in London, suffered a stress fracture in her right ankle – caused by repeated pressure.
Jeanette is just one of many to have suffered injuries like this in the past year, health workers say. Typically because they are new to exercise, increase in intensity in a short amount of time, with a lack of expertise at hand – a fitness instructor would gradually make someone new to exercise easier – they pushed their bodies too much, too quickly.
Like many people, Jeanette Pallister, 49, wanted to intensify her practice during lockdown
There has been “a significant increase in the number of stress fractures at the clinic in the past year,” said Kumar Kunasingam, an orthopedic surgeon specializing in ankle and foot surgery at Croydon NHS University Hospital and the Schoen Clinic in Marylebone, London.
And where it used to be something he treated with top athletes, “I now see people with stress fractures,” he says.
Ziad Harb, an orthopedic surgeon specializing in foot and ankle surgery at Ashford and St Peter’s Hospital, Surrey, says he has seen a quadruple increase in stress fractures from the first lockdown.
“It’s one of the most striking trends I’ve seen in the past year,” he told Good Health.
A recurring theme is that patients have taken on a virtual ‘challenge’ – often inspired by a good cause, to help with fundraising – such as running or walking 100 miles in a month. For many, this is a drastic increase in regular and vigorous exercise.
Others are challenges inspired by TikTok (the video-based social media network) – “people injure themselves by mimicking intense bursts of exercise, such as dancing,” says Mr. Kunasingam.
Jeanette, from Mayfair in London, suffered a stress fracture in her right ankle – caused by repeated pressure
A stress fracture is caused by overuse or ‘overload’ of the bone – the bone is weakened because it is not used to the demands placed on it.
This overload has a cumulative, harmful effect. “I now see patients literally breaking their bones to keep fit,” says Mr. Kunasingam.
It’s like bending a ruler over the side of a desk; gradually cracks will form and if you continue it will break. ‘
He adds: “Stress fractures are not caused by one incident, but by an accumulation of forces over weeks or months that build up in the bone.
“ Often times, the person may have low grumbling pain during and after exercise for a period of time before doing anything about it, by which time it will get worse as they continue to run on it. ”
Jeanette’s stress fracture was in her fibula, one of the three bones that make up the ankle joint – a common site for stress fractures. A US study in the Journal of Sports Medicine in 2015 found that 80 percent of stress fractures occur in the lower extremities.
The five long bones, the metatarsal bones that make up each of our toes, and the bones in the center of the foot, are particularly vulnerable – perhaps unsurprisingly, given that a force of up to three times our body weight can be applied to the foot while running. Stress fractures can also occasionally occur in the hip.
More seasoned athletes are also at risk if they increase or change their activity too quickly, such as moving from grass to hard sidewalks.
Jeanette is just one of many to have sustained these types of injuries in the past year, health workers say (stock image)
Stress fractures are more common in women between the ages of 30 and 50, possibly due to hormonal changes and the effect on bone density – or a diet without fatty fish, red meat and fortified grains, which contain vitamin D – essential for the health of the bones. Mr. Harb, who also works at Princess Margaret Hospital, Windsor, says the underlying weakness is multifactorial, but often there is also a vitamin D deficiency.
External factors also play a role, he says – these include poor footwear i.e. wearing fashionable athletic shoes instead of proper running shoes, running on inappropriate terrain (e.g. hard surfaces such as sidewalks), and running without warming up (causing the muscles and tendons to prepare for exercise, improve their range of motion, and prevent constriction).
Mum of two Jeanette, who runs a pub with husband Dave, 50, says she only went jogging during lockdown “ to get more out of it. ”
On the day of her injury, she had done her usual 20-minute run, and went for a three-hour walk around lunchtime.
“ When I got home around 5pm, my right ankle felt sore and quickly became red and swollen, and the front was in pain, ” she says. Within about an hour it had doubled in size and was too painful to walk on.
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Fortunately, Dave still had some crutches from when he had knee surgery earlier, so I used them to move.
“But that night my ankle was so bloated that I couldn’t see the ankle joint.”
It’s important to get a stress fracture treated quickly, because if you keep exercising on it, pain and swelling will worsen. That means it won’t heal and could potentially lead to surgery if the fracture gets bigger.
The only way the bone can heal is to let it rest and immobilize it (in an Aircast or ‘immobilizer’ boot and by using crutches).
Fortunately, Jeanette had an appointment with her physical therapist about an unrelated shoulder injury two days later. Fearing that her was just a stress fracture, he ran the classic tests, which included pressing on the sensitive area – causing extreme pain.
In addition to tenderness when touching the bone, other clues Mr Harb is looking for include ‘swelling, warmth, difficulty bearing weight and a thickening of the skin on the fat pad close to the toes – this could be an indication that an additional load is required. for example by means of metatarsal bones, ‘he explains.
“Tightness of the calf muscles can ring bells about a stress fracture, especially if they also suffer from swelling and pain in the foot,” he adds. Stress fractures are often not visible on X-rays but appear on an MRI.
“It is extremely important to identify the intrinsic and extrinsic causes because if you don’t correct them, stress fractures can be missed, take longer than average to heal or come back in the future in a most troubling way,” said Mr. Harb. If a stress fracture is noticed early, it usually takes about six weeks to heal.
“But some bones have poor blood flow, so it may take longer to heal, so the boot should be worn longer.”
Physical therapist Gary Jones of Physio 206 in Bromsgrove, Worcestershire, who has also seen more stress fracture patients, says getting out of an Aircast boot isn’t the end of the story.
“It could be a long rehabilitation,” he says. ‘With a stress fracture of the shin – the shin – it can take up to four months before you can fully train on it again.
‘At first it will be very stiff and other parts of the body – such as the calf and foot muscles – will become weaker because they are not used in the normal way, which can start after just 48 hours of wearing the boot. It requires a phased return of stretching, followed by rebuilding. ‘
Jeanette returned to Mr. Kunasingam at the end of March. In addition to resting from jogging, she stretched her ankle daily and started using an exercise bike for ten minutes every other day.
Now that her fibula has healed enough, she can go back to gentle jogging, jogging for ten minutes twice a week.
“ But I’ll be a bit wary of overdoing it and will stop if I feel pain, ” she says. “I will be very careful how I exercise in the future.”