Return to Sports in Stress Reaction and Stress Fractures in Indian Athletes: A Case Series.

Abstract

A stress fracture is a painful condition which occurs when the adaptive ability of the bone is unbalanced. This imbalance predominantly occurs due to increased intensity, frequency, or duration of training. Identifying the etiology of stress fracture and its proper treatment prevents recurrence. Besides, evidence-based and supervised rehabilitation is indispensable for permanent remission of pain and return to sports to preinjury functional levels. The case series discusses the continuum of stress reaction to stress fracture in athletes, causes of stress fractures, their management, and return to sport. The paper aims to give a clear discussion about the management with rehabilitation guidelines for metabolic causes of stress fractures. This study was a case series of five cases coming to Sports Medicine outpatient clinic of Sports Injury Centre, VMMC and Safdarjung Hospital, New Delhi, and physical medicine and rehabilitation outpatient clinic of Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow over a period of 1 year. The discussed cases are young Indian athletes, both male and females, who have presentation along the continuum of medial tibial stress syndrome (MTSS) to stress reactions and stress fracture. The findings of the paper highlight the significance of rehabilitation for individuals suffering from MTSS. Accurate diagnosis with targeted rehabilitation leads to quicker return to sports. The rehabilitation program comprises of identifying and treating the cause of stress fracture, removing any risk factors, biomechanical correction wherever indicated, structured exercise program, training in underwater treadmill, cyclical increase in loading, reducing activity every 3rd week.