What is a knee stress fracture?

Hello Professor Goss, can you please tell us about knee stress fractures? Stress fractures around the knee are becoming more and more common nowadays especially with the current climate around Covid-19 where a lot of people are sometimes taking out sports that they're not used to such as running or changing surfaces and this is becoming a common finding nowadays. A stress fracture in general is a a fracture related to overuse or repetitive trauma, this is usually common in the lower leg especially the feet, around the knee and around the ankle as well. Nowadays I've seen them also around the fibula which is the smaller bone in the leg and sometimes around the tibia and the femur as well where you get a stress injury to the lower part of the femur or the upper part of the tibia which is your leg bone. The symptom, the main symptom is pain related to activity, when you put your foot down it hurts and it's usually related to excessive running, excessive repetitive trauma or people for example who do marathon running, who do triathlons etc. The way to diagnose it is to have an assessment so you need to go for a clinical examination and we then discuss the history and findings and then we normally obtain an x-ray and if the x-ray is not very clear then sometimes we get further imaging such as a CT scan or an MRI scan. The reason why they are important is it is important to diagnose them so that we can treat them and the most important thing in treating stress fractures anywhere including around the knee is to rest the knee completely for at least 6 to 8 weeks, I would recommend at least 8 weeks, just to allow this fracture which is a disturbance of the bone itself and the architecture, we want to allow it to heal and mend together. Combined with taking painkillers, icing it to reduce the swelling, if there is swelling wearing a proper footwear, elevating it and sometimes wearing an elasticated knee stocking can also help. Wearing a brace or such is not necessary in a stress fracture, just let it heal on its own. I'm talking about around the knee itself. And then returning to exercise once the pain goes away completely, but also knowing how to work around the stress fracture and how to avoid it. There are certain important points that I would like to highlight to try and avoid stress fractures. First of all, when you start exercising or doing something new, it should be at an incremental level so slowly build up your levels. should be goals so you should try and achieve goals slowly and not overdo it if you feel pain or if it's uncomfortable and you're doing something wrong you just need to ease off cross training is very helpful and trying to reduce stress factors and wearing the correct footwear especially running shoes and sometimes getting gait analysis to determine if there's a a problem with your running can be very helpful and very useful. Sometimes wearing a specific brace if you have an injury from previous can help to prevent further injury and prevent further damage such as a stress fracture and more importantly if there is something and you feel discomfort don't just carry on, just stop and take it and just elevate your leg and rest to allow things to settle down. It is also important to know your biology if you have a vitamin D deficiency or if you have osteoporosis. That can be an important factor and that can be diagnosed by certain blood tests and bone body mass index, sorry bone mass index measurement using a DEXA scan etc. to determine if there is evidence of osteoporosis, osteopenia or normal bone structure and then finally I think warming up before any exercise is extremely important to try and alleviate any injuries and to help the muscles take some of the load off the bone. Stress factors are common nowadays and it's important to try and follow these preventive measures to avoid injuries.