In those individuals with low vitamin D or low bone mineral density, the therapeutic goal for supplementation should range from at least 50 nmol/L (20 ng/mL) to as high as 90–100 nmol/L (36–40 ng/mL) based on the Food and Nutrition Board recommendations. Serum 25(OH)D 3 level is the study of choice for identifying vitamin D deficiency. It is recommended that most patients should receive 800–1000 IU (or perhaps as much as 2000 IU) of vitamin D3 daily because it is relatively safe and has a high therapeutic index. This level 1 study suggests that calcium and vitamin D supplementation may have prevented a significant percentage of their recruits from sustaining a stress fracture along with a significant decrease in morbidity and financial burden. Another randomized, double-blind, placebo-controlled study examined whether calcium and vitamin D intervention could reduce the incidence of stress fractures in female recruits during basic training. A prospective study of Finnish military recruits found that the average serum vitamin D concentration was significantly lower in the group that had sustained a stress fracture. Recent studies have evaluated the potential association between serum vitamin D levels and stress fractures. Rest, adequate hydration and caloric intake, and varying the training program with cross-training activities are the mainstays of recovery. Without adequate rest and recovery, overly aggressive training regimens increase the risk of injury, cause negative feelings for the activity and those involved in the training, and paradoxically decrease athletic performance. The muscle fatigue and repetitive impact on hard training surfaces increases the athlete’s risk of developing stress fractures. This condition frequently occurs in athletes who are training for competition or a specific event and train beyond the body’s ability to recover. Athletes such as competitive runners and triathletes often exercise longer and harder in order to improve performance, but work overload and too little time for recovery may lead to physical and psychology symptoms of overtraining syndrome. Endurance sports training require a balance between workload and recovery. Overtraining has been a recognized cause of injury since the ancient Greek Olympic games. Overall, general fitness is protective, and studies have shown that military recruits with higher activity levels before enlistment had fewer stress fractures during basic training. As muscle fatigues, its capacity to absorb the energy of an externally applied load diminishes, resulting in higher peak stresses and more rapid accumulation of microdamage. This is referred to as the neuromuscular hypothesis. Muscle fatigue may be an important factor in fatigue fractures. Proper neuromuscular function can dissipate the energy of externally applied impact loads on the bones and joints that can occur during running and jumping. Muscle strength can also affect an individual’s susceptibility to stress fractures. Maximizing the patient’s biologic capacity to repair microcracks requires an assessment of the athlete’s general health focusing on nutritional behaviors, hormonal status, and medication and tobacco use. In order to decrease this repetitive microtrauma, providers must evaluate the patient’s training regimen, biomechanics, and equipment. Treatment principles for stress fractures include re-establishing the normal balance between the creation and repair of microcracks in the bone. In order to optimize a patient’s recovery and outcome from these injuries, a holistic approach should be taken by orthopedists and sports medicine practitioners that includes specialists in athletic training, nutrition, endocrinology, psychology, sports-specific mechanics, and physical therapy. Certain sports are more commonly associated with stress fractures, including running (69 %), fitness class/cross-fit (8 %), racket sports (5 %), and basketball (4 %). Stress fractures occur along a continuum of severity and may occur in nearly any sports or repetitive activity.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |