San Diego Padres fans groaned when they saw superstar Fernando Tatis Jr. placed on the injured list in June with a stress reaction — often a precursor to a stress fracture — in his thighbone. It came just as the slugger was in the midst of his best stretch of the season. The injury to his femur has already kept him out for two months and caused him to miss the MLB All-Star Game.
Stress reactions are repetitive use injuries, so they are common among athletes. As the name suggests, the injury occurs when repeated stress on a bone causes microscopic damage. For professional baseball players such as Tatis, who play, practice and work out daily with very few days off, the activity that caused the injury continues to be repeated, which means the bone doesn’t have time to heal.
While a stress injury is possible in any bone, they are most common in the legs, ankles and feet. According to a study published by the National Institutes of Health, 11% of all stress fracture injuries in athletes occur in the thighbone.
Who’s at Risk for a Stress Reaction?
You certainly don’t need to be a professional athlete to develop a repetitive use injury, such as a stress reaction or fracture. Any activity that involves running and jumping can cause the injury, with basketball, track and field, gymnastics, volleyball and tennis frequently mentioned as top contributors.
The symptoms usually start with pain in the area around the bone. With repeated activity, the pain could get worse over time and swelling may develop. And, if left unaddressed, the bone could develop a crack, which is a more severe injury, known as a stress fracture.
In the case of Tatis, he reports that he’d felt discomfort for most of the season. While he played through the pain, his doctors ultimately recommended he stop playing so the injury wouldn’t get worse.
Preventing Stress Reactions and Fractures
There are actions you can take to limit the risk of developing a stress reaction through repeated activity:
- Gradually increase intensity of workouts
- Warm up before activity to prepare your body for repeated action
- Alternate types of exercise
- Use the right equipment and shoes
- Maintain a healthy diet and appropriate nutrition
- Allow time for your body to recover from activity
However, if you do feel persistent pain, it’s a good idea to talk with your doctor. If they suspect a stress reaction or fracture, they may order X-rays. If the damage to the bone is so small that it does not show up in an X-ray, an MRI may be needed to identify the source of the pain.
How Stress Reactions Are Treated
Fortunately, the best and most common treatment for a stress reaction or fracture is rest. Simply avoiding the activity that caused the damage for a significant period, likely several weeks, may give the bone time to heal. Depending on the location of the injury, it may even be possible to stay active during the recovery time by switching to a low-impact form of exercise, such as swimming or cycling.
In more painful cases, a boot or crutches may be needed. And if a stress fracture is significant enough that it doesn’t heal on its own with rest, surgery may be required. However, those cases are few and far between.
The good news is that with stress reactions and fractures, rest and being smart about recovery really can work wonders. A six- to eight-week recovery time is not uncommon.
In Tatis’ case, the Padres are being cautious. In mid-August, he reportedly began to increase his rehabilitation regimen and the team hopes to have his powerful bat back in the lineup in time to help the final push for the playoffs.
Dr. Joel Smith is a board-certified orthopedic surgeon affiliated with Sharp HealthCare.
