DEAR DR. DONOHUE: My daughter runs track for her high school. She’s a junior and has been on the track team since her freshman year. This past week, she complained of thigh pain. For a couple of days we used a heating pad, but it didn’t work. I had her see an orthopedic doctor. He took X-rays, but nothing was found. He then had her take a CT scan. It revealed stress fractures of her femur.

 I have no experience with this. She isn’t in a cast, but she is on crutches. How long does this take to heal? Will she run again? — N.D.

 ANSWER: Stress fractures are tiny cracks in a bone. They come from doing too much work with too little rest. Athletes who suddenly increase their running time or running distances are the ones likely to develop stress fractures. They were a common injury for Army recruits until training schedules were modified to prevent them. Older people with osteoporosis are another sector of the population subject to them.

 Foot and lower leg bones are the ones that usually suffer stress fractures. They often are the cause of the shin pain called shin splints. The femur, the large thighbone, is less frequently involved.

 The pain of stress fractures ranges from mild to severe. Pain comes from the rubbing together of the surfaces of the stress cracks. Activity that doesn’t cause pain is permitted. By activity, I don’t mean your daughter should run. Crutches allow her to get around without pain. If she’s a swimmer, her doctor will probably allow her to swim to stay in shape.

 These fractures usually heal in three to four weeks. She might not be able to run this year, but she will next year. Only her doctor can approve of track running this year. If she is allowed to do so, she has to gradually work into it.

 DEAR DR. DONOHUE: What’s the better treatment for something like a muscle pull or a twisted ankle — ice or heat? I’ve gotten conflicting advice on this. — W.C.

 ANSWER: For the first two days of such injuries, cold or icing is the recommended therapy. Cold causes blood vessel constriction, which limits swelling. RICE is the acronym adopted for these injuries: Rest, Ice, Compression, Elevation. Apply the ice or cold for 10 to 15 minutes every two or three hours while awake.

 From that point on, heat is preferred. Dry heat like a heating pad and moist heat (submersion in hot water or covering with a towel moistened with hot water) are equally good. The water should not be boiling. Application of heat is in the range of 15 to 20 minutes around four or five times a day.

 Some authorities continue cold therapy throughout the recuperation period. Others alternate cold and heat in the same session. They claim that constriction of blood vessels with cold followed by expansion with heat creates a pumping action that reduces swelling faster. Stick with whatever feels better to the patient.

 DEAR DR. DONOHUE: You and other writers often tell exercisers to stay “well-hydrated.” That leaves me in the dark. What exactly does that mean?

 I need more precise instructions. I play hard racquetball for two hours at a time. — R.M.

 ANSWER: To stay well-hydrated, drink two 8-ounce glasses of water two to three hours before you get on the racquetball court. That’s enough time for water to leave the stomach and be absorbed.

 While playing, drink half a glass of water every 30 minutes. The fluid doesn’t have to be water. If you want to drink a sports drink, go ahead.

 You know if you drank enough fluid by weighing yourself before and after play. A pound of weight loss indicates your lost three-quarters of a quart of fluid. You haven’t lost fat weight. It’s all fluid.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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