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in the case of ptsd, the single exposure ptsd model was in part inspired by clinical response to trauma treatment. the model has been extended through empirical research to work both with single and multiple trauma exposure and focuses on the criteria set forth by the dsm-iv for the diagnosis of ptsd (apa, 2000). the model may be applied to help with diagnosis, prognosis, and treatment planning (o’malley, clark, & ronald, 2010).
there are a number of common stress-related conditions that can negatively impact a major life event. the most common are specifically related to stress such as marital discord, bereavement, or substance-use problems (singleton et al., 2004). another set of medical conditions that can be triggered by stress-related conditions is the “stress fractures.” this term refers to injuries from exposure to prolonged, repeated, and sometimes high intensity stress (brost-walter, chiarello, wylie, walker, & dennis, 2001). stress fractures can range from stress-related muscle injuries, which are caused by an overuse of a muscle group and occur less often as an actual injury (maupin, krolak, jacobson, & freed, 2001) to stress-induced fracture of a bone, including the tibia, fibula, sternum, femur, or pelvis. both lower limb extremities are most commonly affected (2:1) and 85% of stress fractures occur in the weight-bearing portion of the leg (simkins, szűcs, drew, paine, & gauthier, 1995). stress fractures can be caused by overuse, or more commonly, an event that creates undue and extreme stress (chiarello, o’connor, lehman, & freeman, 2004; daniels et al., 2007; roberts, dye, manley, & sowden, 2009). unfortunately, stress fractures are often not identified early or detected on the first clinical presentation and are often misdiagnosed as a musculoskeletal injury. thus, it is not uncommon for doctors to treat patients with an initial diagnosis of a stress fracture but then discover at the end of the course of treatment that the injury is a stress fracture rather than a musculoskeletal one. in fact, those attending an athletic competition or training who complain of leg pain, especially when in contact sport activities, should be followed up by a knowledgeable physician or physiotherapist (roberts et al., 2009). the term, stress-induced bone disease, is another, broader term for stress fractures. because stress fractures can be seen in patients with other medical conditions, the inclusion of stress fractures in the broad category is an oversimplification. some stress fractures are caused by abnormal bone development or remodeling, for example, in a patient who has hyperparathyroidism (brost-walter et al., 2001). despite this, for the purposes of this guidance, stress fractures are included with stress-related medical conditions.
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