February 21, 2017

Understanding Stress Fractures

You’re out for your morning run when suddenly you develop a severe pain in your foot. Or maybe you’re playing your weekly game of tennis when your lower shins begin to ache. The pain subsides when you’re not exercising, but comes back when you start exercising again. You head to the doctor and hear an unexpected diagnosis: You’ve experienced a stress fracture.

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Sticks and Stones Can Break Your Bones … and So Can Stress Fractures

Injured bones come in many forms. While most complete fractures are obvious especially when they are are out of normal position (displaced) or through the skin (compound), some fractures may not be easily detected even with conventional x-rays. One of the most common types of fracture is the stress fracture. Rather than a complete break occurring from one side of the bone to the other side, a stress fracture occurs within in the bone typically at a microscopic level. With a stress fracture there may be a hairline crack in the outside shell of the bone (cortex) or within the interior honeycomb lattice work of the bone. Each of these tiny cracks or bone defects on its own would not cause significant discomfort, but taken together, they can be quite painful. Left untreated, this can lead to more significant injury, including a complete bone break.

How Stress Fractures Happen

The bone is a living structure no different than any part of the body. Each day as we go about our normal activities, our bones break down, but with proper nutrition and rest, the lost bone is replaced with new bone in an endless cycle. However, when something throws that cycle out of balance — poor nutrition, inadequate amounts of sleep, certain metabolic disorders, or most commonly, extreme repetitive physical activity — the amount of bone that is replaced does not equal the amount that is lost. As a result, the number of tiny cracks and damage in the bones increases, leading to the pain and discomfort of a stress fracture.

Stress fractures can occur in almost any bone in the body, but are most common in the lower extremities, particularly the foot and ankle. Runners are most susceptible to stress fractures, particularly distance runners because of the repeated stress of the foot hitting the ground. However, athletes in almost any sport can experience stress fractures. For example, even golfers have reported stress fracture injuries in their ribs. Overuse is usually the culprit in these injuries, although wearing inappropriate footwear or using improper technique can also cause this painful injury.

Osteoporosis, caused either by aging or inadequate diet, is also a risk factor for stress fractures. Women who lack bone density may experience fractures by engaging in daily activities, making management of osteoporosis vital to preventing injury.

Diagnosing Stress Fractures

The first sign of a stress fracture is pain. Unlike a broken bone, in which the pain starts immediately after injury and doesn’t go away, the pain from a stress fracture increases in intensity over time and diminishes with rest. There could be some swelling or bruising at the sight of the fracture, as well as tenderness in that spot. If you suspect a stress fracture, a doctor can confirm the diagnosis, by examination and in some cases confirmation with an x-ray. However, because the fractures are generally small, hard to see, and typically missed on conventional x-rays, more advanced imaging such as an MRI may be required for diagnosis.


The best treatment for a stress fracture is rest. It usually takes from six to eight weeks for a stress fracture to heal. During this time, your physical activities will be limited to low- or no-impact exercises, such as swimming. In some cases, you may need to wear protective footwear or a cast and use crutches for several weeks to allow your injury to heal. In rare cases, when the fractures do not heal, surgery to may be required.

If You’re In Pain

Stress fractures are common. If you experience any type of pain while exercising or playing a sport, stop the activity and apply basic first aid — apply an ice pack and elevate the limb to reduce swelling — and see a doctor as soon as possible. Do not try to play through the pain as you could do more serious damage to your bone, including a more serious fracture. The sooner you diagnose and treat a stress fracture, the sooner the cracks will heal and you can get back on the track or court.

Of course, prevention is always worth more than the cure, so take care to avoid stress fractures. Go easy when starting a new activity and incorporate adequate rest into your workout plans to avoid overuse. Wear high-quality footwear and use proper technique, and you’ll stay healthy and pain-free no matter which sport you choose.

About the Author: Paige Gale writes about health, fitness and sports medicine for several blogs and magazines. An accomplished athlete, Paige spent two months recovering from a stress fracture due to marathon training; she credits Dr Ron Glousman with getting her back into shape.

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