Stress Fracture

A stress fracture is a common sports injury that results from overuse or repeated stress to a bone. It usually occurs in the low leg, such as the tibia and ankle. A stress fracture differs from other bone fractures that are usually the result of a single, traumatic event.

Stress fractures produce pain directly over the site of the fracture. The pain is made worse by activity and is relieved with rest. 

A stress fracture usually occurs when muscles become tired and are unable to absorb the added shock that occurs during physical exercise. As a result, excessive stress is transferred directly to the bone causing a tiny crack that may sometimes be referred to as a “hairline fracture”.

Stress fractures often are the result of increasing the amount or intensity of an activity too rapidly. They also can be caused by the impact of an unfamiliar surface, improper equipment (a runner with shoes with worn soles) and increased physical stress (an athlete who undergoes a significant increase in playing time).

Studies have shown that athletes participating in tennis, track and field, gymnastics, and basketball are very susceptible to stress fractures. In all of these sports, the repetitive stress of the foot striking the ground can cause trauma. Without sufficient rest between workouts or competitions, an athlete is at risk for developing a stress fracture. 

Diagnosis of Stress Fractures

The diagnosis can be made with a thorough medical history and physical exam. Bone tenderness will be evaluated, as will the condition of the soft tissue and surrounding joints. Additional tests may not be necessary. 

X-rays usually do not show any evidence of a stress fracture until after several weeks of pain. Occasionally, a computed topography (CT) scan or magnetic resonance imaging (MRI) may be considered.

Treatment of Stress Fractures

The most important treatment is rest. Individuals need to rest from the activity that caused the stress fracture, and engage in a pain-free activity during the 6-8 weeks it takes most stress fractures to heal.

If the activity that caused the stress fracture is resumed too quickly, larger, harder-to-heal stress fractures can develop. Re-injury also could lead to chronic problems where the stress fracture might never heal properly.

Stress Fracture Prevention

The following tips may help to prevent stress fractures:

  • Set incremental goals. Gradually build up your activity level when starting a new sport or exercise regimen. For example, do not immediately set out to run 5 miles a day.
  • Cross-training. Pursue alternating activities that accomplish the same fitness goals. Instead of running every day to meet cardiovascular goals, add biking or swimming to your weekly regimine. Add strength training and flexibility exercises.
  • Maintain a healthy diet. Eat a healthy, well-balanced diet with a sufficient source of calcium and vitamin D. 
  • Use proper, well-functioning equipment. Do not wear old or worn running shoes.
  • Stop and rest. If pain or swelling occurs, immediately stop the activity and rest for a few days. See your doctor if continued pain persists.

It is important to remember that if you recognize the symptoms early and treat them appropriately, you can return to sports at your normal playing level.

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Last updated: 5/13/2022