Injury Tip Sheet: Stress Fractures

Bryan Christie

Bryan Christie

Injury Tip Sheet: Stress Fractures

Learn what you need to know to help treat and prevent this common injury

Kathy Weber, M.D., M.S.
Daphne R. Scott, PT, Dsc
Chicago, IL

Fast facts

  • Occur most often in the leg and foot
  • Occur more often in women than in men
  • Majority heal without surgery or complications

What you need to know

What is a stress fracture?

  • Stress fractures are tiny (micro) breaks that occur in bones
  • Bones, like muscles, need time to recover.  If you demand too much of the bone it weakens and can develop small breaks or fractures
  • Stress fractures are generally the result of overuse; when muscles become weakened or fatigued by overuse they cannot properly absorb repeated shock or impact and the impact gets transferred to the surrounding bone

Signs & symptoms

  • Pain at the site of the fracture; symptoms for stress fractures in the lower leg can be similar to symptoms for shin splints
  • Localized pain at the site of the stress fracture
  • There may be mild swelling
  • Initially the individual may experiences localized pain at the site during exercise and typically decreases after exercise or with rest
  • Pain initially will resolve with rest but overtime if the stress fracture is not treated pain will be noted during rest

When should I see a doctor or other professional?

  • You should see a doctor if the pain does not decrease with rest or the pain persists
  • You develop a rash or redness and bruising at the injury site
  • If pain does not subside with time, see your doctor
  • Your physician will perform a physical exam and typically radiographs of the area will be obtained.  If the radiographs are inconclusive, your physician will determine if further imaging is necessary to determine the exact location and severity of the fracture
  • Many times the clinical history and the exam is sufficient to diagnose a stress fracture

Causes

  • Repetitive pressure or use of force on a bone, such as with running or jumping
  • Increasing the intensity of training without proper conditioning
  • Sudden trauma to the bone such as landing improperly after a long jump or a direct blow to a bone can result in a stress fracture

Risk factors

  • Individuals who have weakened bones from conditions such as osteoporosis
  • Athletes who play on hardened surfaces or who use worn out shoes or orthotics
  • People who have flat feet or high arches
  • Increasing activity to much, to soon, without adequate recover

What you can do

Prevention

  • Never increase the intensity of your workouts by more than 10% each week
  • Ensure that you properly stretch prior to and after all workouts
  • Make sure you rest between workouts to allow your body time to recover
  • Cross training and maintaining a healthy diet to improve bone strength can help improve bone health

Recommendations for treatment and rehab

  • Treatment is specific to the type and location of the stress fracture.  Some stress fractures require strict immobilization and non-weight bearing status while others may be treated with relative rest and others with surgery.  Your physician will tailor the treatment to the specific stress fracture.
  • Elevate the limb, if possible, and ice the site of the fracture to reduce swelling
  • You should work with you physician to develop a return to activity guideline.  Remember if you return to your regular activity too soon, recovery time lengthens and the fracture could have difficulty healing

What can I do to stay active?

  • Participation in any weight bearing activities if the stress fracture is in the leg will be at the discretion of a doctor and should only be participated in after consulting with a health care professional
  • Low impact activities such as swimming can typically be performed but should be approved by your treating physician prior to participation in said activities
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