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Stress fractures in runners.

Risk factors and signs and symptoms to watch for.

What is a stress fracture and is it different from a ' normal ' fracture ?


Essentially it is a small crack in the bone or a series of tiny microfractures in the hard matrix of the bone. Stress fractures are usually caused by overuse over a period of time rather than a sudden impact but both will need rest to allow the bone to heal. It's unsual for stress fractures to need any surgery as traumatic fractures sometimes need but the nature of the treatment will depend upon which bone is affected.

Occasionally stress fractures can cause a ' complete ' fracture if left untreated.



Which bones get stress fractures ?


They are far more common in the weightbearing bones of the lower limb with over 60% of them in the shin but they can occur in the heel, foot bones or the neck of the thigh bone or sacrum and spine. Some sports like gymnastics can cause problems in the wrists and hand sbut htisis far less common. Treatment often varies according to which bone is affected as some need a more aggressive treatment regime to prevent any further issues.


When do stress fractures happen ?


Stress fractures generally occur though bone that is weakened either by prolonged excessive use. It's more common in certain sports or activites where there is prolonged or repetitive loads placed through the skeleton particularly things like distance running, gymnastics, tennis or dancing. The most common culprits in stress factors include :


  • Overtraining or a change in training regime.

  • Poor recovery post training - recovery is important to help the bone replace cells lost during training. This weakens the bone.

  • Poor sleep

  • Stress - long term cortisol can cause to mild ostopenia

  • Fatigue - poor recovery

  • Hormonal changes ( especially post menopausal or post natally )



Are any groups more at risk ?

As we have already seen the very nature of some sports makes them more prone to causing stress fractures. Likewise some groups of people will be at a slightly higher risk of developing them.


  • Prev stress fractures - if it's happened once then unfortunately there is a higher chance of it happening again.

  • Female - stress fractures are more common in young females athletes particularly if the menstrual cycle is irregular.

  • Low BMI or sub-optimal nutrition - Restrictive diets or not having enough energy intake to fuel your activity levels can lead to a lack of vitamins needed to maintain bone health

  • Foot problems - some foot problems can alter the way your foot transmits weight through your lower elimb causing excessive stress in some areas of the skeleton.

  • Prev steroid use - prolonged steroid use will weaken the structure of the bone

  • Post Pregnancy - the huge hormonal changes can predispose to poor bone health - coupled with the poor sleep, stress and a relatively rapid increase in activity it can be perfect grounds for bone problems.


What are the symptoms that might mean I have a stress fracture ?


Stress fractures are often best diagnosed by taking a careful history and physical examination

  • Pain with activity - especially in weight bearing positions.

  • Worse with increasing activity

  • Night pain

  • Pinpoint tenderness or bony tenderness

  • Sometimes swelling if the bone is close to the surface


MRI scans can be used to diagnose if there is any uncertainty. X-rays are of limited use as it just isn't sensitive enough to be reliable.


What is the treatment for a stress fracture ?


To a degree it will depend upon the bone affected - some bones such as the top of the femur or the tarsal scaphoid in the foot can be slow to heal and can cause chronic problems if persistant so they tend to be treated more aggressively. Always listen to your health professional and resist the urge to get back to too much activity too soon. It really is a case of being patient and waiting for Mother Nature to heal the skeleton.


  • Rest- THIS IS ESSENTIAL ...stopping the loading going through the bone will give it a chance to heal and reabsorp valuable nutrients.

  • Change in training regime - introducing unloaded activities such as cycling or pool work to your training programme. Rest days are just a s important as training

  • Offloading the affected bone - orthotics or taping can sometimes help to relieve the stress through the bones

  • Reducing inflammation - ice or anti-inflammatory / painkillers can be used if the pain is making walking difficult. Ice can also be used if the bone is close to the surface suvh as the foot or shin.

  • Adequate nutrition - if the right building blocks are not available then new bone won't be built. Adequate nutrition fo ryour energy expenditure is important for every athlete.

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