Stress Fractures

It is that time of year, there has been an increase of activity over the past few months with the pre- season training for university sports, the start of the rugby and hockey season and the end of Oxford half marathon. As a result, we have seen a few clients with stress fractures in clinic recently. Therefore, we would like to expand on the topic of stress fractures, how they happen and what you can do to prevent and manage them.

What are stress fractures?

Stress fractures are common but often underestimated injuries that can affect anyone, from athletes and active individuals to those who engage in routine physical activities. They typically occur due to repetitive stress, overuse or overloading activities. They are small, hairline cracks in the bone that develop over time, and if left untreated, they can lead to more severe complications. Stress fractures typically occur in stress-loading bones such as the shin bone, the foot (metatarsals) or the hip (femoral/pelvis). An MRI scan is usually carried out to confirm clinical diagnosis.

How do stress fractures happen?

Normally in bone, there are cells called osteoblast, which help to make new bone tissue, and osteoclast which break down old bone. These cells work in harmony together continuously in equilibrium to ensure that our bones are strong and healthy. This process is called bone remodelling. Overloading forces and repetitive stresses on the bone can disturb the natural bone remodelling process. This means the forces acting on the bone are too great for the osteoblasts to lay down new bone to repair the bone. This results in a stress reaction in the bone tissue which is a warning signal to stop the repetitive loading. If the repetitive overloading of the bone continues, this can lead to the development if a stress fracture.

What are the risk factors?

  1. A sudden increase of load or intensity of repetitive activities including running, brisk walking, jumping.
  2. Inadequate rest in training
  3. History of Osteopenia or Osteoporosis
  4. Women, mostly pre- and post-menopause. Oestrogen is the female sex hormone that drops during menopause. Research has shown that Oestrogen has bone protective qualities are or lost as this hormone drops which subjects post-menopausal women to a higher risk of developing a stress fracture
  5. Presence of or history Vitamin D, other nutritional deficiencies or malnutrition
  6. BMI <19
  7. Smoking
  8. Oral steroid use

What are the Symptoms of Stress Fractures?

  1. Pain felt over a small and specific area which usually develops over time.
  2. Pain is typically exacerbated with weight-bearing and is better with rest. However, pain can begin to be present at night and at rest if the bone is not properly rested.
  3. Bone tenderness to touch
  4. Presence of swelling

It is important to note that not all stress fractures present will all the typical symptoms and if you suspect you have a stress fracture it is best for you to come and see us for a full and extensive assessment.

How are stress fractures treated?

If there are signs that the injury is due to overtraining, repetitive exercises, a sudden increase of activity then rest and off-loading from any repetitive activity will usually allow the injury to improve. For stress fractures in the feet that may be causing you to limp we may recommend complete off- loading and the use of an aircast boot and in some cases crutches to protect the bone. However, if there is no clear history of excessive or repetitive loading, further investigations would be required to help to understand the cause of the injury. For example, a DEXA bone scan, which involves taking an x-ray of the affected area and compare your bone density with a normal population for your age group. This helps us to identify if you have osteopenia, the initial stage of bone loss or osteoporosis, the more severe progression of bone loss which increases the risk of bone fractures.

Additionally, we may advise you to get a blood test to check for any vitamin deficiencies such as calcium and vitamin D levels. Both of which are vital for bone health and structure. It is important for us to consider not just your activity levels but also your nutrition and past medical history.

Prevention of stress fractures
Preventing stress fractures is often more manageable than treating them. Here are some tips to help reduce your risk:

  1. Gradually increase the intensity and duration of your workouts to allow your body to adapt to the stress.
  2. Appropriate Footwear: Invest in good-quality athletic shoes that provide adequate support and cushioning for your specific activity.
  3. Strength and Conditioning: Engage in a variety of physical activities to prevent overuse of specific muscle groups and bones.
  4. Ensure you have a health balanced diet to meet you physical demand


Stress fractures can be painful and debilitating, but with prompt diagnosis and proper treatment, a full recovery can be made. By understanding the causes, symptoms, and treatment options for stress fractures, you can take steps to prevent them and maintain your bone health. If you suspect that you may have a stress fracture or you feel you may be at risk of developing one please feel free to contact us at Tops:health for a personalised assessment and guidance. We are always happy to help.

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