What is a stress fracture?
Stress fractures occur most often in sports that place repeated, high-impact stress on the bones over long periods of time. Particularly, when training volume, intensity or frequency increases more quickly than the body can safely adapt. In these situations, microscopic bone damage accumulates faster than the normal bone repair process can keep up. Without adequate recovery, this ongoing overload weakens the bone structure and can progress from a stress reaction to a true stress fracture. The risk is further amplified when athletes train on hard surfaces, lack sufficient rest or have underlying factors such as inadequate nutrition or low bone density.
Causes of a stress fracture
Stress fractures are common in sports that involve repetitive impact and high training volume. They typically occur when a bone is subjected to sudden increases in training intensity, frequency or duration. Fatigue, poor biomechanics, hard training surfaces or inadequate nutrition can also increase the risk of developing a stress fracture.
Common causes include:
- Repetitive impact or overuse
- Sudden increase in activity intensity, duration or frequency
- Inadequate rest between activities
- Poor footwear or training on hard surfaces
Risk factors for a stress fracture
- Participation in high-impact sports
- Rapid changes in training routines
- Low bone density or osteoporosis
- Nutritional deficiencies, including low calcium or vitamin D
- Female athlete triad (low energy availability, menstrual irregularities, low bone density)
Symptoms of a stress fracture
The most common symptoms of a stress fracture are localized, gradually increasing pain at the site of the fracture which typically worsens with weight-bearing or repetitive activity.
- Localized pain that develops gradually and worsens with activity
- Pain that improves with rest but returns with weight-bearing
- Swelling or tenderness over the affected area
- Pain that becomes constant as the injury progresses
Diagnosing a stress fracture
Diagnosis is based on medical history and physical examination. X-rays may initially appear normal, so MRI or bone scan is often used to confirm the diagnosis.
Treatment of a stress fracture
If you suspect you have a stress fracture limit weight-bearing activities to prevent further injury. You should schedule an appointment to determine the severity of the fracture and begin an appropriate recovery plan.
- Rest, ice and avoidance of high-impact activities
- Activity modification or cross-training
- Protective bracinig
- Pain management with non-impact measures
- Gradual return to activity once healing occurs
- Physical therapy
Recovery from stress fracture
Recovery from a stress fracture demands patience and a gradual progression to return to activity because bone heals at a slower rate than muscle or tendon. It is less tolerant of premature loading. Successful rehabilitation prioritizes complete bone healing by initially reducing or eliminating the repetitive stresses that caused the injury, then progressively reintroducing load in a controlled manner.
Equally important is identifying and correcting the underlying contributing factors, such as training errors, inadequate recovery, biomechanical issues or nutritional deficiencies. By respecting the healing timeline and addressing the factors that contribute to the injury, athletes can return to activity safely with a stronger foundation and a reduced risk of reinjury.
When to seek care for a stress fracture
- Pain persists or worsens despite rest
- Pain occurs during normal daily activities or at rest
- Noticeable swelling or tenderness over a bone
- Inability to bear weight
- History of osteoporosis or recurrent stress fractures