Stress fractures — small cracks in the bone — are common in runners and in people who do repetitive high-impact activities. Rest, modified activity, and strength training are the usual ways to manage them, but newer technologies can accelerate healing and return to sport. One such technology is LIPUS treatment, a type of ultrasound therapy for fracture healing.  

What is LIPUS?

LIPUS, or low-intensity pulsed ultrasound, uses low-intensity sound waves delivered in short pulses to stimulate bone healing. Originally developed to treat traumatic fractures, it’s now also used for complicated stress fractures, which are known for slow recovery due to a limited blood supply.  

How does LIPUS work for stress fractures?

LIPUS machine used for upper limb fracture

We think the pulses from LIPUS improve healing in several ways: 

  • Stimulating bone cells to build up new bone
  • Improving the blood supply, which delivers oxygen and nutrients to the damaged area
  • Assisting calcium deposition, making the bone stronger

Who should use LIPUS?

Alongside other treatments, LIPUS can help heal high-risk stress fractures such as:

  • Medial malleolar stress fractures
  • Base of the first or second metatarsal stress fractures

Recent evidence supports LIPUS for slow-healing stress fractures. One study found that navicular stress fractures treated with LIPUS healed about 40% faster, with less pain, than those treated conservatively alone. Another study found that anterior tibial stress fractures were successfully treated with LIPUS therapy.

How to use LIPUS treatment

LIPUS therapy is usually applied daily for 20 minutes, directly onto the stress fracture site, using an attachment strapped to the limb. The ultrasound waves penetrate the skin and soft tissue to stimulate bone growth and blood flow. It’s painless and non-invasive.

Additional treatments for healing stress fractures

Other treatments enhance the effect of LIPUS on bone healing:

  • Relative rest from impact activity, supported by offloading devices such as walking boots or crutches. Cross-training, such as swimming and aqua jogging, maintains fitness while the fracture heals.
  • Optimising vitamin D and calcium, which are critical for fracture healing. Low levels slow healing and delay the return to sport. In some cases, extra tests — blood tests and a DEXA scan — are needed to assess bone health.

Frequently asked questions about LIPUS treatment.

Does LIPUS work for stress fractures?

The evidence is most supportive for slow-healing, high-risk stress fractures (such as the navicular and anterior tibia), where studies suggest faster healing and less pain. For simple, low-risk fractures that heal well on their own, the added benefit is less clear — which is why we use LIPUS selectively, for the fractures most likely to be slow to heal.

How long does LIPUS treatment take?

Each session lasts about 20 minutes and is done once daily at home. The overall course spans several weeks to a few months, depending on the fracture and its response.

Which stress fractures benefit most from LIPUS?

The high-risk, slow-healing ones — anterior tibial, navicular, Jones (fifth metatarsal), medial malleolar, and base-of-metatarsal stress fractures. These have a poorer blood supply and are more prone to delayed or non-union, so a healing boost is most valuable here.

Can I buy or rent a LIPUS machine?

LIPUS devices (for example, the Exogen system) are usually supplied or prescribed by a specialist, and rental options are available in some countries. Availability varies by region, so if you’re outside the UK, it’s best to ask a local sports medicine or orthopaedic service how to access a device.

Is LIPUS painful?

No. LIPUS is painless and non-invasive — you feel little or nothing during a session, as the sound waves are low-intensity.

Does LIPUS replace rest?

No. LIPUS is an adjunct to the core treatment of a stress fracture — relative rest and offloading, good bone health (vitamin D and calcium), and a graded return to activity. It supports healing rather than replacing these measures.

Final word from Sport Doctor London about LIPUS treatment

Low-intensity pulsed ultrasound (LIPUS), together with supportive measures such as relative rest, vitamin D, and calcium, offers a comprehensive approach to healing complex stress fractures. By enhancing bone healing and blood flow, LIPUS can reduce recovery time and improve outcomes in fractures most likely to heal slowly.

If you have a stress fracture that’s slow to settle, Dr Masci can assess you in London and advise whether LIPUS is appropriate. Contact the team here or call +44 (0) 203 488 0350.  

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