Stress fractures are a common condition experienced by runners.

Causes of a stress fractures

In general, stress fractures are caused by too much load on the bone at one time. Excessive loading can be induced by increasing the intensity, volume or frequency of training. Also, excessive pounding on inappropriate surfaces or wearing old shoes does not help. Usually, we see stress fractures in military personnel, active sportspeople, or elite athletes. However, anyone that increases training suddenly over a short period is at risk.

Sometimes, people might have other causes unrelated to their training. For example, weakening of bones also known as osteoporosis can place you at increased risk. Weakening of bones can be secondary to vitamin deficiencies, hormonal imbalance, or other medications. In women, a condition known as ‘female athletic triad’, a combination of poor nutrition, eating disorders, and irregular periods can lead to weakened bones and increased risk of stress fractures.

How do we diagnose a stress fractures? 

Generally, pain occurs with impact activity such as walking, running, or sport. Initially, pain can be mild and vague meaning that stress fractures may be misdiagnosed as a muscle strain or joint arthritis. As the condition progresses, rest and night pain is common. Often, people with more severe stress fractures limp and have difficulty walking for any length of time.

Typically, a thorough examination is needed to confirm the diagnosis and exclude other causes of pain. Touching the bone is often painful. Hopping or jumping often reproduces pain at the fracture site.

In the early stages, an X-ray may be normal. Often bone scan or more commonly MRI is needed to see bone swelling and fracture.

Treatment of a stress fracture

Rest from impact activity is the best treatment. Often, taking some time away from running or formal sport will allow the bone to heal. Cross-training with non-impact activities such as swimming or cycling will keep you fit despite rest. Icing the fracture site can reduce swelling. Finally, we generally advise against medications such as ibuprofen, as anti-inflammatories have been shown to slow bone healing.

Overall, during this time of bone healing, we suggest you see your therapist to perform rehab exercises. Exercise therapy is important to develop a stronger pelvis and lower body to cope with the demands of running.

As the pain improves, we suggest gradual re-introduction of fitness activities such as gym and walking. Rather than starting running, we suggest a slower progression using a walk/run program.

In some cases, we recommend further investigations to check on your hormonal and bone health. For example, in cases with a suspected weakening of bones, we recommend hormonal blood tests and a bone density X-ray (also called a DEXA scan). Generally, it is important that hormonal or vitamin deficiencies are treated prior to returning to full activity. Vitamin D deficiency is common in UK and requires high dose supplementation over many weeks.


There are a few simple tips to prevent future stress fractures. First and foremost, controlling the amount that you do also known as load management is the most important factor. We suggest you use the 10% rule ie try not to increase your load by more than 10% per week. Secondly, eat healthily and increase foods containing calcium (dairy products) and Vitamin D (eggs, fatty fish). Finally, avoid exercising through pain and seek medical advise if your musculoskeletal pain does not settle with a few days of rest.

Dr Masci discusses specific stress fractures in these blogs:

Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.

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