Stress Fracture – Prevention and treatment

Tuesday, 03 November 2015 1193 Views 0 Comments
Stress Fracture – Prevention and treatment

By Shailja Kaushik

Stress fracture is a very common sports injury and the name alone frightens athletes.  According to an article, published in the International Journal of Sports Medicine, athletes at an international level face a greatest risk of multiple separate fractures, protracted healing or fractures requiring surgery.[i]

What is a stress fracture?

When an athlete is involved in excessive physical activity, the muscles tend to become so tired that they are unable to absorb any more shock. The excess stress gets transferred to the bone which develops tiny cracks and this condition is known as a stress fracture. Thus, it is an overuse injury and mostly affects the bones which bear the weight in the lower leg, particularly the feet.

In the research study Stress Fractures in Athletes, 320 cases of athletes diagnosed with stress fractures were analysed, and the most common bone injured was – tibia (49%) followed by the tarsals (25.3%), metatarsals (8.8%), femur (7.2%), fibula (6.6%), pelvis (1.6%), sesamoids (0.9%) and spine (0.6%).  Tarsal stress fractures take the longest time for diagnosis and recovery.[ii]

Stress fractures can be low risk or high-risk. While low risk stress fractures heal faster without the use of assistive devices; high-risk stress fractures do not heal easily and the person has to rest for a longer period. Low-risk fractures involve bones such as tibia, fibula, metatarsal bones; high-risk fractures, though not very common, involve the pelvis and the femur.


The primary causes of stress fractures are:

  • Sudden increase in the intensity or amount of exercise
  • Switching running surfaces, from soft to hard
  • Wearing improper or worn-out shoes
  • Considerable increase in the time spent running
  • In high-intensity sports such as track running, gymnastics, basketball, volleyball and tennis, there is recurring stress every time the foot strikes the ground, causing trauma to the muscles
  • Insufficient rest between activities or workouts
  • Weak and narrow bones.

In a study published in the Annals of Internal Medicine, four findings about those suffering from stress fractures were surprising[iii]:

  1. Athletes with stress fracture had lower bone mineral densities
  2. Injured subjects had a higher incidence of menstrual irregularity
  3. Use of oral contraceptives protects against the development of stress fractures
  4. Subjects with stress fractures had lower intakes of dietary calcium and dairy products.


  • Engage in strength training which in turn enhances the size, strength and endurance of leg muscles
  • Gradually build up your stamina by setting up incremental goals over a period of time
  • Cross-training i.e. alternating activities such as running one day and cycling the next will also play an important role in preventing stress fractures
  • Eating a healthy diet with calcium and vitamin-D rich foods increases the strength of bones.


  • Activity-induced pain which goes away with rest
  • Burning sensation along the affected bone, usually the foot
  • Pressing the area inflicts pain
  • Pain aggravates on running, walking or putting even slight weight on the affected bone
  • If the stress fractures are in the tibia or femur, the muscles around the bone will also feel stiff.


  • You must immediately visit an orthopaedist if a stress fracture is suspected. Usually doctors perform a bone scan or MRI to diagnose a stress fracture
  • If you do suffer from a stress fracture, complete rest and analgesics are the first line of treatment. One should take rest for 3 to 6 weeks except in the case of stress fractures in the femur, when the rest period is usually in the range of 2 weeks
  • Braces or shoe inserts should be used to heal the injury
  • Until symptoms subside, avoid all strenuous activities[iv]
  • While you are recovering try to follow a light aerobic exercise regime, healthy diet and lifestyle. On the comeback, your doctor or trainer will advise you to start with cross-training. Keep it slow and light before you move onto a faster and heavier training pace.


[i] Hulkko A; Orava S. Stress Fractures in Athletes. International Journal of Sports Medicine. 1987, 8(3):221-226] [i] Hulkko A; Orava S. Stress Fractures in Athletes. International Journal of Sports Medicine. 1987, 8(3):221-226] [i] Hulkko A; Orava S. Stress Fractures in Athletes. International Journal of Sports Medicine. 1987, 8(3):221-226] [ii] G.O Matheson; D.B. Clement; D.C. Mckenzie; J.E. Taunton; D.R. Lloyd-Smith and J.G. Macentyre. Stress Fractures in Athletes: A Study of 320 cases. American Journal of Sports Medicine. 1987.
[iii] Kathryn Myburgh; Janice Hutchins; Abdul B, Stephen Hough and Timothy Noakes. Low Bone Density is an etiologic factor for stress fractures in ankles. Annals of Internal Medicine. 1990.
[iv] S. Tzila Zwas; Raya Elkanovitch and George Frank. Interpretation and Classification of Bone Scintigraphic Findings in Stress Fractures. Journal of Nuclear Medicine. 1987.

(Dr. Rohan Habbu is an Orthopedic Hand, Nerve & upper Extremity Surgeon. He has done Fellowship in Arthroscopy & Sports Surgery and is an avid runner. To know more, reach out to him on or +91 982017 13941)

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