Everything You Need to Know About Stress Fractures

In a perfect world, you'd be able to always perform at maximum intensity, pushing to reach new personal records as you go. In reality, injuries can (and do) happen. If pain continues to be ignored, certain injuries can progress into a stress fracture.

Stress fractures tend to be more common in the lower extremities, like your feet and legs, said Kenneth Jung, MD, a foot and ankle orthopaedic surgeon at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles and foot and ankle consultant to the Los Angeles Rams.

While stress fractures are common, the injury itself can seem somewhat murky. Here's what you need to know about stress fracture symptoms, how they occur and steps to take to treat the affected area.

A stress fracture is a tiny crack that forms in a bone, according to the American Academy of Orthopaedic Surgeons, or AAOS. It's different from a classic fracture though.

"Stress fractures are different from regular fractures because they do not involve a high velocity injury or significant trauma", said Jasmine Toor, MD, a sports medicine physician at Baltimore's Mercy Medical Center. Instead, she said, they tend to happen from exercises that require a lot of repetition, like long-distance running or gymnastics.

Stress fractures are most common in "weight-bearing bones of the body as this is where most weight and forces transfer during certain exercises and activities", Toor said.

A stress fracture is "visible on an X-ray", said Phillip Adler, PhD, ATC and licensed athletic trainer and operations manager of orthopaedic outreach for Corewell Health West medical centre in Grand Rapids, Michigan.

According to the AAOS, stress fractures are usually a result of overuse. They happen when muscles become fatigued and aren't able to absorb added shock. The muscles then transfer the extra stress to the bone, causing a crack to form.

Stress fractures can happen with activities that tire out muscles or are repetitive, leading to a high demand on the bones, Toor said.

When a stress fracture happens, "people are either increasing the frequency of training too fast and don't give the body a chance to recover, while loading the bone the same way every day or doing the same intensity workout every day", Jung said.

These factors can "lead to overuse of the bone", Jung said, noting that he sees this "in a lot of youth athletes where they're playing on multiple teams and overlap in teams and sports". Adult runners and athletes are also prone to stress fractures from increasing their mileage too quickly, Jung said.

(Related: How to Increase Your Running Mileage Without Getting Injured, According to Experts)

Pain with activity is the most common complaint with a stress fracture, the AAOS said, noting that symptoms begin to subside with rest. The exact amount of rest required varies but the AAOS said it typically takes six to eight weeks to heal.

According to the Cleveland Clinic, the following may also be symptoms of a stress fracture:

• Pain, swelling or aching at the site of fracture
• Tenderness or "pinpoint pain" when touched on the bone
• Pain that happens when you're not exercising, during normal activity or with everyday walking
• Pain that is worse with hopping on one leg

Treatment for a stress fracture is "typically a matter of reducing the stress or load on the bone", Jung said. If you have pain while walking, for example, your doctor may recommend that you wear a boot to help decrease the stress on your lower leg or foot. In some instances, athletes will need crutches, Jung said.

As for how much rest is needed, Toor said it really depends on a few factors, including the location of the stress fracture and how well it heals over time. Your doctor can determine the latter during follow-up visits.

In general, though, the AAOS noted that it typically takes six to eight weeks to recover from a stress fracture.

Following a period of rest, Toor said it's imperative to gradually get back into exercises, slowly ramping up the intensity and duration to avoid putting too much stress on the bone. "This is typically monitored by physiotherapy and a sports medicine physician", she said.

Another thing your doctor will probably want to do is check your form. "It is very important to correct form and technique that may have contributed to the stress fracture", Toor said. "A detailed assessment, which can include an evaluation of muscle flexibility, strength and gait assessment is important as impairment in strength and flexibility of muscles result in abnormal forces on the weight-bearing bones".

If your form is off and your GP suspects that led to your stress fracture, it's vital to work to correct it. Repeatedly practising incorrect form could raise the risk of another stress fracture, she said.

There are a few things you can do to lower the risk of developing a stress fracture.

• Strength training. "I recommend strength training to ensure that the muscles around common areas are strong enough to absorb impact or stress so the bone does not have to", Adler said. Consider working with a certified personal trainer or licensed physiotherapist to develop a strength training programme that's specific to your weak points and general body makeup.
• Supportive shoes. "Make sure shoes are properly fitted with enough support based on foot arch type and running style", Adler said. Long-distance runners also need to be mindful of mileage on a shoe, he said. It's generally recommended that you change your shoes every 500 to 800 kilometres.
• Cross-train. Mixing up your go-to exercises can help relieve stress on your bones, Jung said. That means making sure you have a few cross-training days in the mix each week so you're not constantly stressing your bones in the same way, he said.
• Eat a healthy diet. That includes plenty of calcium and vitamin D-rich foods, Jung said. You can ask your GP to test your blood if you're concerned that you may have a deficit in these nutrients.