Stress Fractures

A stress fracture is a type of fracture which usually occurs as a result of abnormal repetitive loads over short periods of time without sufficient rest. 

Our bones are constantly regenerating. In healthy individuals, bone tissue is constantly broken down and rebuilt. A stress fracture occurs when bone is broken down faster than it may be rebuilt. This may occur in a range of sites, more commonly seen through the tibia, femur, pelvis and bones of the feet (i.e. navicular, metatarsals). 

Everytime we exercise, forces are placed through our bones which create ‘micro-damage’. This ‘micro-damage’ is quite normal and in most circumstances the body is able to heal and regenerate without any symptoms. If the exercise we are completing is too long, frequent and intense, then our body may not have sufficient time to recover and a stress fracture may occur. Furthermore, we may be at risk if the rate in which our bone can regenerate is impaired. This may be due to a number of different factors which we will discuss below.

Risk factors for stress fractures:

There are many risk factors associated with the development of a stress fracture. If any of these factors are relevant to you, it is important that you tell your physiotherapist.

  • Female sex
  • High training volume, particularly high repetition and intensity
  • Limited rest between training
  • Low or high body mass index (BMI)
  • Irregular menstrual cycle
  • Poor nutrition (particularly if attributable to disordered eating)
  • Use of oral contraceptive pills
  • Prior stress fracture
  • Aged between 12.5 – 34 or elderly
  • Biomechanical factors (i.e. high foot arch, leg length discrepancy)


To confirm the presence of a stress fracture, your treating clinician may refer you for an MRI, as they are better at detecting bone stress injuries compared to a regular x-ray.

Management of a stress fracture is highly dependent on the affected bone and the individual’s bone health. There are some locations where there is a higher risk of complications if mismanaged, including the tibia, fifth metatarsal, femoral neck and navicular. As such, it is imperative that a prompt assessment by a physiotherapist or physician is conducted.

Most stress fractures are treated with rest for a period of 6-8 weeks, in some instances requiring immobilisation with a boot and restrictions for weight bearing through the affected bone. A period of rehabilitation and graded increase in activity is usually required, as weakness and deconditioning often occurs while allowing the bone to heal. Often, a number of healthcare practitioners may be required to oversee your recovery. Your physiotherapist may advise to seek input from an orthopaedic surgeon, endocrinologist, dietician, sports physician and exercise physiologist.

In summary, bone stress injuries are variable and require different management depending on an individual’s circumstance. Ultimately, the goal is to initially offload the healing bone, address identified risk factors, rehabilitate and gradually re-introduce their usual activities.

Abbott, A., Bird, M. L., Wild, E., Brown, S. M., Stewart, G., & Mulcahey, M. K. (2020). Part I: epidemiology and risk factors for stress fractures in female athletes. The Physician and sportsmedicine, 48(1), 17–24.

Abbott, A., Bird, M., Brown, S. M., Wild, E., Stewart, G., & Mulcahey, M. K. (2020). Part II: presentation, diagnosis, classification, treatment, and prevention of stress fractures in female athletes. The Physician and sportsmedicine, 48(1), 25-32. 

Song, S. H., & Koo, J. H. (2020). Bone stress injuries in runners: A review for raising interest in stress fractures in Korea. Journal of Korean medical science, 35(8).

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