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Olympus Lifestyle Co

Condition

Stress Fractures

Pain that builds with running or impact and gets worse the longer you go? Early assessment, imaging referral, protected loading and a careful return for stress fractures and other bone stress injuries.

A stress fracture is a small crack or area of overloaded bone, caused by repetitive load rather than one single injury. It’s most common in runners, military recruits, court-sport athletes and anyone who has suddenly increased impact activity, and it’s often confused with shin splints, tendon problems or muscle pain. It’s important to get it recognised early, because carrying on can turn a manageable problem into a serious one.

Understanding bone stress injuries

Bone is constantly remodelling, with old bone broken down and replaced with new. When the repetitive load on a bone is too high, or recovery is too short, breakdown outpaces repair and micro-damage accumulates. This sits on a spectrum, from a stress reaction (bone stress without a visible crack) through to a complete fracture, which is why clinicians use the broader term bone stress injury.

The location matters a great deal. Injuries at low-risk sites, such as the inner shin bone, heal reliably with load management. High-risk sites, including the neck of the thigh bone, the navicular bone in the foot, the front of the shin and the base of the fifth metatarsal, have a greater risk of healing problems and need more careful management.

Biological factors also matter, including low energy availability, low bone density and hormonal factors, particularly in distance runners and athletes training heavily.

Symptoms we commonly see

  • Pain at a specific spot on a bone that’s tender to press
  • Pain that builds during running or impact and doesn’t ease with warm-up
  • Pain that progresses to walking, standing or night pain
  • Swelling or a sense of warmth over the area
  • Pain when hopping on the affected leg
  • A recent increase in training, new surfaces or a return after time off

Our evidence-based approach

Bone stress injuries are managed according to where they are and how severe they are. Low-risk injuries usually heal with activity modification followed by progressive loading and return to activity, while high-risk sites often need non-weight-bearing or other measures. Our approach includes:

  1. Assessment to find the likely site and severity, and to identify other contributors to the injury
  2. Imaging referral when needed to confirm the diagnosis and the grade of the injury
  3. Protected loading, reducing impact enough to allow healing while keeping you moving with low-impact training such as cycling or pool work
  4. Strengthening of the calf, hip and trunk, so the bones are better protected as load returns
  5. Running retraining where useful, such as step rate and surface advice
  6. Screening for contributing factors, with referral to your GP or a sports dietitian for concerns about nutrition, bone density or hormones
  7. A graded return to running or impact sport, progressed according to how the bone responds

See our shin splints page for the more common, less severe shin overload problem.

What to expect: recovery timeline

  • Low-risk sites: commonly several weeks to a few months before full return to running, guided by symptoms and progress
  • High-risk sites: typically take longer, and may involve protected weight-bearing, medical review and sometimes surgery
  • Return to sport: a staged, graded process, with careful monitoring for pain at each step

When to seek help urgently

Seek prompt medical assessment for pain in the groin or hip, especially with a limp or pain at rest, as this can indicate a hip stress fracture that needs urgent care. Get assessed urgently too if you can’t put weight on the leg, have severe or worsening pain at night, or pain after a fall or impact.

References

How We Treat This

Sports PhysiotherapyPhysiotherapyStrength and ConditioningInjury Prevention Screening

Q & A

Questions about Stress Fractures

How do I know if it's a stress fracture?

Typical clues are a very specific tender spot on a bone, pain that builds the longer you run and doesn't settle as you warm up, and pain that eventually shows up with walking, at rest or at night. Diagnosis combines your history and examination, with imaging used to confirm it. If we suspect a stress fracture, we'll organise the right imaging through your GP.

Will an X-ray show it?

Often not early on. Plain X-rays can look normal in the first few weeks of a bone stress injury, so an MRI is commonly used when the diagnosis matters. That's why a clinical examination and clear history are so important, and why it's best not to keep running while you wait to be sure.

Do I have to stop running?

Usually you'll need to stop the impact that's irritating the bone, but how strict that is depends on where the injury is. Bone stress injuries at low-risk sites typically heal with activity modification followed by progressive loading, while those at high-risk sites, such as the neck of the thigh bone, may need protected weight-bearing and specialist input. We'll tell you which category you're in and keep your fitness up with low-impact training.

Why did I get a stress fracture?

It's an overload injury: the load on the bone has outpaced its ability to repair itself. Contributors include rapid increases in training, running mechanics, hard surfaces, footwear, low energy intake and low bone density. In a study of collegiate runners, a lower step rate was independently associated with a higher risk, with risk falling by about 5 percent for each extra step per minute. We look at the full picture, not just your training.

How long until I can run again?

It depends on the bone and the site. Low-risk injuries often need several weeks of reduced impact before loading is gradually reintroduced, and higher-risk sites take longer. We base your return on how the bone behaves, including pain-free walking, hopping and graded running, rather than on a calendar date.

Let's get this sorted

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