The Dreaded Stress Fracture
Stress fractures are a common injury sustained in athletes who participate in high impact activities. They are loathed by athletes because they inevitably require time off from their beloved sport with substantial modification of their training.
In runners, bone stress tends to be the result of abnormal loading on an otherwise normal, healthy bone. Reported time frames of healing are between 4 weeks to one a year, depending on the severity, duration, location of the stress fracture and the age of the athlete.
The most common stress fractures seen in runners are in the tibia (50%), followed by bones in the foot (10-25%), the fibula (12%), the femur (5%) and the pelvis (5%). 4
The cause of stress fractures is generally multifactorial and includes training volume, biomechanical deficits, overall physical shape, menstrual activity and nutritional habits. Female distance runners have a 2.3 times higher risk of developing a stress fracture compared to male distance runners.6
Most stress fractures will heal with conservative management, meaning rest. They require time off from high impact activities to let the bone heal, ideally followed by physical therapy to ensure appropriate and gradual re-introduction of loaded activities. It is also important to address the biomechanical deficits that contributed to the overloading of the bone, and normalize strength and motor control deficits.
Some stress fractures do require surgical intervention to facilitate healing. Examples include stress fractures of the navicular bone and some stress fractures of the neck of the femur.
An MRI is the best tool for diagnosing stress fractures. X-rays are likely to result in false negatives upon initial presentation, especially in the early stages of stress fractures and in some cases may not reveal an existing stress fracture at any time.
Since runners with stress fractures are 5 times more likely to develop subsequent stress fractures, it is very important that the factors that contributed to the initial stress fracture in the first place are appropriately addressed.
Your physical therapists at Mondo Sports Therapy can help you with your rehabilitation following stress fractures, and will happily answer your questions if you are concerned you might have a stress fracture. We have free injury clinics weekly at Gilbert’s Gazelles on Tuesdays from 6.30-7.30 AM and at Rogue on Thursdays from 7-8 AM.
- Clement et al. Exercise induced stress injuries to the femur. International Journal of Sports Medicine (1993);14(6):347-352
- Liong SY and Whitehouse RW. Lower extremity and pelvic stress fractures in athletes. Br J Radiol. (2012);85(1016):1148-1156
- Mallee WH et al. Surgical versus conservative treatment for high risk stress fractures of the lower leg (anterior tibial cortex, navicular and fifth metatarsal base: a systematic review. Br J Sports Med (2015);49 (6);370-376
- Matcuk GR et al. Stress Fractures: pathophysiology, clinical presentation, imaging features and treatment options. Emergency Radiology (2016):23(4):365-375
- Wright AA et al. Diagnostic accuracy of various imaging modalities for suspected lower extremity stress fractures: a systematic review with evidence based recommendations for clinical practice. Am J Sports Med. (2016);44(1):255-263
- Wright AA et al. Risk factors associated with lower extremity stress fractures in runners: a systematic review and meta-analysis. Br J Sports Med. (2015):49(23):1517-23