Stress Fractures

What is a stress fracture?

A stress fracture is a small crack in one of your bones. It’s a type of bone fracture (the medical term for broken bones).

Stress fractures are exactly what their name sounds like — fractures that happen when something puts too much stress on your bone. Healthcare providers sometimes call stress fractures overuse injuries because repetitively using the same part of your body usually causes them. You might also see stress fractures called hairline fractures, a name that refers to the hairline crack that forms in your bone.

Any repetitive motion or activity that puts pressure on your bones can cause a stress fracture — playing a sport or doing physical work are common causes. Visit a healthcare provider if you feel pain, swelling or tenderness on or near a bone (especially during or after physical activity).

Types of stress fractures

Stress fractures usually affect weight-bearing bones in your lower body. These are the bones that support the weight of your body when you’re standing or moving. You’re most likely to experience a stress fracture in your:

• Lower leg (your tibia and fibula).
• Foot (especially your metatarsals that connect your ankle and heel to your toes).
• Heel (calcaneus).

They’re less common, but stress fractures can also affect bones in your:

• Lower back (lumbar spine).
• Hips.
• Hands and wrists.

How common are stress fractures?

Stress fractures are common injuries for athletes and people who do physical work. Experts estimate that stress fractures make up around 20% of all sports injuries.

What are the symptoms of a stress fracture?

The most common symptoms of a stress fracture include:

• Pain that starts and gets worse during physical activity.
• Pain that doesn’t get better after stopping activity.
• Pain that’s more noticeable when you’re resting.
• Tenderness to even a light touch on or near your affected bone.
• Swelling.

What does a stress fracture feel like?

Most people with a stress fracture feel less pain after they stop physical activity. But you might feel pain all the time depending on where the stress fracture is. Because stress fractures are more common in your lower legs and feet, the pain is usually worse when you’re walking or standing with weight on your affected bone.

You’ll probably feel pain that’s focused (localized) in one spot near the fracture. For example, if you have a stress fracture in your foot, your whole foot might hurt, but the area around your damaged bone will be the most painful and tender.

What causes stress fractures?

Stress fractures are almost always overuse injuries. This means they happen when something puts too much pressure on a bone and the bone doesn’t have enough time to recover after physical activity. Stress fractures usually develop slowly over time when you do a repetitive motion (like training for a sport or performing the same type of movement all day at work).

Stress fractures start as inflammation on a bone’s surface (healthcare providers call this a stress reaction). Stress reactions are like deep bone bruises. If something keeps putting pressure on that same spot before the stress reaction can heal, your bone can crack and create a stress fracture. The bruise will reach deeper into the bone over time until it makes it weak enough to break. That’s when a stress reaction becomes a stress fracture.

Some of the most common causes of stress fractures include:

• Practicing or training too often without resting enough.
• Starting a new sport or physical activity without the right training, guidance or equipment.
• Quickly increasing your activity level (suddenly ramping up workouts, training or other physical activity).
• Changing the surface you train or work on (switching from running on an indoor track to road running, or starting a job that requires you to stand on a hard floor like concrete).
• Working or training without proper equipment.
• Specializing in one sport too early (children who play the same sport year-round without a break between seasons are more likely to experience a stress fracture than kids who play a variety of sports).

Stress fracture risk factors

Athletes who play sports that put a lot of stress on their lower bodies are more likely to develop stress fractures, including:

• Running (both long-distance running and track and field sports).
• Basketball.
• Tennis.
• Gymnastics (gymnasts are also more likely to develop hand and wrist stress fractures).
• Dance.

Certain health conditions can increase your risk of a stress fracture, including:

• Osteoporosis (providers sometimes call these insufficiency fractures).
• Bunions.
• High arch feet.
• Flat feet.
• Vitamin D deficiency.
• Having overweight or obesity.
• Eating disorders.

How are stress fractures diagnosed?

A healthcare provider will diagnose a stress fracture with a physical exam. They might use imaging tests to confirm the diagnosis and take pictures of the fracture. They’ll examine the part of your body that hurts. Tell them what you were doing when you first noticed pain and other symptoms.

Your provider might ask you to stand or hop on one leg and then the other. This will help them understand where you might have a stress fracture, and how much it affects your ability to move normally.

What tests can help diagnose stress fractures?

Your provider might use some of the following tests to take pictures of your bones:

• X-rays.
• Magnetic resonance imaging (MRI).
• Computed tomography (CT) scan.
• Whole body bone scan.

How are stress fractures treated?

Your provider will suggest treatments based on the location of the fracture and the severity of your symptoms. The most common treatments for stress fractures include:

• Rest: Stop physical activity — especially the sport or activity that caused the fracture.
• Icing: Apply ice or a cold pack to your injured bone. Wrap ice packs in a thin towel to avoid putting them directly on your skin. Your provider will tell you how often (and for how long) you should ice your injury.
• Pain relievers: Over-the-counter (OTC) nonsteroidal anti-inflammatory medications (NSAIDs) and acetaminophen (Tylenol®) can relieve pain and reduce swelling. Your provider might recommend over-the-counter lidocaine patches to numb the area around the fracture. Don’t take pain relievers for more than 10 days in a row without talking to your provider.
• Elevating your injury: Try to keep your injured bone above the level of your heart as often as possible. For example, if the stress fracture is in your leg or foot, you can prop your leg up with pillows or cushions while you’re lying down.
• Compression: Compression helps reduce blood flow to your injured bone and reduces swelling. Apply a compression bandage or wrap around the fracture.
• Immobilization: You might need to wear a cast, boot or special shoe to support your injury and reduce how much pressure you put on it.
• Crutches: Your provider may suggest you use crutches to take pressure off your injured bone.

Stress fracture surgery

Most people don’t need surgery to treat a stress fracture. Your provider might suggest surgery if the fracture isn’t healing like it should, or if you’re experiencing severe symptoms. You might need surgery if the fracture’s in a bone that’s more likely to cause other complications (like your hip joint).

A surgeon will perform a procedure called an internal fixation. They’ll put pins, screws or metal plates into your bone to hold it together while it heals. Your provider and surgeon will tell you what to expect and how long it’ll take to recover.

How soon after treatment will I feel better?

You should start feeling better as soon as you stop putting stress on your injured bone and start treating your symptoms. Don’t resume training, working out or practicing before your provider says it’s safe, even if you’re feeling better. It’ll probably take at least a few weeks for your bone to heal enough before you can return to physical activities. The fracture can come back or get worse if you resume activity too soon.

How can I prevent a stress fracture?

These steps can help prevent a stress fracture:

• Stop exercising or training as soon as you feel pain. Never “play through pain”.
• Warm up and cool down before physical activity.
• Wear the right equipment for all sports and physical activities.
• Follow a diet and exercise plan that’s healthy for you.
• Visit a healthcare provider as soon as you notice pain or other symptoms.

How long does it take to recover from a stress fracture?

Most people need to rest for at least a few weeks after experiencing a stress fracture. You might need to avoid sports and other physical activities for a few months.

As long as you can feel pain, the bone is still fragile in that area, and could break again in the same place. It usually takes six to eight weeks for a stress fracture to heal. Stop the activities that caused the stress fracture while you’re healing.

Your provider will tell you how long you need to take a break from playing sports or working out.

How do I take care of myself after a stress fracture?

Don’t resume physical activities before your healthcare provider says it’s safe. If you stress your bone again before it has time to heal, you’re more likely to reinjure it.

• Ask your provider when it’s safe to increase your activity level.
• Talk to a healthcare provider before starting an exercise program or before taking a job that’ll involve a higher level of physical activity than you’re used to.
• If you’re a runner, wear well-fitting running shoes. You should replace your running shoes every 300 miles.
• Try low-impact activities (like swimming or biking).

When should I see my healthcare provider?

Visit a healthcare provider as soon as you notice new symptoms like pain and swelling. Even if you don’t have a stress fracture, your provider can examine your injury and suggest treatments to prevent more serious complications.

Listen to your body if you’re experiencing pain during and after physical activity. Pain is often the first sign that you need to stop and rest. You can prevent a stress fracture before it happens by stopping physical activity and visiting a healthcare provider as soon as you notice pain and other symptoms.

When should I go to the ER?

Go to the emergency room right away if you’ve experienced trauma.

If you think you have a bone fracture, you need to see a healthcare provider as soon as possible. Go to the emergency room if you experience any of the following:

• Intense pain.
• You can’t move a part of your body.
• A part of your body looks noticeably different or out of its usual place.
• You can see your bone through your skin.
• Swelling.
• New bruising that appears at the same time as any of these other symptoms.

What questions should I ask my provider?

• Do I have a stress fracture or another injury?
• Which treatments will I need?
• Will I need surgery?
• How long should I avoid sports or physical activity?
• How should I ramp my activity back up when it’s safe to start training again?

Can you walk with a stress fracture?

You might be able to walk normally with a stress fracture. It depends on which bone is fractured, and how severe your symptoms are. Your provider will tell you which types of movements are safe while you’re healing. Don’t jog, run, work out or do any intense physical activity without talking to your provider.

Will a stress fracture heal on its own?

A healthcare provider needs to diagnose and treat all stress fractures. Even though rest and giving your body time to heal are the most common treatments, you still need your injury examined and diagnosed by a provider before you can return to sports or other physical activities.

Visit a provider if you’re experiencing stress fracture symptoms. The sooner it’s diagnosed, the faster your bone can start healing. Your provider will help you understand why the stress fracture happened and how you can prevent injuries in the future.

A note from Cleveland Clinic

Stress fractures are one of the most common injuries athletes and physically active people experience. It’s frustrating to know your favorite sport or training regimen could’ve caused your injury. But don’t rush your recovery. Your bone and body need time to heal.

Visit a healthcare provider as soon as you notice any stress fracture symptoms. They’ll diagnose your injury and suggest treatments that help get you back out on the field, court or track as soon as it’s safe.