All About Stress Fractures

By: Rachel Kyprianou, DPT, Shrewsbury Center

A stress fracture is a small crack in a bone, most commonly caused by overuse, typically from an increase in activity level. This includes any increase in the frequency, duration or intensity of a workout. Stress fractures can occur anywhere in the body but most often in the weight-bearing bones of the lower leg and foot.

Who is at risk?

• Individuals starting a new exercise regime who do too much too soon.
• People who participate in activities or sports that have a high frequency of repetitive activities, including high levels of running and jumping.
• Women, especially those with abnormal menstrual periods, are at a higher risk for a stress fracture.
• Individuals with osteoporosis have weak bones and may not be able to handle the normal stresses of daily life.
• Not a who but a what: even a change of footwear can bring on a stress fracture.

What are the symptoms?

Initially, pain from a stress fracture may be barely noticeable. It typically will originate with a small, local area and decrease with rest. You may also note some swelling or bruising.

If you suspect a stress fracture, you should see your doctor as soon as possible. Ignoring your pain may lead to a bone fracture. Until your appointment, avoid activities that have you bear weight through the affected foot.

How are stress fractures diagnosed?

There are several ways, but the best is through either a bone scan or magnetic resonance imaging (MRI). It is more difficult to identify a stress fracture with an X-ray, and it make take several weeks for the stress fracture to show up.

What is the treatment?

The first step is to stop the activity that brought on the fracture in the first place. Sometimes a change in footwear is needed to take stress off the bones. Your doctor may recommend crutches or calcium and vitamin D supplements. Most stress fractures will heal with conservative measures, but surgery may be required if the bone does not heal. Return to activity occurs gradually, once the involved area is pain free.

Will physical therapy help?

Yes. In fact, without proper rehabilitation you are at increased risk for serious problems, such as chronic pain, swelling, weakness and additional fractures. Your physical therapist will design a treatment to correct the abnormal mechanics that led to your injury. This will utilize specific muscle strengthen and specific strengthening exercises, not heavy weights.

When you are pain free and no longer stressing the injured bones, your physical therapist will start to increase activity level. Returning too quickly to an activity can delay healing and increase the risk for a complete fracture. It typically takes six to eight weeks for a stress fracture to heal.