If you suddenly break a bone, you know it. These types of fractures happen when there’s a strong impact or trauma on a bone and you’ll probably notice a lot of pain, swelling and signs of an injury.
Stress fractures are different. These happen over time, from repetitive force or overuse. That repeat stress on the bone can cause small cracks. “Stress fractures can be partial or complete breaks in the bone,” said Brady Bowen, MD, a sports medicine specialist with Banner - University Medicine.
Stress fractures are more common in the weight-bearing bones in your body. You might develop them in your feet (metatarsals), shins (tibia or fibula), hips (femoral neck) or other bones in your legs.
Risk factors for stress fractures
You could be at risk for stress fractures if you:
- Put strain on a certain part of your body repeatedly. Activities like distance running or jumping can stress your bones. Athletes who run or play basketball, soccer or gymnastics may be at higher risk.
- Don’t take in enough calories. “A calorie deficit increases the risk of stress fractures,” Dr. Bowen said. You’re also at risk if you’re underweight.
- Have a mechanical imbalance that puts more stress on certain bones.
- Exercise at high levels often or increase how long or intensely you exercise without giving your body enough time to adjust. Your body needs rest to adapt and repair.
- Use poor form or technique during sports or exercise.
- Exercise with unsupportive or worn-out shoes. Shoes with the right support and cushioning help absorb shock, so there’s less stress on your bones.
- Don’t get your menstrual period regularly. “An irregular menstrual cycle may be one indicator that nutrients aren’t sufficient to support your level of training, which is a risk factor for stress fracture,” Dr. Bowen said.
- Have osteoporosis, which makes your bones weaker and more likely to fracture.
- Don’t get enough calcium since these nutrients are important for bone health.
Tips for preventing stress fractures
Not only are stress fractures painful, but they can also set back your training or workouts. So it’s a good idea to take these steps to try to prevent them:
- Pace yourself: Start slowly and gradually build up how long and intensely you exercise. Don’t try to do too much too soon. Follow a training plan that minimizes the risk of overuse injuries.
- Wear the right shoes: You want shoes with cushioning and arch support. Make sure they fit well and they’re the right shoes for your activities. Replace them as needed, so they’re in good shape to protect your feet and legs.
- Cross-train: Mixing up your sports and workouts can keep your bones safe while you stay fit.
- Build your muscles and bones: Walking, jogging and strength training can help keep your bones dense and more resistant to injury. Balance and flexibility exercises can help your muscles support your bones.
- Choose a balanced diet: “Eat enough calories to support your training,” Dr. Bowen said. Include calcium-rich foods such as dairy products, leafy greens and fortified foods and good sources of vitamin D, such as fatty fish and fortified milk.
- Rest and recover: Give yourself time between workouts to recover. Stretch, get the sleep you need and drink plenty of fluids to help your body heal and adapt.
Signs that you might have a stress fracture
It’s important to recognize the symptoms of a stress fracture so you can start treatment, keep them from getting worse and recover as quickly as possible. Watch for:
- Pain: Pain from stress fractures usually starts as a dull aching sensation you may feel at a specific point in the bone, not in a large area. It might be sharper or more intense when you’re active and might lessen when you rest.
- Swelling: You may notice that the area feels puffy or enlarged compared to the same spot on other side of the body. It might also feel warm.
- Tenderness: The spot where you notice pain might be sensitive to touch, often in a small, focused area.
- Bruising: Bruising is less common in stress fractures than in acute fractures. In stress fractures, it may be a sign of more trauma or bleeding in the area.
- Mobility changes: You may find it harder to run, walk or climb stairs.
When to get medical help
If you rest and treat your pain, your stress fracture may clear up. See a health care provider if you have any of these issues:
- Pain that doesn’t ease up or gets worse with rest and home treatments. These could be signs that the stress fracture isn’t healing or isn’t causing your symptoms.
- Swelling that doesn’t clear up with rest and ice.
- Trouble moving or putting weight on the bone that’s affected.
Get immediate medical help for:
- Intense pain that makes it hard to do your daily activities or to sleep.
- Significant swelling or bruising, especially if it spreads or you also have severe pain.
- Signs of infection include increased redness, warmth or pus.
Diagnosing stress fractures
When you see a health care provider for a possible stress fracture, they may take these steps to make a diagnosis:
- Medical history: The provider will ask about your physical activity levels, any recent changes in your exercise routine and your symptoms. Be prepared to describe when your symptoms started, how they have changed and whether they are different when you’re active or resting.
- Physical examination: The provider may check for tenderness, swelling and areas of pain. They may assess your range of motion and whether pain keeps you from moving normally.
- X-rays: These are often the first imaging tests performed. Stress fractures don’t always show up on X-rays, but they may show signs of bone stress or changes in the bone over time. “An X-ray may suggest a stress fracture, but advanced imaging such as an MRI is often needed to make a diagnosis,” Dr. Bowen said.
- MRI (magnetic resonance imaging): An MRI is more sensitive and may show stress fractures that aren’t visible on X-rays. It provides detailed images of bone and soft tissues and can show bone swelling and changes in bone marrow that could be signs of a stress fracture.
- CT scan (computed tomography): A CT scan can give a more detailed view of the bone if other imaging tests are inconclusive or if you need a more detailed assessment.
Treatment and recovery
These steps can help you treat a stress fracture so you can get back to your activities without pain:
- Rest: Give your bone time to repair. Your provider may recommend using a brace or splint to stabilize the bone or crutches to keep weight off it.
- Pain management: You can apply ice to the injured area several times a day for 15 to 20 minutes at a time and use over-the-counter (OTC) medications like acetaminophen (Tylenol) or ibuprofen (Advil) to reduce pain and inflammation.
- Physical therapy: A physical therapist can design a rehab program to help you improve strength, flexibility and balance, restore function, return to normal activities and prevent future injuries.
- Return to activity slowly: Start with low-impact activities that don’t stress the bone. Swimming and cycling may be good options. Gradually increase your intensity as you get better. Pay attention to how you feel, especially when you return to your regular activities. If you have pain or discomfort, scale back.
- Follow up with your provider: Your provider can monitor your progress and adjust your treatment and recovery plan if needed.
The bottom line
A stress fracture is a break in a bone you can get from overuse or repetitive activity, like running or jumping. They can be painful and can interrupt your sports or exercise routine. You can prevent them by cross-training, increasing your activity level gradually and giving your body a chance to rest and recover between workouts.
The experts at Banner Health can help you prevent sports injuries and find the best treatment options if you need them. Reach out today to connect with the help you need.
