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Dr Lorenzo Masci on Stress fractures: A runner’s curse

Stress fractures: a runner’s curse. How to diagnose and treat them

A stress fracture is usually the result of repetitive trauma to bone. Excess forces on the bone leads to microtauma, bone swelling and eventual fracture. Unlike fractures due to high velocity such as after a fall, stress fractures occur over some time. So how do you diagnose stress fracture and what is the treatment?

What are the more common stress fractures in the body?

Usually, stress fractures occur in the foot or the shin. Other common areas are the hip and pelvis. Rarely, we see stress fractures of the wrist, forearm and shoulder in throwing sports such as tennis or baseball.

Cause of Stress fractures

Generally, too much running or sport over a short period of time can lead to bone fatigue. Increasing the time or intensity of exercise is a common error. Also, running in old worn out shoes can make you more susceptible.

Other causes include medical conditions that lead to weakening of bones (also called osteoporosis). These conditions include vitamin D deficiency and menstrual irregularities.

Diagnosis of stress fractures

As a general rule, stress fractures can be difficult to diagnose because the symptoms can be vague and slow to appear. Usually, pain occurs during or after activity such as running or sport. Often, pain in the area of the bone may be misdiagnosed as a muscle strain or joint injury. For example, stress fractures in the shins may be confused with shin splints or stress fractures in the hip may be misdiagnosed as hip impingement.

X-rays often miss stress fractures particularly in the early stages. Often, MRI scans are needed to confirm bone swelling and fractures.

Treatment of a stress fracture

The best treatment is rest. Enforced rest from running or sport and doing low impact activity such as swimming or cycling will allow the stress fracture to heal. If you push through pain, then the fracture can enlarge and may never heal properly. Crutches or a walking boot may be needed for more severe cases.

Other treatments include regular ice and physiotherapy to treat any strength deficits. Generally, we advise against pain medications such as ibuprofen as evidence suggests that these medications prevent proper healing.

As the pain settles, we advise a return to normal activities such as walking followed by a gradual walk/run program.

In cases involving weakening of bones, hormone treatment and vitamin supplementation may be needed.


Prevention is often better than a cure. For stress fractures, simple advice can protect you from developing stress fractures:

  • Follow the 10% rule. Avoid increasing training mileage or intensity by more than 10% per week.
  • Eat healthily including foods high in calcium and vitamin D
  • Wear supportive shoes and change them regularly
  • Avoid running through pain. If you have pain, you should stop and rest for a few days.

Contact OneWelbeck Orthopaedics today

If you have any questions regarding stress fractures, please visit our contact page. Anyone looking to talk with us directly can phone the clinic on 0203 653 2002.

Dr Masci is a Sports and Exercise Medicine consultant with an interest in overuse injuries such as bone stress and tendonitis. He also has an interest in ultrasound-guided injections.