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What Causes Stress Fractures and How to Treat Them


Stress fractures, often dubbed the “overuse injuries” of the bone, are not uncommon in the realm of orthopaedic issues. This type of injury results from repetitive strain and increased pressure on the bone, typically overshadowing the bone’s natural ability to repair and adapt. Although these fractures are frequently encountered among athletes, it’s essential to recognize that they can afflict anyone. This article delves into the aetiology, symptoms, diagnosis, and management of stress fractures.

1. Aetiology: The Root Causes

At its core, the bone is a dynamic tissue, continually remodelling in response to the stresses it encounters. The remodelling process involves both bone resorption (osteoclast activity) and bone formation (osteoblast activity). When repetitive stress is applied to the bone without ample recovery time, the rate of resorption may surpass that of formation, leading to a weakened bone, ripe for fracture.

Several factors contribute to the onset of stress fractures:

  • Physical Overactivity: Sudden changes in physical activity, intensity, frequency, or duration can result in increased stress on specific bones.
  • Improper Equipment: Wearing inappropriate or worn-out footwear can distribute force unevenly.
  • Surface and Environment: Hard surfaces, or those that don’t absorb impact well, can increase the risk.
  • Osteoporosis: Reduced bone density and weakened bone structure can predispose individuals to stress fractures.

2. Recognizing the Symptoms

Stress fractures manifest subtly and can easily be mistaken for muscle strains or other orthopaedic complaints. Key symptoms include:

  • Pain that intensifies with activity and diminishes with rest.
  • Swelling and tenderness at the specific site of the fracture.
  • Possible bruising.

3. Diagnosis: Getting to the Heart of the Issue

Clinicians primarily rely on the patient’s history and physical examination for initial assessment. Radiographs (X-rays) are typically the first imaging modality employed, but stress fractures may not always be visible immediately. If suspicion remains high, an MRI or bone scan can be more sensitive in detecting these fractures.

4. Management and Recovery

Management is predominantly conservative. The following are the mainstays of treatment:

  • Rest: It’s paramount to allow the bone to heal naturally. Activity levels should be adjusted, and weight-bearing restricted as advised.
  • Pain Management: Non-steroidal anti-inflammatory drugs (NSAIDs) can alleviate pain and reduce inflammation, but it’s crucial to use them under guidance, considering their potential side effects.
  • Protective Gear: Braces or orthotic devices may help offload the pressure from the affected bone.
  • Physical Therapy: Once the initial healing phase is over, physical therapy can be beneficial in regaining strength and flexibility.

5. Prevention is Better than Cure

To minimise the risk of stress fractures:

  • Gradually increase physical activity levels.
  • Use appropriate footwear and replace them when worn out.
  • Ensure adequate nutrition and bone health.
  • Listen to one’s body: recognizing and respecting pain is essential.


Stress fractures, though common, are not trivial injuries. They underscore the importance of balanced activity, adequate rest, and keen self-awareness. By understanding the causes and being vigilant about symptoms, one can navigate the path of physical activity with reduced risk and increased enjoyment.

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This article was written by our team of specialist therapists at Perfect Balance Clinic. If you would like more specific advice about how our team can help you with this condition or symptoms you may be having, please complete the contact form below and one of the team will get back to you shortly.

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