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No.3 - Stress fractures



No.3 in our series of nine most common running injuries is "Stress fractures"

What is a stress fracture?

A stress fracture is a small crack that occurs in bone usually as a result of repetitive stress placed on the bone. Stress fractures commonly occur in relation to running or running related sports and are usually due to overuse.

Many runners have suffered the curse of a stress fracture.

They are seen more commonly in the female distance runner. I myself had six during my running career and notable Australian distance runners such as Jeff Riseley and Julian Paynter have had interruption to their careers from stress fractures. 

Stress fractures will most commonly be found in weight bearing bones.

The most common locations for stress fractures in runners include:

●      The metatarsal (bones of the foot)

●      The navicular (bone of the foot)

●      The tibia (bone of the shin)

Other likely, but less common, areas for stress fractures include the femur (thigh bone) and the pelvis. 

Signs and Symptoms

Symptoms of stress fractures can vary however most people will complain of pain that has developed over time and is relieved with rest. Pain is usually more intense with physical activity, especially weight bearing impact activity (such as running or jumping).

Swelling and tenderness is usually present over the area of pain. Bruising and discolouration is less likely but might still be seen over the area of pain.

Often you will experience aching at night that can keep you awake.

How does it happen?

As mentioned earlier, stress fractures usually occur due to overuse. Bones are always remodelling and changing just like many other tissues in our body. Usually the cells that make up bone are matched by the cells that breakdown bone. With the repetitive nature of running and jumping this balance can be thrown out of kilter resulting in microscopic damage. This damage is usually not great enough to cause a more significant fracture to the bone, but due to repetitive force from overuse, does not allow the body to heal effectively enough before further stress is placed on it. 

Overuse in running may be characterised by running frequently beyond the point of fatigue, rapid increases in intensity or mileage or even switching activities to an activity that your body may not be familiar with or conditioned for such as increase in training on the track or road.

We often see someone develop a stress fracture when returning to running from another injury. If the athlete has been keeping aerobically fit with some sort of cross training, their fitness can be better prepared to build the training than their skeleton is ready to absorb.

Certain risk factors that may contribute to developing a stress fracture include (but are not limited to):

●      sports or activities with repetitive impact stress (such as running or jumping)

●      rapid changes in physical activity

●      poor bone density

●      poor nutrition

●      inappropriate footwear or equipment

●      poor muscle strength and endurance

●      poor flexibility

How do I treat a stress fracture?

Treatment of a stress fracture will depend on the location of the injury but will most likely involve:

●      a period of rest or reduced activity to allow the fracture pain to settle

●      potential modification of your current activity to prevent further aggravation

●      stretching and strengthening of surrounding muscles to protect the bone from further stress

●      a potential review of footwear and/or equipment to ensure that it is appropriate for the activity that you are participating in. 

Other management strategies that may be employed for stress fractures may include, but are not limited to:

●      Ice (to help settle pain and inflammation over the area of injury)

●      Anti inflammatory medication (to help settle more severe pain and inflammation)

●      Modifying training to include non-weight bearing or low impact stress exercises (so that the athlete can keep up their levels of activity without aggravating the fracture)

●      Fixation in a CAM boot (pictured below) to immobilise the area of injury and distribute weight bearing pressure to allow pain to settle and the bone to heal.

As always, management will depend on the specific area of the injury and its severity. If you suspect that you may be suffering from a stress fracture, seek advice from an experienced running health care professional. 

Article written by Rob O’Donnell, Physiotherapist and Director of Southern Suburbs Physiotherapy Centre and former Australian Distance running representative with contributions from other SSPC staff.

Southern Suburbs Physiotherapy has clinics in 3 locations: 705 Centre Road East Bentleigh, 100 Lower Dandenong Road Parkdale and 99 Bay Street Brighton and there are physio’s with special interests in treating runners at all locations. For more details go to

SSPC have also now developed a biomechanical assessment room at East Bentleigh that allows us to study how the shoe interacts with your walking or running posture.  From a thorough history, hands on joint and clinical evaluation, we will then assess the suitability of your shoes, for whatever your training, general exercise and sports requirements with a CLINICAL gait assessment.

You are welcome to drop in and see our Sports Podiatrist, Rick Osler at SSPC for your footwear assessment and recommendations. Shoes are expensive, and it is easy to get it wrong.  With all of the noise and marketing out there, we can help deconstruct the rubbish and apply the best available running research evidence to get an outcome that works for you.  

Happy running.