Stress Fractures

Patient Information: Stress Fractures

What are stress fractures? How are they caused?

  • A stress fracture is when tiny cracks form in a bone due to excess stress and overuse
    • Overuse occurs when bone is not given adequate time to recover from activity, and fatigued muscles are unable to absorb forces on the bone
    • Excess stress can be caused by increases in duration or intensity of exercise, new activities, or new exercise surfaces
  • A lack of micronutrients vital to bone health (calcium, vitamin D) can increase the likelihood of a stress fracture
    • Nutritional deficiencies and stress injuries are both part of the Female Athlete Triad
  • Most stress fractures occur in the lower leg and foot, but can occasionally occur in the upper leg and spine

What are the symptoms of a stress fracture?

  • Pain and possibly swelling that is markedly worse with activity and improves with rest
  • Tenderness to touch over the affected bone

How is a stress fracture diagnosed?

  • A physical exam can lead to the diagnosis of a probable stress fracture
  • X-rays are typically normal, but may be done to rule out a full fracture or other bone problems
  • Musculoskeletal ultrasound can be done to look for inflammation in or around the bone
  • MRI or CT scans may be done for stress fractures in complicated areas, or those that are slow to heal

How is a stress fracture treated?

  • Reducing bone stress using boots, casts, or crutches
  • Anti-inflammatory medications for pain
  • Return to activity is slow and gradual and begins after a set healing period, if pain has subsided
  • Activity Progression
    • No weightbearing, no impact (swimming, biking)
    • Weightbearing, no impact (elliptical, weights)
    • Weightbearing, impact (running, jumping)
  • Intensity progression:
    • Always begins with low intensity, short duration exercise, and eventually progresses to longer duration, high intensity activities

How can I prevent stress fractures?

  • Slowly increase duration and intensity of activities, particularly with new activities or new surfaces
  • Use activity-appropriate, supportive footwear
  • Always warm up and stretch, and do a cool down
  • Integrate cross-training into your exercise routine (for example, low body weightlifting for runners)
  • Include variety in your activities and sports
  • Schedule rest days, and low impact days (yoga, etc)
  • Have adequate intake of calcium, vitamin D, protein, and healthy fats for bone and muscle recovery

Where can I learn more about stress fractures?

To schedule an appointment, visit the Steward St. Elizabeth’s Sports Medicine website at:



736 Cambridge St, CCP9, Brighton, MA 02135

Phone 617-779-6500 Fax 617-779-6555


Adapted from: American Academy of Orthopaedic Surgeons (, Hospital for Special Surgery (, Mayo Clinic ( This information is for patient reference only. It is not intended to diagnose or guide treatment without evaluation by a physician.