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Stress fractures are a common injury in athletes and are most often associated with participation in sports involving running, jumping or repetitive stress. A stress fracture is a micro fracture of a bone that results when the rate of healing is unable to keep up with the rate of breakdown that is being caused by repetitive stress placed upon it. Stress fractures occur most frequently at the beginning of a sports season due to the increase in physical activity that is required. Studies have shown that athletes participating in tennis, track and field, gymnastics, and basketball are particularly susceptible to this type of injury.

Stress fractures can occur in two ways:

  1. The redistribution of impact forces resulting in increased stress at focal points in bone.
  2. The action of muscle pull(s) across bone.

The tibia, which is the larger and stronger bone of the lower leg, is the site of approximately 50% of all stress fractures in athletes. – Running & Fitnews

 Symptoms of a stress fracture:

  • Localized bone pain
  • Pain is aggravated with physical activity and relieved with rest
  • Area may be tender to the touch, with occasional swelling and redness


One of the biggest mistakes athletes make after being diagnosed with a stress fracture is returning to training too quickly. It’s important to let the body heal and if it’s rushed, there is a greater risk that the injury will reoccur. Depending on the severity of an injury, the healing process can be anywhere from eight to seventeen weeks. Clinicians recommend that training begin slowly with a low intensity and be pain free. Cross training is a great option for recovery and may include deep water running, cycling and gym work.


Stress fractures are managed best by taking preventative measures. Stress fractures are directly related to training loads and how fast an athlete increases the frequency, intensity, and duration of their activity. Bones can adapt to repetitive stress but extreme stress, if it occurs too often, can overwhelm the body’s ability to adapt. Having a varied training schedule is essential for prevention as well as having the proper athletic gear. Distance runners are particularly susceptible to this type of injury and it’s recommended that athletes replace athletic shoes as they wear out, approximately 700-1,000 kilometres or 6-12 months.

Other risk factors beyond training schedules and loads are nutrition and gender. Calcium and vitamin D deficiency decreases bone density which can increase the chance of injury. For female athletes, amenorrhea (infrequent menstrual cycle), osteoporosis and/or an improper diet can all contribute to the occurrence of stress fractures.

Coaches and athletes should be aware of the effects of overtraining and the importance of taking rest days. If you think you may have a stress fracture, keep in mind that this type of injury should not be self treated. Proper diagnosis should come from a physician and depending on the location and severity, recommendations for treatment will differ.

References from the SIRC Collection:

1. Avoiding a Stress Fracture is Largely up to You. Running & Fitnews. July 2012;30(4):9-13.
2. Dawson-Cook S. STRESS FRACTURES. American Fitness. September 2010;28(5):56-57.
3. Ekstrand J, Torstveit M. Stress fractures in elite male football players. Scandinavian Journal Of Medicine & Science In Sports. June 2012;22(3):341-346.
4. Hunt A. IT’S JUST SHIN SPLINTS… RIGHT?. Triathlon Life. Winter2009 2009;12(1):54-56.
5. Moran D, Evans R, Hadad E. Imaging of Lower Extremity Stress Fracture Injuries. Sports Medicine. February 2013;43(2):345-356.
6. POLLOCK N. STRESS FRACTURES IN SPORT. Sportex Medicine. October 2011;(50):20-24.
7. Poynton E. Stress Fractures. Modern Athlete & Coach. January 2011;49(1):16-17.
8. Smith R. Stress Fractures of the Hip in Young Athletes. Hughston Health Alert. Spring2007 2007;19(2):6.

The information presented in SIRC blogs and SIRCuit articles is accurate and reliable as of the date of publication. Developments that occur after the date of publication may impact the current accuracy of the information presented in a previously published blog or article.