Top 4 things to know about stress fractures

You have probably heard of a stress fracture before but may not know much about them, including what a stress fracture is, how it happens, how to heal from one, and how to prevent one. If you want to keep your bones healthy, then read on to find out how! 

1) What is a stress fracture? 

A stress fracture is an injury to your bone from repetitive overloading. Injuries like this are known as “bone stress injuries” or “stress reactions.” All stress fractures are bone stress injuries, but not all bone stress injuries are stress fractures (kind of like squares and rectangles). Bone stress injuries can be seen on MRI. Stress fractures can be seen both on MRI and x-ray because they are larger and more severe. However, all forms of bone stress injury should be taken seriously. Stress fractures are different from regular fractures (or bone breaks) because they happen gradually over time, rather than from one event. 

2) How do stress fractures occur? 

Stress fractures, or bone stress injuries, occur when we stress our bones too much, too frequently, without allowing adequate time for them to recover in between. Impact activities like running and jumping put a lot of stress on our bones. But even low impact activities like swimming and walking can stress our bones a bit. 

When our bones are stressed it results in “microdamage” to our bones. This is normal and healthy, and our bones respond by growing more bone cells. This is how our bones stay strong. However, if we put so much stress on our bones that they cannot keep up, then this leads to a stress injury. 

We can think about this by using a simple formula: Load – capacity = risk of injury

Load is the total amount of stress we put on our bones. Capacity is our bones’ ability to recover from that load. If the load exceeds our capacity, it leads to a bone stress injury. 

3) How do you heal from a stress fracture? 

There are a few key principles that are important for recovering from a stress fracture or bone stress injury:

1. Manage the load: It is important to avoid all painful activities when you have a stress fracture or bone stress injury. This is a good indicator that you are allowing yourself to heal.
2. Maintain fitness: You will likely need to be out of your sport while you recover from a stress fracture or bone stress injury, but that does not mean you have to lose your fitness. Cross training by biking, using an elliptical, or swimming can be a good way to maintain your cardiovascular fitness, as long as it is pain free. 
3. Strengthen your muscles: Having weak leg muscles increases your risk of bone stress injuries, so it makes sense that strengthening your leg muscles can help prevent them. Our muscles are important for helping us absorb forces during impact activities. The more impact our muscles can help absorb, the less force our bones will have to absorb. 
4. Return to activities safely: It is important not to return to your sport or activities all at once, but to gradually resume activities in a pain free way. This is how you build back up your bone capacity (from the formula above). Your sports medicine physical therapist at Girl Fit can help guide you in safe return to sport and activity! 

4) How do you prevent a stress fracture? 

If we consider our formula, load – capacity = risk of injury, then there are two ways to decrease the risk of a bone stress injury. (Sorry if you hate math.) The first is to decrease the load, the second is to increase the capacity or, in this case, your bone health. 

To decrease loading, you may need to decrease the volume of bone-stressing activities in your life. If you are a runner, this may mean decreasing your total weekly mileage. Another way to decrease the load on your bones is to change your body mechanics, or the way you move. For example, having a PT assess your running and helping you to change the way you run can help your bones absorb less force while you run. 

To increase your bone health, it is best to start when you are young if possible – as in, before puberty. Children who participate in high impact, multidirectional sports such as basketball, soccer, or gymnastics, are less likely to sustain bone stress injuries as adults because they grow stronger bones. 

If you are already past puberty, then don’t worry, there are things you can do as well. If you’ve had a bone stress injury before, talk to your doctor and seek a dietician, as our diet is incredibly important in the health of our bones. We want to ensure we eat enough calories to sustain us during all of our activities. If you have an eating disorder or think you may have an eating disorder, talk to your doctor and seek a psychiatrist who will be able to help you recover. Finally, your physical therapist can help you improve your bone health as well by teaching you to strengthen the right muscles and by safely guiding you through plyometric exercises. 

To schedule a physical therapy evaluation with one our specialized physical therapists at Girl Fit just give us a call at 617-618-9290 or email us at office@girlfitPT.com.  If you aren’t in pain, but would like an evaluation of your strength, flexibility, posture, movement, and sport specific skills you can schedule a Wellness Visit with one of our physical therapists.  They will work with you to create an injury prevention program, provide you with guidance on training and load management, and answer all of your questions about preventing injuries and enhancing performance in your sport.  

We are offering physical therapy and Wellness Visits both in person and via Telehealth physical therapy.  

Jess Danahy, PT, DPT

Follow us on Instagram @girlfitrocks

References

Warden SJ, Edwards WB, Willy RW. Optimal loading for managing low-risk tibial and metatarsal bone stress injuries in runners: The science behind the clinical reasoning. JOSPT. 2021;51(7):322-330. 

JOSPT Insights. Podcast Episode 48: Effective rehab for runners with bone stress injury, with Dr Stuart Warden (Part 1 or 2). Aug 2021. 

JOSPT Insights. Podcast Episode 49: Effective rehab for runners with bone stress injury, with Dr Stuart Warden (Part 2 or 2). Aug 2021. 

RunningReform. Load vs capacity and injuries. Vimeo. https://vimeo.com/339686848.