Are you at risk of stress fractures?

Stress fractures are tiny cracks in bone that develop over time in response to repeated mechanical stress, most often from high-impact or repetitive activity. Though common in athletes and physically active individuals, they can occur in anyone whose bones are subjected to loading that exceeds their ability to adapt and strengthen.

As Mr Jerome Davidson, Consultant Trauma and Orthopaedic Hip Surgeon, explains, “Stress fractures are often underestimated because the symptoms can seem mild at first. In reality, they are a sign that the bone is struggling to cope, and early assessment makes a significant difference to both recovery time and long-term outcomes.”

With extensive experience treating both athletic and non-athletic patients, Mr Davidson regularly sees how timely diagnosis, appropriate rest and targeted rehabilitation can prevent a minor stress injury from becoming a more serious problem.

What are the symptoms of a stress fracture? Can they happen anywhere?

A stress fracture typically causes localised pain that worsens with activity and improves with rest. You may notice:

• Pain that begins during exercise and may persist even at rest.
• Tenderness at a specific spot on the bone.
• Swelling or bruising in the affected area.

Stress fractures can occur in many bones, but they are most common in the weight-bearing bones of the lower leg and foot, including the tibia (shin), metatarsals (the five long bones in the foot), and navicular bone (located in the mid-foot region). 

They can also appear in the hip (such as the femoral neck), pelvis or other areas subject to repetitive load.

How is a stress fracture diagnosed?

A stress fracture may be suspected based on your clinical history and a physical examination, especially if pain is focal and activity-related. Initial x-rays often appear normal in the early stages because the crack is very small, and signs may take weeks to show. In many cases, more sensitive imaging such as MRI – the current gold-standard test – or a bone scan is required to confirm the diagnosis.

Prompt and accurate diagnosis is important, particularly for high-risk locations or when symptoms don’t improve with rest.

How do I know if I’m at risk of stress fractures? What increases my risk?

Stress fractures arise from an imbalance between the repetitive load on a bone and the body’s ability to repair microscopic damage. Several factors increase your risk:

Training and exercise

• Rapid increases in training intensity, duration or frequency
• High-impact sports such as long-distance running, dance, gymnastics or basketball
• Changes in training surface or footwear

Biological and lifestyle factors

• Being female, particularly in athletics (one study found the risk of stress fracture almost doubled in female athletics when compared to male athletics)
• Hormonal factors such as amenorrhea (absence of menstruation) or menopause
• Low bone density or osteoporosis
• Nutritional deficiencies (especially calcium and vitamin D)
• History of previous stress fractures
• Biomechanical abnormalities (for example, leg length differences or poor gait mechanics)
• Smoking and certain systemic conditions

Globally, stress fractures account for about 10-20% of sports-related injuries, with certain populations at particularly high risk.

Do I need to see a medical professional if I’m concerned I may have a stress fracture?

Yes. Seeking medical evaluation early is important if you have persistent pain during activity that doesn’t resolve with rest. Delaying assessment can allow the injury to worsen, possibly leading to a more serious fracture or longer recovery time. A consultant can differentiate stress fractures from other causes of pain (such as muscle strain or tendon injury) and recommend appropriate imaging and management.

While urgent conditions (e.g. complete traumatic breaks) warrant immediate care, stress fractures require thorough evaluation and timely intervention – but not unnecessary alarm.

Treatment and recovery from stress fractures

How long does a stress fracture take to heal?

Healing time varies by location and severity, but most stress fractures take about 6-8 weeks to heal with appropriate rest and reduced load. High-risk sites or more severe injuries may require longer.

What is the best treatment for a stress fracture?

Conservative (non-surgical) treatment is the foundation for most stress fractures. This can include rest; activity modification; reduced weight bearing; cold therapy; elevation; physiotherapy; and the gradual introduction of low-impact training.

Nutrition optimisation, including adequate intake of calcium and vitamin D, also supports bone health and recovery.

When might surgery be considered for a stress fracture?

Most stress fractures do not require surgery. However, surgery may be considered in specific areas, such as fractures in areas with poor blood supply; fractures that fail to heal with conservative treatment; or for elite athletes where expedited recovery is needed.

Surgical intervention typically involves internal fixation using pins or screws to stabilise the bone. Mr Davidson emphasises, “Surgery is often the last resort. In the majority of cases, careful rest, rehabilitation and a phased return to activity achieve excellent outcomes.”

When can I return to running or exercise after a stress fracture?

Returning to high-impact activities should be guided by clinical assessment and imaging findings – not just the absence of pain. A gradual return is recommended, starting with low-impact activities and only progressing to full training once bone healing is confirmed and strength has improved. Rushing back too soon can increase the risk of recurrence or more serious injury.

What can I do to prevent future stress fractures?

Preventing stress fractures involves addressing both training and biological factors:

• Increase activity gradually, avoiding sudden spikes in load
• Use appropriate footwear and surfaces
• Incorporate cross-training and strength exercises
• Monitor and optimise nutrition, including calcium and vitamin D intake
• Address biomechanical issues with profession assessment and exercises

Maintaining overall bone health and balanced training helps the body adapt to stress safely.

What to do if you suspect you have a stress fracture

Stress fractures are a common but manageable condition when recognised early and treated appropriately. If you suspect you may have a stress fracture, it’s important not to ignore persistent pain or delay seeking medical advice. With conservative care, many people fully recover and return to their activities stronger.

If you are concerned about a hip stress fracture and wish to book a consultation with Mr Jerome Davidson, please use our online booking form or call 020 8168 0111.