Dull ache that is progressively getting worse with sports and exercise?
Ever had that niggling pain while playing sport and training and it just gets a touch worse each time?
Dull ache in your shin or back? Tender during and after training?
Pain that creeps in during the activity and gets a little worse each session or game?
If that sounds familiar, you might be dealing with a stress fracture and training through it is one of the worst things you can do.
So that’s the bad new…the good news? With the right management, most people make a full recovery and get back to doing what they love.
This blog explains stress fractures in easy to understand language so you can follow it easily and know exactly what to do for it so you can fix that annoying pain.
TL;DR: Stress Fractures | The Key Takeaways
A stress fracture is a small crack in bone caused by repetitive loading, not a single traumatic event
Common in runners, field sport athletes, and anyone who has recently ramped up training
They account for around 20% of all sports injuries
Common sites are the tibia, foot bones, femur, and fibula
Training through a stress fracture significantly delays recovery and risks serious complications
Physio-guided load management and graduated return to sport is the gold standard treatment
What is a stress fracture?
- A stress fracture is a small crack or area of bone damage that builds up over time from repetitive, cumulative loading, not a single incident.
- Think of it like bending a paperclip back and forth. One bend won’t break it. But repeat it enough times and eventually it gives way.
- Our bones are constantly changing, old bone is replaced with the new. This cycle takes roughly three to four months to complete.
- When the training load increases faster than the bone can adapt and repair, microdamage happens and a stress fracture is the result.
Where do stress fractures occur?
- Depends from sport to sport and where your body distributes load.
- In runners, most common sites are the shin bone, midfoot, small foot bones, thigh bone and the hip bone
- In cricketers, AFL players and gymnasts, lower back stress fractures are also common due to repeated hyperextension
- You can have upper limb stress fractures are well for throwing sports however these are rare
Common symptoms for stress fractures
Stress fractures develop gradually and are often dismissed as normal training soreness. Key signs to watch for include:
- Localised pain that worsens during activity and eases with rest
- A specific, pinpoint tender spot directly over the bone
- Pain that starts earlier and earlier into your training sessions over time
- Swelling or mild bruising at the site
In more advanced cases, pain at rest or pain the morning after training.
What causes stress factures?
- It can be caused by things happening within the body (intrinsic) or things happening outside the body (extrinsic)
- Intrinsic factors include: poor physical activity baseline, low bone density, low muscle mass, previous history of stress factures, hormonal or menstrual irregularities.
- Extrinsic factors include: sudden increase in training load (most common), running on hard, uneven, or cambered surfaces, inappropriate footwear, Vitamin D and calcium deficiency and smoking
Do you need scans for stress factures?
It depends… there are a few things to consider:
- X-rays don’t always show stress fractures
- MRI’s are best however they can be expensive
Seeing a physiotherapist first and going through a thorough history and assessment can help give you clearer answers and management strategies.
If a scan is necessary, your physiotherapist may refer you to one however in most cases, this is not necessary.
How long does stress fracture recovery take?
- Depends on the site of injury, how early the injury has been identified
- Low risk stress fractures: typically 6–8 weeks before graduated return to running
- Moderate risk or delayed diagnosis: 8-12 weeks
- High risk: 12–16+ weeks, with more cautious progression and closer monitoring
Should I keep training if I have a stress fracture?
- High impact and loading activities need to be stopped or modified immediately
- However, staying active and maintaining cardiovascular fitness is important, this could be by using a stationary bike
How does physiotherapy help for stress fractures?
Physiotherapy can help you determine:
- Why the stress fracture occurred in the first place – whether it is loading error, biomechanical issue etc
- Understanding of specific fracture site, risk level and appropriate de-loading strategies
- Potential strength and biomechanical deficits
- A tailored rehabilitation program specific to your goals
- Self-management strategies for the long term to prevent the same injury from happening again
Recovery is usually broken down into 3 steps:
Settle it down
- First priority: hands on therapy to reduce swelling, inflammation and promote healing to the area
- Expert advice on de-loading and management ideas to off load the affected area while still keeping active
Build it back up
- Rehabilitation of the injured limb, to rebuild strength, control and proprioception
Return to activity
- Final phase is to build gradual return to walk, return to run programs and return to sport programs
FAQs
Is a stress fracture the same as a shin splint?
Not quite, although its a common misunderstanding.
Shin splints cause more of a diffused pain along the boarder of the shin bone. This occurs due to muscle overload creating lots of internal pressure however there is no fracture of the bone.
A stress fracture is more localised and has microfractures of the bone.
Do I need a moon boot or crutches?
Depends on the location and severity. High-risk fractures, are commonly managed in a moon boot for a period.
Some fractures require crutches or partial weight-bearing.
Often it can be a as simple as de-loading your training without needing to put on a moon boot or crutches!
Can a stress fracture come back?
Yes, especially if the underlying issue such as biomechanics and strength deficits are not addressed properly.
A structured rehabilitation program is not optional, it’s what keeps you on the field long term!
Next Steps: Get Your Bone Pain Assessed
- If you’re dealing with bone pain that is progressively worsening, don’t wait, act now and get it assessed.
- Getting assessed early can mean faster recovery, less complications and a stronger return to activity.
References
May T, Marappa-Ganeshan R. Stress Fractures. [Updated 2023 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554538/
Kahanov L, Eberman LE, Games KE, Wasik M. Diagnosis, treatment, and rehabilitation of stress fractures in the lower extremity in runners. Open Access Journal of Sports Medicine. 2015;6:87–95. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4384749/
