Stress Fracture and Bone Stress

Bone Stress Injury:

A bone stress injury (BSI) implies that the bones can’t endure recurring mechanical loads, bringing about structural exhaustion and bone pain. Bone stress injury is a cause of worry in marathon runners; alongside the frequency of recurring episodes and morbidity issues, they also relapse.


A BSI results from disturbance of the homeostasis between microdamage development and its evacuation. The mini cracks because of repetitive stress on bone cause periosteal resorption to surpass the bone redesigning rate that leads to BSI.


Around 10-20% of consultations are advised for bone stress injury in sports according to National Institute of Health. Lower appendage stress fractures are considerably more typical than the upper appendage.

The tibial shaft is the most continuous site in sports person and comprises all pressure cracks. Metatarsal stress fractures are generally typical, happening in around 10-20% of the sportsperson. Femoral shaft and neck fracture 8% of stress breaks in military staff and 11% in athletes.

Risk factors:

Risk factors are broadly divided into extrinsic and intrinsic factors.

  • Extrinsic risk factors include the environmental factors of a sportsperson, such as training ground.
  • Intrinsic risk factors include a patient’s bone structure and function.

Bone Stress Injury Leading to Stress Fracture:

Delay in BSI diagnosis leads to stress fractures and more complicated problems resulting in permanent immobility.

Stress Fractures:

Stress fractures are tiny fissures and cracks in a bone. They’re brought about by redundant force, frequently from overuse, for example, over and over jumping around or running a marathon. Moreover, they originate from the ordinary utilisation of a bone that is weakened by a condition, for example, osteoporosis.


From the onset, one may scarcely feel the pain related to a stress fracture, yet it will deteriorate with time. The tenderness begins typically at a particular spot and diminishes during rest. One may find swelling around the localised area of pain and injury.

Risk factors:

Factors that can increase risk:

  • Sports.
  • Increased activity.
  • Gender. Women, especially those who have abnormal or absent menstrual periods.
  • Foot problems. People who have flat feet or high, rigid arches are more likely to develop stress fractures.
  • Weakened bones.
  • Previous stress fractures.
  • Lack of nutrients.

Clinical Presentation:

  • The most common symptom is pain with movement that dies down with rest.
  • Pain that deteriorates after some time that proceeds with the aggravating movement.
  • Swelling and tenderness may likewise be found around the localised area of pain.

Diagnostic Procedures:

Bone scans have been viewed as the best quality level for assessing stress and pressure incited injuries for a long time. The following are the diagnostic methods through which bone scans are done:

  • Radiography
  • Magnetic resonance imaging (MRI)
  • Computed tomography (CT scan)

Physiotherapy of Stress Fractures:

Initial treatment incorporates; analgesia, adjusted weight-bearing tools (cranes, walker), physical activity module, as well as ending the exercises that causes strain on the bones. If the patient can’t move around without pain, brief immobilisation is advised. As the resting phase ends, physical activity starts with a progressive re-visitation of action over the resulting weeks. In the procedure, a person proceeds with non-intrusive treatment. Recuperation, gaining strength, and progressive re-visitation of action are critical to prevent or decrease re-injury probability.


  • Proper footwear.
  • The gradual build-up of muscles and strength.
  • Warm-up before exercise.
  • Cool down properly after exercise.


When stress fractures or bone stress injury is not treated on time, they may cause chronic health issues. To cure the injury, one needs to eliminate the root cause of the problem.


Bone stress injury and stress fractures are most commonly associated with overtraining with inadequate recovery time. A physiotherapist helps regain muscular and physical strength with rest, analgesia, activity modification, cross-training, and a gradual return to sport.


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* Contact Reach Physiotherapy for a list of references used for this blog content.