What you need to know from Women’s Sports Medicine at TRIA
Stress fractures are more common in women than in men, including among female athletes compared to male athletes. Read this handout to learn more about what a stress fracture is, what commonly causes a stress fracture, treatment and more.
What is a stress fracture?
A stress fracture is a tiny crack in a bone. Stress fractures most commonly occur in the tibia, also known as your shinbone (the large front leg bone below your knee). Other common places that stress fractures occur include the:
- Tarsals (the 7 bones around the middle and back of your foot)
- Metatarsals (5 long bones that connect from your heel to your toes)
- Femur (the longest bone in the human body, which connects your knee to your hip)
- Ribs and other bones
As the picture below highlights, a stress fracture starts out as a silent stress reaction with no symptoms. Strain on the bone is minimal with no pain. As the stress worsens, strain on the bone and pain increases to become a stress reaction. More strain leads to more pain and a stress fracture.
What causes a stress fracture?
A stress fractures can occur when something affects your body’s normal process of forming new bone to replace old bone. The formation of new bone can’t keep up with the rate that the old bone is being resorbed (removed by gradually breaking down). Stress fractures most commonly occur with:
- A quick increase in duration (how long), intensity (how hard) or frequency (how often) of activity.
- Changes in footwear or training surface.
- Muscle fatigue or biomechanical problems—Biomechanical refers to how your muscles, bones and joints react under certain conditions when you are being physically active.
- Problems with bone health, hormone imbalances and menstruation.
What are the risks for a stress fracture?
Female athletes are 3.5 times more likely to sustain a fracture then male athletes. The increased risk for a stress fracture in women may be related to:
- A disruption in menstrual cycle that can lead to decreased bone density.
- Differences in anatomy (structure of the body) between women and men.
What are symptoms of a stress fracture?
Typically, pain caused by a stress fracture is localized over the bone. The pain gets worse with activity and better with rest. If the pain is left untreated, you can experience pain doing normal daily activities or at night.
How is a stress fracture diagnosed?
If you suspect you have a stress fracture, see a sports medicine specialist as soon as possible. They will diagnose a stress fracture primarily by:
- Doing a physical exam.
- Asking you questions about your history.
Identifying what may have caused or contributed to a stress fracture is very important. X-rays don’t always show stress fractures, especially early in the development of a stress fracture. Your sports medicine specialist also may refer you to physical therapy to help determine if a biomechanical problem contributed to your stress fracture.
How is a stress fracture treated?
The first step to treating a stress fracture is to limit activity. Depending on the severity and location of your stress fracture, your sports medicine specialist may advise limiting weight bearing on the area. Other changes in training could be made as well, including using different footwear. Your sports medicine specialist will develop a treatment plan specific to your individual needs. A stress fracture that is not treated correctly can become a full fracture (refer back to previous chart).
What are the long-term effects of a stress fracture?
If a stress fracture is treated correctly, you should have no long-term effects. Determining why the stress fracture started is important.