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Symptoms and Signs of Stress Fracture

Doctor's Notes on Stress Fracture

A stress fracture is usually a hairline break in the bone caused by repeated stress to the bone. The primary signs and symptoms are bone pains especially when the bone is repeatedly stressed. In some patients, once the stress stops, the pain stops or eases off. Localized swelling may occur and there may be point or spot tenderness in the area where the bone is fractured. If not diagnosed, the pain will continue to be noticed more often during stress and pain at night is a common symptom. Some individuals may have chronic pain even when the fracture is not stressed. Often, stress fractures may not be seen in x-rays.

Causes of stress factors are overuse injuries usually occurring in athletes or military recruits, but anyone can get them. Some stress fractures are more likely to be caused by certain sports. For example, runners are likely to cause tibial stress fractures while basketball players are more likely to develop navicular bone fractures in the foot.

Medical Author:
Medically Reviewed on 3/11/2019

Stress Fracture Symptoms

The primary symptom of a broken bone is pain. The pain often begins toward the end of an activity and resolves with rest. If the injury is not recognized or if the symptoms are ignored, the pain will begin earlier during the exercise and continue even after the activity or exercise is finished. Pain at night is a common complaint. Eventually, the pain will become persistent with minimal activity.

Localized swelling may be occur at the site of injury, and there may be spot tenderness if the area is touched.

Stress Fracture Causes

Most people think of a fracture as an event that occurs when a single, large force is placed upon a bone and it breaks. Stress fractures, however, are caused by repetitive forces placed upon a bone over time that are greater than the bone can bear, and overwhelm the ability of the bone to repair itself in time to absorb the next force.

Most commonly, stress fractures occur as an overuse injury in athletes or in military recruits, but they can occur any time the lower extremities of the body are overburdened. Bones of the feet, shin, thigh, and pelvis are at greatest risk for stress fractures.

Because of the increased potential for osteoporosis in women, they are twice as likely as men to sustain a stress fracture. As people age, theirbone mineral density decreases and places them at greater risk of stress fracture.

The risk of developing a stress fracture increases if the body design is unable to absorb the forces of walking, running, or jumping; or if the bone is in a weakened condition before the force is applied. Some examples include:

  • height and weight (in a tall or heavy person, more force has to be absorbed by the legs);
  • improper muscle or bone alignment from the back to the feet decreases the bones ability to absorb the shock or force applied;
  • muscle weakness or fatigue that prevents the muscles from assisting in absorbing the force generated; and
  • weak bones; common causes may include osteoporosis or bones weakened because of medication (an example would include long-term use of corticosteroids such as prednisone).

Stress fractures may occur because of overuse injuries and the failure to have adequate equipment to protect the body. Certain fractures are more sports-specific. Runners can develop stress fractures of the tibia, while tennis and basketball players more often injure the navicular bone in the foot. Poorly cushioned shoes can contribute to a stress fracture, as can training on excessively hard surfaces such as concrete.

Sports Injuries Types, Treatments, and Prevention Slideshow

Sports Injuries Types, Treatments, and Prevention Slideshow

Sports injuries are injuries that occur when engaging in sports or exercise. Sports injuries can occur due to overtraining, lack of conditioning, and improper form or technique. Failing to warm up increases the risk of sports injuries. Bruises, strains, sprains, tears, and broken bones can result from sports injuries. Soft tissues like muscles, ligaments, tendons, fascia, and bursae may be affected. Traumatic brain injury (TBI) is another potential type of sports injury.


Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.