Stress fracture shin, The most common areas for stress fractures

A stress fracture is sometimes also known as a hairline fracture or a fatigue fracture. They are basically an incomplete fracture, or a crack in the bone, caused by repetitive forces, rather than one sudden incident.

Stress fractures are particularly common in runners due to the repetitive impacts and the forces this passes through the bones. The most common areas for stress fractures include:

Metatarsals (long bones in the foot)
Tibia (shin bone)
Femur (thigh bone)
Calcaneus (heel bone)
Talus (ankle bone)

The Metatarsals and Tibia are by far the most common stress fracture locations in runners.

Symptoms of a stress fracture include a generalised area of pain which develops gradually, is worse with repeated weight bearing and often eases with rest. There may be mild swelling in the area and it may be possible to feel a tender area directly over the bone.

As already mentioned, stress fractures are common in runners, but there are certain factors which may increase the risk of developing a stress fracture. Increasing mileage too quickly is the most common culprit. Not sticking to the 10% increase per week rule means that the body does not have time to adapt and build the strength required to sustain this level of intensity. Consistently running on hard surfaces, especially concrete pavements is another factor which is easily corrected by adding in grass, track and sand training sessions. Wearing extra cushioned running shoes, or adding in a shock absorbing insole may also be beneficial.

Stress fracture treatment mostly involves rest. For weight bearing bones this will usually mean avoiding full weight bearing with the help of crutches or a walking boot. Stress fractures are not usually put in a plaster cast.

The healing time for a weight bearing stress fracture is between 4 and 8 weeks. During this time the activity which caused the stress fracture should be avoided completely, although after 2 weeks of complete rest, other non-weight bearing exercises such as swimming or cycling may be undertaken, provided they are pain free.

After the bone is healed, a return to sport can be initiated, although should be very cautious and gradual to prevent a re-injury. Exercises to strengthen the surrounding area may be used, as should stretching exercises to ensure a full range of motion at the joints above and below.

Before returning to sport, it is important that all contributing factors are corrected to reduce the risk of a re-injury. If unsure, get a professional to look at your training programme and your running shoes.