Stress fractures – how do they happen and how do you recover?

In the final part of our three blogs looking at pain around the shins, this time it’s stress fractures.

Just as overuse and over-exertion can lead to muscle and tendon injuries, it can also impact our bones.

This can happen as a result of a significant increase in training or mileage – it’s something that we’ve seen in those doing their first marathon too quickly for example. As a result these injuries are most common in the lower leg, foot and ankle, such as the tibia in the lower leg with its weight-bearing role.

Stress fracture = pain?

It’s something that you don’t always notice instantly like a ‘normal’ fracture. In fact a stress fracture may not be painful at all, and at this stage it is commonly referred to as a stress reaction.

As the reaction gets worse then the pain levels will increase, usually presenting as tenderness around the affected area. As this diagram shows, a stress reaction can get worse over time, potentially leading to a more conventional fracture of the bone.

Pain over time

Stress fractures aren’t easy to diagnose – in fact it’s very easy to miss them on an x-ray to the point where a bone or even CT scan may be required to show the strain on the bone in question.

Treating a stress fracture

This is an injury where a degree of rest will almost certainly be required – but just as you would strengthen a muscle after injury, the same is true here.

Initially this shouldn’t involve anything ‘high-impact’ such as running, beginning with controlled loading exercises such as squats before moving onto skipping, jumping and eventually running.

What’s key is to determine your own speed of recovery, stopping training the second that the pain comes back. Over time this point will increase until you’re back to a normal level of activity.

Even after the recovery, imaging may not return to normal for some time as this diagram shows. So long as you’re pain-free and back to a sensible level of activity, there’s no need to panic if a scan still shows an anomaly.

Return to normal

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