A Runners Guide To Stress Fractures

No other running injury has the potential to sideline you for a long period of time quite like a stress fracture.

When I was younger, I always used to wince when I heard the term “stress fracture”.

My mind assumed that because it contained the word “fracture” that runners with the condition must have suffered some mishap when out training!

What is a stress fracture?

Stress fractures are a classed as an overuse injury.

They form when muscles are fatigued and unable to absorb as much of the impact from a foot strike as they normally would.

This causes tiny cracks in the bone to form.

If left untreated, a stress fracture can eventually lead to a complete fracture to form.

Why do I get stress fractures?

As a runner, chances are that you picked up a stress fracture from doing too much too soon.

When you don’t give your legs enough time to adjust and recover from an increase in your mileage or training intensity, the microscopic tearing of the bone tissue can cause cracks in the bone to form.

Who’s most at risk?

As stress fissures are caused by too much impact (normally from running and jumping), the condition can affect a number of groups, including:

  • Runners,
  • Basketball players,
  • Football players,
  • Soccer players,
  • Members of the military

In addition to athletes, there are also a few others who could be prone to the condition:

  • Anyone with osteoporosis / osteoarthritis
  • Rheumatoid arthritis
  • Other bone-weakening conditions

What are the most common areas to get stress fractures?

As you might have guessed, stress fractures commonly occur on weight-bearing bones that are prone to repeated impact such as:

  • tibias
  • metatarsals
  • fibula
  • pelvis
  • calcaneus
  • navicular bones


A stress fracture is probably one of the more difficult injuries to diagnose but there are certain things that you should look out for.

Tenderness and Warmth

With a stress fracture, you’ll often find that the affected area will feel tender and it’ll often be accompanied by a warmth and even localized bruising.


As oblivious as it might sound. pain is our bodies way of letting us know that something’s not as it should be.

With stress fractures, there’s often a delay to the pain – chances are that you won’t feel too uncomfortable when running but it’s after that the discomfort sets in.

This delayed discomfort can range from a couple of hours to a few days. It’s because of this delay that it can often be attributed to Delayed Onset Muscle Soreness.

The easiest way to tell is by applying pressure to the affected area – you’ll know if it’s a possible stress fracture as you’ll experience a painful sensation.


Because most injuries will normally cause some inflammation of the tissue, swelling is normal in this with a stress fracture.

Who Should I Seek Help From?

Okay, so there’s a tonne of conflicting information on the web about what you should do if you suspect that you’re suffering from a stress fracture.

While you should always seek medical treatment from a Doctor if the problem is affecting your day-to-day life, personally, I feel that your best course of action is to seek out a good physiotherapist.

Diagnosis Exams

Once you’ve booked an appointment with a physiotherapist, chances are they’ll run you through a couple of tests during your first meeting:

Bump Test

With a straight leg slightly off the table, your physio will ‘bump’ your heel with the palm of their hand.

If you experience pain or discomfort in the injured area, it will give them grounds to investigate further as it can be a sign of a fracture.

Fulcrum test

Along with the bump test, the second test that a physio is likely to carry out when potentially diagnosing a stress fracture is the Fulcrum test.

While it does sound like a form of Medieval torture, the test itself if quite straight forward.

While you’re seated on the examination table, your physio will place an arm under the thigh of the affected leg creating a pivot point.

They’ll then apply downward pressure on the other arm, slowly moving to the affected area.

If you experience a sharp pain it’s likely you’ll receive a positive diagnosis.

Fulcrum test video

The video below provides a great overview:

Stress Fracture Prevention

Obviously, seeing proper treatment from a professional is the best long term solution, however, there are still a few things that you can do to speed up your recovery and prevent the injury from occurring again…


We’ve previously written about how many conditions can be managed by following the R.I.C.E recovery framework and it can really help manage the inflammation of affected areas.

Rest – take time off running to prevent further aggravation.

Ice – Break out the frozen peas, or even better, ice packs and properly ice the affected area.

Compression – Wrap the troublesome area with a loosened bandage, compression socks, tights or calf guards.

Elevate – Quite literally, get your feet up! Getting your feet higher than the level of your heart really helps minimize swelling.

Take These Two Supplements To Speed Up Recovery

Supplements have the potential to really help with your recovery.

Ensuring that you take vitamin D and calcium can really help to strengthen your bones.

How To Avoid Stress Fractures When You Start Running Again

Want to know what the most common cause of stress fractures is amongst those runners who’re coming back from injury?

Making the mistake of jumping right back into training where you left off.

When you’re returning to training, it’s important that you ease right back – train as if you’re a beginner again.

Start slowly with a focus on time rather than mileage. Three twenty minute runs a week is preferable to a single run of one hour.

This allows your body to properly recover in between sessions and strengthen the bones without causing excessive fatigue.

Once you’re comfortable with this you can aim to follow the 10% rule – adding 10% to your weekly time each week.


If there’s one injury that has potential to ruin your training it’s a stress fracture.

Left untreated, it not only has the potential to put halt to any training plans that you follow but it can also lead to fully blown fractures.

However, with proper physical therapy and a solid recovery strategy you’ll be back on your feet without too many setbacks.


  1. PhysioPedia – Fulcrum test