Everything runners need to know about stress fractures

Stress Fractures… probably the single most frustrating injury a runner can face on account that it causes a larger set back than most running injuries: at least 6 -8 weeks of no running.

In this article we address the big questions surrounding stress fractures.

What is a Stress Fracture?

A stress fracture is a small crack, or severe bruising, that forms in any of the weight- bearing  bones in the body. Stress fractures are considered overuse injuries and occur when repetitive force results in microscopic damage to the bone. There is not enough time being given for healing between exercise sessions hence why runners can be at risk of developing one.

What causes a Stress Fracture and how can I avoid getting one?

TRAINING: Doing too much too quickly. This is the most common cause of stress fractures. Examine your training history to determine whether you are drastically increasing your mileage or intensity. Traditionally the recommendation is not to exceed a 10% mileage increase per month.

Studies have shown that runners with larger calf circumference are at a lower risk of tibial stress fracture…. yay to everyone sporting Cankles!
Another study found that women with larger muscular cross-sectional area in their calf were at lower risk of any kind of stress frcature. Therefore improving the strength, size and endurance of muscles in your calves helps to safe guard the legs in the future.

Running fast incurs greater impact when your feet hit the ground. Consider limiting spadework sessions.

Women are more prone to developing stress fractures. Those who are amenhorreic (missing monthly period) are at a significantly higher risk from sustaining a stress fracture due to hormone dynamics. If you are amenhorreic seek advice from your GP as it can affect not only your immediate injury risk but your bone density later on in life.

FOOTWEAR: If your shoes have seen too many miles… bin them. The liklihood is they no longer have the adequate support to provide the shock-absorption you need. If you have any concerns about your feet the best place to start is with a podiatrist and bring your trainers with you. Podiatrists are highly trained to assess your gait pattern looking for issues arising from the way you walk.

NUTRITION: A balanced and varied diet rich in calcium and vitamin D will help build bone strength. Stress fractures are more common in winter months when vitamin D is in shorter supply. Active individuals need higher levels of vitamin D than the inactive population.

SURFACES: change up the surface you typically run on. Many runners report that trails or grass feels kinder on their bodies than the road. Running continuously on the road causes the build up of repetitive force.

How would I know if I have a stress Fracture and what do I do?

A stress fracture typically feels like an aching or burning pinpointable pain. It will be painful to press and will progressively worsen as you run or even walk on it.

If your physio or podiatrist suspects you have a stress fracture they will point you in the direction of A&E.


X-rays are generally poor for diagnostic purposes but are a first line of investigation. Preferably a bone scan or better still an MRI should be used to confirm the presence of a stress fracture. Unfortunately these more accurate images are more expensive and not routinely offered on the NHS .



It is important that the exact location and severity of your stress fracture is established. This will determine whether any protective measures, such as an air boot or crutches, are needed. Do not ignore your pain as continued use may fracture the bone completely.



How do you treat a Stress Fracture? 

Until you get a proper diagnosis it is good practice to follow the PRICE protocol.

Protect & Rest– Avoid weight bearing activites. If you have to bear weight for any reason, make sure you are wearing a very supportive and cushioned shoe.
Ice– Apply ice to keep the swelling down. Use cold packs for 20 minutes at a time, several times a day.
Compression- To prevent additional swelling, lightly wrap the area in a soft bandage or compression sock.
Elevation- As often as possible, rest with your foot raised up higher than your heart.

The goal of treatment is to relieve pain and allow the fracture to heal.

You can participate in some non-weightbearing cross training, like aqua jogging or swimming (follow HERE to discover lots of brill info on running in the pool), which can often be started right away. You may have to wait several weeks to use the ellitical or exercise bike. Certain Non- weight bearing pilates and mat work exercises can also be done to maintain strength and conditioning.

Work towards eating a well balanced and varied diet. An improper diet can impede your body’s ability to repair your bones.

In most cases it takes from 6 to 8 weeks for a stress fracture to heal, more serious stress fractures can of course take longer. Although it is hard to be sidelined with an injury, returning too soon can put you at risk for larger, harder to heal stress fractures.

Can I run with a stress fracture?

NOPE. Typically stress fractures require 8 weeks AWAY from running. Once you have been given the green light from your physio/ GP/ podiatrist consider follow our guide to getting back into running.

You may experience some mild discomfort in your initial runs due to scar tissue and bone remodelling at the injury site. As long as the soreness is mild and settles quickly after your run you should be OK. Do consider a few sessions with a physiotherapist who specialises in running injuries to iron out those initial niggles.

Try to do something OTHER than obsessing about not being able to run. On one of the occasions I diagnosed a runner with a stress fracture their response was ‘well that gives me 6 weeks to get a 6-pack’. #alwayslookonthebrightside

By Rebecca McNamara