| What We Treat
Stress Fractures
Bone pain that’s getting steadily worse with each run, now hurting at rest? Stress fractures are the end of a spectrum — and the earlier they’re recognised, the shorter the layoff.
Overview
What Is a Stress Fracture?
Bone continually remodels in response to load. A stress fracture occurs when repetitive loading outpaces the bone’s ability to repair itself, producing first a stress reaction and eventually a genuine fracture line. They are most common in runners, dancers and military recruits. Crucially, some sites — the neck of the femur, the front of the shin, the navicular in the foot — are considered high-risk and need a different, more protective management approach.
Low-Risk Sites
The shaft of the tibia at the inner border, the fibula, and the shafts of the metatarsals. These have a good blood supply, heal reliably with a period of reduced loading, and generally allow a return to running within six to twelve weeks.
Symptoms
How It Tends to Feel
Stress fractures follow a fairly predictable progression, and recognising it early shortens the layoff considerably:
Pinpoint Bone Tenderness
Tenderness you can localise to one specific spot on the bone, rather than spread over an area.
Progressively Earlier Onset
Pain arriving sooner in each successive run, then during warm-up, then during walking.
Pain After Stopping
Unlike most overuse injuries, pain persists or worsens after activity ends.
Night or Rest Pain
A significant marker suggesting the injury has progressed beyond a stress reaction.
Pain on Hopping
A useful screening test — sharp, localised pain on hopping on that leg is suggestive.
Groin Pain With a Limp
In a runner, this raises the possibility of a femoral neck stress fracture, which is a high-risk site.
Causes & Risk Factors
What Drives It
Stress fractures reflect an imbalance between loading and the bone’s capacity to adapt — and both sides of that equation matter.
Rapid Training Increases
A sudden rise in running volume, intensity or frequency without adequate adaptation time.
Low Energy Availability
Insufficient energy intake relative to expenditure impairs bone remodelling and is one of the most important modifiable factors.
Menstrual Irregularity
Absent or irregular periods indicate hormonal disruption that substantially increases stress fracture risk.
Low Bone Density
Reduced bone mineral density, whether from age, nutrition or hormonal factors, lowers the threshold for injury.
Previous Stress Fracture
A strong predictor of further stress fractures, and a signal to investigate underlying bone health.
How We Can Help You
Treatment & Management
Management depends heavily on site. Low-risk fractures need load management and a graded return; high-risk sites need protection, imaging and sometimes a surgical opinion.
What the evidence says
Femoral neck stress fractures on the tension side of the bone carry a real risk of displacement, which converts a manageable injury into a serious one requiring surgery with a risk of avascular necrosis. This is why groin pain in a runner with pain on hopping warrants prompt imaging rather than watchful waiting.
Relative energy deficiency in sport is a well-described syndrome linking low energy availability to impaired bone health, and it is a major contributor to stress fractures in both male and female athletes. Addressing it is central to preventing recurrence.
When to Seek Help
Red Flags — Don’t Ignore These
Suspected stress fracture warrants proper investigation:
⚠ Seek prompt medical assessment if you notice:
- Groin or thigh pain in a runner with pain on hopping (possible femoral neck stress fracture — needs prompt imaging)
- Inability to weight-bear, or a sudden increase in pain (possible progression to complete fracture — attend A&E)
- Pinpoint bone tenderness with pain at rest and at night
- Bone pain with fever, night sweats or unexplained weight loss
- Repeated stress fractures, particularly with menstrual irregularity or restrictive eating patterns
Femoral neck stress fractures can displace, which substantially worsens the outcome. If you are a runner with groin pain and pain on hopping, please seek prompt medical assessment rather than continuing to train.
Common Questions
Frequently Asked Questions
Will an X-ray show it?
Often not, particularly in the first few weeks. X-rays are frequently normal in early stress fractures and only show changes once healing begins. MRI is far more sensitive and is the investigation of choice where a stress fracture is suspected.
How long will I be off running?
For a low-risk site, typically six to twelve weeks with a graded return. High-risk sites take longer and may require protected weight-bearing or surgery. Cross-training usually continues throughout, so fitness needn’t be lost entirely.
Why did this happen to me?
Usually a combination of a training increase and something reducing the bone’s capacity to adapt — most often energy availability, vitamin D status, or hormonal factors. Investigating that side of it is what prevents the next one.
Can I keep training?
Not on the injured bone, but cross-training that doesn’t load it — swimming, cycling, aqua-jogging depending on the site — is usually encouraged and maintains fitness well. Ignoring bone pain and continuing to run risks progression to a complete fracture.
Catch It Early, Return Sooner
An accurate assessment of the site and risk level, the right imaging, and a plan that addresses why it happened.
Book Your Initial AssessmentThis page is for general information only and isn’t a substitute for individual medical advice. If you’re experiencing any of the warning signs above, contact your GP or seek emergency medical care as appropriate.