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6 Stress Fracture Warning Signs All Women Should Know About

A small crack in a bone or severe bruising within a bone is generally termed stress fracture. Most stress fractures are caused by overuse and repetitive activity injuries in which recurrent strains lead to material fatigue and micro architectural discontinuities.

They account for up to 20% of athletic injuries, more often in women especially athletes who participate in the setting of track and field events. In women, menstrual disturbances, low energy intake, low body mass index and sometimes low bone mass, may be contributing factors.

Description of stress fracture

Often stress fractures occur in the second and third metatarsals in the foot, which are generally thinner and longer than the adjacent first metatarsal. This area has greatest impact on your foot as you push off when you walk or run.

Stress fractures are also common in the calcaneus (heel); talus (a small bone in the ankle joint); fibula (the outer bone of the lower leg and ankle); and the navicular (a bone on the top of the mid foot).

Many stress fractures are the results of overuse injuries. They occur over the time when recurrent pressure results in microscopic damage to the bone. However, this repetitive force that causes stress fracture is not potent enough to cause any acute fracture such as a broken ankle caused by a fall. Worn out stress fractures occur when an athletic movement is repeated very often and the weight bearing bones and supporting muscles do not have enough time to heal between consecutive training sessions.


By using questionnaires and scanning their bone-density, a study was conducted on 50 runners where the athletes were categorized as low, moderate, or high risk based on the components of the female athlete triad, which includes low bone mineral density, low energy availability (EA) with or without disordered eating, bone stress injuries and menstrual dysfunction. Around 27 runners were classified as low risk, sixteen of them had moderate risk, and high risk group consisted of seven athletes. Moderate or high risk group athletes have poor chances of avoiding a season ending injury.

Here are some key information below about how to detect stress fracture at early stage and necessary medical assistance:

stand like the posture of a dog on your yoga mat with your wrists under your shoulders and knees under your hips. Tuck under your toes and lift your hips up off the floor while you draw them up at back towards your heels.

Keep your knees slightly bent if you have tight hamstrings, otherwise try and straighten out your legs while keeping your hips back. Take your hands forward as much possible to give yourself more length if you need to.

Press firmly through your palms and rotate inner elbows towards each other. Hollow out the abdominals and keep your legs engaged to keep the torso moving back towards your thighs. Hold for 8 to 10 breaths before dropping back your hands and knees to rest.

Warning Signs of a Stress Fracture

As outlined in a consensus statement by a panel of experts of sports medicine, here are six key indications that you may be at risk of developing a stress fracture

  1. Low energy availability or loss of body weight, as a result of past or current disordered eating
  2. Low body mass index (BMI)
  3. Irregular menstrual cycle
  4. Delayed and erratic menstrual cycle (among 15 years old or older)
  5. Low bone mineral density
  6. Previous stress fractures (or stress reactions)

This risk stratification protocol came from the experts in the hopes of developing some standardized guidelines that are briefed below to return back to daily workout.

Medical assistance

Ignoring the pain can have serious consequences. Visit your doctor as soon as possible if you think you have a stress fracture. Until your appointment with the doctor, follow the RICE protocol. RICE stands for rest, ice, compression, and elevation.

  • Rest - Avoid activities that put weight on your foot. If you need to carry weight for any reason, make sure you are wearing the best gym shoes to support your feet and ankle.
  • Ice - Apply ice immediately after the injury to keep the swelling down. Use cold packs for 20 minutes at a time, six to seven times a day. Do not apply ice directly on your skin.
  • Compression - To prevent additional swelling, lightly wrap the area in a soft bandage.
  • Elevation - As often as possible, rest with your foot inclined at an angle higher than your heart.

In addition, non steroidal anti inflammatory drugs, or NSAIDs, such as ibuprofen or naproxen can help relieve pain and reduce swelling.

However, sports medicine experts offer their valued opinion for medical assistance for coaches and medical staffs regarding ways of treating stress fractured women:

  1. Anyone in the moderate or high risk categories needs to be assessed to ensure that they are getting enough calories to support their training, along with calcium and vitamin D.
  2. Such athletes need to be monitored on an ongoing basis to ensure some crucial areas such as nutrition, menstrual function, and bone health is addressed properly time to time.
  3. Higher risk athletes may want to consider alternate training by making low-impact cross training after regular warm up exercise which is always a part of their weekly routine. Good sleep and recovery are also important.
  4. Not all stress fractures occur under similar circumstances. Most of the stress fractures in low-risk athletes are usually in the foot as a consequence of biomechanics and choice of sports whereas in the higher risk categories many of the fractures occur in places like the pelvis, sacrum and femoral neck, where the bones tend to have a different and softer interior structure. These fractures may be less of a direct consequence of biomechanical forces and more the result of weakened bone.
  5. To reduce stress on your foot and leg, it is highly recommended for athletes to wear their best gym shoes to support their feet and ankle.
  6. Besides guidelines for the coaches and medical staffs, specialized doctors must carry out some crucial treatment such as:
    • Casting - Stress fractures in the fifth metatarsal bone (on the outer side of the foot) or in the navicular or talus bones take longer to heal so sports doctor may apply a cast to your foot to keep your bones in a fixed position and to remove the stress from your injured leg.
    • Surgical treatment - Some stress fractures require surgery to heal properly. In most cases it involves supporting the bones by inserting a type of fastener. This is called internal fixation. Pins, screws, and/or plates are most frequently used to hold the small bones of the ankle and foot together during the healing process.


In most cases, it takes six to eight weeks for a stress fracture to heal. More serious stress fractures may take longer. Returning to activity too soon after recovery can result in reinjury. Reinjury could lead to chronic problems and the stress fracture might never heal properly in future.

Once the stress fracture has healed and you are pain free, consult your doctor before a gradual return to activity. During the early phase of rehabilitation, your doctor may recommend alternating days of training with days of rest which gives your bone the time to grow and withstand the new demands being placed upon it. Start with light warm up exercise slowly increase the frequency, duration, and intensity of your exercise as your fitness level improves.


To prevent oneself from getting stress fracture an athlete must

  • Follow a healthy diet rich in calcium and vitamin D
  • Use proper equipment especially good shoes which is the key to prevent stress fracture,
  • Start new activity slowly and gradually increase your time.
  • Cross train by alternating among a high-impact sport like running with low impact sports like cycling or swimming.
  • Add strength training to your workout. Strength-training exercises use resistance methods like light weights, resistance bands, or your own body weight to build muscles and strength.
  • Stop your activity if pain or swelling returns. Rest for few days, if pain continues consults doctor.

Ignored stress fracture can lead to

If a stress fracture is not properly treated, serious problems may develop. For instance:

  • The fracture can get worse eventually, if you do not change your activities. If it does not receive professional medical attention, it can heal improperly and become a source of pain and disability for the rest of your life.
  • The fracture can cause a defect in some specific bones that can limit the ability to move the foot, or make it difficult to find shoes which fit well.
  • You can develop arthritis, which may be caused by fractures that extend up to a joint (the juncture where two bones meet).

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