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Diagnosing Running Stress Fractures

Diagnosing Running Stress Fractures
Diagnosing Running Stress Fractures

The Symptoms Of A Running Stress Fracture

There are no hard and fast rules for what a running stress fractures will feel like and but here are a few guidelines regarding commonly mentioned symptoms of a stress fracture:

  • Although most develop gradually, running stress fractures often come on without warning and frequently there is no other obvious explanation for the onset of pain, meaning no trauma or injury has occurred to trigger the arrival of the pain.
  • Don’t be fooled into thinking that you only have a stress fracture if you are unable to run. Early on people can often run through the pain of a stress fracture. However a little rule is that if it doesn’t feel better as a run progresses it can be a sign of a stress fracture. Unlike some stages of certain tendon complaints, not always but typically stress fractures don’t get better through the run, they get progressively worse. Eventually with stress fractures they can end up hurting not just during or after running but whilst walking or even when you are not putting any weight on the limb at all.
  • Running stress fractures generally feel like an aching or burning localised pain somewhere along the bone. If the stress fracture is on a bone like the tibia or femur and there are a lot of muscles around it, then these muscles may also feel very tight.
  • Usually, it will hurt to press the area meaning you may be able to find a spot on the bone that pressing on it will produce exquisite pain.

If you suspect you have a running stress fracture, then you should stop running and see your physiotherapist, GP or sports medicine specialist as soon as possible.

Diagnosing Running Stress Fractures

Clinical tests such as palpation of the area and the “hop test” (which means it hurts if you hop on the injured leg) can be coupled with a detailed history of training loads and pain presentation to help diagnose a stress fracture. However for certainty and the grading of severity then investigations are beneficial.
If you suspect you have a stress fracture then there are some tests that can be ordered to confirm the diagnosis.

  • Traditional X-rays often are not sensitive enough to pick up running stress fractures, at least not in the early stages. With chronic stress fractures or healing stress fractures an X-ray may identify the evidence of healing at the site of injury but in the initial diagnosis are of little use.
  • The use of MRI or bone scans are more sensitive ways of assessing and diagnosing stress fractures and as a result are preferred over plain X-rays. Bone scans when correlated with the clinical history are an accurate and reliable way to identify the presence of a stress fracture however MRI is better when wanting to get an idea of the severity and estimate return to running time frames.

Tip: If the pain felt when running is focused on one area of the bone and becomes constant or worse during a run, then you should stop training and see your physiotherapist or sports medicine specialist immediately.

Picking up a bone reaction early on is crucial. Sometimes if caught early on there may simply be a stress reaction of the bone and things have not progressed to being an actual stress fracture. Conversely, running through the pain of a stress fracture may cause the progression to a more significant or even complete bone fracture.
If you manage to catch a running stress fracture early on in the stress reaction stage, which is likely if you stop immediately at the onset of any symptoms then this may only require you to have a mere few weeks off training. Where as pushing through the pain associated with a stress fracture and continuing to run could lead to a complete fracture of the bone, meaning a significant time away from running somewhere in the realm of several months.

Disclaimer: Sydney Physio Clinic provides this information as an educational service and is not intended to serve as medical advice. Anyone seeking specific advice or assistance on Diagnosing Running Stress Fractures should consult his or her general practitioner, physiotherapist, sports medicine specialist, orthopedic surgeon or otherwise appropriately skilled practitioner.

Hayden Latimer is the founder of and principle physiotherapist at Sydney Physio Clinic. Since graduating from Otago University, Dunedin, New Zealand he’s gained wide experience practicing across the globe for over 15 years and is now extremely knowledgeable in helping people reduce discomfort and restore function and mobility.


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