Physiotherapy for Stress Fractures

The stress fractures are overuse injuries that occur when the muscles become fatigued. The fatigued muscles are unable to absorb the load and impact from running; hence this load is transferred to the bone, causing a fracture. The stress fractures can also be caused by conditions which weakens the bone such as osteoporosis.

Therefore the two types of stress fracture are:

  • Excessive force through a normal bone
  • Excessive force through an abnormal bone

Female athletes are more susceptible to develop the stress fractures due to a condition referred to as the ‘female athlete triad’:

  • Amenorrhea (infrequent menstrual cycle)
  • Eating disorders (bulimia or anorexia),
  • Osteoporosis (reduced bone density)

Most commonly the stress fractures occur through the metatarsals, tibia, navicular, and neck of femur. Sometimes lumbar stress fractures can also occur depending on the demands of your sports. Most commonly it occurs in the cricketers and gymnasts.

What causes stress fractures?

The main reasons a stress fracture occurs are:

  • A change in training surface e.g. switching from grass to hard court in tennis
  • A rapid increase in the amount and intensity of training
  • Poor muscle conditioning
  • Inadequate support or worn out trainers

Symptoms of stress fractures

The major symptoms of a stress fracture are a localized, burning pain that occurs with the activity and eases with rest, tenderness on palpation and sometimes increased tightness of muscles around the fracture region.


X-rays are normally the first step in diagnosing the stress fracture. If it doesn’t show up on x-ray, then a bone scan or MRI may be needed.

Treatment for Stress Fractures

While determining the actual cause of a stress fracture, a detailed subjective and objective assessment with your physiotherapist is needed. This helps to determine whether it was training load or surface that caused the injury, or whether muscle tightness, poor biomechanics, or joint stiffness may have contributed to the injury. To aid healing of the stress fracture, rest and protected mobilization by wearing a moonboot is needed between four to eight weeks. Physiotherapy treatment can commence during this time, and following this.

Physiotherapy treatments such as soft tissue release and dry needling of tight structures may be recommended to improve shock absorption and biomechanics while running/playing sport. Joint mobilizations of stiffer joints may be appropriate to prevent overload of the joint near which the stress fracture occurred. You physio may recommend strengthening exercises that are aimed to improve the stability, in particular around the knee, pelvis, and foot. This may entail working on single leg squatting techniques,functional exercises related torunning techniqueand strengthening the intrinsic muscles to the foot.

Further the progressive muscle strengthening will also help you to return safely to your normal activities after the fracture has healed, and may be a key to prevent its recurrence. Strong, well-conditioned muscles help to dissipate forces which would otherwise transmit to the bones and joints along the kinetic chain. During this time, the gentle low load exercise such as swimming, cycling and using a cross trainer may be suitable. After the fracture has healed, you will be recommended to gradually return to sport.

If you are concerned that you may have developed a stress fracture, contact us at or call 0124 – 4227006 or 09810922362 to get an assessment with one of our experienced physiotherapists.