Stress fractures in running

Running is an excellent form of exercise, offering countless physical and mental health benefits. However, it’s not without its risks, particularly when training loads increase too quickly or underlying risk factors are overlooked. One common overuse injury in runners is the stress fracture—an area of micro-damage in overloaded bone caused by repetitive strain. These injuries often affect weight-bearing bones like those in the shin or hip, and recognising the early signs can prevent more serious complications.

Specialist consultant in sport and exercise medicine Dr Noel Pollock, a former 1500m runner himself, explains all you need to know.

What are stress fractures in running?

Stress fractures are areas of microdamage in the bone that develop as a result of repetitive stress and overuse, particularly in weight-bearing activities like running. Unlike an acute fracture caused by a single traumatic event, stress fractures occur gradually over time when the body is unable to repair the small amounts of damage caused by repetitive force. These injuries are common in runners, particularly those who suddenly increase their training volume or intensity quickly or who have underlying risk factors.

How do stress fractures in the shin develop?

Stress fractures in the shin, medically referred to as tibial stress fractures, are among the most common types of these injuries in runners. The tibia, or shinbone, bears a significant amount of weight during activities like running, jumping, and walking. Overuse can cause damage to the bone structure if underlying risk factors are present and/or rest periods are insufficient to allow for repair.

Early signs of a tibial stress fracture may include pain along the shin that worsens during exercise and improves with rest. The pain often becomes more persistent if the injury progresses. Swelling and tenderness along the bone and pain on walking may also be present.

Runners with weaker muscles or with reduced energy balance, where energy (food) intake does not match expenditure, are at a higher risk of tibial stress fractures. Similarly, poor footwear, reduced bone density (osteoporosis), and insufficient calcium or vitamin D levels can contribute to the development of these injuries.

What about hip stress fractures?

Stress fractures in the hip, though less common, are a serious concern for runners. The most frequently affected area is the femoral neck, the part of the thighbone connecting the shaft to the hip joint.

Hip stress fractures often present with deep, aching pain in the groin area that may radiate to the thigh or buttock. This pain is typically exacerbated by weight-bearing activities, such as running, and may linger even during rest as the injury worsens.

Certain factors increase the risk of hip stress fractures, including a sudden uptick in training intensity,negative energy balance (where food intake does not match energy expenditure), or a history of bone health issues like osteoporosis.

How are stress fractures diagnosed and treated?

A doctor will typically diagnose stress fractures through a combination of a physical exam, medical history, and imaging studies Because stress fractures may not immediately appear on X-rays, advanced imaging techniques like MRI are usually preferred for diagnosis. MRI can also diagnose stress reactions, when the bone is overloaded and is at risk for future stress fracture.

Treatment involves rest from high-impact activities to allow the bone to heal, and the correction of underlying risk factors. Required rest may range from several weeks to a few months, depending on the severity of the fracture. In some cases, crutches or a protective boot may be necessary to reduce weight-bearing on the affected area. Careful management is required in some stress fractures which could progress to require surgical intervention, if not properly treated.

By addressing risk factors such as muscular weakness, reduced energy intake, training errors, improper footwear, and nutritional or hormonal deficiencies, runners can reduce their chances of developing stress fractures. Recognising the early warning signs and seeking medical advice promptly is essential for recovery and safe return to activity.

If you would like to book a consultation with Dr Pollock, do not hesitate to do so by visiting his Top Doctors profile today.