top of page
  • dane91998

Bone Stress Series: Part 2 - Bone Stress Reactions vs Stress Fractures

Bone Stress Injuries

Bone Stress Injuries are overuse injuries associated with repeated loading of bone by weight-bearing activities (such as running, jogging, and landing) and inadequate recovery periods.

Bone Stress Injuries represent the mismatch of bone loads and recovery. This displays the failure of the bone to withstand repetitive loads, which leads to structural fatigue, localised bone pain, and tenderness around the affected area.

Bone Stress Injuries are commonly seen in runners, track and field athletes, endurance athletes, military recruits, gymnasts, and dancers, but also among otherwise healthy people who have recently started a new or intensive physical activity accounting for 10% of all sports-related injuries.

Stress fractures account for > 10% of total sports-related injuries and it could be as high as 30% in running.

How do Bone Stress Injuries occur?

New activities or increased loading amounts stimulate bone cell turnover in normal healthy bone.

First, the body breaks down select portions of the bone, temporarily weakening it, and then within 1-2 weeks new bone tissue is laid down. Once established, the new bone is stronger, denser, and better adapted to the latest activity or increased load.

However, if we continue high loading or impact activities during this turn-over period we don’t give our bones adequate time to recover. Over time, the overloaded bone will accumulate micro-fractures and eventually break down, developing into a bone stress injury.

There are three progressive stages of bone stress injuries:

  1. Bone strain/stress response: There are signs of bone stress on medical imaging but an athlete is not yet experiencing symptoms.

  2. Stress reaction: The bone stress injury is significant enough to cause localised pain on the bone, which aggravates during sporting activities mentioned previously. Athletes will often also experience tenderness to the touch.

  3. Stress fracture: The final stage of the bone stress continuum is when a fracture or break in the bone develops, which can be seen on medical imaging. Typically pain is very pronounced in a clear localised area, and often bearing weight on the limb is enough to provoke pain

Physiotherapy's role in assisting with Bone Stress Injuries Management of bone stress depends on several variables, including which bone is affected, the location of injury, and the stage of injury.

The extent of the injury largely dictates the physiotherapy management. Analysing the presented symptoms is vital for the management of each individual. Rest may be required in certain presentations however modifications in physical activity may also be required.

There are alternatives to bone loading that still mean you can train but with less weight-bearing.

Slowly progressing weight-bearing loads is critical to recovering from bone stress injuries. Our Physio's are both Strength and Conditioning trained coaches who can accurately guide you through the progressing loading program


Bone stress reactions or fractures are somewhat common amongst the running and athletic community. If you would like more information on how to manage these types of conditions then please contact us at High Line Active Physiotherapy Richmond

19 views0 comments


bottom of page