Stress fractures: causes, symptoms, and treatments

A broken bone often brings to mind a single, dramatic event — maybe a car accident or a fall with instant, obvious pain. Stress fractures, though, usually take a different route. They start quietly, with a dull ache that’s easy to brush off. Over time, that twinge can grow stronger, especially if you don’t pay much attention to it. 

“A stress fracture can sneak up on you — it’s not the same as a high-impact injury that comes from one big fall or blow,” says Rodrigo Quevedo, PT, DPT, a physical therapist at Hinge Health. “They show up more in people who do a lot of high-impact activities like running and dancing, or  people who do a lot on their feet. But anyone can get one.”

Because the pain creeps up gradually, many people miss the early warning signs and keep pushing through. This can delay recovery and increase the risk of a broken bone, Dr. Quevedo says. “The sooner you listen to your body’s signals and make activity adjustments, the easier it is to get back to doing what you love.”

Read on to learn about stress fractures, including what causes them, how they tend to feel, treatment options, prevention strategies, and a selection of exercises recommended by Hinge Health physical therapists.

What is a stress fracture?

A stress fracture is a tiny crack in a bone that develops from repeated or prolonged pressure — usually from overtraining, rather than a sudden injury.

Bones are active, living tissue that’s constantly being refreshed and renewed. When you introduce new or more intense movements to your routine — such as running farther or faster more often — your bones adapt and get stronger over time. But if you go too hard or too fast before your body is prepared to do so, that natural rebuilding process can fall behind, and tiny cracks may develop.

"If you kick off marathon training with a big jump in distance, you might be asking your bones to do more than they are ready for before they get a chance to adjust,” Dr. Quevedo says. That’s when stress fractures are more likely to show up.

Stress fractures most often happen in weight-bearing bones, like:

• The shin (tibia)

• Bones of the foot and ankle

• Sometimes the thigh (femur) or your calf bone (fibula)

Symptoms of stress fractures

Stress fractures often start with a subtle but persistent discomfort rather than a severe pain you can’t ignore. Common symptoms include:

• Localized pain or tenderness. This is often the first and most noticeable sign. The discomfort tends to be focused in one specific spot and feels worse when you press on it or are active.

• Pain that gets sharper with movement and eases with rest. People often notice it most when they exercise or go about routine activities; it usually settles down when they stop.

• Mild swelling. You may see or feel some swelling around the area, particularly after you’ve been active.

• Bruising. Some people notice mild bruising, though this isn’t always present.

• Ongoing, nagging pain. If you keep up the same activities without dialing back on activity or doing simple at-home treatments, the pain can intensify and persist during rest.

Causes of stress fractures

Many factors work together to increase your risk for stress fractures. These include ramping up exercise intensity too quickly and not including enough rest days into your workout routine. Some of the most common factors include:

• Doing a lot of high-impact or repetitive movement. Activities like running and jumping can help your bones get stronger, but they also raise your risk when you do more than your body is currently prepared for or don’t give yourself enough downtime between sessions. Research shows overtraining is a main contributor of stress fractures in runners.

• Increasing activity levels too quickly. Sudden changes in how often, how long, or how hard you work out can create extra strain. For instance, jumping from little or no activity to frequent long-distance running doesn't give bones time to adapt.

• Focusing your activity on just one or two days per week. “If you sit most of the week and go for a long hike or spend hours playing sports only on weekends, your body may not be ready for that much intensity in one go,” Dr. Quevedo says.

• Limited rest and recovery. Your bones need regular opportunities to rebuild and become stronger after hard or new activity. Exercising intensely every day, especially with high-impact movement, slows recovery and increases your injury risk.

• Wearing worn-out or breaking in new shoes. Shoes can change how forces move through your legs. If your shoes aren't comfortable, or if you change to a pair your body isn't used to yet, it can sometimes contribute to stress fracture risk.

• Not getting enough nutrients. Your bones need the right balance of energy (calories), protein, calcium, and vitamin D for steady repair and growth. If your intake is falling short, your body may not keep up. “Many people don’t realize how much factors like footwear or nutrition affect their bones,” Dr. Quevedo shares. “Sometimes, simple changes — like swapping out shoes or focusing on nutrient-rich meals — can make a difference.”

How long does it take for stress fractures to heal?

“Recovery time isn’t the same for everyone,” Dr. Quevedo says. Things like age, overall health, the exact bone involved, sleep habits, and how quickly you address symptoms can all play a role. Generally, though, many people heal from a stress fracture in about six to eight weeks, but sometimes they take longer. Staying active in ways that don’t stress the area, while eating well and getting plenty of rest, can help support healing.

Treatments for a stress fracture

With the right mix of rest, guided movement, and support, most stress fractures heal without surgery or invasive medical procedures. Treatment usually involves a few key strategies, including:

• Try physical therapy and targeted exercises. Targeted exercises can help strengthen the muscles around the affected bone and ease pressure off the area. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.

• Stay active, but switch to low-impact activity. Depending on the severity of your stress fracture, staying active can contribute to recovery, as it promotes blood flow to the affected area. Temporarily swapping high-impact activities like those that involve running or jumping for lower-impact ones, like swimming, cycling, or doing an elliptical workout, is the key to helping your bone to recover. Movement — as long as it doesn't aggravate symptoms — promotes healing. 

• Pace your activities. Modify activities that trigger pain. If standing or walking for long periods, for example, aggravates symptoms, break up activity into shorter sessions. “A physical therapist can help you find your movement sweet spot, or the level of activity that keeps your body strong without compromising recovery,” Dr. Quevedo says. 

• Take over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can help ease pain so you can do your targeted exercises and stay mobile when you have pain from a stress fracture. Other options are topical NSAIDs or pain relief creams. If you have a medical condition or take other medications, check in with your provider to make sure these OTC options are ‌safe to take.

• Follow the PEACE & LOVE method. Instead of focusing just on rest, this PEACE & LOVE approach encourages gentle movement and gradual return to activity, which helps bones regain resilience and strength. It also involves using compression (like elastic athletic tape or a brace) and elevating the affected area. 

• Apply cold or heat therapy. Ice decreases inflammation and swelling by reducing blood flow to the area and eases pain by numbing nerve endings. Heat can help relax tight muscles surrounding the injured area. Try both or stick to the one that works best for you. 

• Use supports. Some people might need to use temporary supportive devices, such as a boot or crutches, to keep weight off the area while healing. These supports can make it easier and more comfortable to move around as your body rebuilds strength. Consider talking to your physical therapist or healthcare provider to see if this is an appropriate option for you. 

• Try TENS therapy. TENS, or transcutaneous electrical nerve stimulation, uses gentle pulses to quiet your pain response and help reduce pain. One option is the wearable device Enso, available through Hinge Health. It’s small, wireless, and portable. For a stress fracture, place the pads on the surrounding muscles of your injury (not overtop the stress fracture itself).

Staying active while you heal

Since the majority of stress fractures happen in weight-bearing bones (like the shin or bones in the foot), it is often helpful to focus on movements that don’t put extra load on the injured area. The following gentle, non-weight-bearing strengthening exercises allow you to maintain strength and mobility while giving your bone the break it needs to heal.

These strength exercises and stretches will get you moving and feeling better as your bone heals. They build lower body and core strength, flexibility, stability, and mobility, while minimizing load on the injured bone. The exercises also aid healing by increasing the flow of oxygen and nutrients to the injury site. 

Each of these moves works to support your return to healthy activity. Strengthening your lower body and core can help your body move more efficiently and take pressure off your healing bone. Maintaining flexibility enables you to keep moving comfortably during everyday activities. “Staying familiar with movement and gently working your muscles is one of the best ways to support bone health during recovery,” says Dr. Quevedo.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

How to prevent a stress fracture

While you can’t always prevent a stress fracture, certain strategies can help prepare your body to be even more resilient, especially when doing high-impact activities. From swapping out your footwear to prioritizing recovery workouts, here’s how you protect your bones:

• Know your risk factors. If you’re active in sports like running, track and field, or dance, or if you have a history of bone health issues like osteoporosis or osteopenia (low bone density), you may be at higher risk. When you know your risk factors, you can take steps to protect yourself and train mindfully. 

• Ramp up gradually. Increase the length or intensity of your activity little by little. This gives your bones time to adapt and get stronger. If you haven’t been active and want to start running, for example, try the run-walk method

• Alternate activities. Alternate higher-impact days with activities like biking, swimming, or yoga to reduce repeat stress on specific bones in your lower body.

• Strength train. Strong muscles absorb more activity, helping to reduce strain on your bones. Focusing on core, glutes, hips, hamstrings (back of thigh muscles), and calves can help support and protect major bones in your lower body.

• Prioritize recovery. When doing high-impact or high-intensity activities, your body needs time to rest and recover. Alternating vigorous workout days with rest days gives your bones time to rebuild and come back stronger. Rest doesn’t mean lying on the couch all day. You can still do lower-impact activities on your recovery days. 

• Wear comfortable shoes. Athletic shoes are designed to help manage the forces of your movement. If yours are becoming uncomfortable or losing their cushioning, swapping them out can help you keep moving comfortably

• Get adequate calcium and vitamin D. Make sure you’re getting enough calcium (found in dairy, leafy greens, and fortified foods) and vitamin D (from sun exposure, fatty fish, eggs, or supplements). Good nutrition helps your bones repair and keeps them strong.Talk to your doctor about supplements if you’re concerned about getting enough of these nutrients from your diet alone.

When to see a doctor

Stress fracture pain often improves with simple, at-home care and activity modifications. If your pain is severe, getting worse, or interfering with your daily life, reach out to a healthcare provider. It’s also a good idea to get care if you have:

• Swelling that won’t go down

• Difficulty when standing or walking

• Numbness or changes in skin color around the area

• History of osteoporosis or other bone health conditions

PT tip: take care of yourself

“The basics go a long way. Hydrate, prioritize sleep, and eat a mix of nourishing foods — these habits have a direct impact on how quickly and fully you recover from a stress fracture,” says Dr. Quevedo. “If you show your bones some care every day, they’ll show up for you in everything you do.”

How Hinge Health can help you

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

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2. Dubois, B., & Esculier, J.-F. (2020). Soft-tissue Injuries Simply Need PEACE and LOVE. British Journal of Sports Medicine, 54(2), bjsports-2019-101253. doi:10.1136/bjsports-2019-101253

3. Warden, S. J., Edwards, W. B., & Willy, R. W. (2021). Preventing Bone Stress Injuries in Runners with Optimal Workload. Current Osteoporosis Reports, 19(3). doi:10.1007/s11914-021-00666-y

4. Costa, T. M. da R. lemos, Borba, V. Z. C., Correa, R. G. P., & Moreira, C. A. (2022). Stress fractures. Archives of Endocrinology and Metabolism, 66(5), 765–773. doi:10.20945/2359-3997000000562

5. OrthoInfo. (2019). Stress Fractures - OrthoInfo - AAOS. Aaos.org. https://orthoinfo.aaos.org/en/diseases--conditions/stress-fractures/

6. Karpouzos, A., Diamantis, E., Farmaki, P., Savvanis, S., & Troupis, T. (2017). Nutritional aspects of bone health and fracture healing. Journal of Osteoporosis, 2017(4218472), 1–10. doi:10.1155/2017/4218472