Common Symptoms of a Bone Stress Injury

You may have a bone stress injury if you experience:

• Deep, localised bone pain

• Pain that worsens with running or impact

• Pain with hopping on one leg

• Tenderness directly over the bone

• Symptoms that settle with rest but return quickly with activity

• Progressive worsening over 1–3 weeks

 

⚠ If pain begins occurring at rest or at night, this may indicate a higher-grade injury and should be assessed promptly.

 

Bone Stress Injury vs Stress Fracture – What’s the Difference?

Bone stress injuries exist on a spectrum:

1. Stress reaction – early bone irritation (MRI visible)

2. Bone stress injury – structural bone overload

3. Stress fracture – small crack in the bone

Early diagnosis significantly reduces recovery time.

 

Common Locations of Stress Fractures in Runners

Bone stress injuries most frequently occur in:

• Tibia (shin bone)

• Metatarsals (foot bones)

• Femoral neck (hip)

• Navicular

• Calcaneus (heel)

• Pelvis

Some sites are considered high risk due to poorer blood supply and greater complication risk.

 

High-Risk Stress Fracture Sites

• Anterior tibia

• Femoral neck (superior surface)

• Navicular

• Base of 5th metatarsal

High-risk injuries require more structured and sometimes more conservative management.

 

Why Do Bone Stress Injuries Occur?

Bone stress injuries are rarely caused by a single factor. They usually result from a combination of:

 

1. Training Load Errors

• Rapid mileage increases

• Sudden change in intensity

• Inadequate recovery

• Return to sport after time off

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2. Biomechanical Capacity Issues

• Reduced calf strength

• Hip weakness

• Poor impact tolerance

• Sudden footwear changes

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3. Nutritional & Hormonal Factors

• Low energy availability (RED-S)

• Inadequate fueling

• Vitamin D deficiency

• Low calcium intake

• Hormonal disruption

• Low BMI

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At Omnia Physio, we assess the full picture — not just the painful area.

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How Is a Bone Stress Injury Diagnosed?

Clinical Assessment

Your assessment will include:

• Detailed training load history

• Hop testing

• Localised palpation

• Strength and capacity testing

• Biomechanical review

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Imaging

• X-ray (often negative early)

• MRI (gold standard for diagnosis)

 

We collaborate with our team of local GPs and those located inside the My Health practice along with sports physicians when imaging is required.

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Bone Stress Injury Treatment 

Effective management involves progressive load control, not complete rest.

Phase 1 – Load Protection

• Temporary reduction of impact activity

• Offloading high-risk injuries (crutches if required)

• Alternative cardio (cycling, swimming, deep water running)

• Pain monitoring framework

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Phase 2 – Rebuild Strength & Capacity

• Heavy slow resistance calf strengthening

• Hip and lower limb loading

• Progressive bone reloading

• Plyometric reintroduction when safe

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Phase 3 – Structured Return to Running

Return to running is criteria-based, not time-based.

We progress based on:

• Pain response

• Hop test symmetry

• Strength benchmarks

• Load tolerance

This reduces re-injury risk and long-term bone overload.

 

How Long Does a Stress Fracture Take to Heal?

Recovery depends on:

• Injury grade

• Location

• Risk classification

• Individual bone health

 

Typical timeframes:

• Low-risk bone stress injury: 6–10 weeks

• Moderate grade: 8–12 weeks

• High-risk site: 12+ weeks

 

Premature return significantly increases recurrence risk.

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Frequently Asked Questions About Stress Fractures

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Can I cycle with a stress fracture?

Often yes, depending on site and severity.

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Do stress fractures show on X-ray?

Often not early. MRI is far more sensitive.

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Will I lose all my fitness?

No. We maintain aerobic capacity with modified training.

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Do I always need crutches?

Only in certain high-risk or painful injuries.

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Book a Bone Stress Injury Assessment

Early diagnosis improves outcomes and reduces time away from sport.

 

If you are a runner, triathlete or athlete with persistent bone pain, book an assessment at:

Omnia Physio – Potts Point, Sydney
Specialising in running and endurance injuries.

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