If you’ve ever had the frustrating experience of dealing with a stress fracture (looking at you, runners!), you know the typical inner debate that goes along with this injury: will this thing heal on its own? Do you need to do anything about it, other than rest?
First, let’s provide a short answer:
Stress fractures can heal on their own with proper rest and care. Typically, they take about 6 to 8 weeks to recover, but it’s important to avoid activities that caused the injury. If pain persists, consulting a healthcare professional is recommended.
In this article, we’ll cover how to know whether you’re actually dealing with a stress fracture (it isn’t always obvious), what to do about them, and when to get a healthcare professional involved.
First, be sure that you actually have a stress fracture
As we alluded to above, it’s not always obvious that you have a stress fracture. It’s typical for injuries like anterior or posterior shin splints to present as pain that feels like it’s inside the bone, but actually it’s related to the connective tissue.
So, how do you know if you have a stress fracture? Look over this list of symptoms and compare them against your own:
Common symptoms of a stress fracture
The symptoms can include
- Swelling
- Tenderness or pain upon touching a part of the bone
- Experiencing pain during physical activity
- Pain that remains after stopping physical activity
- Starts out as a dull ache and gets worse upon further use
Stress fractures and physical exertion (especially from high impact sports) tend to go hand in hand, since stress fractures occur as a result of overuse. If you suspect that you’ve got one, it’s likely that you already know what caused it.
If you notice any of these symptoms develop, especially if they get worse with any physical activity, discontinue that activity. We also suggest you temporarily discontinue activities that put that body part in a potentially compromised position, such as weight bearing activities that cause pain to worsen.
Note that the most reliable way to determine if you’ve got a stress fracture is by getting an MRI bone scan. If you aren’t sure, then getting in touch with your healthcare provider or a local orthopedic specialist is definitely your best bet.
There is a chance that something that feels like a stress fracture might be something else like a sprain or damage to the cartilage. However, if you truly do have a fracture it is very important not to ignore it.
Stress fractures vs normal aches and pains
Many athletes ignore little aches and pains. This is especially true for competitive sports, or athletes who are very enthusiastic about their sport. This is always a judgement call on the part of the athlete, but it’s important to know the difference between a small ache that can be trained through, and unhealthy pain that will only get worse without some type of intervention.
A little bit of muscle soreness (also called “delayed onset” muscle soreness) generally isn’t bad. The problem occurs when the athlete misinterperets unhealthy pain or injury as normal soreness.
If a particular pain you’re experiencing remains for more than a couple days, or if it compounds with each training session,that is a good indicator to stop. This is especially true if the pain feels like it is coming from a bone rather than soft tissues like tendons or muscles.
Healthy hurts versus injuries
Here are some good tips on how to recognize if you are experiencing an injury or if it is a good, healthy soreness. It is most likely an injury if:
- The pain is unilateral, meaning it only affects one side of the body
- The pain does not go away with rest in a normal amount of time
- There is inflammation in the affected area
- The pain affects your range of motion or gait
- The pain interferes with your daily life
What to do if you have a stress fracture
There are several things you can do on your own if you experience pain that makes you suspect that you have a stress fracture.
NSAIDs
If you are in quite a lot of pain, you can take nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. Do not exceed the directions on the label, and do not take these medications if they’ve been contraindicated by your doctor.
Ice or cold packs
Ice and cold packs can do wonders to decrease inflammation and decrease localized pain in the acute phase of the injury (the first 2-4 days).
RICE
In the acute phase of the injury (the first 2-4 days), we recommend implementing rest, ice, compression, and elevation (RICE). The most important of these is rest; healing cannot occur if you continue to put stress on your fracture (pun intended) then you are at risk for the fracture becoming worse.
Ice can help decrease inflammation if it becomes a problem (although some research suggests that some inflammation might actually be conducive to healing faster). Compression is also helpful for dealing with inflammation, but only in moderation; it is good to let your muscles expand every once in a while. Elevation has a similar effect on inflammation.
POLICE
POLICE is another, newer acronym that gives us a suggestion of what we can do to recover faster. It mean Protection, Optimal Loading, Compression, and Elevation. Protection refers to using supportive equipment such as foot and ankle braces or other gear to help protect the affected area while still allowing for movement.
Optimal loading is referring to the fact that if we only rest and become completely sedentary while we are healing it actually becomes counterproductive. It has been proven that movement is good for healing even when we have injuries. While it also true that we should not go at the normal pace we do, it is good to do rehabilitative exercises, or at least less intense training. This is also where physical therapy can be very beneficial!
Immobilize the area
If you’re attempting DIY rehabilitation for your injury, make sure to immobilize the area and gradually reintroduce movement as the joint tolerates it.
Reintroducing movement and exercise
For the enthusiastic athlete, runner, or lifter, this is the toughest part: the waiting game. As we mentioned above, the injury itself can take 6-8 weeks to rehabilitate.
As a general guideline, we recommend continuing to take it very easy on the area for at least a couple of weeks. Don’t worry; you won’t lose much fitness during this time.
Once you’ve had no pain for at least 2 days, reintroduce some regular movement for a few minutes. For a runner, this may mean going on a slow, one mile jog. Wait until the next day and pay attention to what your body is telling you. If the reintroduction of activity aggravates the injury, continue to wait.
What about stretching?
Another thing you may want to reintroduce at this point is some basic flexibility and mobility work. As long as it doesn’t aggravate your injury, we say go for it. There’s some evidence to suggest that running (in isolation) can reduce flexibility, and it may behoove you to get ahead of any mobility demands you’ll be placing on your body once you get back to your sport.
When to contact a medical professional
The most basic guideline we give our patients for pain is that if your pain persists for more than two weeks, it’s time to seek medical help.
Most typical injuries tend to resolve on their own within a week or two. If your pain lasts longer than that, it’s possible that you’ve got something else going on.
Remember that it’s always better to take a couple of weeks off than to try and tough it out and sideline yourself for six months to a year.
Best of luck, and if you’ve got any questions, feel free to reach out to us at Petersen Physical Therapy!
