Bone Stress Injuries: picture of a Magnetic Resonance Imaging Study of a femur (thigh bone) with a stress fracture

Bone Stress Injuries

Bone stress injuries can be stressful.

They can be hard to understand, hard to suspect, and have unpredictable healing times.

What Are Bone Stress Injuries?

Bone stress injuries are usually caused by high loads on normal bone, or normal loads on weaker bones.

High loads can be from too much, too fast, too soon.

Too many days without rest, too high an intensity of activity, and amping too quickly when starting something new or playing with older kids.

Weaker bones come from unhealed past injuries, not enough calories in the diet, and girls not having regular periods that build bone strength.

In describing bone stress injuries to patients, I often use the analogy of bending my pen while bored in class one day.

  • If I just start trying to bend my pen, the pen doesn’t bend much. This represents normal bone.
  • As I continue to play with my pen, it does start to bend more. This represents a stress reaction where the bone is softer and less able to resist continued load. A stress reaction will create swelling (bone edema) on a Magnetic Resonance Imaging (MRI) study. No true fracture line will be visible either on the MRI or plain x-ray study.
  • If I’m really bored in class, my continued bending the now even more weakened pen eventually will cause it to completely break on one side. This represents a stress fracture where a fracture line is seen on one cortex (outer lining of the bone) on either MRI or plain x-ray.
  • Even more attempts to bend my pen may result in breaking it in half. This represents a complete fracture where the fracture line is now easily visible on either MRI or plain x-ray.
Bone Stress Injuries: picture of a Magnetic Resonance Imaging Study of a femur (thigh bone) with a stress fracture

Bone Stress Injuries: Stress Fracture of Left Femoral Neck. This MRI picture shows a fracture line involving only one cortex (outer lining) of the femur (thigh bone) with bone swelling (edema) also present.

When do you suspect a Bone Stress Injury?

If there’s that history of too much, too fast, or too soon, I worry about a bone stress injury.

If there is an injury that just doesn’t seem to get better, I worry about a bone stress injury.


Now, if an athlete can take the tip of their index finger and point directly to a single spot on a bone, I definitely worry about a bone stress injury.

How to you get a Bone Stress Injury to heal?

First thing is knowing exactly what you are dealing with by getting an accurate diagnosis.

Then looking at possible causes- including amount of training, nutrition, mechanics, and bone health

Important to then put together a sensible and individualized treatment plan.

Some bone stress injuries may need lower levels of changes in activity, diet, and mechanics.

Some bone stress injuries are higher risk and may need more aggressive treatment plans.

This blog post does not intend to diagnose or provide management tips for a bone stress injury, or for any injury or illness. With any suspected bone stress injury, or other injury, please immediately contact a sports medicine specialist for evaluation and treatment. 


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