A stress fracture is a small bone injury caused by repeated overuse, common in runners and those who increase their physical activity quickly. It manifests itself as pain that appears with activity and improves with rest, and requires evaluation to prevent it from progressing.
How it is produced and how it is recognized
Stress fractures are not caused by a single blow, but by the accumulation of microloads on a bone that is unable to adapt to the rhythm of the stress [20]. They are typical in runners, in athletes who intensify their training and in people who return to activity abruptly. The characteristic complaint is a localized pain that appears with activity and subsides with rest, and which tends to worsen if ignored. An important point: initially they may not be seen on a plain radiograph, so the diagnosis is based on clinical suspicion and, when required, on more specific imaging studies [21].
How they are handled
Management focuses on reducing the load on the affected bone and correcting the factors that led to overload: training progression (rapid increases), footwear and surface, and aspects such as nutrition and rest [21][22]. Return to activity is gradual and guided, to allow the bone to recover without relapse. Prevention is the best strategy: increase activity progressively, respect recovery times and do not ignore early pain [22].
Who is most exposed
They appear more frequently when several factors are combined: rapid increases in training volume or intensity, changes in surface or footwear, and individual aspects such as insufficient nutrition or rest [21][22]. They are not exclusive to elite athletes: anyone who increases their activity suddenly, for example when starting to run, can develop them.
Why it is not advisable to endure the pain
The temptation to continue training despite pain is understandable, but in a stress injury it is often counterproductive: continued overload can cause the injury to progress and recovery to be longer [20]. Stopping in time and seeking assessment is not giving up, but rather the quickest way to return to activity. In consultation, the diagnosis is confirmed, how much to reduce the load is defined, and a gradual return plan is drawn up.
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References
- 1.Presutti F, et al. Stress Fracture in Athletes: A Practical Approach. J Clin Med. 2026;15(8):3077.
- 2.Schroeder JD, et al. Bone Stress Injuries: Diagnosis and Management. Am Fam Physician. 2024;110(6):592-600.
- 3.Patel DS, et al. Stress Fractures: Diagnosis, Treatment, and Prevention. Am Fam Physician. 2011;83(1):39-46.
Educational content with clinical review by Dr. Andrea Pintor. It does not replace an individual medical evaluation.