There is generally a history of a repeated activity eg running. Often the patient may have increased his/her training in intensity or duration in the weeks or months preceding the injury.
A stress fracture commonly presents with a history of:
- initially pain after exercise
- developing to pain during and after exercise
- finally there is pain without exercise
On examination the site of the injury may be slightly swollen and warm. There is generally local bone tenderness, and there may be some palpable thickening of the bone.
Notes:
- stress fractures can be very challenging to manage and unfortunately can take months to heal, so prevention or at least early recognition is essential
- following diagnostic clues should raise the possibility of a stress fracture (1):
- symptoms started after a significant increase in activity (breaking 'the 10% rule', viz only increase activity by 10% each week; don't increase both intensity and time by 10% at the same time)
- weight-bearing pain that progresses with continued activity to non-weight-bearing pain
- focal bony tenderness (especially tibia and ankles/feet)
- pelvic (pelvis/sacrum) and groin (femur) pain
- lower limb pain in a runner
- unremitting focal lumbar pain on extension (pars interarticularis fracture)
- lateral rib pain (particularly in rowers, due to pull of serratus anterior).
Reference:
- (1) ARC. Sports-Related Musculoskeletal Disorders. Reports on the Rheumatic Diseases 2008;14.