Melbourne Podiatry Clinic

Do you have a stress fracture?????

Tara Bo(ne)wman talks ???? BONES ???? and bone stress injuries.

As someone who has endured (and I don’t use that term loosely) two bone stress injuries in the past 6 months I know all too well just how frustrating and debilitating they can be. That dull poorly localized ache that you can’t seem to shake, pain with every stride of a run, pain that coincides with an increase in training or breaks from training. These are all common signs and symptoms of a bone stress injury.

The BEST way to prevent stress fractures is to prevent them from occurring in the first place. Proper education on the risk factors and early intervention are THE KEY to avoid months off sport. Bone is an incredibly adaptive tissue that changes in response to the load placed on it. But there is a delicate equilibrium that exists between too little or too much load. It can be hard to know if you are at risk of a bone injury or what to do when you feel like one may be starting so I will highlight the main risk factors to bone density below:


  • Peak bone mass is higher in men than women (bone mass is your baseline density of bone)
  • Prior to puberty men and women acquire bone mass at similar rates but after puberty men acquire greater bone mass than women


  • Oestrogen, women who have their first menstrual period early or who are on an oestrogen based oral contraceptive tend to have a higher peak bone mass than those that don’t.
  • Women who cease menstruation due to low body weight or excessive exercise may lose significant amounts of bone density which MAY NOT be recovered even after their menstrual cycle returns

Oestrogen is responsible for: 

  • Closure of epiphyseal growth plates 
  • Oestrogen deficiency is responsible for increased bone loss 


  • Calcium and Vitamin D are the two big nutritional players in bone health. Calcium is an ESSENTIAL nutrient in bone development and Vitamin D essential for bone growth, density and remodelling. The most bioavailable source of calcium is dairy 
  • The best source of Vitamin D is skin exposure to the SUN  and therefore Vitamin D deficiency is more likely in winter and for people who play indoor sports


  • LOAD IT OR LOSE IT. Being sedentary is a KNOWN RISK FACTOR for osteoporosis. Adults who exercise regularly achieve greater peak bone mass than those that do not

Bony stress injuries like many other pathologies are for the most part caused by ‘premature overload’ or doing TOO MUCH TOO SOON. When the load on bony tissue is too great and exceeds the rebuilding of bone (recovery) this leads to injury. The bone is unable to withstand this repetitive loading which leads to structural fatigue, localised pain and tenderness. 

What causes excessive bone stress?

  • Changing shoes (Particularly to minimalist shoes)
  • Changing running surface from grass to bitumen
  • Returning to training after a period of rest (not gradually increasing sessions) 
  • Inadequate muscular strength/ poor physical conditioning 

How is a bone stress injury defined? How does a stress reaction differ from a stress fracture? 

  • A stress reaction is a precursor to a stress fracture and is characterised by an increase in bone turn over e.g. more microdamage to bone than is being rebuilt. On an MRI they are seen as periosteal thickening or bone marrow oedema. 
  • Contrastly a stress fracture has a distinct fracture line on an X-ray or MRI.
  • A stress reaction can usually be managed faster and the return to play/activity is sooner than a fracture.

Let us help!

If you feel you are a risk of a bone stress injury, are answering yes to the factors contributing to low bone mineral density or feel you might have the beginning of a bone stress injury get on top of it early! Managing your risk factors is the best way to prevent a bone stress injury and prevent you from missing out on your training goals. Together, LET’S BUILD RESILIENT BONES!

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