Bone stress injuries occur when the load being place on the bone is too much for it to adapt to and it starts to breakdown. They occur along a spectrum but will broadly be labelled as a stress reaction or a stress fracture. A stress fracture happens when the stress reaction has persisted too long and the bone begins to form a fracture line similar to when someone breaks a bone. Certain areas for stress reactions and fractures are considered high risk; this is due to the fact that if they are not managed correctly, they can lead to long term ongoing issues, for this reason it is important to seek assessment early on if you suspect you have this condition. 

Bone stress injuries usually occur when someone begins a new activity and can do too much too soon. The activities will usually, but not always, involve some level of impact such as walking and running. Once the process begins and is of a noticeable level people will often complain of a pain that begins early in their exercise or activity and doesn’t ease throughout, potentially only getting worse. It can be quite common to have morning pain. At times, the level of new activity can be surprisingly low to cause this response. In these instances it is important to give a thorough medical history to your healthcare practitioner or have medical investigation into possible underlying factors, particularly for females.

Common Areas Affected:

Tibia (Shin

Smaller bones in the Foot


Symptoms vary but may include tenderness over site, pain with activity and ache that becomes more constant and can even disrupt sleep

Xray will only show longer term stress fractutres, stress reactions will show up on MRI scans

As an example we have all possibly noticed how many more people are out walking when lockdowns have occurred. During the longer lockdown, radiology clinics noticed a spike in individuals being imaged for bone stress injuries simply due to more walking. 

If you are experiencing these symptoms please get an assessment to prevent it worsening.