Stress fractures in runners and how to treat them

Meet Joe – Joe is a middle-aged accountant from the Northern Beaches who recently attended the Fixio physiotherapy clinic with left shin pain.

Joe started running 6 months ago to “lose weight” and one of his New Year resolutions for 2021 is to run his first half marathon. During the last 6 months Joe has been running sporadically from Dee Why to Curl Curl, a distance of about 6km. Since the start of 2021 though, Joe decided to run from Dee Why to Manly 3 times a week, a 17km round trip. Joe found the increase in k’s difficult, but pushed through some minor hip and ankle pain because he wants to run that half marathon.

Examining, evaluating and diagnosing an injured runner

Musculoskeletal physiotherapists use a comprehensive assessment of the entire mid-lower body to accurately diagnose shin splints and stress fractures in runners.

Things like:

  • Activity history
  • Posture
  • range of motion
  • foot type
  • footwear
  • flexibility
  • strength
  • functional movement patterns
  • walking and running gait

Are examined and measured to give your physio a holistic view of the zones causing you pain.

What are stress fractures?

In normal healthy bone, increased stress and physical loading can cause some deformation and microdamage. Stress fractures have 3 stages[1]:

Stage 1 – Fracture initiation, which occurs at the site where the load stress is concentrated in a specific spot

Stage 2 – Fracture propagation occurs when physical loading is pushed past the level at which bone can be repaired or new bone can be laid down in the area.

Stage 3 – The final stage is a complete fracture with symptomatic presentation to our Fixio physio.

What are the symptoms of stress fractures for a runner?

People with stress fractures of the lower leg will commonly have:

  • pain in the lower leg that comes on during exercise
  • an ache in the front part of the lower leg that may continue after exercise
  • pain on both sides of the shin bone
  • tenderness or pain along the inner part of the lower leg
  • mild swelling in the lower leg as it progresses

How are stress fractures treated by physiotherapy?

Because risk factors for stress fractures include faulty biomechanics, abnormal bony alignments, incorrect footwear and other physical factors, it’s important that stress fracture treatment is broad ranging.

Usually, a 3-phase (acute, subacute, and chronic) treatment approach is beneficial for runners with a stress fracture. [2]

At our Fixio clinic, Joe underwent treatment to increase joint mobility, flexibility, dynamic control and we went through a video running gait analysis and participated in gait retraining to address his hip and ankle impairments.

The acute phase focuses on rest and interventions to relieve symptoms, whereas the subacute phase focuses on progressing weight bearing tolerance.

How can I avoid stress fractures and shin splints?

You can’t completely eradicate any chance of suffering stress fractures, but there are steps you can take to minimise your risk:

  • wear comfortable running shoes that fit well and offer good support
  • avoid exercising on hard, slanted or uneven surfaces
  • increase exercise intensity and length gradually
  • warm up and stretch before exercising
  • don’t just push through the pain, listen to your body.

Shin splints and stress fracture are not injuries to leave unattended. Physiotherapists see too many patients who have caused themselves ongoing pain and discomfort simply due to not having the issue seen to earlier. If you are suffering from increasing pain or stiffness in your legs and shins it is prudent to make an appointment with your local Fixio physio to have a full evaluation of the injury.


[1] Kaeding CC, Miller . the comprehensive description of stress fractures: a new classification system.

J Bone Joint Surg Am. 2013;95:1214-1220.

[2] Liem BC, ruswell HJ, Harrast MA. Rehabilitation and return to running after lower limb stress ractures.

Curr Sports Med Rep. 2013;12:200-207.

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