Stress Fracture – Femur

A stress fracture is a small crack in the bone from chronic overuse. Most stress fractures occur in the lower leg and foot. They can also occur in the hip and other areas.


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A blow to the bone does not cause a stress fracture. Rather, it is typically caused by repeated stress or overuse. Some causes are:

  • Increasing the amount or intensity of an activity too quickly (most common)
  • Switching to a different playing or running surface
  • Wearing improper or old shoes

Stress fractures can worsen by continued physical stress. Smoking can also make stress fractures worse because it interferes with bone healing.

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A risk factor is something that increases your chance of getting a disease or condition. Risk factors for a stress fracture include:

  • Sex: female
  • Certain sports, especially involving jumping or running:
    • Tennis
    • Track, especially distance running
    • Gymnastics
    • Dance
    • Basketball
  • Amenorrhea (women only)
  • Reduced bone thickness or density
  • Poor muscle strength or flexibility
  • Overweight or underweight
  • Poor physical condition

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Symptoms include:

  • Localized pain on the bone
  • Pain when pressure is applied directly over the fracture and the area around it
  • Pain when putting stress on the affected leg
  • Swelling and warmth at the injury site

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The doctor will ask about the symptoms and medical history, and examine the injured area for localized pain and swelling. Tests may include:

  • X-ray —to look for break in the bone
    • Stress fractures are very tiny and usually not seen on an x-ray until at least two weeks after symptoms begin.
  • MRI scan —to look for swelling and inflammation inside the bone
  • Bone scan —to look for evidence of a stress fracture

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If diagnosed with a stress fracture, the physician may refer you to physical therapy.  Physical therapy will focus on increasing range of motion, strength and improving stabilization and functional integration.

Range of Motion

Following a period of immobilization to allow the bone to heal, the physical therapist will help you recover range of motion.  The therapist will design a stretching and flexibility program that will allow you to bend, straighten, and rotate the lower extremity through an increasing range. The therapist may also incorporate the use of specific manual therapy techniques to improve muscle tone, pliability and joint mechanics as well as use modalities to control pain and associated inflammation.


As range of motion progresses, the therapist will begin to work on increasing strength in the lower body and core.  Typically, exercises will start with simple muscle contractions and become more advanced as you become stronger and stronger.

Stabilization and Functional Integration

Stabilization and functional activity integration represent the final phases of rehabilitation.  The therapist will create specific protocols to retrain a focus on return to the activities you enjoyed prior to the injury.  Exercises will focus on continued strength and endurance as well as controlled use of the injured area, recreating balance.

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To reduce your chance of having a stress fracture:

  • Wear proper footwear.
  • Run on a softer surface, such as grass, dirt, or certain outdoor tracks.
  • Gradually increase the amount and intensity of an activity.
  • Do not overdo any activity.
  • Reduce weight to reduce stress on the bones.
  • Avoid smoking.

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  • American Academy of Orthopaedic Surgeons

  • American Orthopaedic Society for Sports Medicine

  • American Podiatric Medical Association

  • Canadian Orthopaedic Association

  • Canadian Orthopaedic Foundation

  • Marx RG, Saint-Phard D, Callahan LR, Chu J, Hannafin JA. Stress fracture sites related to underlying bone health in athletic females. Clin J Sport Med . 2001;11:73-76.
  • Sanderlin BW, Raspa RF. Common stress fractures. Am Fam Physician . 2003;68(8):1527. Available at .
  • Stress fractures. American Academy of Orthopaedic Surgeons website. Available at: . Updated October 2007. Accessed June 25, 2008.
  • Stress fractures. Mayo Foundation for Medical Education and Research website. Available at: . Updated November 3, 2006. Accessed June 25, 2008.
  • Wells CL. Women, Sport & Performance: A Physiological Perspective . Champaign, IL: Human Kinetics; 1991.
  • Wheeler P, Batt ME. Do nonsteroidal anti-inflammatory drugs adversely affect stress fracture healing? A short review. Br J Sports Med . 2005;39:65-69.

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