Stress Reaction vs. Stress Fracture – What’s the Difference?
Stress reactions and stress fractures are both injuries involving the bone and often is correlated with repetitive overload and impact to the bone when there has been insufficient rest between activity.
Stress reactions are a sign at the early-stage of a bone stress injury, causing pain and tenderness to the touch. A stress fracture is the final stage of a bone stress injury, when pain is more pronounced and the bone has developed a break/crack.
Typically known as an ‘overuse injury’, stress fractures account for a large portion of sports related injuries - most commonly with runners and track and field athletes. Athletes participating in sports that place repeated stress on their lower bodies are most at risk of developing a bone stress injury.
Learn about the symptoms of stress reactions and stress fractures, the recovery timeline and treatment process, and how to prevent a stress bone injury.
What is a stress reaction?
A stress reaction, otherwise referred to as a bone stress response, is the early stage of bony injury resulting from repetitive stress or loading to the bone.
Commonly seen in athletes due to the repetitive movements of their sport and training, stress reactions are typically experienced as a gradual onset of pain, usually described as a dull ache, developing in a specific area of the bone. It may also occur when there has been a sudden spike in the amount or intensity of training or activity. Common location areas of a bone stress injury include; shin, foot, thigh, heel, lower leg, pelvis, and lower back.
Early signs of a stress reaction:
- Pain may improve with light activity at the very early stages but generally remains or worsens with activity.
- Swelling and/or redness around the area
- Tenderness or discomfort when pressing on the area
- Following activity pain may lesson with rest
Magnetic resonance imaging (MRI) is commonly used to diagnose bone stress injuries. An MRI can visualize lower grade bone injuries which may not be detected through an X-ray. As with all bone injuries, early intervention can mitigate long term damage. If you experience any of the above signs of symptoms, an MRI can provide more context and distinguish between a soft tissue or bone injury so that appropriate treatment can be prescribed.
What is a stress fracture?
A stress fracture is the end stage or a bony injury, where a stress reaction has developed small crack/break in the bone. This results from repeated force or impact without sufficient rest and reloading of the area following initial stages of a bone stress response. . Generally this type of fracture does not occur from a once off event, and is instead a build up over time.
Early signs of a stress fracture
- Dull pain that progressively gets worse during physical exercise
- Early morning stiffness, pain, and difficulty ‘warming up’
- Sensitive to touch, swelling and redness around the area
- A progressive increase in pain or stiffness over time (development from bony stress response)
Stress fractures need to be de-loaded and allow for time to heal the damage to the bone. Prolonging diagnosis and treatment can not only increase the timeline for recovery, but it can also lead to long-term bone damage.
Recovery timeline for stress reactions and stress fractures
The recovery timeline for bone stress injuries can vary greatly depending on the severity and the location of the injury. An MRI will help to better diagnose the severity of the injury, and determine its specific location on the bone. This is very important to factor into the recovery timeline, with some locations of bone healing slower due to a lesser blood supply to that region of the bone. Generally, a bone related injury can take up to 8 weeks or longer to fully heal. Stress reactions, if caught early and managed with proper recovery and rest, can settle and heal quicker than an end stage stress fracture. A physiotherapist or medical professional can provide a more accurate timeline for recovery based on your personal circumstances.
Treatment for stress reactions and stress fractures
Treatment for a bone stress injury is very important with early intervention helping prevent further injury and prevent flare ups and reoccurrence. Physiotherapy plays a large part in supporting the treatment of a bone stress injury. Physios can guide their patients rehabilitation with specific load management protocols, biomechanical assessment to find contributing factors to the stress response, muscle strengthening and conditioning, , provide soft tissue and joint mobilisation therapy, and suggest proper warm-up and cool down methods.
Depending on the severity of the stress injury, initial treatment may involve reducing any weight bearing load on the injured bone. It is advised to seek out a physiotherapist or medical professional to receive treatment specific to your bone stress injury.
Preventing bone stress injuries
Taking steps to prevent bone stress injuries as soon as you begin experiencing pain or inflammation in a specific area will assist in preventing more serious bone injuries. Ways to prevent bone stress injuries can include:
- Strengthening your muscles
- Investing in proper equipment for your sport (ie Supportive running shoes)
- Warming up and cooling down before and after activity
- A diet to support your activity demands
- Listening to your body and rest when it’s needed
Seeking Treatment
A stress reaction is the first sign of an overuse bone stress injury and early action and diagnosis in conjunction with a physiotherapist or medical professional can help to reduce the incidence of further or future bone stress injuries and significantly reduce recovery timeframes.