How Do Stress Fractures Heal?

How Do Stress Fractures Heal? 0:27
When Can I Run? 2:11
Low vs High-Risk Injuries 2:43
RED-S and the Athlete Triad 4:41
How Do I Start Running After a Stress Fracture? 6:29
Grab my Stress Fracture Guide Here: runningmatekc.com/combat-stre...
When we develop a bone stress injury, what happens is there's an imbalance between the damage that occurs and our body's ability to remove that damage. Then we begin to experience some pain, and eventually we get an image that says that we have a stress fracture. What's the process that our body goes through to heal that stress fracture, and what can we do to make sure that we heal it to the best of our abilities? There's two different processes that work together to allow our body to heal a stress fracture. The first one is called targeted remodeling. This happens through two different cells, our osteoblast and our osteoclast. Our osteoclasts break down the bone that has been damaged.
Now to envision this, let's zoom in on the fracture. We can envision the osteoblast and osteoclast acting like a small tube of superglue. Very, very precisely, it's going to go and it's going to fill in the specific injury site, it's going to make it super solid, but it's going to take some time to make sure we don't have superglue all over everything. Now, we have a second process that helps with this, and that's called global remodeling. It's a bigger process that's less specific. I want you to imagine I have some putty and I'm going to fill in this crack, but I'm not going to take my time. I just want this thing over with, I'm going to slap some putty down. It's going to heal. And then eventually over time, it'll get back to its normal formation. These two processes work together, very specific remodeling, and then more global remodeling that happens in a much quicker fashion.
This global remodeling, because it's faster, because it's not as specific, is part of the reasons why sometimes people will say, "Well, I had a stress fracture right here, and I still have a bump there." That's a normal thing. One of the downsides about global remodeling is that it is affected to a greater degree by our hormones. With many bone stress injuries, hormones are a component of why that injury happened in the first place. So if our hormonal function is not exactly where we want it to be, it could affect how that bone is going to heal from a global standpoint. All right, so that's a general process for how this happens. But how long is this going to take, because all I want to do is get back to running? We have two types of bone in our body. We have cortical bone and we have cancellous bone.
Cortical bone is more present at the end of long bones. It's more sturdy in nature. Cancellous bone, or spongy bone, is more present in our spine, in our pelvis and in the proximal aspect of our hips. It's important to designate these types of bone because we get stress fractures in both of these bone types and they heal at different rates. We categorize bone stress injuries into high, medium, and low risk. A big reason why we do that is because different bones are made up of different percentages of cortical and cancellous bone. Bones that are more cancellous or spongy in nature are generally higher risk because they have a harder time healing, they take longer, and often, there's more things that have gone into why that injury happened in the first place.
Injuries to cortical bone tend to heal a lot quicker. That's why someone with a metatarsal stress fracture or a stress fracture of their tibia tends to get back to running quicker than someone that has a sacral stress fracture or a femoral neck stress fracture. Cortical bone, we can return to running quicker. Spongy bone, we have to take a longer time. It takes between four weeks to three months for our cortical bone to completely turn over. That's a lot different than spongy bone. Spongy bone can take around 200 days to completely turn over and recover.
To get diagnosed with a stress fracture, you're going to need an MRI. On that MRI they're going to tell us the location of the stress fracture and they're going to grade it. There's a few different ways to grade stress fractures. This table is helpful here. If we have a stress fracture that is a higher grade, it's going to take longer for that bone to heal. If we have a stress fracture that is a lower grade, we're going to be able to return to running quicker. The grade of the image is going to affect when we can return to running. The bone that's affected is going to affect when we can return to running. We see that low-risk bone stress injuries tend to return to running at about 13 weeks after an injury. When we look at those high-risk sites, we see that it tends to be about 24 weeks to return to running.

[@svatekzprahy]

you're so much more helpful than anyone else

[@Jordan-lr4bi]

I started running on week 5 from injury, an MRI (taken on week 3) showed a grade 2 tibial stress fracture. 2 weeks back running now, still not completely pain free but I'm slowly improving/ not getting worse. Reduced mileage to 25% and am mostly on grass.

[@NathanCarlson]

Keep it up!!! The start is the hardest part!

[@ziyakhan1994]

Thanks for this! Not a runner, but i play squash. I had an "associated transverse oblique undisplaced" stress fracture of the left central and anterior acetabulum diagnosed in May 2022 from an MRI done in January 2022. Worst part? The doctor said he suspected a hip impingement in January, and recommended light exercise. Come May 2022, I was ordered bed rest and crutches. As of December 2022, still can't walk painlessly but hey, no more crutches!

[@NathanCarlson]

Sorry to hear about the injury!!

[@gregthurman687]

Hells 😅 out there I tttttttttt😊 3:17 🎉😮😮

[@gregthurman687]

I’m fplnoyao if you’re uusing it in a instant then😊😮i😮iiii 4:52

[@user-wx9wq8dy8e]

Very realistic and helpfull. Injuries are very very frustrating for sport junkeys. This video puts things in perspective.

[@cheyenne1820]

Its taken me a whole year to return to running after a femoral neck stress fracture. I went from running 7 miles daily to hardly being able to walk within a week. I pushed off seeing a doctor for two months, I thought It would heal on it’s own, then went another two months before I got a MRI to properly diagnose me. One thing I saw that was true for me was that with femoral stress fractures the pain often comes when you’re lifting the weight off the injured leg.

[@NathanCarlson]

Those are tough injuries!

[@Anjali_Jaglan_16]

Hey.....pls tell me how did you recover from this fracture..I am in pain for 3 months

[@Anjali_Jaglan_16]

Pls I too diagnosed with neck femur stress fracture

[@dilpreetkaur7938]

Hey.. plzzz share how did you recover from it..... I too have got a FNSF... Pls reply if possible.

[@Anjali_Jaglan_16]

@@dilpreetkaur7938 kb hua h apko dilpreet or kaise hua or apko pain kha Hota h?

[@ramyanaidu9626]

Screening CT demonstrates undisplaced linear lucency noted involving the posterior cortex of tibia in the distal one third. Undisplaced fracture - ?Stress etiology...this was the observation in MRI.. What does this mean? Is this high risk or medium?

[@SlavicRatnik]

You def know your stuff, I have a FnNSF injury grade 3 initially but now its a grade 4 on the MRI scale, you helped me understand my injury more than my surgeon that really wants me to get surgery, I do not want to get surgery, we'll see how things go. Want to get back into running and lifting weights. Another question arises too, if there is a push pull going on in the femoral neck whats happening with the FN when bodyweight squatting, barbell squats, deadlifts and clean/power cleans?

[@TarikRom-hu3jj]

How feel now1

[@shivanikamble1501]

hello, how are the things now?

[@SlavicRatnik]

@@shivanikamble1501 Im good, I ended up going to another surgeon who was a lot more chill. I now have 3 compression screws in my hip at 20 years but I can squat 315lbs and run 12:10 2 miles or a 19-20 min 5K. I was very stressed because I never knew if I would do what I wanted again... I trusted my surgeon and in what he said and God helped me :)

[@shivanikamble1501]

@@SlavicRatnik i have medial femoral stress fracture, doctor has put me on bed. rest.. he said body will the heal itself.. hoping for speedy recovery... also wishing you good health

[@SlavicRatnik]

@@shivanikamble1501 I wll pray for you Shivan just try not to walk on it as much and just know that you probably won't need surgery unless its a grade 4. It's gonna suck because you wont be able to walk but ask your doctor if you can swim so you can still stay healthy and have hope :)! God Bless you!

[@isabellechavez8488]

Stress fractures in both my hips and I haven’t been able to walk for almost a year, should I just get surgery?

[@Alex.1739]

Grade 4 distal tibia stress fracture Healing "very satisfactorily" at 5 months 8 months can I start running?

[@stt3z]

My ct scan showed I had a subtle stress injury on my great toe , is that a big issue ? I been resting it and thinking about it getting a mri Or just ignore it but possible turn to a bigger thing .

[@futureoriented2599]

Sir mere tibia m stree fracture hua tha long jump ki practice k time March m ...aur abhi kl fir dusre Dr. Ko consult Kiya to MRI karaya usme bol rahe minor injury hai...kh rahe ya plaster kara lo ya dava ...fir dava hi di hai 2 week ki.... Sir kya ye pain ab mera hamesha k liye ho gaya...mtlb stairs chadne m long distance chlne m problem hoti hai.. Sir i want to be a great athelete 😢😢 Will i run again as i did...painlessly😢😢😢😢😢

[@maggiequintero6723]

Hi, I was recently diagnosed with ischiofemoral impingement. Bone marrow edema with the right femoral neck and intertrochanteric region extended to the lesser trochanter compatible with the séquela of a stress fracture. What does this all mean. I have an appt next week but can’t wait too long. Thoughts?

[@davidcoomber4050]

Why do they start playing music in these video’s

[@dex1nHo]

Hi, thanks for this informative video. I have kicked ground with my heel while playing football in boots. I felt little pain in heel and since thn i have mid foot pain. Doctor sent me to do rendgen scan and result was: Sesamoid bone or broken bone but unclear, they sent me to do CT, result was: OS Peroneum fracture(but says MAYBE), 6mm calcium structure i am not sure what it is? and "small additional accessory ossicles" Medial, OS Naviculare accessorium. On rendgen there was small white "piece" under cuboid. Doctor said its it normal for such injuries and it takes time for it to heal, do u have any experience with such "patients", how much it takes to recover approximatelly? I havent played football for 3 months, and pain midfoot is still there when i wake up mostly, first few steps, after walking more i dont feel pain.. but i do feel sometimes tightening/mild pain behind my heel(achilles tendon i guess). I hope i will be able to play football again in 2/3 months? should i workout, or do some exercises to help it heal stronger/faster? or rest as much as possible is better option? Sorry for long post, but doctors just sent me home without any explaining, saying its NOTHING BAD, and it takes time.. so sent me to work without saying take rest etc..

[@NathanCarlson]

Sorry to hear that! Gotta find a good local rehab provider to help you out!

[@dex1nHo]

@@NathanCarlson do you get any idea if i should do some light strenghtening exercises or smth like that?

[@highershelf]

Thank You, this is super useful. Could you please tell me what to do if I had had a bicycle fall (my elbow got a surgery, so it took all the focus), and my hip stayed swollen for months, but I kept being a triathlete, as well as a bicycle messenger, plus, I kept travelling to university and rehab constantly (at the age of 19)? All this happened 3,5 years ago, and now I am noticing it as things started slowing down. I can no longer walk to the grocery store without feeling my left hip at random. I am 22 years of age now. Is it too late for me NOT to get surgery? If I need it, should I do it as early as possible (on the MRI, changes are seen)? Thank You, I appreciate your help.🙏

[@shivanikamble1501]

hello how did you recover?

[@leaffaninoc]

I would welcome an understanding of your recommendations regarding recovery for tennis and pickleball players. How should we come back from a stress fracture in the femoral head/neck area? Not fun!

[@TarikRom-hu3jj]

Any updates

[@leaffaninoc]

@@TarikRom-hu3jj none

[@emmanoonan9480]

How long to return to running from a sacral stress fracture ? Hoping for 6 weeks- is this realistic ?

[@NathanCarlson]

Most of the sacral stress fxs I’ve worked with end up running around 12 weeks.

[@egecalskan7157]

I have shin splints since 9 months my MRI and Xray were clear and i want to ask can ı have a problem in muscle?

[@bahubalisinghsangam8830]

When I can walk after metatarsal fracture surgery

[@eric-running-to-chamonix]

This seemed good but I couldn't finish because the background music was just noise that I had to try to filter out. It was too much work and I gave up.

[@NieterHereNorThere]

Diagnosed with a grade 2 in October. Took 6 weeks off. Started building back slowly, but I started workouts too soon. Back on the shelf in January. I don't plan on running again until March. My question is, is it normal to experience mild pain following easy runs during the recovery process. As in, should I completely shut it down if there is any pain again, or is that just a normal part of the healing process?

[@shivanikamble1501]

hello, hows the recovery now?

[@NieterHereNorThere]

@shivanikamble1501 It's going great! I was very cautious with the build-up and took days off whenever I started to feel any discomfort in my tibia. I'm now running 35-40 miles (including 2 quality days) per week. I'm basically back to normal, but it took almost 5 months to get here.

[@tommymurta1685]

I sustained a grade 4 femoral shaft stress fracture at the end of February. Haven’t ran since. I’ve been using crutches, non weight bearing, and plan to stop using them after the end of week 4.. which is in a few days. Is this wise? I am doing PT starting next week and don’t plan to run unless they allow me to.

[@shivanikamble1501]

how did you recover, did you use crutches?

[@tommymurta1685]

@@shivanikamble1501 I did recover and actually ran my first full marathon 3 weeks ago! I did full non weight bearing crutches for 4 weeks, then 1 week of some weight bearing, then 1 week of just one crutch. 6 weeks total using crutches. I began PT during week 5, did two months of PT (which was helpful). In addition to PT, I did a walk/run program to get back to full running. Many universities have published programs online.

[@shivanikamble1501]

@@tommymurta1685 good to hear that gives me lot of hope although i am not an athlete . I limp a little, when does the limping go away?

[@tommymurta1685]

@@shivanikamble1501 I never had a limo with my SF. But I imagine that will improve with PT and time

[@tapandhar4707]

My right leg tibia broke last September 7. Now my legs swelling walk nd sitting. How can solve this problem?

[@NathanCarlson]

Definitely check in with a good local health care provider

[@tapandhar4707]

@@NathanCarlson today my tibia brokes 99 days. I am walking slowly. How many days after runing properly?

[@SasukeUchiha-pg9gs]

My doctor asked for an X-ray of both my tibias, after examining them he told me I have stress fractures on both my tibias ( a very small one on my right tibia) Both appeared to be in the beginning phase and I’m assuming that means it’s grade 1? He told me to rest my lower body but I can still work my upper body. ❓My question is, can I use my elliptical cycling machine now? ❓Or should I not work my legs at all. I tried it today for an hour at low intensity and there was no pain at all.

[@mostlycraft]

did you manage?

[@joandarc8430]

Should I use crutches so there is no weight bearing on the stress fractured tibia?

[@NathanCarlson]

I’d refer to your physician on that.

[@FactFunKids]

3 months gone i have vanished the pain should i start little jogging slowly..

[@shivanikamble1501]

hows are you now?

[@callmesupreme1533]

Ortho said i had Severely displaced zone Il fracture of Right sacrum how long will it take to heal ??

[@shivanikamble1501]

how long did it take to heal?

[@callmesupreme1533]

@@shivanikamble1501 i had two fixator pins in my hips I had to wear for 6 weeks and did physical therapy for 3 weeks twice a week I was able to walk again so it took like 2 months

[@MminaMaclang]

I came to this video because my stress fracture happened when I started practicing basic jumps on roller skates. I was wondering if buying more expensive skating boots with a higher support rating can help prevent these injuries in the future. Or if that wouldn't prevent anything at all, and it would be more advisable to drink Vitamin D supplements regularly.

[@NathanCarlson]

Sorry to hear about the injury! Have you found a good local rehab specialist? That's always the best place to start.

[@zorojuro7731]

Does it help to vitamin d suplementa i mean wouldnt it be better if i just expose myself in sunlight.

[@shivanikamble1501]

how is the fracture now?

[@abuzafar1425]

I Have stress fracture in upper tebial bone ..i never running ....but I have run in 20days in a exam... What can I do please suggest....any exercise

[@NathanCarlson]

Sorry to hear that!

[@shivanikamble1501]

hello, did you recover?

[@annaddley4867]

I had MRI and been told stress fracture.i had pain for year now should I have a operation

[@shivanikamble1501]

hello, did the fracture heal?

[@Darlinm3]

So having bilateral tibia stress fractures is high risk ? 😧

[@NathanCarlson]

Having bilateral BSIs would likely warrant further investigation.

[@nishantkoli8803]

Sir I got fractured in my left leg during the running and my exrey reports says that fracture of proximal shaft of trbia seen .soft tissue swelling.joint spaces appear normal bone density is normal .and my age is 18years old.pls sir let me know how much time my injury will take to recover bcoz I am preparing myself for Indian army

[@zorojuro7731]

Bro me too i am preparing for indian armh but stress fracture 😐😑😑😑

[@LongIslandYachtClub]

Im air assault US army. Believe it or not, stress fractures are the #1 injury in the us army because of ruck marches. 35-40 lbs (15-18 kilo) doesnt sound like a lot, but trotting hills with it over 6-12 miles (10-20 km) starts shattering the bones. Sounds like you need some more conditioning and a calcium/vitamin D supplement as well as some more resistance training. It isnt running that causes it, its the ruck marches. I just did 12 miles (20km) with 40 lb pack, 12 lbs of water, a 15 lb vest and an 8 lb rifle (roughly 75 lbs of gear or maybe 35 kilos) at 13:30 per mile for 12 miles on hills and mud (20km in 2 hrs 42 minutes). Here i am 3 days later with dull (non muscular) pain in my shins and thighs and im thinking about getting checked out. Im in very very very good shape. I run a 35 minute 5 mile (8 km), bench press 275 lb (125 kilos) and deadlift 505 lb (230 kilos) and believe me, the ruck marches are the cause. I wouldnt expect the indian army to be much different in terms of the ruck march requirements (maybe a bit less weight and a bit slower if you are just joining).

[@shivanikamble1501]

hello, did you recover?

[@adriandavidrafaelsiburian2090]

I started scoring goal after 3 day 😂😭

[@MminaMaclang]

What the hell did you do to Scorbunny!!!!!!

[@ryans.madero8318]

Was breakdancing all my life and got a grade 1 L5 fracture. I’m wondering if I’m gonna be able to breakdance ever again. I’m 40 years old and can still do some amazing things well used to. I’m on week 1 of my injury… 😭🫡