It is estimated that 15-20% of runners will sustain a stress fracture in their running lifetime.

We wanted to look into the research to give our patients a better understanding what factors may contribute to this.


But what is a stress fracture?

A stressy is a result from repetitive micro-trauma to the bone which leads to an increased amount of bone cell activity. As the micro-trauma increases the breakdown of bone cells increases at a rate which doesn’t allow for sufficient regeneration of new bone cells. This results in an area of weakened bone thus contributing to fractures.


If you’ve had a stressy before then chances are higher at getting another.

We know this with many injuries – the biggest predictor of current injury is having that injury previously. With particular relevance to stress fractures the likelihood of having another was found to be 5 times higher according to one study.

This could be due to incorrect/improper rehab management plans or returning to sport too early. So, it is imperative to work with your health care provider whether it be a Chiropractor, Physiotherapist or GP to provide the best management plan.

What we do know is that the risk is higher in female runners.

Studies have confirmed that out of populations tested females rank 2-3 times higher than their male counterparts. But why is this?

The truth is there are many theories but more research has to be done in order to understand this variance. Several studies have theorised that hormone irregularity, biomechanical variances such as pelvis width and bone mineral density can play into the increased risk of stress fractures but again research is mixed in these theories with no concrete proof or studies confirming any of these.


We do know that Oral Contraceptives DO NOT contribute to the risk of stress fractures in runners.

4 studies were performed and all reported on no significant increase in risk of stress fractures in runners.


Research is looking toward focusing more into the running specific training practices such as increase in mileage over short time frames or types of terrain of which there is surprisingly no such evidence or studies testing this.


  • Females with previous history of stress fractures should seek referral to their health care practitioner for investigation with symptoms related to stress fractures


  • Previous injury is the biggest predictor of injury



  • More research into training loads and terrain is needed to understand more about risk factors for stress fractures.


Alexis A Wright et al, – Risk factors associated with lower extremity stress fractures in runners: a systematic review with meta-analysis Br J Sports Med, 2015