Stress fractures

To find out if you have a stress fracture, your doctor asks you about your health and does a physical exam. Often, imaging tests are needed too. They might include:

• X-rays. Stress fractures often can't be seen on regular X-rays taken shortly after your pain starts. It can take weeks for signs of stress fractures to show on X-rays.
• Magnetic resonance imaging (MRI). An MRI uses radio waves and a strong magnetic field to make images of bones and soft tissues. This test is considered the best way to find stress fractures.
• CT scan. This series of X-rays can make detailed images of the inside of the body. It can be useful when the results of an MRI aren't clear.
• Bone scan. This exam isn't done often. Many types of bone problems look alike on bone scans, so the test isn't specific for stress fractures. It also uses a high dose of radiation. But a bone scan might be recommended if your doctor still thinks you have a stress fracture after an MRI finds no signs of the injury. With a bone scan, a small amount of radioactive material is given to you through a needle in a vein. The material is mainly absorbed by areas where bones are being repaired. These show up on the scan image as a bright white spot.

Treatment aims to lessen the bone's weight-bearing load until it heals. You might need to wear a walking boot or brace or use crutches.

Sometimes, surgery is needed to help a stress fracture heal completely. You may be more likely to need surgery for stress fractures that happen in areas with a poor blood supply. Surgery also might be a treatment choice to help healing in elite athletes who want to return to their sport sooner. It may be an option for laborers whose work involves using the affected body part.

Let your doctor know if you have pain. You may be told to take small amounts of acetaminophen for relief. You'll likely be told to stay away from pain relievers called nonsteroidal anti-inflammatory drugs (NSAIDs). These include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). NSAIDs can slow bone healing.

It's important to give the bone time to heal. This may take weeks or months. In the meantime:

• Rest. Stay off the affected limb as directed by your doctor. Do so until you are cleared to bear weight.
• Ice. This can ease swelling and pain. Place ice packs on the injured area for 15 minutes every three hours.
• Get active slowly. When your doctor says it's OK, you can start doing activities that are gentle on bones, such as swimming. Then slowly take on your usual activities. Get back to running or other high-impact activities over time. Build up the time and distance bit by bit. Stop any activity that causes pain at the site of the stress fracture. Replace it with an activity that puts less stress on the bone until the pain goes away.

You're likely to start by seeing your primary doctor. If you are a competitive athlete, you might go straight to a doctor who treats muscle and bone problems.

What you can do

Before the appointment, make a list of:

• Your symptoms, including any that seem unrelated to the reason for your appointment.
• Key personal information, including your level and type of physical activity, and whether you've recently been training more.
• All medicines, vitamins or other supplements you take. Include the amounts you take, also called doses.
• Questions to ask your doctor.

Take a family member or friend along if you can. The person could help you remember the information you're given.

For stress fractures, basic questions to ask your doctor include:

• What is the likely cause of my symptoms?
• What tests do I need?
• Do I need to stop my activity? For how long?
• Should I see a specialist?

Feel free to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions such as:

• When did your symptoms begin?
• Have you recently increased your physical activity?
• Have you broken bones in the past?
• Do you have regular menstrual periods?
• Do you have any dietary restrictions?
• Do you take vitamin D and calcium supplements?